[Difficulties in differential diagnosis of the AL- and ATTR-cardiac amyloidosis. Case report].

The article presents a clinical case describing a complex differential diagnosis of cardiac amyloidosis types and verification of the diagnosis of AL-amyloidosis.

Relationship between parameters of myocardial electrical remodeling and parameters of contractile function, deformation and myocardium work in patients with chronic heart failure with low left ventricular ejection fraction and atrial fibrillation.

Aim    To compare electrocardiographic parameters and characteristics of myocardial contractility by echocardiography data in patients with chronic heart failure (CHF) with low left ventricular ejection fraction (LV EF) and atrial fibrillation (AF).Material and methods    The study included 66 patients with CHF and LV EF ≤40%. Electrocardiography was used to assess the QRS complex duration, QRS fragmentation, frontal QRS-T angle (fQRS-Ta), and 3D vectorcardiographic parameters, including the planarity of QRS loop, and the spatial QRS-T angle (sQRS-Ta). Echocardiography assessed LV EF, global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE).Results    Statistically significant correlations between electrocardiographic parameters and LV EF were not found. The presence of QRS fragmentation was associated with impaired GLS, higher GWW values, and lower GWE. A number of weak but significant correlations was observed: GLS worsened with increasing QRS duration, fQRS-Ta, and sQRS-Ta and decreasing QRS planarity index; GWW increased with increasing QRS duration; GWI, GCW, and GWE decreased as the QRS planarity index decreased. GWI decreased with increasing sQRS-Ta; GCW decreased with increasing fQRS-Ta and sQRS-Ta; GWE decreased with increasing QRS duration, fQRS-Ta and sQRS-Ta.Conclusion    Correlations were found between indicators of myocardial electrical remodeling and parameters of myocardial contractility, strain, and performance in CHF patients with low LV EF and AF. Further study of these parameters may be promising for assessing the severity of changes in myocardial structure and function in patients with various cardiovascular pathologies.

[Efficacy and Safety of Nonfluoroscopic Approach During Catheter Ablation of Ventricular Tachycardias].

Aim      To evaluate a possibility of using radiofrequency catheter ablation guided by intracardiac echocardiography (ICE), its efficacy and safety for treatment of ventricular tachycardia (VT) of various etiology.Material and methods  Catheter intervention was performed for 20 enrolled patients with symptomatic VT. Ablation procedures were guided by a 3D electroanatomical mapping system and ICE.Results Mean duration of the procedure was 201.2±62.5 min. The procedure was successful (non-inducibility of VT) in 100% of cases. None of the patients had postoperative complications.Conclusion      Ablation of VT arrhythmogenic substrate guided by 3D electroanatomical navigational mapping and ICE without X-ray is feasible and safe.

[Features of vectorcardiograms in patients with hypertension complicated by chronic heart failure with reduced left ventricle ejection fraction].

AIM: To explore the features of vectorcardiograms (VCG) of patients with essential hypertension complicated by chronic heart failure with reduced left ventricular ejection fraction (CHFrLVEF). MATERIALS AND METHODS: We analyzed VCGs of 70 hypertensive patients with CHFrLVEF and 275 hypertensive patients without clinical signs of CHF and with LVEF50%. We assessed the presence of rhythm and conduction disturbances, and the parameters of the synthesized VCG, i.e., module of the maximum QRS vector, planarity index of the spatial QRS loop (P/S), and spatial angle between the integral QRS and T vectors (sQRS-Ta). RESULTS: In hypertensive patients with CHF, certain conditions were detected more often as compared with hypertensive patients without CHF, i.e., atrial fibrillation (AF) in 52.9% vs 5.1%; p0.0001, and left bundle branch block (LBBB) in 38.6% vs 0.4%; p0.0001. The module of the maximum QRS vector and sQRS-Ta were significantly greater and P/S was significantly less in VCGs of patients with CHF. ROC-analysis showed that the presence of AF and LBBB just as VCG parameters assessed in this study provide clear discrimination between hypertensive patients with or without CHF both in the group as a whole and in the subgroups (1) without LBBB, (2) with sinus rhythm, and (3) with AF. sQRS-Ta was the most informative parameter (threshold 137, sensitivity 91%, specificity 92%). The P/S indicator at the optimal threshold value 0.92 was characterized by lower specificity (68%) with rather high sensitivity (79%). CONCLUSION: AF, LBBB, increased module of the maximum QRS vector and sQRS-Ta, and decreased P/S index are present in hypertensive patients with CHFrLVEF as compared with patients without CHF.

[A new approach in the diagnosis of lung lesions in patients with COVID-19: lung ultrasound protocol versus CT scan].

