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Stress Echocardiography by the ABCDE Protocol ln the Assessment of Prognosis of Stable Coronary Heart Disease. 在评估稳定型冠心病预后时采用 ABCDE 方案进行负荷超声心动图检查。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-30 DOI: 10.18087/cardio.2024.4.n2572
O A Zhuravleva, T R Ryabova, A V Vrublevsky, N N Svyazova, N Y Margolis, A A Boshchenko

Aim: To assess the role of clinical indicators and parameters of stress echocardiography performed according to an extended protocol as predictors for the occurrence of a composite cardiovascular endpoint (CCVEP) in IHD.

Material and methods: The study included 186 patients (60.2% men, mean age 60.6±9.9 years) with an established (n=73; 39.2%) and suspected (60.8%) diagnosis of IHD. Stress EchoCG with adenosine triphosphate (38.2%), transesophageal pacing (15.1%), dobutamine (2.6%), and bicycle ergometry on a recumbent ergometer (44.1%) was performed. The stress EchoCG protocol included assessment of regional wall motion abnormalities (WMA), B-lines, LV contractile reserve (CTR), coronary reserve (CR), and heart rate reserve. The median follow-up period was 13 [9; 20] months. The composite CCVEP included death from cardiovascular diseases and their complications, acute coronary syndrome, and revascularization and was defined at the first of these events. Statistical analysis was performed with the Statistica 16.0 and SPSS Statistics 23.0 software packages. Differences were considered statistically significant at p<0.05.

Results: Invasive or noninvasive coronary angiography was performed in 90.3% of patients; obstructive coronary disease (stenosis ≥50%) was detected in 67.9% of cases. During the follow-up period, 58 (31.2%) patients had cardiovascular complications. The risk of developing CCVEP was associated with the pretest probability (PTP) of ischemic heart disease (odds ratio, OR, 1.05; 95% confidence interval, CI, 1.02-1.08), dyslipidemia (DLP) (OR 0.40; 95% CI 0.20-0.82), carotid atherosclerosis (OR 0.39; 95% CI 0.18-0.86), LV ejection fraction (OR 0.96; 95% CI 0.93-0.99), appearance at peak stress of new significant (2 LV segments or more) regional WMAs (OR 0.32; 95% CI 0.18-6.55), decreased LV CTR (OR 0.46; 95% CI 0.27-0.79) and CR (OR 0.33; 95% CI 0.18-0.61); p<0.05 for all. In a multivariate analysis with Cox regression, the model with clinical indicators included PTP of IHD (OR 1.04; 95% CI 1.01-1.07; p=0.01) and DLP (OR 0.14; 95% CI 0.02-1.01; p=0.05) as predictors. The model with stress EchoCG parameters included the appearance of new significant WMAs (OR 0.33, 95% CI 0.16-0.65; p=0.001) and reduced <2.0 CR (OR 0.44; 95% CI 0.24-0.82; p=0.01). A comparative analysis of Kaplan-Meier curves confirmed statistically significant differences in the dynamics of the CCVEP occurrence depending on the absence or presence of hemodynamically significant WMAs and/or reduced CR during stress EchoCG (p<0.01).

Conclusion: Reduced LV CR and WMA during stress EchoCG in patients with suspected or confirmed IHD are significant independent predictors for the CCVEP occurrence. Among clinical indicators, PTP of IHD and DLP are of the greatest importance for prognosis.

目的:评估根据扩展方案进行的应力超声心动图检查的临床指标和参数作为预测心血管疾病综合终点(CCVEP)发生的作用:研究纳入了 186 名确诊(73 人,占 39.2%)和疑似确诊(60.8%)为 IHD 的患者(60.2% 为男性,平均年龄为 60.6±9.9 岁)。采用三磷酸腺苷(38.2%)、经食道起搏(15.1%)、多巴酚丁胺(2.6%)和卧式测力计上的自行车测力法(44.1%)进行了应激 EchoCG。负荷 EchoCG 方案包括评估区域室壁运动异常 (WMA)、B 线、左心室收缩储备 (CTR)、冠状动脉储备 (CR) 和心率储备。中位随访时间为 13 [9; 20] 个月。复合 CCVEP 包括心血管疾病及其并发症导致的死亡、急性冠状动脉综合征和血管重建,并在首次发生这些事件时定义。统计分析使用 Statistica 16.0 和 SPSS Statistics 23.0 软件包进行。P<0.05为差异有统计学意义:90.3%的患者进行了有创或无创冠状动脉造影;67.9%的病例发现了阻塞性冠状动脉疾病(狭窄≥50%)。在随访期间,58 例(31.2%)患者出现了心血管并发症。CCVEP的发病风险与缺血性心脏病的检测前概率(PTP)(比值比,OR,1.05;95% 置信区间,CI,1.02-1.08)、血脂异常(DLP)(OR,0.40;95% 置信区间,0.20-0.82)、颈动脉粥样硬化(OR,0.39;95% 置信区间,0.18-0.86)、左心室射血分数(LV ejection fraction,LV射血分数)(比值比,OR,1.05;95% 置信区间,1.02-1.08)、左心室射血分数(LV ejection fraction,LV射血分数)(比值比,OR,0.40;95% 置信区间,0.20-0.82)相关。86)、左心室射血分数(OR 0.96;95% CI 0.93-0.99)、压力峰值时出现新的显著(2 个左心室节段或更多)区域 WMA(OR 0.32;95% CI 0.18-6.55)、左心室 CTR 下降(OR 0.46;95% CI 0.27-0.79)和 CR(OR 0.33;95% CI 0.18-0.61);所有指标的 p<0.05。在Cox回归的多变量分析中,临床指标模型包括IHD的PTP(OR 1.04;95% CI 1.01-1.07;P=0.01)和DLP(OR 0.14;95% CI 0.02-1.01;P=0.05)作为预测因素。应激 EchoCG 参数模型包括出现新的显著 WMA(OR 0.33,95% CI 0.16-0.65;p=0.001)和 <2.0 CR 减少(OR 0.44;95% CI 0.24-0.82;p=0.01)。Kaplan-Meier曲线的比较分析证实,CCVEP发生的动态变化在统计学上存在显著差异,这取决于应激EchoCG时是否存在血流动力学意义上的WMA和/或CR降低(p<0.01):结论:疑似或确诊 IHD 患者应激 EchoCG 时左心室 CR 和 WMA 降低是 CCVEP 发生的重要独立预测因素。在临床指标中,IHD 的 PTP 和 DLP 对预后最为重要。
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引用次数: 0
Clinical, Anamnestic, and Demographic Characteristics of Patients with Myocardial Infarction in Russian Federation According to the Russian Registry of Acute Myocardial Infarction - REGION-IM. 根据俄罗斯急性心肌梗死登记处 - REGION-IM 统计的俄罗斯联邦心肌梗死患者的临床、病理和人口特征。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-30 DOI: 10.18087/cardio.2024.4.n2625
S A Boytsov, R M Shakhnovich, S N Tereschenko, A D Erlikh, D V Pevsner, Yu K Rytova, R G Gulyan, I A Markov, L V Shchepinova, M A Fomina, A S Kletkina, T V Grigoreva, V I Dagaeva, L S Devyatova, L Yu Chesnokova, E S Semenova, Ya A Kamenetz

