Aim. To compare endocardial and epicardial left ventricular (LV) pacing using real-time electrocardiography (ECG)-synchronized three-dimensional echocardiography (3DE).Methods. Experimental intraoperative study included 88 points obtained from 12 patients with compensated heart failure of II-IV functional class NYHA (LV ejection fraction < 35%) and cardiac resynchronization therapy indications - ECG pattern of complete left bundle branch block (LBBB) and QRS complex duration > 150 ms. During isolated LV pacing as part of cardiac resynchronization therapy implantation procedure endocardial and epicardial stimulation points matched under fluoroscopic control using quadripolar coronary sinus leads and endocardial electrodes for temporary pacing were obtained. The overall number of corresponding pacing sites included 44 endocardial and 44 epicardial stimulation positions. The mean age of patients was 68.5 [63; 73.5] years, 83% males (n=10). Before study enrollment, 12-channel ECG, echocardiography, and a six-minute walk test were performed for all participants along with cardiac magnetic resonance imaging and control coronary angiography if indicated. The prevalence of coronary heart disease was 50% (n=6) while dilated cardiomyopathy was the most common etiology of chronic heart failure in other cases. Intraoperative ECG with estimation of paced QRS complex morphology at each point was registered via LabSystem Pro Electrophysiological Recording System (Bard Electrophysiology, USA). 3DE was performed using TomTec and Philips Qlab 3DQ Advanced software (Philips Medical Systems, USA).Results. Three-dimensional parametric imaging of LV regional segmental excursion and myocardial contractility using 3DE revealed statistically significant difference in semi-quantative parameters such as ExcAvg (p<0.001), ExcMax (p=0.001), ExcMin (p<0.001) and LV ejection fraction based on 3D modelling (p=0.003) while endocardial pacing was more beneficial. During the course of endocardial stimulation, the 3DE dyssynchrony index estimated at the 2nd stimulation site was also significantly lower (p=0.03). Identical dyssynchrony parameters valid for the 16 and 12-segment 3D models (SDI-16, Tmsv-12SD) (at p=0.06) demonstrated only a tendency for significant difference. The duration of QRS complex at the time of endocardial pacing was significantly shorter (<190 [179;215] ms) (p=0.0008). Semi-quantitative and quantitative 3DE parameters showed the benefit of endocardial pacing resulting in cardiac contractility improvement with less dyssynchrony and LV volume reducing during intraoperative period.Conclusion. Endocardial pacing has potential benefit over the epicardial pacing represented by intraoperative dynamics of LV global and local contractility, intraventricular dyssynchrony estimated by 3DE and also ECG criteria. 3DE is helpful in more precise and reproducibile determing of late activation zone for target LV lead placement that is more manoeuvrable in case of endocardial stimulation.

Background. The main problem in the patient selection for cardiac resynchronization therapy (CRT) is the lack of unified approaches to the definition of mechanical dyssynchrony (MD) and selection criteria. Objective. To reveal the dependence of the criteria of dyssynchrony in patients on the method and point of stimulation and to reveal the correlation of these data with the width of the QRS complex and the percentage of global two-dimensional longitudinal deformation. Design and methods. The study involved 12 patients with drug-compensated CHF of class II-IV, LVEF< 35 % and a QRS duration >130 ms, having CRT indications. All patients were intraoperatively injected with a retrograde transaortically guided electrode. During stimulation of each point (88 points), transesophageal Echo-KG (PE Echo-KG) was performed. TomTec and Philips Qlab 3DQ Advanced software was used for data analysis. Results. The segmental excursion and myocardial contractility differed significantly depending on the stimulation point. A moderate inverse correlation was found between ExcAvg, LVEF and QRS duration. There were a direct correlation of the SDI-16 and the QRS duration was shown, and an inverse correlation of SDI-16 with ExcAvg and LVEF. 2D longitudinal global strain was inversely correlated with the EF. Conclusion. The technique is useful for regional LV myocardial contractility assessment and patient selection and comparison of alternative approaches to LV pacing to improve response to CRT.

