4D FLOW МРТ в оценке диастолического кровотока в левом желудочке у пациентов с гипертрофической кардиомиопатией

Objective. To assess phase-contrast MRI in the evaluation of left ventricular hemodynamics changes in various forms of hypertrophic cardiomyopathy.Materials and methods. 11 patients were examined: without pathology of the cardiovascular system (n = 3), with apical (n = 3), diffuse-septal (n = 2) and focal-basal (n = 3) types of hypertrophic cardiomyopathy. All patients underwent MRI of the heart with an additional phase-contrast sequence of the left ventricular area. Postprocessing carried out in the 4D FLOW application (Siemens).Results. Data were obtained on the geometry and dynamics of vortex diastolic flows in the left ventricular of all patients. In patients with hypertrophic cardiomyopathy, an increase in the distance to the center of the vortex and a decrease in the normalized area and peak velocity of the vortex is determined. The diffuse-septal type is characterized by a minimal vortex peak velocity; apical type - by the maximum vortex sphericity index. For patients with a focalbasal type of hypertrophic cardiomyopathy the maximum changes in blood flow are determined in late diastole (absence of vortexes).Conclusion. 4D FLOW Phase-contrast MRI allows identifying and assessing LV vortical flow. Quantitative analysis can be used to characterize the remodeling of LV blood flow of various types of hypertrophic cardiomyopathy.Цель исследования: оценить изменения гемодинамики левого желудочка с помощью фазово-контрастной МРТ у пациентов с различными формами гипертрофической кардиомиопатии.Материал и методы. Обследовано 11 пациентов: без патологии сердечно-сосудистой системы (n = 3), с апикальной (n = 3), диффузно-септальной (n = 2) и фокально-базальной (n = 3) формами гипертрофической кардиомиопатии. Всем пациентам выполнено МРТ-исследование сердца с дополнительной фазовоконтрастной последовательностью области левого желудочка. Постпроцессорная обработка проведена в приложении 4D FLOW (Siemens).Результаты. Получены данные о геометрии и динамике вихревых диастолических потоков в левом желудочке у всех пациентов. У пациентов определяется апикальное смещение вортекса, уменьшение нормализованной площади и пиковой скорости вортекса. Диффузно-септальная форма характеризуется минимальной скоростью вихревого потока, апикальная форма – максимальным индексом сферичности вортекса. Для пациентов с фокально-базальной формой максимальные изменения кровотока определяются в позднюю диастолу (отсутствие вортексов)Заключение. Метод 4D FLOW фазово-контрастной МРТ позволяет выявить и оценивать изменения диастолических вихревых потоков в левом желудочке. Количественный анализ данных можно использовать для характеристики ремоделирования кровотока в левом желудочке при различных типах гипертрофической кардиомиопатии

2020 Clinical guidelines for Atrial fibrillation and atrial flutter

Russian Society of Cardiology (RSC).With the participation of Russian Scientific Society of Clinical Electrophysiology, Arrhythmology and Cardiac Pacing, Russian Association of Cardiovascular Surgeons.Approved by the Scientific and Practical Council of the Russian Ministry of Health

Drug-Eluting vs Bare-Metal Stents in Patients with Chronic Kidney Disease and Coronary Artery Disease: Insights from a Systematic Review and Meta-Analysis

BACKGROUND: Most drug-eluting stent (DES) trials have excluded patients with chronic kidney disease (CKD). The efficacy of DES implantation in patients with CKD is therefore not known. OBJECTIVES: To evaluate the outcomes with DES vs bare-metal stent (BMS) implantation in patients with CKD. METHODS AND RESULTS: MEDLINE, EMBASE, and CENTRAL were searched for studies including at least 100 patients with CKD (estimated glomerular filtration rate ≤60 mL/min/1.73 m2 or on dialysis) treated with DES or BMS and followed for at least 1 month and reporting outcomes of all-cause mortality, cardiovascular (CV) mortality, myocardial infarction (MI), target-vessel revascularization (TVR), and stent thrombosis (ST). Thirty-one studies (5 randomized) with 91,817 participants (49,081 DES and 42,736 BMS) fulfilled the inclusion criteria. DES was associated with lower all-cause mortality (relative risk [RR], 0.77; 95% confidence interval [CI], 0.71-0.84), CV mortality (RR, 0.51; 95% CI, 0.38-0.70), MI (RR, 0.90; 95% CI, 0.86-0.95), TVR (RR, 0.61; 95% CI, 0.47-0.80), and numerically lower ST (RR, 0.75; 95% CI, 0.55-1.01) when compared with BMS. Analysis by study type (RCTs vs non-RCTs) showed similar results for most outcomes (Pinteraction\u3e.05) except all-cause mortality, where there was no difference between DES vs BMS in RCTs (Pinteraction≤.04). The effects were greater with 2nd-generation DES vs BMS (for example, ST: RR, 0.38; 95% CI, 0.20-0.72). CONCLUSIONS: In patients with CKD, the available evidence, largely from observational studies, suggests significantly fewer events with DES vs BMS with even a lower ST rate with 2nd-generation DES. These findings should be tested in large, randomized trials

CORRELATION BETWEEN LEFT VENTRICULAR CONTRACTILITY AND MYOCARDIAL T1-RELAXATION TIME DURING MAPPING IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY BY MAGNETIC RESONANCE IMAGING