Aim: Based on data from the Russian REGION-MI registry, to characterize patients with myocardial infarction (MI) hospitalized in Russian hospitals, describe their historical, demographic, and clinical characteristics, and compare the results with the data of previous Russian and international registries of acute coronary syndrome.

Material and methods: REGION-MI is a multicenter prospective observational study. The follow-up period was divided into three stages: during the hospital stay, at 6 and 12 months after the inclusion in the registry. Demographic and historic data and information about the present case of MI were entered into the patient's individual record card.

Results: The median age of all patients was 63 years; 68% of patients were men. The mean age of women was older than that of men. Among all MI cases, 70% were ST-segment elevation myocardial infarction (STEMI). Patients with non-ST-segment elevation myocardial infarction (NSTEMI) were older and had more comorbidities than patients with STEMI. The median time from the first symptoms to ECG recording was two hours, and from the first symptoms to CAG 7 hours. CAG was performed in 91% of patients with STEMI and 84% of patients with NSTEMI. Stenting was performed in 69% of patients. Although many patients had a complicated cardiovascular history, at the time of admission only 31.5% of patients were taking at least one drug from the groups of antiplatelets, oral anticoagulants, statins, and beta-blockers.

Conclusion: Patients with MI in the Russian Federation are younger than patients with MI in European countries. Among the clinical and historical characteristics, conspicuous is the presence of modifiable risk factors in many patients, as well as the presence of a previous diagnosis of ischemic heart disease. Furthermore, a small proportion of patients took statins, antiplatelet agents or anticoagulants at the outpatient stage, which indicates a great reserve of both primary and secondary prevention of cardiovascular diseases in the Russian Federation. The delayed seeking medical help is also noticeable, which indicates the need for increasing the public awareness of the symptoms of MI and the importance of timely hospitalization.

目的:根据俄罗斯REGION-MI登记处的数据,描述在俄罗斯医院住院的心肌梗死(MI)患者的特征,描述他们的历史、人口统计学和临床特征,并将结果与之前俄罗斯和国际急性冠状动脉综合征登记处的数据进行比较:REGION-MI 是一项多中心前瞻性观察研究。随访期分为三个阶段:住院期间、纳入登记册后的 6 个月和 12 个月。人口统计学数据、历史数据和本次心肌梗死病例的相关信息都被输入了患者的个人记录卡:所有患者的中位年龄为 63 岁,68% 的患者为男性。女性的平均年龄大于男性。在所有心肌梗死病例中,70%为ST段抬高型心肌梗死(STEMI)。与 STEMI 患者相比,非 ST 段抬高型心肌梗死(NSTEMI)患者年龄更大,合并症更多。从首发症状到心电图记录的中位时间为两小时,从首发症状到CAG的中位时间为7小时。91%的STEMI患者和84%的NSTEMI患者接受了CAG治疗。69%的患者接受了支架植入术。虽然许多患者有复杂的心血管病史,但入院时只有31.5%的患者至少服用了一种抗血小板药物、口服抗凝剂、他汀类药物和β-受体阻滞剂:结论:俄罗斯联邦的心肌梗死患者比欧洲国家的心肌梗死患者更年轻。在临床和病史特征方面,许多患者存在可改变的风险因素,以及曾被诊断为缺血性心脏病。此外,一小部分患者在门诊阶段服用了他汀类药物、抗血小板药物或抗凝剂,这表明俄罗斯联邦在心血管疾病的一级和二级预防方面都有很大的储备。延迟就医的现象也很明显,这表明有必要提高公众对心肌梗死症状的认识以及及时住院治疗的重要性。
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引用次数: 0
Features of The Dynamics of Profibrotic Markers and Regression of Left Ventricular Hypertrophy After Renal Denervation in Patients With Resistant Hypertension and Stenosing Atherosclerosis of the Coronary Arteries. 耐药性高血压和冠状动脉狭窄性动脉粥样硬化患者肾脏去神经化后左心室肥大的表皮标志物动态变化和消退特征
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-30 DOI: 10.18087/cardio.2024.4.n2411
I V Zyubanova, A Yu Falkovckaya, M A Manukyan, E I Solonskaya, A A Vtorushina, S A Khunkhinova, A M Gusakova, S E Pekarskiy, V F Mordovin

Aim: To compare the changes in serum concentrations of matrix metalloproteinases (MMPs) and their tissue inhibitor (TIMP) to the dynamics of blood pressure (BP) and parameters of left ventricular hypertrophy (LVH) 6 months after renal denervation (RD) in patients with resistant arterial hypertension (RAH) and complicated coronary atherosclerosis.

Material and methods: In 22 RAH patients with complicated coronary atherosclerosis (revascularization and/or history of myocardial infarction (MI)), 24-hour BP monitoring, echocardiography, and measurement of blood MMPs and TIMP were performed at baseline and six months after RD. The comparison group consisted of 48 RAH patients without a history of coronary revascularization or MI.

