Classification Model of Heart Transplant Outcomes Based on Features of Left Ventricular Functional Geometry

The function of the transplanted heart can be significantly affected by acute allograft rejection, chronic rejection, high blood pressure. These factors may induce cardiac remodelling with further adverse consequences for the patients. Dynamic change in the configuration of the left ventricle (LV) from end diastole to end systole (LV functional geometry) is an important factor of the heart pump function. The objective of this study is to evaluate the time dependent changes in parameters of LV functional geometry in the transplanted heart and to assess relations between the changes and adverse outcomes of the heart transplantation (HT). We used linear discriminant analysis (LDA) to build classification models based on either the standard echocardiographic parameters of LV systolic function and global longitudinal strain (GLS) or LV function geometry indexes. The training set for model building included data from patients with different degrees of systolic dysfunction. Using the models, we retrospectively classified data from 31 patients after orthotropic HT. In contrast to the LDA models based on the standard echocardiographic characteristics and GLS, the model based on the LV functional geometry data showed high accuracy in predicting allograft rejection and development of the heart failure in the HT patients. © 2018 Creative Commons Attribution

Socially and professionally-psychological portrait of the residents as the basic foundations of their preparation for professional work

The article presents the results of a comprehensive analysis of the problems of post-graduate training program for residents of Cardiovascular Surgery. Typical cognitive status were identified characteristic of the main forms of training, their intensity and patterns of changes in different forms and methods of training to each individual young professionals.В статье представлены результаты комплексного анализа проблем последипломного обучения ординаторов по программе сердечно-сосудистой хирургии. Были выявлены типичные познавательные состояния, характерные для основной формы обучения, их интенсивность и закономерности изменений в разных формах и методах обучения индивидуально каждому молодому специалисту

Myectomy versus alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy

OBJECTIVES: There is very little evidence comparing the safety and efficacy of alcohol septal ablation versus septal myectomy for a septal reduction in patients with hypertrophic obstructive cardiomyopathy. This study aimed to compare the immediate and long-term outcomes of these procedures. METHODS: Following propensity score matching, we retrospectively analysed outcomes in 105 patients who underwent myectomy and 105 who underwent septal ablation between 2011 and 2017 at 2 reference centres. RESULTS: The mean age was 51.9 ± 14.3 and 52.2 ± 14.3 years in the myectomy and ablation groups, respectively (P = 0.855), and postoperative left ventricular outflow tract gradients were 13 (10-19) mmHg vs 16 (12-26) mmHg; P = 0.025. The 1-year prevalence of the New York Heart Association class III-IV was higher in the ablation group (none vs 6.4%; P = 0.041). The 5-year overall survival rate [96.8% (86.3-99.3) after myectomy and 93.5% (85.9-97.1) after ablation; P = 0.103] and cumulative incidence of sudden cardiac death [0% and 1.9% (0.5-7.5), respectively P = 0.797] did not differ between the groups. The cumulative reoperation rate within 5 years was lower after myectomy than after ablation [2.0% (0.5-7.6) vs 14.6% (8.6-24.1); P = 0.003]. Ablation was associated with a higher reoperation risk (subdistributional hazard ratio = 5.9; 95% confidence interval 1.3-26.3, P = 0.020). At follow-up, left ventricular outflow tract gradient [16 (11-20) vs 23 (15-59) mmHg; P < 0.001] and prevalence of 2+ mitral regurgitation (1.1% vs 10.6%; P = 0.016) were lower after myectomy than after ablation. CONCLUSIONS: Both procedures improved functional capacity; however, myectomy better-resolved classes III-IV of heart failure. Septal ablation was associated with higher reoperation rates. Myectomy demonstrated benefits in gradient relief and mitral regurgitation elimination. The results suggest that decreasing rates of myectomy procedures need to be investigated and reconsidered. © The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved

Clinical features histories cardiovascular system in pregnant after surgical correction of congenital heart and vascular

Аn assessment of the cardiovascular system of women after surgical correction of congenital heart disease and vascular clinical and anamnestic data. Study group comprised 190 pregnant women were divided into three subgroups. In the first subgroup included 130 women from the operated ’pale' heart defects. Second subgroup included 30 patients with the operated 'blue1 vices. Third subgroup consisted of 30 pregnant women after adjusting blood flow obstruction of major vessels. The control group consisted of 45 healthy pregnant women. Analysis of clinical and anamnestic data showed that women who have had surgical correction of congenital heart and blood vessels, pregnancy, starting from the first trimester, develops in heart failure and pulmonary hypertension due to incomplete recovery anatomical and physiological relationships of the cardiovascular and respiratory systems, with an increase in the severity of clinical manifestations during pregnancy.Проведена оценка сердечно-сосудистой системы женщин после хирургической коррекции врождённых пороков сердца и сосудов по клинико-анамнестическим данным. Основную группу составили 190 беременных, разделенных на три подгруппы. В 1-ую подгруппу вошли 130 женщин с оперированными «бледными» пороками сердца. 2-ая подгруппа включала 30 пациенток с оперированными «синими» пороками. 3-ю подгруппу составили 30 беременных после коррекции препятствия кровотоку магистральных сосудов. Контрольную группу состояла из 45 здоровых беременных женщин. Анализ клинико-анамнестическим данных показал, что у женщин, перенесших хирургическую коррекцию врождённых пороков сердца и сосудов, беременность, начиная с первого триместра, развивается в условиях недостаточности кровообращения и лёгочной гипертензии, обусловленных неполным восстановлением анатомо-физиологических взаимоотношений сердечно-сосудистой и дыхательной систем, с нарастанием тяжести клинических проявлений в течение беременности

