Novel and conventional echocardiographic parameters for choosing management tactics in patients with degenerative mitral valve diseases

Mitral regurgitation (MR) is the second most common valvular heart disease in terms of prevalence and frequency of indications for cardiac surgery. Severe MR is characterized by a significant decrease in exercise tolerance and high mortality. The most common cause of organic MR is degenerative diseases. A detailed and systematic assessment of mitral valve and MR mechanisms is critical for the management of these patients, planning the type and timing of surgical intervention. Echocardiography plays a leading role among modern imaging methods in such patients. Examination of a patient with MR should include determining the pathogenesis of regurgitation, its severity and hemodynamic consequences. The aim of the review was to analyze the potential for using conventional and novel echocardiographic parameters to select the management strategy for patients with degenerative mitral regurgitation

nticoagulant therapy monitoring in COVID-19 patients in the intensive care unit: thromboelastometry and echocardiography

Aim. To determine the effectiveness of thromboelastometry (TEM) and echocardiography for anticoagulant therapy monitoring in patients with COVID-19.Material and methods. We analyzed treatment regimen of 92 patients with COVID-19. The patients were divided into two groups. In the control group (n=30), anticoagulant therapy with unfractionated heparin (UFH) was carried out under laboratory control of coagulation parameters. In the experimental group (n=62), anticoagulation was maintained by intravenous UFH under control of coagulation, echocardiography (Philips, Epiq 5) and TEM (ROTEM® delta). Echocardiography determined the pulmonary artery acceleration time (AT), mid-systolic notching (SN). The TEM method was used to study external (EXTEM) and internal (INTEM) pathways, differential tests (FIBTEM, HEPTEM) of coagulation. Statistical analysis was performed by calculating non-parametric statistics parameters, comparisons of differences in groups (Mann-Whitney test), area under the curve (AUC), and regression equations.Results. A high correlation level between echocardiographic and TEM parameters was determined. Their levels associated with a positive prognosis were calculated (AT>113,5 ms., AUC 0,979; p<0,0001; no SN, AUC 0,931; p<0,0001; FIBTEM ML (60 min) >1,12%, AUC 0,971, p<0,0001; INTEM ML (60 min) >2,01%, AUC 0,941, p<0,0001, EXTEM ML (60 min) >1,4%, AUC 0,934, p<0,0001; MCFfib not >26 mm, AUC 0,954; p<0,0001; MCFin not >56,6 mm, AUC 0,938; p<0,0001; MCFex not >47,9 mm, AUC 0,838, p<0,0001). In 33,9% of patients in the experimental group, heparin resistance was detected. In this connection, combined therapy with UFH and direct oral anticoagulants (DOACs) was used, followed by the switch to DOACs. In the control group, artificial ventilation was used in 50% of patients, mortality — 36,6%, myocardial infarction — 13,3%, deep vein thrombosis — 6,6%, pulmonary embolism — 6,6%, while in the experimental group, mechanical ventilation — 12,9%, myocardial infarction — 4,8%, mortality — 8,1%.Conclusion. The dynamic assessment of echocardiography and TEM parameters made it possible to monitor pulmonary thrombosis processes, significantly reduce complications, the use of artificial ventilation and mortality in COVID-19 patients

Risk factors for myocardial infarction during carotid endarterectomy in high-risk patients with coronary artery disease

Aim. To determine the value of various risk factors for predicting the myocardial infarction (MI) during carotid endarterectomy in high-risk patients with coronary artery disease (CAD).Material and methods. The single-center cohort prospective study included 204 high-risk patients with CAD who required carotid endarterectomy (CEA). Before surgery, all patients underwent treatment of CAD, and all patients were clinically stabilized. The first step was CEA. Clinical and diagnostic factors associated with the risk of perioperative MI were studied. There were following end points of the study: stroke, MI, death due to MI. The diagnosis of MI was established when there was a combination of an increase in cTn-I troponin above the 99th percentile upper reference limit with electrocardiographic manifestations of myocardial ischemia, or with chest pain or equivalent symptoms consistent with myocardial ischemia.Results. There were no strokes. There were no deaths due to MI. Perioperative MI developed in 8 (3,9%) patients. There were following most significant predictors of perioperative MI: severe impairment of local left ventricular (LV) contractility (hazard ratio (HR), 13,57; 95% confidence interval (CI), 1,427-124,782, p<0,05) and a decrease in left ventricular ejection fraction <50% (HR, 10,909; 95% CI, 1,052-271,229, p<0,05). However, following factors were insignificant for predicting perioperative MI (p>0,05): SYNTAX score, prior cerebrovascular accident, myocardial infarction, insulin-dependent diabetes mellitus, obesity, chronic obstructive pulmonary disease.Conclusion. In high-risk patients with CAD, severe impairment of local LV contractility and global LV systolic dysfunction are the most significant risk factors for perioperative MI during CEA