Results: In 6 months after RD, BP was decreased comparably in both groups. In the group of complicated atherosclerosis, there were no significant changes in profibrotic markers or LVH parameters. Thus, at baseline and after 6 months, the values of the studied indicators were the following: left ventricular myocardial mass (LVMM) 233.1±48.1 and 243.0±52.0 g, LVMM index 60.6±14.5 and 62.8±10 .9 g/m2.7, proMMP-1 4.9 [2.1; 7.7] and 3.6 [2.0; 9.4]  ng/ml, MMP-2 290.4 [233.1; 352.5] and 352.2 [277.4; 402.9] ng/ml, MMP-9 220.6 [126.9; 476.7] and 263.5 [82.9; 726.2] ng/ml, TIMP-1 395.7 [124.7; 591.4] and 424.2 [118.2; 572.0] ng/ml, respectively. In the comparison group, on the contrary, there was a significant decrease in LVMM from 273.6±83.3 g to 254.1±70.4 g, LVMM index from 67.1±12.3 to 64.0±14.4 g/m2.7, proMMP-1 from 7.2 [3.6; 11.7] to 5.9 [3.5; 10.9] ng/ml, MMP-2 from 328.9 [257.1; 378.1] to 272.8 [230.2; 343.2] ng/ml, MMP-9 from 277.9 [137.0; 524.0] to 85.5 [34.2; 225.9] ng/ml, and the MMP-9/TIMP-1 ratio from 0.80 [0.31; 1.30] to 0.24 [0.07; 0.76]. The BP dynamics in this group was inversely correlated with MMP-2 at 6 months (r=-0.38), and the MMP-9/TIMP-1 ratio was correlated with LVMM and the LVMM index at baseline (r=0.39 and r=0.39) and at 6 months (r=0.37 and r=0.32). The change in TIMP-1 from 543.9 [277.5; 674.1] to 469.8 [289.7; 643.6] ng/ml was not significant (p=0.060).

Conclusion: In RAH patients with complicated coronary atherosclerosis, the dynamics of profibrotic biomarkers and LVH parameters after RD was absent despite the pronounced antihypertensive effect, probably due to the low reversibility of cardiovascular remodeling processes or more complex regulatory mechanisms of the MMP system.

目的:比较抵抗性动脉高血压(RAH)和复杂冠状动脉粥样硬化患者肾脏去神经(RD)6个月后血清基质金属蛋白酶(MMPs)及其组织抑制剂(TIMP)浓度的变化与血压(BP)动态和左心室肥厚(LVH)参数的关系:对22名患有复杂冠状动脉粥样硬化(血管重建和/或心肌梗死(MI)病史)的抵抗性动脉高血压(RAH)患者在基线和肾脏去神经后6个月进行了24小时血压监测、超声心动图检查以及血液中MMPs和TIMP的测量。对比组包括48名无冠状动脉血运重建或心肌梗死病史的RAH患者:结果:RD 6 个月后,两组患者的血压降幅相当。在复杂性动脉粥样硬化组中,淀粉样变性标志物和 LVH 参数均无明显变化。因此,在基线和 6 个月后,研究指标值如下:左室心肌质量(LVMM)233.1±48.1 g 和 243.0±52.0 g,LVMM 指数 60.6±14.5 g/m2.7 和 62.8±10.9 g/m2.7,proMMP-1 4.9 [2.1; 7.7] 和 3.6 [2.0; 9.4] ng/ml,MMP-2 290.4 [233.1; 352.5] 和 352.2 [277.4; 402.9] ng/ml,MMP-9 220.6 [126.9; 476.7] 和 263.5 [82.9; 726.2] 纳克/毫升,TIMP-1 分别为 395.7 [124.7; 591.4] 和 424.2 [118.2; 572.0] 纳克/毫升。相反,对比组的 LVMM 从 273.6±83.3 g 显著降至 254.1±70.4 g,LVMM 指数从 67.1±12.3 降至 64.0±14.4 g/m2.7,proMMP-1 从 7.2 [3.6; 11.7] 降至 5.9 [3.MMP-2从328.9 [257.1; 378.1] 降至272.8 [230.2; 343.2] ng/ml,MMP-9从277.9 [137.0; 524.0] 降至85.5 [34.2; 225.9] ng/ml,MMP-9/TIMP-1比值从0.80 [0.31; 1.30] 降至0.24 [0.07; 0.76]。该组患者的血压动态与 6 个月时的 MMP-2 成反比(r=-0.38),MMP-9/TIMP-1 比值与基线(r=0.39 和 r=0.39)和 6 个月时的 LVMM 和 LVMM 指数成正比(r=0.37 和 r=0.32)。TIMP-1从543.9 [277.5; 674.1] ng/ml到469.8 [289.7; 643.6] ng/ml的变化并不显著(P=0.060):结论:在患有复杂冠状动脉粥样硬化的RAH患者中,尽管降压效果显著,但RD后组织坏死生物标志物和LVH参数的动态变化并不明显,这可能是由于心血管重塑过程的可逆性较低或MMP系统的调控机制更为复杂。
{"title":"Features of The Dynamics of Profibrotic Markers and Regression of Left Ventricular Hypertrophy After Renal Denervation in Patients With Resistant Hypertension and Stenosing Atherosclerosis of the Coronary Arteries.","authors":"I V Zyubanova, A Yu Falkovckaya, M A Manukyan, E I Solonskaya, A A Vtorushina, S A Khunkhinova, A M Gusakova, S E Pekarskiy, V F Mordovin","doi":"10.18087/cardio.2024.4.n2411","DOIUrl":"https://doi.org/10.18087/cardio.2024.4.n2411","url":null,"abstract":"<p><strong>Aim: </strong>To compare the changes in serum concentrations of matrix metalloproteinases (MMPs) and their tissue inhibitor (TIMP) to the dynamics of blood pressure (BP) and parameters of left ventricular hypertrophy (LVH) 6 months after renal denervation (RD) in patients with resistant arterial hypertension (RAH) and complicated coronary atherosclerosis.</p><p><strong>Material and methods: </strong>In 22 RAH patients with complicated coronary atherosclerosis (revascularization and/or history of myocardial infarction (MI)), 24-hour BP monitoring, echocardiography, and measurement of blood MMPs and TIMP were performed at baseline and six months after RD. The comparison group consisted of 48 RAH patients without a history of coronary revascularization or MI.</p><p><strong>Results: </strong>In 6 months after RD, BP was decreased comparably in both groups. In the group of complicated atherosclerosis, there were no significant changes in profibrotic markers or LVH parameters. Thus, at baseline and after 6 months, the values of the studied indicators were the following: left ventricular myocardial mass (LVMM) 233.1±48.1 and 243.0±52.0 g, LVMM index 60.6±14.5 and 62.8±10 .9 g/m2.7, proMMP-1 4.9 [2.1; 7.7] and 3.6 [2.0; 9.4]  ng/ml, MMP-2 290.4 [233.1; 352.5] and 352.2 [277.4; 402.9] ng/ml, MMP-9 220.6 [126.9; 476.7] and 263.5 [82.9; 726.2] ng/ml, TIMP-1 395.7 [124.7; 591.4] and 424.2 [118.2; 572.0] ng/ml, respectively. In the comparison group, on the contrary, there was a significant decrease in LVMM from 273.6±83.3 g to 254.1±70.4 g, LVMM index from 67.1±12.3 to 64.0±14.4 g/m2.7, proMMP-1 from 7.2 [3.6; 11.7] to 5.9 [3.5; 10.9] ng/ml, MMP-2 from 328.9 [257.1; 378.1] to 272.8 [230.2; 343.2] ng/ml, MMP-9 from 277.9 [137.0; 524.0] to 85.5 [34.2; 225.9] ng/ml, and the MMP-9/TIMP-1 ratio from 0.80 [0.31; 1.30] to 0.24 [0.07; 0.76]. The BP dynamics in this group was inversely correlated with MMP-2 at 6 months (r=-0.38), and the MMP-9/TIMP-1 ratio was correlated with LVMM and the LVMM index at baseline (r=0.39 and r=0.39) and at 6 months (r=0.37 and r=0.32). The change in TIMP-1 from 543.9 [277.5; 674.1] to 469.8 [289.7; 643.6] ng/ml was not significant (p=0.060).</p><p><strong>Conclusion: </strong>In RAH patients with complicated coronary atherosclerosis, the dynamics of profibrotic biomarkers and LVH parameters after RD was absent despite the pronounced antihypertensive effect, probably due to the low reversibility of cardiovascular remodeling processes or more complex regulatory mechanisms of the MMP system.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 4","pages":"45-53"},"PeriodicalIF":0.5,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Features of the Course of Arterial Hypertension in the Era of the COVID-19 Pandemic: Common Pathogenetic Links Between Hypertension and SARS-CoV-2]. [COVID-19大流行时期动脉高血压的病程特点:高血压与 SARS-CoV-2 之间的共同病原学联系]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-30 DOI: 10.18087/cardio.2024.4.n2525
S A Berns, M S Leontyeva, E V Tavlueva, V S Bashnyak, O M Drapkina