Aim. To assess hemodynamic response to active standing test (AST) with beat-to-beat blood pressure (BP) monitoring, their association with office BP and symptoms of orthostatic intolerance in patients with heart failure (HF).Material and methods. Outpatient HF patients with documented left ventricular ejection fraction <40%, followed up in a HF center and receiving optimal medical therapy, underwent AST with beat-to-beat non-invasive BP monitoring.Hemodynamic response was assessed according to the European Federation of Autonomic Societies criteria.Results. The study included 87 patients (mean age, 57±10 years; men, 76%). Normal hemodynamic response to orthostatic stress was observed in 36 (41,4%) patients. Pathological response prevailed during the first minute of orthostatic stress — initial orthostatic hypotension (OH) (n=29, 33,3%) and delayed BP recovery (n=18, 20,7%). Classical OH was detected in 4 (4,6%) patients. There was no orthostatic hypertension, defined as an increase in systolic BP (SBP) ≥20 mm Hg. According to office BP, hypotension was observed in 19 (21,8%) patients (SBP <90 mm Hg in 4 patients and 90-100 mm Hg in 15), hypertension (SBP >140 mm Hg) in 11 (12,6%) patients. Pathological response to orthostatic stress were more often observed in office SBP >140 mm Hg compared to SBP ≤140 mmHg (90,9% and 53,9%, p=0,020).Orthostatic intolerance was noted in 43 (49,4%) patients and were not associated with the level of office SBP (p=0,398) or pathological responses to orthostatic stress (p=0,758 for initial OH and p=0,248 for delayed BP recovery).Conclusion. The pathological hemodynamic response in AST with beat-to-beat BP monitoring in ambulatory patients with HF is most often represented by initial OH and delayed BP recovery associated with office SBP >140 mmHg. The frequency of symptoms of orthostatic intolerance did not differ between groups depending on the presence of an inadequate response to orthostatic stress.

Heart failure (HF) is associated with unfavorable outcomes and high health care costs. Determination of the hemodynamic response to orthostasis can be an additional tool in assessing the stability and compensation of HF patients. Active orthostatic test (AOT) with blood pressure monitoring serves as a simple and available screening method. However, a complete characteristic of the hemodynamic response, especially during the first minute of orthostasis, can be obtained only with continuous blood pressure monitoring. The presented case series demonstrate the types of hemodynamic response in patients with heart failure with reduced ejection fraction in AOT with continuous blood pressure monitoring, available data on the mechanisms of its development, clinical and prognostic role, and also presents the advantages and limitations of AOT.

The potential impact on cardiovascular morbidity and mortality have become one of the most important issues of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 may be associated with more frequent development of acute cardiovascular complications, while patients with established cardiovascular diseases are characterized by a higher risk of severe infection and adverse in-hospital outcomes. Due to the spread scale of the pandemic, understanding the long-term cardiovascular consequences of COVID-19 is of no less importance. Inability to extrapolate available international data to the Russian population has led to the initiation of a national multicenter study (registry) of patients recovered from COVID-19 and with concomitant involvement of the cardiovascular system or with baseline severe cardiovascular diseases. The article presents its rationale, design and implications of the results for clinical practice.

