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

Analysis of the restoration of cardiology diagnostics scope in the Russian Federation during the COVID-19 pandemic: results of the Russian segment of the INCAPS COVID 2 study under the auspices of the International Atomic Energy Agency

Aim. To assess the changes in cardiology diagnostics scope in the Russian Federation during the coronavirus disease 2019 (COVID-19) pandemic.Material and methods. In an online survey organized by the Division of Human Health of the International Atomic Energy Agency (IAEA), including questions about changes in the workflow of diagnostic laboratories and the scope of cardiac diagnostics from March 2019 (pre-pandemic) to April 2020 (first wave of the pandemic) and April 2021 (recovery stage), 15 Russian medical centers from 5 cities took part.Results. The decrease in the diagnostics scope by April 2020 by 59,3% compared to March 2019, by April 2021, stopped and was replaced by growth (+7,1%, the recovery rate, 112,1%). The greatest increase was in routine examinations, such as echocardiography (+11,6%), stress echocardiography (+18,7%), stress single photon emission computed tomography (+9,7%), and to a lesser extent resting computed tomography angiography (+7,0%) and magnetic resonance imaging (+6,6%). The performance of stress electrocardiography, stress magnetic resonance imaging and positron emission tomography for the diagnosis of endocarditis in April 2021 compared to March 2019 decreased by 10,3%, 63,2% and 62,5%, respectively.Conclusion. Due to the resumption of patient admissions for cardiac examinations during the ongoing COVID-19 pandemic, with the anti-epidemic measures taken and certain changes in the workflow, there has been a recovery in the diagnostics scope in most of the included centers

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

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&lt;0.0001), a moderate negative correlation between Err-FT and LV hypertrophy (r=–0.5; p&lt;0.0001), and between Err-FT and myocardial T1relaxation time prior to contrast enhancement (r=–0.5; p&lt;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

Possibilities for correcting cognitive deficits in stroke in people who have had Covid-19

