Case Study: Using 3D Speckle Tracking Echocardiography for Left Ventricular Aneurysm Diagnosis

Nowadays magnetic resonance imaging (MRI) is a gold standard for diagnosing abnormalities of left ventricular geometry and function, however, it is not universally accessible. Furthermore, MRI is not compatible with pacemakers and similar devices. 3D speckle tracking echocardiography (3D STE) is a cutting-edge echocardiography imaging technique for myocardial deformation assessment. As such, 3D STE looks very promising for diagnosing structural complications of myocardial infarction (MI) and choosing the optimal surgical techniques.&#x0D; In this case study, we used 3D STE to assess left ventricular function in a patient with left ventricular aneurysm.&#x0D; The patient was admitted to National Amosov Institute of Cardiovascular Surgery three weeks after having a second MI (the first MI was reported 4 years ago). His coronary angiography showed diffuse coronary artery disease. 2D echocardiography (performed on Toshiba Artida) results: end-diastolic volume (EDV) 206 ml, end-systolic volume (ESV) 141 ml, ejection fraction (EF) (Simpson’s method) 31%. An object sized 2.2*1.6 cm was discovered in the apical region (left ventricular thrombus). 3D STE results: EDV 209 ml, ESV 182 ml, EF 13%. Global area strain (GAS) was considerably decreased (–13.7 %) showing the pattern of ischemic cardiomyopathy with multivessel disease. Due to several reasons, it was impossible to obtain an MRI scan, so a CT coronary angiography was performed (Toshiba Aquilion One). The results of multi-slice computed tomography (MSCT) were consistent with those of echocardiography.&#x0D; According to the results, the initial plan to resect the apical akinesia region was ruled out. The patient underwent coronary artery bypass grafting (CABG) (4 shunts), the removal of thrombi from the left ventricle (additional fresh thrombi were discovered during the surgical intervention), and left ventricular aneurysm repair under cardiopulmonary bypass. Post-treatment 3D STE results: EDV dropped to 135 ml, EF rose from 13% to 32%. GAS increased up to –20.4 %, while the strains of all segments increased to subnormal levels. The overall dynamics was positive, and the patient was discharged to undergo postoperative rehabilitation.&#x0D; The case shows that 3D STE data is consistent with CT data in patients with abnormal ventricular remodeling. 3D STE is a good method for differentiation between akinetic scar tissue and a dyskinetic left ventricular aneurysm.</jats:p

Effect of pH of the Reaction Mediumon the Structure and Properties of Spinel-Type Ferrite Nanopowder

In this work using sol-gel auto-combustion synthesis was synthesised single-phase magnesium-substituted lithium ferrite at different pH reaction medium. The synthesized materials were investigated by X-ray and Mossbauer methods. It was shown that the pH of the reaction medium plays a crucial role in the formation of the mi-crostructure and properties of synthesized systems. Keywords: spinel, ferrite, combustion synthesis, microstructure.</p

Longitudinal Strain by Speckle Tracking during Dobutamine Stress Echocardiography in Suspected Coronary Arteries Disease

 &#x0D; Background. Speckle tracking echocardiography (STE) provides valuable information about global and regional myocardial function. STE during dobutamine stress-echocardiography (DSE) enables more reliable ischemia diagnosis.&#x0D; The aim of the study was to evaluate STE feasibility as a DSE visualization method and its accuracy compared to coronary angiography (CAG) in the patients with moderate-to-high coronary arteries disease (CAD) risk.&#x0D; Methods. We prospectively examined 140 patients (84 [60.0%] men and 56 [40.0%] women) with suspected CAD in order to verify diagnosis and evaluate myocardial viability and coronary reserve.&#x0D; Results. Mean left ventricular ejection fraction (LVEF) was 54.4±15.8%. All the patients had normal blood pressure (BP) and heart rate (HR) during the test. There were no significant hemodynamics alterations during the test. There were no significant complications during DSE with only 15 (12.9%) cases of different relatively low grade supraventricular and ventricular arrhythmia, mainly transitory without interventions. There were 116 (82.9%) positive DSE results, of which 2 (1.72%) were false-positive. In 2 (8.3%) patients with negative DSE results, CAG revealed 1-vessel insignificant (50– 70%) lesions with developed collaterals (false-negative results). According to DSE and CAG results, 96 (82.3%) patients underwent revascularization interventions: 86 (89.6%) percutaneous coronary interventions (PCIs) and 10 (10.4%) coronary artery bypass grafting (CABG) surgery. Sensitivity and specificity of DSE with STE for primary CAD diagnosis according to the “golden standard” CAG results were 98.3% and 91.7%, respectively, with identical positive and negative predictive values and very high overall accuracy of the method (AUC = 0.98; OR = 627.0, p&lt;0.0001). Sensitivity and specificity of DSE with STE for defining indications for intervention and revascularization were 97.9% and 91.7%, respectively, with high overall accuracy (AUC = 0.95; OR = 564.0, p&lt;0.0001). Combined quantification of ΔGLS and ΔWMSI for primary CAD diagnosis showed significantly lower sensitivity 86.2%(p=0.0002)andspecificity80.4%(p=0.0064)withsignificantlylowerintegralmethodaccuracy(AUC0.83,p&lt;0.0001).&#x0D; Conclusions. DSE with STE as a visualization method is a safe and optimal method for ischemia diagnosis and evaluation of myocardial viability and coronary reserve in patients with suspected CAD. Given the lower ΔGLS and ΔWMSI accuracy compared to integral DSE with STE result evaluation, as well as frequent GLS growth in significant number of patients with definite positive test result, authors recommend evaluating integral test result rather than strain value.</jats:p