Objective. To determine a correlation of myocardial deformation with myocardial T1-relaxation time during extracellular volume (ECV) fraction mapping and the degree of focal fibrosis in each left ventricular (LV) segment in patients with hypertrophic cardiomyopathy (HCM). Material and methods. A diagnostic test was carried out in 30 patients diagnosed with HCM and in a control group of 10 patients without LV pathology. Cardiac magnetic resonance imaging was performed on a 3.0 T Philips Achieva TX MRI scanner (Philips, Best, the Netherlands) in accordance of the specialized protocol using a 32-channel cardiac coil with heart rate synchronization and the use of gadolinium-based contrast agents at a dose of 0.3 ml/kg. LV T1 mapping was done using the Modified Look-Locker Inversion Recovery (MOLLI) sequences. Postprocessing was performed on Philips and CVI42 workstations. When the data were processed, T1-relaxation time was estimated before and after contrast enhancement.Results. In all cases, myocardial thickness, extent of myocardial fibrosis, myocardial T1-relaxation time parameters, and ECV could be estimated according to the American Heart Association 16-segment coronary artery model. Before injection of contrast agent, the average LV T1 relaxation time in patients with HCM was 1317±94 msec which was significantly higher than that in the control group (1093±23.7 msec). ECV in the control group was lower (24.8±1.9%) than that in the HCM group (29.8±4.5%). In the univariable group, each index was related to myocardial deformation indicators (radial (Err-FT) and circular (Ecc-FT)) at the segment level. There was a moderate positive correlation between LV thickness and Ecc-FT (r=0.52; p<0.0001), a moderate negative correlation between Err-FT and LV hypertrophy (r=–0.5; p<0.0001), and between Err-FT and myocardial T1relaxation time prior to contrast enhancement (r=–0.5; p<0.0001).Conclusion. Myocardial T1 time relaxation mapping before contrast enhancement has detected that ECV in patients with HCM is much higher than in those with the intact myocardium. LV deformation in patients with HCM correlates with changes in myocardial T1 time and the magnitude of myocardial hypertrophy and to a lesser extent with focal LV fibrosis

Our new tornado-compatible aortic valve prosthesis: notable results of hydrodynamic testing and experimental trials

Aims A shortcoming common to all existing designs of mechanical cardiac valve prostheses is an increased trombogenicity caused, among other factors, by the lack of hydrodynamic compatibility between the luminal part of the prosthesis and the patterned blood flow. The aim of the study is to design and test our new mechanical aortic valve prosthesis to exclude life-long anticoagulation treatment. Materials and methods Standard hydrodynamic tests of the new prosthetic valve have been carried out for comparing with the other existing valve designs. A new method for the heart valve prosthesis testing in a tornado-like flow has been developed. The valve function has been verified in a swine excluding the anticoagulation treatment during the period of time exceeding six months. Results The significant advantage of the new prosthesis in the standard hydrodynamic tests has been demonstrated. The tests in the tornado-like flow have shown that only this prosthesis allows maintaining the pattern, the head and flow rate characteristics of the tornado-like jet. Upon implanting the new prosthesis in the aortic position in a swine, the good performance of the valve without anticoagulation therapy has been confirmed in the course of more than six months. Conclusion Obtained has been the evidence of the merits of the new mechanical aortic valve owing to the due consideration of the hydrodynamic peculiarities of the aortic blood flow and the creation of the design providing the proper hydrodynamic compatibility

ECG-triggered skeletal muscle stimulation improves hemodynamics and physical performance of heart failure patients

BACKGROUND: Muscular counterpulsation (MCP) was developed for circulatory assistance by stimulation of peripheral skeletal muscles. We report on a clinical MCP study in patients with and without chronic heart failure (CHF). METHODS AND RESULTS: MCP treatment was applied (30 patients treated, 25 controls, all under optimal therapy) for 30 minutes during eight days by an ECG-triggered, battery-powered, portable pulse generator with skin electrodes inducing light contractions of calf and thigh muscles, sequentially stimulated at early diastole. Hemodynamic parameters (ECG, blood pressure and echocardiography) were measured one day before and one day after the treatment period in two groups: Group 1 (9 MCP, 11 no MCP) with ejection fraction (EF) above 40% and Group 2 (21 MCP, 14 no MCP) below 40%. In Group 2 (all patients suffering from CHF) mean EF increased by 21% (p<0.001) and stroke volume by 13% (p<0.001), while end systolic volume decreased by 23% (p<0.001). In Group 1, the increase in EF (6%) and stroke volume (8%) was also significant (p<0.05) but less pronounced than in Group 2. Physical exercise duration and walking distance increased in Group 2 by 56% and 72%, respectively. CONCLUSIONS: Noninvasive MCP treatment for eight days substantially improves cardiac function and physical performance in patients with CHF

The first Russian experience in successfully using an implantable СardioWest TAH-t artificial heart system (SynCardia)

The paper describes the first Russian experience in using an implantable CardioWest TAH-t artificial heart (AH) system (SynCardia, USA) to treat critical heart failure. The AH system was implanted in a 60-year-old female patient with dilated cardiomyopathy, a limited probability of survival, and unoperated defects. The main medical and technical characteristics of the AH system and the patient’s clinical status in the preoperative and immediate and late (up to 238 days) postoperative periods are presented. Indications for and contraindication to implantation of the system and its possible application modes are considered. Equipment and a procedure for AH implantation, approaches to postoperative management, and treatment policy for postoperative complications are described in detail. The application of the AH system permitted the patient to wait for a donor heart. The latter was successfully transplanted in the patient

Management of coronary disease in patients with advanced kidney disease

© 2020 Massachusetts Medical Society. BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction