Impact of inter-ventricular lead distance on cardiac resynchronization therapy outcomes

Cardiac resynchronization therapy (CRT) has been shown as an essential treatment of patients with heart failure, leading to improvements in symptoms, left ventricular (LV) function, and survival. However, up to 30% of appropriately selected patients remain non-responders to CRT. The aim of our study was to test a hypothesis on the impact of lead positioning in the ventricular walls on CRT response in patients with advanced chronic heart failure with and without pre-operative inter and intra-ventricular myocardial dyssynchrony. We examined 53 guideline-selected CRT candidates. Response to CRT was defined in 6 months after implantation of CRT devices. All patients underwent standard and Doppler echocardiography for assessment of LV function and mechanical dyssynchrony. Individual right ventricular (RV) and LV lead tip position, inter-lead distance, and the horizontal and vertical components were measured on the radiograph images with using an automated custom made software Our results showed that the RLV inter-lead distance is an essential parameter correlated with the CRT outcomes. A logistic model comprising the RLV inter-lead distance with parameters of dyssynchrony demonstrated a high predictive power for odds of CRT success. © 2017 IEEE Computer Society. All rights reserved.Research was supported by Act 211 Government of the Russian Federation, agreement № 02.A03.21.0006 and Program of the RAS Presidium #I.33П

Hypereutectic al-ca-mn-(Ni) alloys as natural eutectic composites

Data Availability Statement: Data are available from the corresponding author on reasonable request.In the present paper, Natural Metal-Matrix Composites (NMMC) based on multicomponent hypereutectic Al-Ca-(Mn)-(Ni) alloys were studied in as-cast, annealed and rolled conditions. Thermo-Calc software and microstructural observations were utilised for analysing the equilibrium and actual phase composition of the alloys including correction of the Al-Ca-Mn system liquidus projection and the solid phase distribution in the Al-Ca-Mn-Ni system. A previously unknown Al10CaMn2 was discovered by both electron microprobe analysis and X-ray studies. The Al-6Ca-3Mn, Al-8Ca-2Mn, Al-8Ca-2Mn-1Ni alloys with representative NMMC structure included ultrafine Ca-rich eutectic and various small-sized primary crystals were found to have excellent feasibility of rolling as compared to its hypereutectic Al-Si counterpart. What is more, Al-Ca alloys showed comparable Coefficient of Thermal Expansion values due to enormous volume fraction of Al-based eutectic and primary intermetallics. Analysis of tensile samples’ fracture surfaces revealed that primary intermetallics may act either as stress raisers or malleable particles depending on their stiffness under deformation. It is shown that a compact morphology can be achieved by conventional casting without using any refining agents. Novel hypereutectic Al-Ca NMMC materials solidifying with the formation of Al10Mn2Ca primary compound have the best ductility and strength. We reasonably propose these materials for high-load pistons.Russian Science Foundation (project no. 20–19–00746)

Management of heart failure patients in Russia: perspectives and realities of the second decade of the XXI century

The article highlights the central components of Russian heart failure (HF) management programs in actual clinical practice. The experience of the Competence Center of Almazov National Medical Research Center, as well as opportunities and prospects for improving the monitoring of decompensated HF

Recognition of One’s Own Mental State by Parents of Children-patients

In present article studied recognition of the situation of actualization of the mental state by child-patients parent's. The research was carried out in two stages. Sample: 70 mothers having children under the age of 7 years. Average age of mothers – 27 years. At the first stage by means of the technique "A relief of a mental state" (Prokhorov, 1998) were received estimates of mental states in the following situations: hospitalization of the child, "bad" medical care, troubles at work, "good" medical care, a usual (background) mental state. Based on the results of the first stage were two sets of descriptions were constructed. At the second stage, these sets were presented for recognition to the same sample. The first set of descriptions was constructed by the tequnique of the machine learning, the second set was constructed by the scheme of E.Yu. Artemyeva (1999). The results show the possibility of recognizing the situations of actualization of the mental state by the parents of child patients, which is limited by the emotional valence of the situation. Differentiation of situations of one valence is obstructed. The condition, actualized in one situation, can be extrapolated to other situations of similar emotional valence. The way to construct a description of the experienced mental state has a matter for recognition of the situation of actualization of a mental state

Type 2 Diabetes Mellitus and Chronic Heart Failure with Midrange and Preserved Ejection Fraction: A Focus on Serum Biomarkers of Fibrosis