Aim. To analyze and compare the clinical, echocardiographic characteristics and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels depending on the central cardiometabolic risk factors, with a focus on obesity, in patients with heart failure (HF) with mid-range ejection fraction (HFmrEF).Material and methods. The study included 111 patients with old myocardial infarction and HFmrEF (men, 100%; mean age, 60 years) predominantly of NYHA class II. Echocardiography and blood sampling for NT-proBNP were performed with sinus rhythm. Left atrial volume (LAV) and left ventricular mass (LVM) were indexed to body surface area (BSA) and height raised to a power.Results. Type 2 diabetes, overweight and obesity were diagnosed in 25%, 19%, 38% of cases, respectively, and were associated with greater changes in the morphologic and functional left ventricular parameters. There were no intergroup differences among patients with and without obesity in the LAV and LVM indexed to BSA. However, in patients with a body mass index (BMI) ≥30 kg/m2, the LAV indexed to height squared and LVM indexed to height2,7 were higher (p<0,05 for all). In 11% of obese patients, there were no changes in the criterion LAV or LVM values indexed to BSA, but the values indexed to height raised to a power exceeded the standard values. In 20% of patients with clinical manifestations of stable HFmrEF and structural and functional echocardiographic criteria, NT-proBNP were ≤125 pg/ml. An inverse correlation was found between NT-proBNP and BMI (r=-0,29; p=0,008), and lower values of myocardial stress marker were observed in obese patients (p=0,048).Conclusion. Considering the high incidence of obesity in patients with HFmrEF and its ability to reduce NT-proBNP, an algorithm modification is required for diagnosing HFmrEF as follows: focus on clinical and personalized echocardiography data, taking into account the obesity and, possibly, indexing the threshold natriuretic peptide values in patients with BMI ≥30 kg/m2. The issues of indexation of echocardiographic parameters depending on morphometric parameters in obese patients today remain open, predetermining the limitations in diagnosis of heart failure with left ventricular ejection fraction >40%. This requires the search for optimal standardization and the development of a unified methodological approach.

Assessment of systolic and diastolic ventricular function is one of the main goals of echocardiography. Nevertheless, some patients require data beyond standard echocardiographic protocol for making more precise clinical decision and prognosis determination. The spectrum of novel parameters, including myocardial strain and strain rate, provides more comprehensive evaluation of the initial changes in myocardium in a variety of clinical conditions. New methods of quantifying the systolic function of left and right ventricles can be applied in patients with arterial hypertension, coronary heart disease, hypertrophic and dilated cardiomyopathies, also in patients with valvular heart disease such as aortic stenosis, aortic and mitral insufficiency. Besides strain analysis in patients with myocardial storage diseases, patients on cardiotoxic chemotherapy and patients with heart transplant turned out to be a specific niche for the method. Here, we provide the possibilities of strain analysis in variable heart pathologies in clinical practice.

Clinical demonstration of the development of acute non-coronarogenic myocardial lesion in a patient with intraoperative rupture of the arterial aneurysm of the basilar artery. Neurogenic cardiomyopathy should be considered in the differential diagnostics of acute heart failure in patients with acute cerebral lesion.

A double-membrane sample-introduction system is described that enables mass spectrometric determination of volatile organic compounds in air, while ensuring their detection limits are as low as a few fractions of ppb of sample composition in real time with a response delay from a few seconds to a few dozens of seconds. It includes two membrane interfaces separated by a volume, the gas pressure in which is maintained through a channel with an adjustable evacuation cross-section. The results of numerical simulation and experimental testing of the system are provided. A technique for selecting and calculating system parameters is described. The possibility of using this system for diagnosing diseases by trace amounts of biomarkers in exhaled air is discussed.

Background. Early pulmonary complications after cardiosurgery worsen general state of the patients, require additional therapeutic and diagnostic measures, increase the pharmacological load, extend the length of stay in the hospital and in some cases leads to the lethal outcome. Objective. The purpose of this study was to evaluate the effectiveness of the infrared radiation with terahertz modulation in the early-onset hospital-acquired pneumonia and ventilator-associated pneumonia in patients after cardiosurgery. Design and methods. This is an observational retrospective open comparative study with pseudo-control (“case-control study”). We included patients with pulmonary complications (infi ltrative and focal changes in the lungs diagnosed as nosocomial pneumonia and ventilator-associated pneumonia) in the early post-cardiosurgery period (after coronary bypass surgery and / or prosthetic heart valves). They were divided into 2 groups: we applied infrared Terahertz radiation at the acupuncture point Da-bao (RР 21) (“IK-Dipole”, Russia) in addition to the standard therapy in the 1st group. The patients of the 2nd group received only standard therapy. Results. Early (the fi rst day) application of infrared radiation with terahertz modulation allowed to reduce terms of stay of the patient in the intensive care unit (by 4-8 days); to reduce radiological and pharmacological stress; to reduce the intubation and ventilation time (by 4-8 days); to improve prognosis; to start earlier (by 4-8 days) the rehabilitation activities. Conclusion. Therefore, the infrared radiation with terahertz modulation helps to improve the quality and effectiveness of treatment in patients with pulmonary complications after cardiosurgery.