Transventricular Left Bundle Branch Pacing

Background. Implementation of conduction system permanent pacing methods in patients with cardiac bradyarrhythmias allows to maintain the physiological sequence of excitation and contraction of the ventricles and to avoid the development of heart failure due to electrical and mechanical dyssynchrony in patients with high rates of ventricular pacing.&#x0D; Case description. A 61-year-old female patient was examined and treated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from January 25 to January 27, 2022 at the department of surgical treatment of complex cardiac arrhythmias with a diagnosis of proximal complete atrioventricular block. A two-chamber pacemaker (Vitatron Q50A2) with a ventricular lead to stimulate the His bundle region (Medtronic 3830, 69 cm) was implanted to the patient with a special delivery system (C315HIS). At an X-ray operating room, 12 ECG leads from the electrophysiological station LabSystem Pro (Bard, USA) were connected to the patient to analyze the criteria for capturing the conduction system on stimulation during ventricular lead placement, and a diagnostic quadripolar electrode was inserted into the right ventricle to record the potential of the His bundle as an X-ray reference point. During placement of the ventricular lead in the area of the His bundle due to high pacing thresholds the decision was made to implement an alternative method of conduction system pacing – left bundle branch pacing through the interventricular septum. After gradual passage of the electrode through the septum, capture of the conduction system of the heart was achieved, although no clear potential of the left bundle was registered. The interval from stimulus to peak R wave in lead V6 was 68 ms, and the interval from stimulus to peak R wave in lead V1 was 110 ms. The difference between intervals was 42 ms, which indicated the criteria of nonselective capture of the left bundle branch, with stimulation thresholds below 1 V at a pulse length of 0.5 ms. In the postoperative period, the patient was evaluated for global longitudinal deformity of the left ventricle on constant ventricular stimulation, which was carried out according to standard methods using speckle-tracking echocardiography; no signs of dyssynchrony were found. Also, the location of the endocardial electrode in the middle segments of the interventricular septum on the right ventricular side was visualized and confirmed by performing B-mode transthoracic echocardiography with subcostal access.&#x0D; Conclusions. Left bundle branch pacing, like His bundle pacing, maintains electrical and mechanical synchrony of the left ventricle at lower pacing thresholds, greater amplitude of the sensitivity signal and lower risks of lead dislocation.</jats:p

Multimodality Imaging in the Diagnosis, Risk Stratification and Management in the Patients with Dilated Cardiomyopathy. Practical recommendations

Дилатаційна кардіоміопатія (ДКМП) визначається наявністю дилатації лівого шлуночка або обох шлуночків та систолічною дисфункцією за відсутності патологічних умов навантаження або ішемічної хвороби серця, достатніх, щоб пояснити ці зміни. Це гетерогенна група захворювань, що часто має генетичне підґрунтя. Серцево-судинна візуалізація є надзвичайно важливою для встановлення діагнозу, оцінювання прогнозу та лікування. Мультимодальний підхід до візуалізації забезпечує найповнішу оцінку всіх аспектів, пов’язаних із цим захворюванням. Цей документ має на меті забезпечити детальні рекомендації з використання мультимодальної візуалізації відповідно до клінічних вимог з урахуванням сучасних світових доказових даних і рекомендацій та з адаптацією до існуючих практик в Україні. Вибір того чи іншого засобу візуалізації має базуватися на конкретних клінічних умовах та індивідуальному контексті. Методи візуалізації розглядаються з точки зору «клінічно релевантних» та засобів, що «можуть використовуватися». До сьогодні лишаються певні пробіли в доказовій базі щодо впливу мультимодальної візуалізації на ведення та лікування пацієнтів з ДКМП, що свідчить про важливість подальших досліджень у цьому напрямку.</jats:p