Мнестичні функції у хворих після інсульту і коронавірусної інфекції відновлюються не в повній мірі. На сьогодні є актуальним пошук способів подолання когнітивного дефіциту у таких пацієнтів. Ціль: з’ясувати можливість подолання когнітивного дефіциту при інсульті в осіб, які перенесли COVID-19, шляхом фармакокорекції Phenibut та магнітотерапії. Матеріали та методи. 46 пацієнтів віком 40-60 років, у яких в анамнезі COVID-19, а в постковідному періоді ішемічний інсульт, на етапі комплексної реабілітації розділені на 3 групи. У 1 групі (n=15) – контрольній – не отримували ноотропних препаратів та фізіотерапевтичних процедур; у 2 групі (n=15) протягом 20 днів проводили процедури магнітостимуляції (частота базових імпульсів 180-195 Гц, частота групи імпульсів 12,5-29 Гц, середня індукція магнітних полів в межах 100 μТ); у 3 групі (n=16) протягом трьох місяців приймали Phenibut (β-Phenyl-GABA) по одній таблетці (250 мг) 3 рази на день. Дослідження когнітивних функцій проводили за допомогою короткої шкали психічного стану – MMSE, батареї тестів для дослідження лобової дисфункції – FAB, тест на запам’ятовування 10 слів за методикою А.Р. Лурія і тестування малювання годинника. Тестування у всіх групах проводили двічі: на початку дослідження та через три місяці. Отримані дані обробляли статистично, застосували модель порядкової логістичної регресії, зокрема логістичну регресію з кумулятивним зв’язком. Результати. У 2 групі покращився результат субтесту «Довільна увага» (3,8±0,3 бали проти 3,1±0,2 у контролі) і тесту FAB (15,2±1,2 бали проти 11,3±0,4 у контролі). У 3 групі вірогідно покращились когнітивні функції у тестах MMSE (26,1±0,8 бали проти 21,2±0,6 у контролі) та FAB (16,3±0,6 бали проти 11,3±0,4). Покращились результати за субтестами «Довільна увага» (3,8±0,1 бали проти 3,1±0,1) та «Пам’ять» (2,6±0,2 бали проти 2,0±0,1). У тесті на запам’ятовування 10 слів різниця показників, порівняно з контролем, склала у кожному наступному поданні: 1,0±0,05; 1,1±0,09; 1,7±0,10 слів, у відстроченому поданні 1,75±0,05 (в усіх випадках р<0,05). Висновки. Використання Phenibut та магнітотерапії у пацієнтів, які перенесли інсульт після COVID-19, призводить до регресу когнітивного дефіциту і депресивної симптоматики. Вплив Phenibut виявився кращим – співвідношення шансів, порівняно з контролем, склало 13,1.Mnestic functions in patients after stroke and coronavirus infection are not restored completely. Nowadays, the search for ways to overcome in such patients is actual. Objective: to find out the possibility of cognitive deficiency’ overcoming in persons after stroke who have suffered from COVID-19 by Phenibut pharmacocorrection and magnetic therapy. Materials and methods. 46 patients aged 40-60 years who had COVID-19 in anamnesis and ischemic stroke in the post-covid period were divided into 3 groups at the stage of comprehensive rehabilitation. In the 1st group (n=15) – the control group – no nootropic drugs and physiotherapeutic procedures were not asdministered; in group 2 (n=15), magnet stimulation procedures were performed for 20 days (frequency of basic impulses 180-195 Hz, frequency of a group of impulses 12,5-29 Hz, average induction of magnetic fields within 100 μT); group 3 (n=16) took Phenibut (β-Phenyl-GABA) one tablet (250 mg) 3 times a day for three months. The study of cognitive functions was carried out with the help of a short mental state scale – MMSE, a set of tests for the study of frontal dysfunction – FAB, a test for memorizing of 10 words according to the A.R. Luria’s method and clock drawing testing All groups were tested twice: at the beginning of the study and after three months. The obtained data were processed statistically; an ordinal logistic regression model was applied, in particular logistic regression with a cumulative relationship. Results. In group 2 the result of the subtest «Voluntary attention» improved (3,8±0,3 points vs. 3,1±0,2 in the control) and the FAB test (15, 2±1,2 points vs. 11,3±0,4 in control). In group 3, the cognitive functions in the MMSE (26,1±0,8 points vs. 21,2±0,6 in the control) and FAB (16,3±0,6 points vs. 11,3±0,4) tests probably improved. The results of the subtests «Discretionary attention» (3,8±0,1 points vs. 3,1±0,1) and «Memory» (2,6±0,2 points vs. 2,0±0,1) improved. In the test for 10 words memorizing, the difference in indicators, compared to the control, was in each subsequent presentation: 1,0±0,05; 1,1±0,09; 1,7±0,10 words, in delayed presentation 1,75±0,05 (in all cases p<0.05). Conclusions. The use of Phenibut and magnetic therapy in patients who have suffered a stroke after COVID-19 leads to regression of cognitive deficiency and depressive symptoms. The effect of Phenibut turned out to be better – the odds ratio, compared to the control, was 13,1

Impact of the first wave of coronavirus disease 2019 (COVID-19) pandemic on the diagnosis of heart disease in the Russian Federation: results from the Russian segment of the IAEA INCAPS COVID study