The aim of this review was to present the mechanism of infection with severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) and its possible effect on the course of arterial hypertension. Another aim was to evaluate the relationship of the renin-angiotensin-aldosterone system with the pathogenetic stages of infection caused by SARS-CoV-2 virus.

本综述旨在介绍严重急性呼吸系统综合征相关冠状病毒-2(SARS-CoV-2)的感染机制及其对动脉高血压病程可能产生的影响。另一个目的是评估肾素-血管紧张素-醛固酮系统与 SARS-CoV-2 病毒感染致病阶段的关系。
{"title":"[Features of the Course of Arterial Hypertension in the Era of the COVID-19 Pandemic: Common Pathogenetic Links Between Hypertension and SARS-CoV-2].","authors":"S A Berns, M S Leontyeva, E V Tavlueva, V S Bashnyak, O M Drapkina","doi":"10.18087/cardio.2024.4.n2525","DOIUrl":"10.18087/cardio.2024.4.n2525","url":null,"abstract":"<p><p>The aim of this review was to present the mechanism of infection with severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) and its possible effect on the course of arterial hypertension. Another aim was to evaluate the relationship of the renin-angiotensin-aldosterone system with the pathogenetic stages of infection caused by SARS-CoV-2 virus.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 4","pages":"72-78"},"PeriodicalIF":0.5,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hemodynamic Changes in Intrarenal Blood Flow are Associated With Poor Prognosis in Patients With Acute Decompensated Heart Failure. 肾内血流的血流动力学变化与急性失代偿性心力衰竭患者的不良预后有关。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-30 DOI: 10.18087/cardio.2024.4.n2575
S A Sovetova, T A Nikiforova, K V Charaya, D Yu Shchekochikhin, V M Kulikov, A M Dubovitsky, S A Suchkova, A A Bogdanova, N A Ananicheva, D A Andreev

Aim: To evaluate a potential role of different patterns of intrarenal blood flow using Doppler ultrasound as a part of determining the severity of venous congestion, predicting impairment of renal function and an unfavorable prognosis in patients with acute decompensated chronic heart failure (ADCHF).

Material and methods: This prospective observational single-site study included 75 patients admitted in the intensive care unit for ADCHF. Upon admission all patients underwent bedside renal venous Doppler ultrasound to determine the blood flow pattern (continuous, biphasic, monophasic). In one hour after the initiation of intravenous diuretic therapy, sodium concentration was measured in a urine sample. The primary endpoint was the development of acute kidney injury (AKI). The secondary endpoints were the development of diuretic resistance (a need to increase the furosemide daily dose by more than 2 times compared with the baseline), decreased natriuretic response (defined as urine sodium concentration less than 50-70 mmol/l), and in-hospital death.

Results: According to the data of Doppler ultrasound, normal renal blood flow was observed in 40 (53%) patients, biphasic in 21 (28%) patients, and monophasic in 14 (19%) patients. The monophasic pattern of intrarenal blood flow was associated with the highest incidence of AKI: among 14 patients in this group, AKI developed in 100% of cases (OR 3.8, 95% CI: 2.5-5.8, p<0.01), while among patients with normal and moderate impairment of renal blood flow, there was no significant increase in the risk of developing AKI. The odds of in-hospital death were increased 25.77 times in patients with monophasic renal blood flow (95% CI: 5.35-123.99, p<0.001). Patients with a monophasic intrarenal blood flow pattern were also more likely to develop diuretic resistance compared to patients with other blood flow patterns (p<0.001) and had a decreased sodium concentration to less than 50 mmol/l (p<0.001) in a spot urine test obtained one hour after the initiation of furosemide administration.

Conclusion: Patients with monophasic intrarenal blood flow are at a higher risk of developing AKI, diuretic resistance with decreased natriuretic response, and in-hospital death.