ИЗУЧЕНИЕ ГЕОДИНАМИЧЕСКИХ ЯВЛЕНИЙ В СОЛИГОРСКОМ ГОРНОПРОМЫШЛЕННОМ РАЙОНЕ ИННОВАЦИОННЫМИ ТЕХНОЛОГИЯМИ

The paper presents investigations on geodynamic phenomena in the Soligorsk mining region with  disturbed  geologic environment  by innovative technologies and GPS-measurements. Methodology foe GPS-monitoring on fundamental bench marks laid in area of the Krasnoslobodsky regional slip has been developed in the paper.Излагается опыт изучения геодинамических явлений Солигорского горнопромышлен-ного района с нарушенной геологической средой инновационными технологиями с помощью GPS-измерений. В результате разработана методика GPS-мониторинга на фундаментальных реперах, заложенных в районе Краснослободского регионального разлома

The effect of the smoking on development of pneumoconioses and dust bronchitis

The aim of the study was to evaluate the effects of smoking on the risk of pneumoconioses and dust bronchitis in persons exposed to industrial dust. A correlation analysis did not reveal any association between smoking and the formation and course of silicosis or asbestosis and chronic bronchitis, registered against the background of these pneumoconioses. There is significant correlation between smoking and the characteristics of dust bronchitis. The significant correlation between smoking index and the parameters of pneumoconiosis from exposure to low-fibrogenic mixed dust was demonstrated as well.Целью исследования явилась оценка влияния курения на риск развития пневмокониозов и пылевых бронхитов у лиц, подвергающихся воздействию промышленной пыли. При корреляционном анализе не выявлено связи между табакокурением и характеристиками формирования и течения силикоза, асбестоза, а также хронического бронхита, зарегистрированного на фоне данных пневмокониозов. Отмечается значимая корреляционная связь между фактом курения и развитием пылевых бронхитов, а также между индексом курения и характеристиками пневмокониоза от воздействия слабо фиброгенной смешанной пыли

INVESTIGATIONS OF GEODYNAMIC PHENOMENA IN THE SOLIGORSK MINING REGION BY INNOVATIVE TECHNOLOGIES

The paper presents investigations on geodynamic phenomena in the Soligorsk mining region with  disturbed  geologic environment  by innovative technologies and GPS-measurements. Methodology foe GPS-monitoring on fundamental bench marks laid in area of the Krasnoslobodsky regional slip has been developed in the paper

Dyslipidaemias in the elderly and the very old: gender differences

Background. Aging of the world population attracts attention to the elucidation of etiology factors triggering development of age-dependent systemic pathologies including atherosclerosis. We assessed the dynamics of lipid parameters changing and their gender differences in people aged 45 years and over. Methods. Total cholesterol, triglycerides (TG) and relative content of very low density lipoproteins (VLDL) and low density lipoproteins (LDL) in blood serum were measured by means of spectral analyzer and electrophoresis on acetate plates in 1650 patients (1167 women, 483 men) aged 45 yrs and over. The prevalence of dyslipidaemias was estimated by standard statistic methods. Results. In age period over 75 yrs the frequency of dyslipidaemias decreased from 81.0 % to 36,4 %. The most significant decrease concerned combined dyslipidaemia (CD) (4 times) and triglyceridemia (2 times). CD lowering in men observed through the age range of 45–90 yrs, in women – from 75 yrs and over. Frequency of hypercholesterolemia in men increased during 60-90 yrs and decreased in women in the period 45-75 yrs. In CD the relative increase of both VLDLand LDL was observed but the VLDL content elevation is associated with high mortality. Conclusion: Frequency of elevated TG and VLDL content in sera significantly decreased in men aged 60 yrs and over and in women aged 75 yrs and over