As myocardial fibrosis might be an important contributor to the association of diabetes mellitus with left ventricular (LV) dysfunction and chronic heart failure (HF), we investigated the profile of some proinflammatory, profibrotic biomarkers in patients with type 2 diabetes mellitus (T2DM) at various stages of the cardiovascular disease continuum from absence of clinic since and symptoms to HF with preserved (HFpEF) and midrange ejection fraction (HFmrEF). Material and Methods. Sixty-two patients with T2DM (age 60 [55; 61]), 20 patients without clinical manifestations of HF and 2 groups with clinical manifestations of stable HF, 29 patients with HFpEF, and 13 patients with HFmrEF, were included in the study. The control group consisted of 13 healthy subjects and normal BMI. All patients underwent transthoracic echocardiography, laboratory assessment of N-terminal fragment of the brain natriuretic peptide (Nt-proBNP), highly sensitive C-reactive protein (hsCRP), soluble suppression of tumorigenesis-2 (sST2), galectin-3, C-terminal propeptide of procollagen type I (PICP), N-terminal propeptide of procollagen type III (PIIINP), matrix metalloproteinase-9 (MMP-9), and tissue inhibitor of matrix proteinase-1 (TIMP-1). Results. Patients with HFmrEF had higher values of LV volumetric parameters, indexed parameters of LV myocardial mass (LVMM), and higher concentrations of Nt-proBNP (all p<0.05). The concentrations of galectin-3 were greater in patients with HFpEF and HFmrEF compared to patients without HF (p=0.01 and p=0.03, respectively). PICP and PICP/PIIINP ratio were greater in patients with HFmrEF compared to patients with HFpEF (p=0.043 and p=0.033, respectively). In patients with T2DM and HF, a relationship was found between galectin-3 and LVMM/body surface area (r=−0.58, p=0.001), PIIINP, TIMP-1, and LV end-diastolic volume (r=−0.68 and p=0.042 and r=0.38 and p=0.02, respectively). Conclusion. The dynamics at various stages of the cardiovascular disease continuum in the serum fibrosis markers may reflect an increase in fibrotic and decrease in antifibrotic processes already at the preclinical stage of HF. At the same time, the changes found in the circulating procollagen levels may indicate a shift in balance towards type I collagen synthesis in HFmrEF compared with HFpEF

Molecular biomarker profile of heart failure with mid-range and preserved ejection fraction in patients with type 2 diabetes

Aim. To study molecular biomarkers in patients with type 2 diabetes (T2D) in combination with heart failure with preserved (HFpEF) and mid-range ejection fraction (HFmrEF) and compare the data obtained with clinical characteristics of myocardial remodeling.Material and methods. The study included 42 patients with T2D (men — 53%, mean age — 60 years) with clinical manifestations of class II HF: 29 patients with HFpEF (group 1) and 13 patients with HFmrEF (group 2). The control group consisted of 13 healthy people, which were comparable in sex and age and had a normal body mass index (BMI). Patients received stable glucose-lowering and optimal drug therapy for HF for 3 months prior to enrollment in the study. Patients with HFpEF and HFmrEF were comparable in clinical and demographic parameters, had glycated hemoglobin (HbA ) of 8,5% and 8,8%, respectively (p&gt;0,05), increased BMI or grade I-II obesity.We studied following biomarkers: NT-proBNP, highly sensitive C-reactive protein (hsCRP), sST2, galectin-3, procollagen type I C-terminal propeptide (PICP), matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1).Results. Volumetric parameters of the left ventricle (LV),LV mass indexed to growth and NT-proBNP were higher in the group of HFpEF patients (p&lt;0,05 for all). The concentrations of galectin-3, PICP were higher, and the MMP-9/TIMP-1 ratio decreased in patients with T2D compared with the control group (p&lt;0,05 for all). PICP values were higher in patients with HFmrEF compared with patients with HFpEF (106,4 (85,4; 140,4) ng/ml vs 46,8 (12,6; 98,6 ng/ml), respectively, p=0,043). In patients with T2D and HF, a relationship was found between TIMP-1 andLV end-diastolic volume (r=-0,68; p=0,042).Conclusion. Patients with HFmrEF and T2D have higherLV volume and mass, higher concentrations of NT-proBNP and PICP in comparison with patients with HFpEF. The direction of MMP-9/TIMP-1 changes may reflect a decrease in antifibrotic processes. Further prospective studies on large samples using a multiple biomarker model are required in T2D and various HF phenotypes

