We analyzed influence of sinus rhythm restoration in patients with severe heart insufficiency and permanent atrial fibrillation on efficiency of cardiac resynchronization therapy. In the study we included 150 patients (76 female patients), mean age was 47,7±10,9 years, with chronic cardiac insufficiency III functional class (FC) according to NYHA with main diagnosis dilated cardiomyopathy (DCMP) and registered stable form of atrial fibrillation (AF). Complex QRS width varied from 146 ms to 240 ms (mean 183±32 ms), ejection fraction (EF) of left ventricle was 30,1±3,8%, EDV was 272,4±49,8 ml. six-minute distance was 247,8±57,3 m. Optimal medical therapy for CCI was ineffective from three to six months. All patients had CRT devices. Control assessment was performed in 36 months. Analysis of CRT results, for 36 months, demonstrated improved HR in 115 (76,7%). In this group for 3-year follow up period EF changed from 29,0±3,8% to 42,5±4,2% (р

To study long-term efficacy of cardiac resynchronization therapy (CRT) in patients with chronic heart failure, CRT was performed in 151 patients aged 55.4±10.3 years (21-76 years) and mean functional class by NYHA of 3.2±0.4. The predominating etiology of chronic heart failure was nonischemic cardiomyopathy (n=98, 65%). The QRS complex width was 183±32 ms (146-240 ms). The clinical examination of study subjects was performed after one, three, six, 12, 24, and 36 months following implantation of CRT device. The follow-up period lasted for 35.7±4.3 months. According to data, recorded by the implanted CRT devices, pacing rates in patients with AF without AV nodal ablation and patients with AF after AV nodal ablation were 66.7±2.6% and 95.3±11.7%, respectively. Majority of nonresponders did not have AV nodal ablation. Finally, CRT had beneficial effects on LVEF, NYHA Class, and quality of life in AF patients with AV nodal ablation. CRT efficacy depended on amount of ventricular capture beats in this category of patients.

Aim: The aim of the study was to use various methods of selection of patients for cardiac resynchronization therapy (CRT) and to evaluate prospects of method implementation in clinical practice to increase treatment efficacy. Materials and Methods: The study comprised a total of 180 patients aged 32 to 75 years (55 ± 12years) with dilated cardiomyopathy (DCM), NYHA functional class III heart failure, left ventricular (LV) ejection fraction (EF) of 30.1 ± 3.8%, 6-min walk test distance of 290.5 ± 64.3 m, end diastolic volume (EDV) of 220.7 ± 50.9 mL, intraventricular and interventricular dyssynchrony of >120 ms. At the selection stage, patients were divided into three groups: group 1 (n = 50) that received assessment of myocardial metabolism defect (MMD) by radionuclide methods, group 2 (n = 70) that received assessment of tricuspid annular systolic velocity (TASV), and control group. Results. One-year follow-up study showed that 141 patients (78.3%) clinically responded to CRT; 39 patients (21.7%) did not respond to CRT. Evaluation of the selection methods demonstrated that 6 (12%), 17 (24,3%), and 20 (33,3%) patients did not respond to CRT in group 1, 2, and 3, respectivley. Group 1 included 44 responders (88%) whose MMD was <15% prior to CRT; if initial MMD was >15%, patients did not respond to CRT. Group 2 included 53 responders (75,7 %) whose TASV was >10 cm/s (12.5 ± 2.1 cm/s) (р = 0.0001). Conclusions: (1) Preserved myocardial metabolism (LV MMD <15%) is a predictor of efficacious CRT in DCM patients. (2) Tricuspid annular systolic velocity is an independent predictor of response to CRT; TASV enables to identify CRT responders with sensitivity of 85% and specificity of 83% at the selection stage. (3) For selection of patients for CRT, the administration of all presented methods is rational in order to increase treatment efficacy.