Сравнительная оценка стандартного эхокардиографического исследования и классификационной модели на основе параметров функциональной геометрии левого желудочка в диагностике систолической дисфункции трансплантированного сердца

Objective. The purpose of this study was to assess the state of left ventricular (LV) systolic dysfunction for an extended period after heart transplantation using the parameters of the functional geometry of the left ventricle. Material and Methods. The study included 31 patients after orthotopic heart transplantation with a follow-up period of up to nine years. We used linear discriminant analysis to build a classification model based on either the standard echocardiographic parameters of LV systolic function or parameters of LV functional geometry indexes aimed at the potential prediction of acute rejection and progression of chronic heart failure. Results. The linear discriminant analysis model based on parameters of LV functional geometry showed a high predictive value to diagnose acute rejection and development of heart failure in heart transplant patients. Conclusion. Linear discriminant analysis classification model based on the LV functional geometry data showed high accuracy in predicting allograft rejection and development of heart failure in heart transplant patients. © 2022 Industrial Laboratory. Materials Diagnostics. All rights reserved.The work was carried out within the framework of state assignments for the Ural State Medical University of Minzdrav of Russia (theme № AAAA-A18-118051590064) and Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences (theme No AAAAA18-118020590031-8). This work was supported by Decree of the Russian Government №211 of March 16, 2013 (agreement 02.A03.21.0006)

Features of heart rate in pregnant operated with congenital heart defects and vascular

An assessment of cardiac arrhythmia and intracardiac conduction in women after surgical treatment of congenital heart disease and vascular data of electrocardiography. Study group comprised 190 pregnant women were divided into three subgroups. First subgroup included 130 women from the operated ’pale' heart defects. In the Second subgroup included 30 patients with the operated 'blue' vices. Third subgroup consisted of 30 pregnant women after adjusting blood flow obstruction of major vessels. The control group consisted of 45 healthy pregnant women. Revealed that the main group of patients is more often observed violation of the nature and the heart rate and intracardiac conduction, with effect from 1 trimester, reaching a maximum change in the period 28-32 weeks.Проведена оценка нарушения сердечного ритма и внутрисердечной проводимости у женщин после оперативного лечения врождённых пороков сердца и сосудов по данным электрокардиографии. Основную группу составили 190 беременных, разделенных на три подгруппы. 1-ая подгруппа включала 130 женщин с оперированными «бледными» пороками сердца. Во 2-ую подгруппу вошли 30 пациенток с оперированными «синими» пороками. 3-ю подгруппу составили 30 беременных после коррекции препятствия кровотоку магистральных сосудов. Контрольную группу состояла из 45 здоровых беременных женщин. Выявлено, что у пациенток основной группы чаще наблюдается нарушение характера и частоты сердечного ритма, а также внутрисердечной проводимости, начиная с 1 триместра, достигая максимальных изменений в сроке 28-32 недели

СТРУКТУРА ЛЕГОЧНОЙ ГИПЕРТЕНЗИИ У ПАЦИЕНТОВ, ОЖИДАЮЩИХ ТРАНСПЛАНТАЦИЮ СЕРДЦА

The selection of recipients for the orthotopic heart transplantation is of great importance. In 2006–2009 we examined 25 tests on reversibility of pulmonary hypertension, i.e. in 14 patients with dilated cardiomyopathy (DCM) (11 males and 3 females aged 41,1 ± 9,3) and in 11 patients with coronary artery disease (CAD) (all males aged 50 ± 4.9). Initial pulmonary vascular resistance (PVR) was 3,61 ± 1,02 and 3,59 ± 0,98 respectively. Alprostadil was infused to all the patients. Pulmonary hypertension was irreversible in 4 (28,5%) DCM patients and in 2 (18%) CAD patients. Initial PVR in those patients was 6,27 ± 3,2 and 5,7 ± 2,4 respectively. The average alprostadil dose necessary for the reverse of pulmonary hypertension was 0,054 ± 0,027 μg/kg/min in DCM patients, and 0,047 ± 0,022 μg/kg/min in CAD patients. Thus, the application of alprostadil for the pharmacological correction of pulmonary vascular resistance is most effective in patients with moderate pulmonary hypertension according to Rich classification. Отбор реципиентов для ортотопической трансплантации сердца имеет большое значение. В 2006–2009 гг. нами проведено 26 проб на обратимость легочной гипертензии: 14 пациентам с дилатационной кардио- миопатией (11 мужчин и 3 женщины, возраст 41,1 ± 9,3 года) и 11 пациентам с ишемической болез- нью сердца (все мужчины, возраст 50 ± 4,9 года). Исходное легочное сосудистое сопротивление (ЛСС) составило 3,61 ± 1,02 и 3,59 ± 0,98 ед. Вуда соответственно. Всем больным была проведена инфузия альпростадила. Легочная гипертензия была необратима у 4 (28,5%) больных с дилатационной кардиомио- патией и у 2 (18%) больных с ишемической болезнью сердца. У этих больных исходное ЛСС составило 6,27 ± 3,2 и 5,7 ± 2,4 ед. Вуда соответственно. Средняя доза альпростадила, необходимая для реверса легочной гипертензии у пациентов с дилатационной кардиомиопатией, составила 0,054 ± 0,027 и 0,047 ± 0,022 мкг/кг/мин у пациентов с ишемической болезнью. Таким образом, применение альпростадила для фармакологической коррекции легочного сосудистого сопротивления наиболее эффективно у пациентов с умеренной легочной гипертензией по классификации Rich.