目的:评估使用多普勒超声检查肾内血流的不同模式在确定静脉充血严重程度、预测急性失代偿性慢性心力衰竭(ADCHF)患者肾功能损害和不利预后方面的潜在作用:这项前瞻性单点观察研究纳入了 75 名因慢性心力衰竭急性失代偿期而入住重症监护室的患者。所有患者入院时均接受了床旁肾静脉多普勒超声检查,以确定血流模式(连续、双相、单相)。在开始静脉利尿治疗一小时后,测量尿样中的钠浓度。主要终点是急性肾损伤(AKI)的发生。次要终点是出现利尿剂抵抗(需要将呋塞米的日剂量增加到基线的 2 倍以上)、利钠反应减弱(定义为尿钠浓度低于 50-70 毫摩尔/升)和院内死亡:多普勒超声数据显示,40 例(53%)患者的肾血流量正常,21 例(28%)患者的肾血流量呈双相型,14 例(19%)患者的肾血流量呈单相型。肾内血流的单相模式与最高的 AKI 发生率相关:在这一组的 14 名患者中,100% 的病例发生了 AKI(OR 3.8,95% CI:2.5-5.8,p<0.01),而在肾血流正常和中度受损的患者中,发生 AKI 的风险没有显著增加。单相肾血流患者的院内死亡几率增加了 25.77 倍(95% CI:5.35-123.99,p<0.001)。与其他血流模式的患者相比,单相肾内血流模式的患者也更容易出现利尿药抵抗(p<0.001),并且在开始服用呋塞米一小时后进行的尿液定点检测中,钠浓度降至 50 毫摩尔/升以下(p<0.001):结论:单相肾内血流的患者发生 AKI、利尿抵抗和钠尿肽反应降低以及院内死亡的风险较高。
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引用次数: 0
Short Registry of Terminal Forms of Chronic Heart Failure in the Samara Region. 萨马拉地区慢性心力衰竭终末期形式的简短登记。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-31 DOI: 10.18087/cardio.2024.3.n2323
O A Rubanenko, I V Skripnik, K V Matuchina, A O Rubanenko, I L Davydkin, A S Benyan, D V Duplyakov

Aim: To study the clinical characteristics and prognosis of patients with functional class (FC) III-IV chronic heart failure (CHF) who meet the criteria for inclusion in the palliative care program.

Material and methods: A short registry of severe CHF forms was conducted at 60 outpatient and inpatient clinics in the Samara region for one month (16.05.2022-15.06.2022). The registry included patients with FC III-IV CHF who sought medical help during that period. Lethal outcomes were assessed at 90 days after the inclusion in the registry using the Mortality Information and Analytics system.

Results: 591 patients (median age, 71.0 [64.0; 80.0] years were enrolled, including 339 (57.4%) men, of which 149 (24.1%) were of working age (under 65 years). The main cause of CHF was ischemic heart disease (64.5%). 229 (38.7%) patients had left ventricular ejection fraction <40%. During the past year, 513 (86.8%) patients had at least one hospitalization for decompensated CHF. 45.7% of patients had hydrothorax, and 11.3% of patients had ascites. Low systolic blood pressure was observed in more than 25% of patients; 14.2% required in-hospital inotropic support; and 9.1% received it on the outpatient basis. 4.2% of patients received outpatient oxygen support and 0.8% required the administration of narcotic analgesics. 12 (1.9%) patients were on the waiting list for heart transplantation. In this study, there was an inconsistency in the number of patients with ventricular tachycardia and/or left bundle branch block (LBBB) who were implanted with cardiac resynchronization therapy devices (CRTD) or an implantable cardioverter defibrillator (ICD), a total of 19 patients (11 patients with CRTD and 8 patients with ICD), while 58 (9.8%) patients had indications for CRTD/ICD implantation. Within 90 days from inclusion in the registry, 59 (10.0%) patients died. According to binary logistic regression analysis, the presence of LBBB, hydrothorax, the requirement for outpatient oxygen support, and a history of cardiac surgery were associated with a high risk of death.

Conclusion: Patients with severe forms of CHF require not only adequate drug therapy, but also dynamic clinical observation supplemented with palliative care aimed at improving the quality of life, including the ethical principles of shared decision-making and advance care planning to identify the priorities and goals of patients in relation to their care.