Поступило в Редакцию 1 июня 2017 г.В окончательной редакции 19 февраля 2018 г

Objective. T o evaluate diastolic function of the left ventricle and anthropometric parameters in patients with abdominal obesity (AO). Design and methods . We examined 438 patients aged 30 to 55 years (44,8 ± 0,3 years) with AO (IDF, 2005) and 115 patients (40,3 ± 0,8 years) without AO (comparison group). Two-dimensional transthoracic echocardiography was performed (GE Vivid 7 Dimension) in 2D mode, in M-mode, also Doppler studies were performed using pulsed, continuous-wave, color and tissue regimes of Doppler. Results. Based on echocardiography, 126 patients with AO and arterial hypertension (HTN) (28,8 %) (94 women and 32 men) had type I left ventricular diastolic dysfunction (LVDD). In patients with AO and without HTN, the E/A ratio and the E’ value were lower, and the DT and isovolumic relaxation time (IVRT), the E/E’ and LAVI ratio are higher than the same parameters in the comparison group (p < 0,0001). Only the ratio E/E’ was in accordance with the criteria for type 1 LVDD. We found positive correlations between the body mass index (BMI) and the IVRT (r = 0,3, p = 0,0001), BMI and the E/E’ ratio (r = 0,4, p = 0,0001), BMI and LAVI (r = 0,4, p = 0,0001), between the waist circumference (WC) and the IVRT (r = 0,3, p = 0,001), the WC and the E/E’ (r = 0,3, p = 0,0001), WC and LAVI (r = 0,4, p = 0,0001) in female with AO without HTN. In patients with AO and without HTN, there is a 3,7-fold increase in LVDD risk in case of BMI ≥ 30,0 kg/m 2 (odds ratio: 3,7, 95 % confidence interval: 1,2–9,0, p < 0,0001). Conclusions. The type I LVDD was found in patients with AO and HTN. in patients with AO without concomitant HTN, the risk of LVDD increases by 3,7 times with a threshold of body mass index ≥ 30,0 kg/m 2.