FUNCTIONAL STATE DYNAMICS OF BLOOD CELLS AND ENDOTHELIUM IN PATIENTS WITH ESSENTIAL HYPERTENSION WITH ENALAPRIL TREATMENT

The influence of ACE inhibitor enalapril therapy on functional activity of blood cells and vasomotor function of endothelium in patients with essential hypertension (EH) was studied. 21 patients with EH II stage and 17 almost healthy persons (all males) were included. Ultrasound of heart, radial and carotid arteries, spontaneous platelet and erythrocyte aggregation, erythrocyte deformity and leukocyte activity were assessed. The second examination of patients with EH was carried out in 12 weeks following enalapril treatment with 10-40 mg a day. Baseline increase of spontaneous platelet and erythrocyte aggregation, erythrocyte hardness and leukocyte activity were revealed in patients with EH. Antihypertensive effect of enalapril was in 15 patients (71 %). Hemoreology improvement and decrease of leukocyte activity were accompanied by increase of volume flow velocity in radial artery while endothelium-dependent vasodilation was unchanged. Long-term enalapril therapy was accompanied by improvement of hemoreology, decrease of leukocyte activity and increase volume flow velocity in radial artery. Positive dynamics of functional states of blood cells did not depend on severity of antihypertensive effect of enalapril

Significant improvement of clinical course and reverse myocardial remodeling in young patients with chronic heart failure using cardiac contractility modulation

Three clinical cases of 2-year follow-up of young patients with chronic heart failure with a low left ventricular ejection fraction of non-coronarogenic genesis after implantation of the cardiac contractility modulation system are presented. Significant positive dynamics of clinical course and reverse myocardial remodeling according to two-dimensional echocardiography and 2D speckle tracking echocardiography (STE) is shown. The 2D STE technique allowed us to demonstrate the improvement in local contractility of the interventricular septum in the area of implanted electrodes and the remote effect of global contractility improving during 1 year of observation with cardiac contractility modulation

Impact of obesity on echocardiographic parameters and N-terminal pro-brain natriuretic peptide levels in patients with heart failure with mid-range ejection fraction: unanswered questions

Aim. To analyze and compare the clinical, echocardiographic characteristics and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels depending on the central cardiometabolic risk factors, with a focus on obesity, in patients with heart failure (HF) with mid-range ejection fraction (HFmrEF).Material and methods. The study included 111 patients with old myocardial infarction and HFmrEF (men, 100%; mean age, 60 years) predominantly of NYHA class II. Echocardiography and blood sampling for NT-proBNP were performed with sinus rhythm. Left atrial volume (LAV) and left ventricular mass (LVM) were indexed to body surface area (BSA) and height raised to a power.Results. Type 2 diabetes, overweight and obesity were diagnosed in 25%, 19%, 38% of cases, respectively, and were associated with greater changes in the morphologic and functional left ventricular parameters. There were no intergroup differences among patients with and without obesity in the LAV and LVM indexed to BSA. However, in patients with a body mass index (BMI) ≥30 kg/m2, the LAV indexed to height squared and LVM indexed to height2,7 were higher (p&lt;0,05 for all). In 11% of obese patients, there were no changes in the criterion LAV or LVM values indexed to BSA, but the values indexed to height raised to a power exceeded the standard values. In 20% of patients with clinical manifestations of stable HFmrEF and structural and functional echocardiographic criteria, NT-proBNP were ≤125 pg/ml. An inverse correlation was found between NT-proBNP and BMI (r=-0,29; p=0,008), and lower values of myocardial stress marker were observed in obese patients (p=0,048).Conclusion. Considering the high incidence of obesity in patients with HFmrEF and its ability to reduce NT-proBNP, an algorithm modification is required for diagnosing HFmrEF as follows: focus on clinical and personalized echocardiography data, taking into account the obesity and, possibly, indexing the threshold natriuretic peptide values in patients with BMI ≥30 kg/m2. The issues of indexation of echocardiographic parameters depending on morphometric parameters in obese patients today remain open, predetermining the limitations in diagnosis of heart failure with left ventricular ejection fraction &gt;40%. This requires the search for optimal standardization and the development of a unified methodological approach