目的:研究符合姑息治疗计划标准的功能分级(FC)III-IV级慢性心力衰竭(CHF)患者的临床特征和预后:萨马拉地区的 60 家门诊和住院诊所对重症慢性心力衰竭患者进行了为期一个月(2022 年 5 月 16 日至 2022 年 6 月 15 日)的短期登记。登记对象包括在此期间就医的 FC III-IV 型慢性心力衰竭患者。使用死亡率信息和分析系统对纳入登记册后 90 天的死亡结果进行评估:共登记了 591 名患者(中位年龄为 71.0 [64.0; 80.0]岁),包括 339 名男性(57.4%),其中 149 名(24.1%)处于工作年龄(65 岁以下)。导致慢性心力衰竭的主要原因是缺血性心脏病(64.5%)。229名(38.7%)患者的左心室射血分数为40%。在过去一年中,513 名(86.8%)患者至少有一次因慢性心力衰竭失代偿而住院治疗。45.7%的患者有胸水,11.3%的患者有腹水。超过 25% 的患者收缩压偏低;14.2% 的患者需要院内肌力支持;9.1% 的患者在门诊接受肌力支持。4.2%的患者在门诊接受氧气支持,0.8%的患者需要使用麻醉镇痛药。12(1.9%)名患者正在等待心脏移植。在这项研究中,室性心动过速和/或左束支传导阻滞(LBBB)患者中植入心脏再同步治疗设备(CRTD)或植入式心脏除颤器(ICD)的人数不一致,共有19名患者(11名患者植入CRTD,8名患者植入ICD),而58名(9.8%)患者有植入CRTD/ICD的适应症。在纳入登记册后的 90 天内,59 名患者(10.0%)死亡。根据二元逻辑回归分析,存在LBBB、胸腔积水、需要门诊氧支持和心脏手术史的患者死亡风险较高:重症慢性心力衰竭患者不仅需要适当的药物治疗,还需要动态的临床观察,辅以旨在改善生活质量的姑息治疗,包括共同决策和预先护理计划的伦理原则,以确定患者在护理方面的优先事项和目标。
{"title":"Short Registry of Terminal Forms of Chronic Heart Failure in the Samara Region.","authors":"O A Rubanenko, I V Skripnik, K V Matuchina, A O Rubanenko, I L Davydkin, A S Benyan, D V Duplyakov","doi":"10.18087/cardio.2024.3.n2323","DOIUrl":"https://doi.org/10.18087/cardio.2024.3.n2323","url":null,"abstract":"<p><strong>Aim: </strong>To study the clinical characteristics and prognosis of patients with functional class (FC) III-IV chronic heart failure (CHF) who meet the criteria for inclusion in the palliative care program.</p><p><strong>Material and methods: </strong>A short registry of severe CHF forms was conducted at 60 outpatient and inpatient clinics in the Samara region for one month (16.05.2022-15.06.2022). The registry included patients with FC III-IV CHF who sought medical help during that period. Lethal outcomes were assessed at 90 days after the inclusion in the registry using the Mortality Information and Analytics system.</p><p><strong>Results: </strong>591 patients (median age, 71.0 [64.0; 80.0] years were enrolled, including 339 (57.4%) men, of which 149 (24.1%) were of working age (under 65 years). The main cause of CHF was ischemic heart disease (64.5%). 229 (38.7%) patients had left ventricular ejection fraction &lt;40%. During the past year, 513 (86.8%) patients had at least one hospitalization for decompensated CHF. 45.7% of patients had hydrothorax, and 11.3% of patients had ascites. Low systolic blood pressure was observed in more than 25% of patients; 14.2% required in-hospital inotropic support; and 9.1% received it on the outpatient basis. 4.2% of patients received outpatient oxygen support and 0.8% required the administration of narcotic analgesics. 12 (1.9%) patients were on the waiting list for heart transplantation. In this study, there was an inconsistency in the number of patients with ventricular tachycardia and/or left bundle branch block (LBBB) who were implanted with cardiac resynchronization therapy devices (CRTD) or an implantable cardioverter defibrillator (ICD), a total of 19 patients (11 patients with CRTD and 8 patients with ICD), while 58 (9.8%) patients had indications for CRTD/ICD implantation. Within 90 days from inclusion in the registry, 59 (10.0%) patients died. According to binary logistic regression analysis, the presence of LBBB, hydrothorax, the requirement for outpatient oxygen support, and a history of cardiac surgery were associated with a high risk of death.</p><p><strong>Conclusion: </strong>Patients with severe forms of CHF require not only adequate drug therapy, but also dynamic clinical observation supplemented with palliative care aimed at improving the quality of life, including the ethical principles of shared decision-making and advance care planning to identify the priorities and goals of patients in relation to their care.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 3","pages":"46-54"},"PeriodicalIF":0.5,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Stress-Echocardiography in Low-risk Acute Coronary Syndrome Without Persistent ST-segment Elevation Diagnostic Algorithm]. [无持续 ST 段抬高的低危急性冠状动脉综合征的负荷超声心动图诊断算法]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-31 DOI: 10.18087/cardio.2024.3.n2430
E E Abramenko, T R Ryabova, V V Ryabov, A A Boshchenko, R S Karpov

This review addresses the capabilities of stress EchoCG as a simple, non-invasive, non-radiation method for diagnosing occult disorders of coronary blood flow in patients with non-ST-elevation acute coronary syndrome on a low-risk electrocardiogram. The capabilities of the enhanced stress EchoCG protocol are based on supplementing the standard detection of transient disturbances of local contractility, generally associated with coronary artery obstruction, with an assessment of the heart rate reserve, coronary reserve and other parameters. This approach is considered promising for a more complete characterization of heart function during exercise and an accurate prognosis of the clinical case, which allows determining the tactics for patient management not limited to selection for myocardial revascularization.

本综述探讨了应激 EchoCG 作为一种简单、无创、无辐射的方法,在低风险心电图上诊断非 ST 段抬高急性冠状动脉综合征患者冠状动脉血流隐性紊乱的功能。增强型应激 EchoCG 方案的功能基于对心率储备、冠状动脉储备和其他参数的评估,对通常与冠状动脉阻塞有关的局部收缩力短暂紊乱的标准检测进行补充。这种方法有望更全面地描述运动时的心脏功能,并对临床病例进行准确预后,从而确定患者管理策略,而不仅限于选择心肌血管重建。
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引用次数: 0
An Increase in the Left Atrium Volume During Exercise is Associated With a Positive Result of a Diastolic Stress Test in Patients With Arterial Hypertension. 运动时左心房容积的增加与动脉高血压患者舒张压测试的阳性结果有关。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-31 DOI: 10.18087/cardio.2024.3.n2643
E S Mazur, V V Mazur, N D Bazhenov, O V Nilova, T O Nikolaeva, D V Alekseev

Aim: To study the relationship between changes in left atrial volume (LAV) during exercise and the result of a diastolic stress test (DST) in patients with arterial hypertension (AH).

Material and methods: The study included 219 patients with AH without ischemic heart disease and atrial fibrillation. During the DST performed before and after exercise, the ratio of transmitral flow velocity to mitral annular velocity (E/e'), the left atrial global longitudinal strain in the reservoir phase (reservoir strain), and LAV were determined. The criterion for a positive DST was an increase in E/e' ≥15.

Results: A positive result of DST was observed in 90 (41.1%) patients. Patients with positive DST were older (65.0 and 59.0 years); among them, there were fewer men (24.4 and 41.1%), but more patients with obesity (66.7 and 40.3%) and diabetes mellitus (36.7 and 8.5%). At rest, patients with positive DST had higher E/e' ratio (11.5 and 8.8), pulmonary artery systolic pressure (29.0 and 27.0 mm Hg), and LAV (60.0 and 52.0 ml), but a lower left atrial reservoir strain (20.0 and 24.0%). During exercise in patients with positive and negative DST, E/e' increased by 5.46 and 0.47 units, respectively. Changes in the LAV and reservoir strain during exercise in these groups were directed differently. In patients with positive DST, the left atrial reservoir strain decreased by 1.0 percentage points (pp) whereas in patients with negative DST, it increased by 8.0 pp. During exercise, the LAV increased by 10.0 ml in patients with a positive DST, whereas in the alternative group, the LAV decreased by 8.5 ml. The AUC for changes in LAV as an indicator of a positive DST was 0.987 while the AUC for the resting left atrial reservoir strain was 0.938. An increase in LAV >1 ml, as an indicator of a positive DST has a sensitivity of 96.9% and a specificity of 95.1%.