Multimodality Cardiovascular Imaging in Patients with Pericardial Diseases. Practical Recommendations

Pericardial pathology has wide distribution in population and is observed in various therapeutic areas, including primary care, intensive care and resuscitation, as well as such subspecialties as rheumatology, infectious diseases, oncology and namely cardiology. It may significantly contribute to morbidity and mortality growth. Therefore, diagnosis and management of patients with pericardial pathology may be challenging, including such nosology as a “mixed” constrictive pericarditis, exudative-constrictive pericarditis or localized postoperative tamponade. Clinical evaluation of such conditions may be rather complicated. That is why the use of multimodality imaging including echocardiography, heart MRI and MSCT grows continuously in the diagnosis and treatment in such patients.&#x0D; The aim of this document is to provide expert evaluation for comprehensive and appropriate use of multimodality imaging in the diagnosis and management of patients with pericardial diseases.&#x0D; This document is based on the American Society of Echocardiography Clinical Recommendations for Multimodality Cardiovascular Imaging of Patients with Pericardial Disease endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography (2013) adopted for local specificities.</jats:p

Рекомендації з проведення повноцінного черезстравохідного ехокардіографічного дослідження (Консенсус робочої групи Асоціації серцево-судинних хірургів України та Українського товариства кардіологів)

Черезстравохідна ехокардіографія (ЧСЕхоКГ) є критично важливим засобом серцево-судинної візуалізації. Наближеність стравоходу до більшості кардіальних структур і магістральних судин забезпечує найкраще ультразвукове вікно, тому часто ЧСЕхоКГ надає цінну додаткову та більш точну інформацію порівняно з трансторакальною ехокардіографією (ТТЕхоКГ) у певних пацієнтів з кількома специфічними діагнозами, а також при багатьох оперативних і катетерних кардіальних втручаннях. Цей документ розроблений на основі світового досвіду сучасної ЧСЕхоКГ [1] і спрямований бути керівництвом з виконання ЧСЕхоКГ в таких ситуаціях: 1) діагностична ЧСЕхоКГ, що виконується з приводу специфічного діагностичного питання; 2) інтрапроцедурна ЧСЕхоКГ при хірургічних та інвазивних катетерних втручаннях. Хоча ці Рекомендації містять запропонований рекомендований протокол отримання зображень, порядок і кількість зрізів може відрізнятися залежно від різноманіття показань до ЧСЕхоКГ. При деяких показаннях щодо специфічних станів рекомендовані додаткові спеціальні зрізи, що описані в розділі «Візуалізація окремих структур» цього документа. Документ не ставить на меті перегляд специфічних показань до ЧСЕхоКГ або вичерпне описання всіх аномалій, які можуть бути візуалізовані за допомогою зазначеного методу. У цьому розділі представлена перша з трьох частин розроблених рекомендацій.</jats:p

Cardiac Chamber Quantification by Echocardiography in Adults: Recommendations from the Association of Cardiovascular Surgeons of Ukraine and Ukrainian Society of Cardiology

Fast technology development over the past decade as well as changes in practical echocardiography (EchoCG) lead to have given rise to a need in the update of previous guidelines for cardiac chambers quantification, which was the aim of this publication by working group of the Association of Cardiovascular Surgeons of Ukraine and Ukrainian Society of Cardiology. This paper provides up-to-date evidence-based data regarding reference ranges for all cardiac chambers, including available data regarding 3D-echocardiography and myocardial deformation (strain), based on the wide range of studies of healthy individuals found in many databases in healthy individuals. In addition, this document contains an attempt to adjust several minor controversies from previous guidelines.&#x0D; This document is based on “Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging” (2015) adapted according to the local peculiarities and printed abridged. Full content of “Cardiac Chamber Quantifica-tion by Echocardiography in Adults: Recommendations from the Association of Cardiovascular Surgeons of Ukraine and Ukrainian Society of Cardiology” is available online at the official Website https://amosovinstitute.org.ua of the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine. This paper contains key recommendations, reference ranges and quantification methods in pictures and tables.</jats:p