Aim. To assess the impact of the first wave of coronavirus disease 2019 (COVID-19) pandemic on the diagnosis of heart disease in the Russian Federation.Material and methods. Fifteen Russian medical centers from 5 cities took part in an online survey organized by the Division of Human Health of the International Atomic Energy Agency (IAEA), containing questions regarding alterations in cardiovascular procedure volumes resulting from COVID-19 in March-April 2020.Results. A number of outpatients undergoing cardiac diagnostic procedures was noted in 80% of clinics. Cardiovascular procedure volumes in the period from March 2019 to March 2020 in general decreased by 9,5%, and from March 2019 to April 2020, by 56,5%. Stress electrocardiography decreased by 38,4%, stress echocardiography by 72,5%, stress single-photon emission computed tomography by 66,9%, computed tomography angiography by 49,7%, magnetic resonance imaging by 42,7%, invasive coronary angiography by 40,7%. The decrease in diagnostic procedure volumes in selected regions (Tomsk Oblast, Kemerovo Oblast, Tatarstan) was not so pronounced compared to Moscow and St. Petersburg (-20,7%, -75,2%, -93,8% in April 2020, respectively, p&lt;0,001).Conclusion. The first wave of the COVID-19 pandemic caused a sharp decrease in the number of diagnostic cardiac procedures in Russia. This has potential longterm implications for patients with cardiovascular disease. Understanding these implications can help guide diagnostic strategies during the ongoing COVID-19 pandemic and minimize the future losses

Impact of the first wave of coronavirus disease 2019 (COVID-19) pandemic on the diagnosis of heart disease in the Russian Federation: results from the Russian segment of the IAEA INCAPS COVID study

Aim. To assess the impact of the first wave of coronavirus disease 2019 (COVID-19) pandemic on the diagnosis of heart disease in the Russian Federation. Material and methods. Fifteen Russian medical centers from 5 cities took part in an online survey organized by the Division of Human Health of the International Atomic Energy Agency (IAEA), containing questions regarding alterations in cardiovascular procedure volumes resulting from COVID-19 in March-April 2020. Results. A number of outpatients undergoing cardiac diagnostic procedures was noted in 80% of clinics. Cardiovascular procedure volumes in the period from March 2019 to March 2020 in general decreased by 9,5%, and from March 2019 to April 2020, by 56,5%. Stress electrocardiography decreased by 38,4%, stress echocardiography by 72,5%, stress single-photon emission computed tomography by 66,9%, computed tomography angiography by 49,7%, magnetic resonance imaging by 42,7%, invasive coronary angiography by 40,7%. The decrease in diagnostic procedure volumes in selected regions (Tomsk Oblast, Kemerovo Oblast, Tatarstan) was not so pronounced compared to Moscow and St. Petersburg (-20,7%,-75,2%,-93,8% in April 2020, respectively, p&lt;0,001). Conclusion. The first wave of the COVID-19 pandemic caused a sharp decrease in the number of diagnostic cardiac procedures in Russia. This has potential long-term implications for patients with cardiovascular disease. Understanding these implications can help guide diagnostic strategies during the ongoing COVID-19 pandemic and minimize the future losses

Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia: The IAEA INCAPS-COVID Study

Background: The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives: This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods: The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results: Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions: The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted

Impact of COVID-19 on the imaging diagnosis of cardiac disease in Europe

Objectives We aimed to explore the impact of the COVID-19 pandemic on cardiac diagnostic testing and practice and to assess its impact in different regions in Europe. Methods The online survey organised by the International Atomic Energy Agency Division of Human Health collected information on changes in cardiac imaging procedural volumes between March 2019 and March/April 2020. Data were collected from 909 centres in 108 countries. Results Centres in Northern and Southern Europe were more likely to cancel all outpatient activities compared with Western and Eastern Europe. There was a greater reduction in total procedure volumes in Europe compared with the rest of the world in March 2020 (45% vs 41%, p=0.003), with a more marked reduction in Southern Europe (58%), but by April 2020 this was similar in Europe and the rest of the world (69% vs 63%, p=0.261). Regional variations were apparent between imaging modalities, but the largest reductions were in Southern Europe for nearly all modalities. In March 2020, location in Southern Europe was the only independent predictor of the reduction in procedure volume. However, in April 2020, lower gross domestic product and higher COVID-19 deaths were the only independent predictors. Conclusion The first wave of the COVID-19 pandemic had a significant impact on care of patients with cardiac disease, with substantial regional variations in Europe. This has potential long-term implications for patients and plans are required to enable the diagnosis of non-COVID- 19 conditions during the ongoing pandemic