Objective. To study the impact of cardiometabolic risk factors and polymorphic variants rs2290149 and rs10838692 of the MADD gene on myocardial remodeling in the elderly patients with hypertrophic cardiomyopathy (HCM). Design and methods . We enrolled 257 patients with left ventricular hypertrophy (LVH) of various origin (mean age 57,7 ± 11,2 years; men — 5 %, women — 48 %): HCM (n = 154) and LVH caused by cardiometabolic risk factors (n = 103). The control group included 288 healthy donors. A standard clinical (laboratory and instrumental) diagnostic methods were applied. Genotyping for SNPs rs2290149 and rs10838692 of the MADD gene was performed using real time polymerase chain reaction (PCR). Results . Pre-obesity and obesity in patients with HCM were associated with increased left ventricular (LV) posterior wall thickness (14,82 ± 3,6 versus 12,77 ± 3,69 mm, respectively, p = 0,01), but not with the LV mass index and the interventricular septum. Obese HCM patients had greater detection rate of the symmetrical LVH (64 versus 10 % in non-obese HCM patients, p = 0,001). We observed a significant increase in frequency of TT genotype of rs2290149 and rs10838692 of the MADD gene in patients with LVH of various origin compared to healthy group: 81,6 vs. 71,5 % (ТТ : ТС+СС, p = 0,007) and 54,1 vs. 43,1 % (ТТ : ТС+СС, р = 0,002), respectively. The allele frequency also differs for rs2290149 (T : C = 89,6 : 10,4 % vs. 82,3 : 17,7 %; odds ratio (OR) = 1,864, 95 % confidence interval (CI) 1,306 to 2,660; p = 0,01) and for rs10838692 (T : C = 72,6: 27,4 % vs. 62,2 : 37,8 %; OR = 1,611, 95 % CI 1,246 to 2,082; p = 0,01). We found a significant increase in frequency of TT genotype of rs10838692 of MADD gene in patients with HCM 55,2 % (ТТ : ТС+СС, р = 0,019) and LVH caused by cardiometabolic risk factors — 52,4 % (ТТ : ТС+СС, p = 0,014) compared to healthy group (43,1 %). We also detected a trend towards the predominance of the TT genotype in rs2290149 of the MADD gene in patients with LVH caused by cardiometabolic risk factors (80,4 %) (ТТ : ТС+СС, р = 0,097), reaching a statistical significance in the HCM group (82,5 %) (ТТ : ТС+СС, р = 0,025) compared to healthy group (71,5 %). The allele frequency also differs for rs2290149 (T : C = 89,9 : 10,1 %, p = 0,01 in HCM; 89,2:10,8 %, р = 0,04 in LVH caused by cardiometabolic risk factors) versus 82,3 : 17,7 % in control group and for rs10838692 (T : C = 72,4 : 27,6 %, p = 0,01; 72,8 : 27,2 %, р = 0,01, respectively) versus 62,2 : 37,8 % in control. Conclusions . Pre-obesity and obesity in patients with HCM led to a greater LV posterior wall thickness and symmetrical myocardial remodelling. The T allele and TT genotype of SNPs rs10838692 and rs2290149 of the MADD gene were associated with the presence of LVH of various origin in the older subjects, but do not affect the degree of myocardial hypertrophy. Patients with HCM showed greater frequency of simultaneous carriage of the TT genotype and сombined carriage of the T allele of the polymorphic variants rs10838692 and rs2290149 of the MADD gene compared to the control group. The presence of obesity/overweight in patients with combined carriage of the TT genotype and simultaneous carriage of the T allele is associated with a greater thickness of the LV posterior wall, an increase in the left atrium size and the LV end-diastolic dimension.

The aim of the study was to evaluate the repeatability of the human breath acetone concentration during stress testing. Eight healthy men aged 19 to 34 years were tested (mean age 26.9 ± 1.4). Subjects performed a stress testing on cycle ergometer at twice-weekly intervals. As a result of processing the obtained data, a good similarity between the initial and repeated curves of the acetone concentration was found. In addition, a good repeatability of some parameters was revealed, which show the peculiarities of the change in acetone concentration in healthy individuals. The results obtained in this work can be useful in the creation of diagnostic methods that use the acetone concentration in the exhaled air.

The electronic systems of a small high-sensitivity static mass spectrometer and software and hardware tools, which allow one to determine trace concentrations of gases and volatile compounds in air and water samples in real time, have been characterized. These systems and tools have been used to set up the device, control the process of measurement, synchronize this process with accompanying measurements, maintain reliable operation of the device, process the obtained results automatically, and visualize and store them. The developed software and hardware tools allow one to conduct continuous measurements for up to 100 h and provide an opportunity for personnel with no special training to perform maintenance on the device. The test results showed that mobile mass spectrometers for geophysical and medical research, which were fitted with these systems, had a determination limit for target compounds as low as several ppb(m) and a mass resolving power (depending on the current task) as high as 250.