Conclusion: In AH patients, changes in left ventricular filling pressure are associated with a unidirectional change in LAV. An increase in LAV during exercise by more than 1 ml can serve as a criterion for a positive DST result. This assessment was consistent with the assessment of the DST result by the E/e' criterion >15 in 94.5% of cases.

目的:研究动脉高血压(AH)患者运动时左心房容积(LAV)的变化与舒张压力试验(DST)结果之间的关系:研究对象包括219名无缺血性心脏病和心房颤动的动脉高血压患者。在运动前后进行的 DST 期间,测定了二尖瓣口血流速度与二尖瓣瓣环速度之比(E/e')、左心房贮血期整体纵向应变(贮血应变)和 LAV。DST 阳性的标准是 E/e' 增加≥15:90例(41.1%)患者的DST结果为阳性。DST 阳性的患者年龄较大(65.0 岁和 59.0 岁);其中男性较少(24.4% 和 41.1%),但肥胖(66.7% 和 40.3%)和糖尿病(36.7% 和 8.5%)患者较多。静息时,DST 阳性患者的 E/e' 比值(11.5 和 8.8)、肺动脉收缩压(29.0 和 27.0 毫米汞柱)和 LAV(60.0 和 52.0 毫升)较高,但左心房储压应变(20.0 和 24.0%)较低。DST 阳性和阴性患者在运动时,E/e'分别增加了 5.46 和 0.47 个单位。这两组患者运动时 LAV 和储腔应变的变化方向不同。在 DST 阳性的患者中,左心房储压应变降低了 1.0 个百分点(pp),而在 DST 阴性的患者中,左心房储压应变增加了 8.0 个百分点。在运动过程中,DST 阳性患者的左心房储血量增加了 10.0 毫升,而替代组患者的左心房储血量减少了 8.5 毫升。作为 DST 阳性指标的 LAV 变化的 AUC 为 0.987,而静息左心房储库应变的 AUC 为 0.938。以 LAV 增加 1 毫升作为 DST 阳性指标的敏感性为 96.9%,特异性为 95.1%:在AH患者中,左心室充盈压的变化与LAV的单向变化有关。运动时左心室充盈压增加超过 1 毫升可作为 DST 阳性结果的标准。在 94.5% 的病例中,这一评估结果与根据 E/e' 标准 >15 评估的 DST 结果一致。
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引用次数: 0
Determining The Risk of Atrial Fibrillation Paroxysm in Patients With Chronic Heart Failure With Intact and Reduced Ejection Fraction. 确定射血分数完整和降低的慢性心力衰竭患者心房颤动阵发性发作的风险。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-31 DOI: 10.18087/cardio.2024.3.n2466
I P Zakharov, P Sh Chomakhidze, F Yu Kopylov, E A Sultygova, D F Mesitskaya, E A Lyubimova, D A Andreev

Aim: To determine predictors for the development of atrial fibrillation (AF) in patients with chronic heart failure (CHF) with preserved and reduced ejection fraction by echocardiography (EchoCG) according to an extended protocol with determination of diastolic function and left atrial global strain.

Material and methods: Data of 168 patients with stage I-III CHF without a history of AF were analyzed. All patients underwent echocardiography according to an extended protocol with the determination of diastolic dysfunction (DD), left atrial ejection fraction (LA EF), and left atrial global strain (LA GS). Tissue Doppler imaging (TDI) was used to evaluate the early (E) and late (A) LV filling velocity and the early (E') and late (A') diastolic mitral annular velocity. In all patients, Holter ECG monitoring (HM ECG) of heart rhythm was performed for 3 days, and ECG monitoring with telemedicine technologies was performed for 7 days, 3 times a day for 3 minutes. The follow-up period was 3 months or until an AF episode.

Results: During the study, paroxysmal AF (pAF) was detected in 41 (24.4%) patients using various methods of heart rhythm monitoring. Complaints of palpitations were noted for 10 (24.4%) patients during pAF, which was recorded using a CardioQVARK® device, HM ECG or a 12-lead ECG. In 5 (12.2%) patients, daily ECG monitoring revealed pAF without associated complaints. HM ECG detected 8, 2, 4 (19.5%, 4.8%, and 9.7%) cases during 24, 48 and 72 hours, respectively; a single-channel CardioQVARK® detected 30 (73.2%) cases when used 3 times a day for 7 days. These results showed that AF frequently develops in CHF without accompanying symptoms. The method for detecting pAF with CardioQVARK® showed good results: it was twice more effective than HM ECG and three times more effective than 12-lead ECG. Also, according to ultrasound data, significant changes in the following parameters were noted in patients with AF: LA EF <36% (OR 1.04, 95% CI: 1.02-1.08), p=0.003; LA GS <9.9% (OR 1.16, 95% CI: 1.02-1.38), p<0.001; TDI E med <5.7 cm/s (OR 0.97, 95% CI: 0.94-1.00), p=0.026. Grade 2 DD did not show statistically significant results (OR 1.1, 95% CI: 0.7-1.5, p=0.54). However, it was detected more frequently in patients with AF, in 34% of cases, compared to 29% of cases in patients without AF, which requires further study on a larger patient sample.

Conclusion: Patients with CHF have a high risk of developing pAF (24.4%). 75% of patients with AF do not feel the development of paroxysm. All CHF patients should undergo EchoCG with assessment of LA EF, TDI E med and LA GS to identify a group at risk for the development of AF. Heart rhythm remote monitoring with CardioQVARK® devices can be considered a reliable method for early detection of pAF and timely initiation of anticoagulant therapy in patients with CHF.