Aim. To study a range of selection methods for cardiac resynchroizing therapy (CRT) and to evaluate the possibility of their application in clinical practice for treatment improvement.Material and methods. Totally 88 patients studied with the diagnosis dilation cardiomyopathy (DCMP) at the age 32-75 y. o. (55±12), HF III NYHA, ejection fraction (EF) of the LV (LV) was 30,1±3,8%, distance in 6-minute walking test — 290,5±64,3 m, end-diastolic volume (EDV) — 220,7±50,9 ml, intra- and interventricular dyssynchrony was more than 120 ms. At the stage of selection the patients were separated to 3 groups: first — 28 patients — the defect of myocardium metabolism (DMM) was assessed using radionuclide methods; second — 24 patients — systolic velocity assessed of fibrous annulus of tricuspid valve of the right ventricle (Srv); third — 36 patients — controls.Results. Control assessments were done in 1 year. Clinical responders for CRT were 69 patients (78,5%), not responded to CRT — 19 patients (21,5%). In assessment by the each method of selection it was revealed that in the 1st group there were 3 (10,7%) nonresponders, 6 (25%) in 2nd group, 10 (27,7%) in the 3rd. In the 1st group the responders were 25 (89,3%) of patients, whose LV DMM before CRT was 15%. If it was more than 15%, patients were nonresponders. In the second group the responders were 18 (75%) of patients, whose Srv before CRT was more than 10 m/s, in average — 12,5±2,1, (р=0,0001).Conclusion. 1. Maintaining of myocardium metabolism (DMM LV less than 15%) is a predictor of CRT efficacy in DCMP patients. 2. Srv is an independent predictor of the CRT response and makes it with the sensitivity 85% and specificity 83% to reveal the responders to CRT at the stage of selection. 3. While selecting patients to CRT it is aimful to use all described methods together to improve quality of treatment.

Objective . To assess the impact of renal sympathetic denervation (RSD) in patients with resistant hypertension (RH) on the structural and functional changes (SFC) of the heart, and to determine predictors of the effectiveness of the procedure Design and methods . Sixty patients (54.6 ± 9.5 years) with RH were included in the analysis. They signed an informed consent for both research and RSD. All of them received full-dose antihypertensive therapy (AHT) (4.1 drugs), including at least one diuretic. BP and heart rate (HR) measurement and cardiac diastolic function (DF) assessment by echocardiography were performed at baseline and after 24 weeks in all subjects. RSD was completed by endovascular radiofrequency ablation of renal arteries. AHT remained unchanged. Results. There was a significant reduction of office BP, as well as a significant regression of myocardial mass in 36,7 % patients at 24 weeks after the procedure. DF was initially impaired in 58.6 %, and after the procedure it normalized in 31 %, and the diastolic dysfunction decreased in 14 % patients. Blood pressure, HR, ATH and left ventricular volume (LVV) were comparable in subgroups, and the dynamics of MM correlated only with the initial values of LV wall. Conclusion. Significant positive changes of DF and the decrease of LV MM were registered 24 weeks after RSD. The initial values of LV wall thickness were the only predictor of MM regression.

Objective. To assess the safety of transcatheter radiofrequency denervation (TRFD) of renal arteries (RA) in patients with resistant hypertension (RH) by ultrasound of the kidneys. Design and methods. We assessed estimated glomerular filtration rate (eGFR) and performed ultrasound examination of the kidneys and RA at 1, 24 and 48 weeks after TRFD in 35 patients (mean age — 52 +- 10 years) with blood pressure (BP) > 160/100 mmHg despite 3 full-dose antihypertensive drugs as a part of the single-center prospective safety/efficacy study (NCT01499810). Results. Office BP decreased by 34,9/18,2 mmHg (p < 0,001/0,001) and -42,7/-21,7 mmHg (p < 0,01/0,01) at 24 and 48 weeks after TRFD, respectively. No significant changes of eGFR and renal blood flow were found, however, the resistive index (RI) decreased significantly in segmental RA: from 0,62 Ѓ} 0,05 initially till 0,58 +-0,06 and 0,59 +- 0,06, respectively, at follow-up points (p = 0,003; p = 0,049 and p =0,063). Conclusions. TRFD of RA has no adverse effect on either renal function or blood flow in the trunk and segmental branches of the RA. On the contrary, the decrease of resistive index in segmental RA after the intervention indicates improvement of renal blood flow.

Проведена оценка роли систолической дисфункции правого желудочка (ПЖ) у больных ишемической и дилатационной кардиомиопатией для отбора кандидатов на сердечную ресинхронизирующую терапию (СРТ). Для оценки систолической функции ПЖ измеряли систолическую скорость фиброзного кольца трикуспидального клапана на стороне свободной стенки ПЖ методом импульсной тканевой допплерографии (TDI) до проведения ресинхронизирующей терапии. Критерием положительного ответа на СРТ (группа респондеры) считалось обратное ремоделирование левого желудочка в виде снижения конечно-систолического объема КСО ≥ 15 % по сравнению с исходным значением и через 6 мес. после СРТ. С помощью ROC-анализа было определено пороговое значение систолической скорости трикуспидального клапана (cut off < 10 смс), которое позволяет выделить больных нереспондеров до имплантации кардиоресинхронизирующих устройств с чувствительностью 85 % и специфичностью 83 %.