Электронное и программное обеспечение автоматизированного портативного статического масс-спектрометра© Ю.В.Чичагов, 1 А

Цель. Оценить аддитивный эффект дистантного прекондиционирования и применения открывателя калиевых каналов никорандила на стрессиндуцированную ишемию миокарда у больных со стабильной стенокардией. Материал и методы. Обследованы 42 пациента со стабильной стенокардией с воспроизводимой ишемией миокарда по результатам повторных нагрузочных ЭКГ-тестов на тредмиле Welch Allyn, США, по протоколу Bruce, которые были рандомизированы в 2 группы. Первая - группа воздействия (n=21), 2-я - группа контроля (n=21). Всем больным выполнялись повторные стресс-эхокардиографические тесты с перерывом в 40 мин, во время которых пациентам исследуемой группы оказывалось прекондиционирующее воздействие в виде трех эпизодов ишемии-реперфузии обеих нижних и одной верхней конечности раздуванием манжет тонометров с давлением, обеспечивающим прекращение кровотока по артериям конечностей под контролем ультразвуковой допплерографии. 18 больным проведено повторное исследование по указанному протоколу после двухнедельного приема никорандила в дозе 30 мг/сут. Оценивались длительность и мощность нагрузки, время достижения депрессии ST 1 мм, средняя депрессия сегмента ST, частота сердечных сокращений при депрессии ST 1 мм. С помощью методики 2D Strain проводилась количественная оценка динамики деформации миокарда. Статистическая обработка данных производилась c использованием пакета Statistica версии 6.0. Результаты. По результатам исходных стресс-тестов величины основных параметров, характеризующих переносимость физической нагрузки и степень ишемической нагрузки, достоверно не различались. До приема никорандила в группах прекондиционирования и контрольной время достижения депрессии ST в 1 мм составило соответственно 317,7±44,3 и 306,6±52,8 с, а время сохранения ишемических изменений в восстановительном периоде - 205,1±41,1 до 198,7±54,3 с (р>0,05). Обнаружены различия в общей длительности нагрузки - 443,4±18,3 и 392,6±21,2 с (p

The aim of the study was to analyze the changes in the human breath acetone concentration during stress testing. Using the portable mass spectrometer we obtained recordings of acetone concentration during stress testing on bicycle ergometer for groups of healthy subjects, athletes and patients with congestive heart failure (CHF). As a result, we found significant differences (p <; 0.05) of some parameters of acetone concentration that differ significantly between healthy subjects and patients with CHF. In addition, a parameter that allows classifying patients with CHF into subgroups based on the functional class of CHF was obtained. The results obtained in this study may be useful for the objectification of the functional status of patients with CHF.

Objective. We present the data of the retrospective clinical study in order to summarize the experience of the implementation of infrared radiation with terahertz modulation 0,086–7,5 μm (0,02 to 8 THz) in patients with acute ischemic stroke (AIS). Design and methods. We followed up 61 patients with AIS (age from 18 to 86 years, mean age 59 ± 1 year), 24 women and 36 men, who were divided into two groups: group I (n = 30) and II (n = 31). Patients from the group II received standard pharmacotherapy in acute stroke unit and during hospitalization. Patients from the group I in addition to standard pharmacotherapy underwent procedures of transcranail application of infrared radiation. The radiator was established on parietal area in a projection of an acupuncture point Bai-Huey (VG‑20) independent of brain lesion localization. Results. Patients from the group I demonstrated earlier recovery, earlier consciousness, a more rapid regression of neurological symptoms and earlier expansion of physical activities compared to the second group. For two years of dynamic supervision patients from the group I showed stable and even better indicators of Barthel index, Rankin scale and National Institutes of Health Stroke Scale (NIHHS) compared to the group II. This can be due to the better compliance of patients from the group I to treatment and a positive effect of the 6–10 procedures of the infrared radiation modulated by terahertz frequencies. Conclusions. Infrared radiation modulated by terahertz frequencies can be recommended in acute ischemic stroke as a part of complex treatment. A prospective controlled randomized study involving patients with ischemic stroke is required in order to develop the precise approaches for infrared radiation application.