目的:通过超声心动图(EchoCG)确定射血分数保留和降低的慢性心力衰竭(CHF)患者发生心房颤动(AF)的预测因素:分析了 168 例无房颤病史的 I-III 期 CHF 患者的数据。所有患者均按照扩展方案接受了超声心动图检查,以确定舒张功能障碍(DD)、左心房射血分数(LA EF)和左心房整体应变(LA GS)。组织多普勒成像(TDI)用于评估左心室早期(E)和晚期(A)充盈速度以及二尖瓣瓣环舒张早期(E')和晚期(A')速度。对所有患者进行了为期 3 天的心律 Holter ECG 监测(HM ECG),并利用远程医疗技术进行了为期 7 天的 ECG 监测,每天 3 次,每次 3 分钟。随访期为 3 个月或直至房颤发作:研究期间,使用各种心律监测方法检测到 41 名(24.4%)患者出现阵发性房颤(pAF)。有 10 名(24.4%)患者在阵发性房颤期间出现心悸症状,心悸症状是通过 CardioQVARK® 设备、HM 心电图或 12 导联心电图记录的。5名患者(12.2%)在日常心电图监测中发现心房颤动,但无相关主诉。在 24、48 和 72 小时内,HM ECG 分别检测到 8、2 和 4 个病例(19.5%、4.8% 和 9.7%);单通道 CardioQVARK® 在连续 7 天每天使用 3 次的情况下,检测到 30 个病例(73.2%)。这些结果表明,心房颤动经常发生在无伴随症状的慢性心力衰竭患者身上。使用 CardioQVARK® 检测心房颤动的方法显示出良好的效果:它比 HM 心电图有效两倍,比 12 导联心电图有效三倍。此外,根据超声数据,房颤患者的以下参数发生了显著变化:LA EF <36%(OR 1.04,95% CI:1.02-1.08),p=0.003;LA GS <9.9%(OR 1.16,95% CI:1.02-1.38),p<0.001;TDI E med <5.7cm/s(OR 0.97,95% CI:0.94-1.00),p=0.026。2 级 DD 的结果没有统计学意义(OR 1.1,95% CI:0.7-1.5,P=0.54)。然而,在心房颤动患者中,DD的检出率更高,占34%,而在非心房颤动患者中,DD的检出率仅为29%:结论:慢性心力衰竭患者罹患心房颤动的风险很高(24.4%)。75%的房颤患者感觉不到阵发性心房颤动的发生。所有慢性阻塞性肺病患者都应接受 EchoCG 检查,同时评估 LA EF、TDI E med 和 LA GS,以确定心房颤动的高危人群。使用 CardioQVARK® 设备进行心律远程监测是一种可靠的方法,可用于早期发现心房颤动,并及时为慢性阻塞性肺病患者启动抗凝治疗。
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引用次数: 0
Limitations of Diagnosis of Ischemic Left Ventricular Dysfunction Using the Values of Strain, Twist and Untwist in Patients With Myocardial Infarction of Various Localization. 使用应变值、扭转值和非扭转值诊断不同部位心肌梗死患者缺血性左心室功能障碍的局限性
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-31 DOI: 10.18087/cardio.2024.3.n2253
D A Shvets, S V Povetkin

Aim: To compare capabilities for diagnosing regional and global myocardial dysfunction using the values of longitudinal and circular strain, left ventricular (LV) torsion and untwisting in patients with myocardial infarction (MI) of various locations.

Material and methods: Patients included in the study (n=121) were divided into three groups: patients with unstable angina (n=30), patients with anterior MI (n=45), and patients with inferior MI (n=46). Clinical, laboratory and instrumental test were performed, including echocardiography. For a quantitative analysis of LV contractility, the maximum systolic peaks of regional and global longitudinal and circular strain, systolic and diastolic rotation, LV torsion and untwisting were measured.

Results: Anterior MI was characterized by injury of the LV apical segments, while inferior MI was characterized by injury of the basal segments. In anterior MI, the longitudinal strain was reduced less than 14.5% and circular strain less than 19.3% in the apical segment of the LV anteroseptal wall (ASW). In akinesia of the LV ASW apical segment, longitudinal and circular strains were reduced less than 10%. The magnitude of the circular strain of the LV ASW apical segment (diagnostic threshold 19.3%, sensitivity (Se) 87%, specificity (Sp) 90%) was superior to that of the longitudinal strain as a diagnostic marker for regional ischemic dysfunction in anterior MI. The magnitude of the circular strain of the basal segment of the LV inferior wall in inferior MI has a greater diagnostic value for identifying regional systolic dysfunction than the value of the longitudinal strain of this LV segment. The diagnostic threshold was 17.3%, Se 79%, Sp 80%.

Conclusion: A decrease in the circular strain of the LV ASW less than 19.3% in the LV apical segment is more specific (Sp 90%) for diagnosing regional systolic dysfunction in anterior MI than a decrease in longitudinal strain. A circular strain value of less than 17.3% in the basal segment of the LV inferior wall is more specific (Sp 80%) than the longitudinal strain of this segment for diagnosing regional systolic dysfunction in inferior MI. Predominant injury to the LV apex in anterior MI can cause systolic and diastolic myocardial dysfunction, which is manifested by a decrease in LV circular deformation, torsion and untwisting.

目的:比较不同部位心肌梗死(MI)患者使用纵向和环向应变、左心室扭转和解旋值诊断区域和整体心肌功能障碍的能力:参与研究的患者(121 人)分为三组:不稳定型心绞痛患者(30 人)、前心肌梗死患者(45 人)和下心肌梗死患者(46 人)。他们接受了临床、实验室和仪器检查,包括超声心动图检查。为了对左心室收缩力进行定量分析,测量了区域和整体纵向和环向应变的最大收缩期峰值、收缩期和舒张期旋转、左心室扭转和解旋:结果:前心肌梗死的特征是左心室心尖段受损,而下心肌梗死的特征是基底段受损。在前壁心肌梗死中,左心室前隔壁(ASW)心尖段的纵向应变降低了不到14.5%,环向应变降低了不到19.3%。在左心室前隔壁心尖段出现运动障碍时,纵向应变和环向应变的降低幅度均小于 10%。作为前壁心肌梗死区域缺血性功能障碍的诊断指标,左心室ASW心尖段的环向应变(诊断阈值19.3%,敏感性(Se)87%,特异性(Sp)90%)优于纵向应变。在下壁心肌梗死中,左心室下壁基底段的环向应变比左心室该段的纵向应变在鉴别区域收缩功能障碍方面具有更大的诊断价值。诊断阈值分别为 17.3%、Se 79%、Sp 80%:结论:在诊断前壁心肌梗死的区域收缩功能障碍时,左心室心尖段ASW环形应变的下降小于19.3%比纵向应变的下降更具特异性(Sp 90%)。在诊断下壁心肌梗死时,左心室下壁基底段的环向应变值小于 17.3% 比该段的纵向应变更具特异性(Sp 80%)。在前壁心肌梗死中,左心室心尖的主要损伤可导致收缩和舒张性心肌功能障碍,表现为左心室环形变形、扭转和解旋的减少。
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Kardiologiya
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