AIM: To develop a protocol for ultrasound diagnostics of COVID-19 pneumonia and to assess the diagnostic capabilities of the method in comparison with computer tomography (CT). MATERIALS AND METHODS: The study included 59 patients with a new coronavirus infection. In order to identify changes in the lung tissue characteristic of a new coronavirus infection, we used a special protocol for ultrasound of the lungs, which was developed by us in such a way that the data obtained were compared by segment with the results of CT of the lungs. RESULTS: When comparing the results of lung ultrasound with the data of CT diagnostics, according to the new protocol, the percentage of lung tissue damage during ultrasound of the lungs averaged 70.8% in the group [62.5; 87.5], and according to the results of CT 70.0% [60.0; 72.5] (p=0.427). Thus, the ultrasound of the lung lesions was almost completely consistent with the changes revealed by CT. In order to assess the diagnostic value of lung ultrasound in identifying severe lung tissue lesions corresponding to CT 34, ROC analysis was performed, which showed the high diagnostic value of lung ultrasound in identifying severe lung tissue lesions. CONCLUSION: A new protocol was developed for assessing the severity of lung tissue damage according to ultrasound data, which showed a high diagnostic value in detecting COVID-19 pneumonia in comparison with CT. The results obtained give reason to recommend this protocol of ultrasound of the lungs as a highly sensitive method in diagnosing the severity of COVID-19 pneumonia. Its application is very important for dynamic examination of patients, especially in conditions of low availability of CT.

[Myocardial scintigraphy with 99mTc-pyrophosphate in the diagnosis of cardiac amyloidosis: place in the diagnostic algorithm, features of the implementation and interpretation of the study].

The article summarizes the current experience of the nuclear medicine department of the Chazov National Medical Research Center of Cardiology in the implementation of myocardium scintigraphy with 99mTc-pyrophosphate with the differential diagnosis of the types of cardiac amyloidosis. Causes of false-positive, equivocal and non-diagnostic results, are analyzed. Possible ways to eliminate mistakes, including by modifying protocols of planar and tomographic research and optimizing the whole diagnostic algorithm for amyloidosis of the heart, are discussed.

[Focus ultrasound for cardiology practice. Russian consensus document].

This document is a consensus document of Russian Specialists in Heart Failure, Russian Society of Cardiology, Russian Association of Specialists in Ultrasound Diagnostics in Medicine and Russian Society for the Prevention of Noncommunicable Diseases. In the document a definition of focus ultrasound is stated and discussed when it can be used in cardiology practice in Russian Federation.

The value of the spatial QRS-T angle for assessing the severity of heart damage in patients with arterial hypertension.

Aim      To study the relationship between clinical, echocardiographic, and laboratory indexes with increased QRS-T spatial angle (sQRS-T) in patients with arterial hypertension (AH).Material and methods  The study included 160 patients with AH, 61 (38 %) men and 99 (62 %) women aged 58 [49; 67] years. Patients with ischemic heart disease or His bundle blocks were not included. Echocardiography was used to determine the left ventricular end-diastolic dimension (LV EDD), left ventricular posterior wall thickness (LVPWT), interventricular septal thickness (IVST), relative wall thickness (RWT), left ventricular myocardial mass (LVMM), and LVMM index (LVMMI). Also, the following indexes were analyzed: office systolic and diastolic blood pressure (SBP, DBP), disease duration, body mass index, plasma levels of glucose, cholesterol, and creatinine, and glomerular filtration rate. The QRS-T spatial angle was calculated as an angle between the integral vectors QRS and T using a vectorcardiogram derived from a 12-lead digital electrocardiogram. Data are presented as median (25th percentile; 75th percentile].Results The QRS-T spatial angle for the group was 65 [43; 90]°. The QRS-T spatial angle increased with increases in the AH grade (grade 1 AH, 55 [37; 74]°; grade 2 AH, 60 [41; 82]°; grade 3 AH, 88 [62; 107]°; р<0.0001); the AH stage (stage 1, 50 [41; 77]°; stage 2, 68 [44; 93]°; stage 3, 78 [59; 110]°; р=0.0002), and the cardiovascular risk degree (low and moderate risk, 49 [37; 70]°, high risk, 62 [43; 88]° (р=0.005); very high risk, 88 [61; 117]° vs. high risk, 62 [43; 88]° (р=0.0002). The QRS-T spatial angle was greater with diabetes mellitus (78 [60; 117]°) than without it (63 [43; 89]°) (р=0.03). Weak but significant correlations were found between sQRS-T and body mass index (r=0.2; p<0.01), SBP (r=0.4; p<0.0001), DBP (r=0.2; p<0.01), LV EDD (r=0.2; p<0.01), LV PWT (r=0.3; p<0.001), IVST (r=0.3; p<0.001), LVMM (r=0.3; p<0.001), LVMMI (r=0.3; p<0.001), and blood glucose (r=0.2; p<0.01).Conclusion      In patients with AH, a large QRS-T spatial angle is related with significantly higher values of SBP and DBP, LV dimension, blood glucose, and body mass index.

The modified protocol of transesophageal atrial pacing in stress echocardiography as an alternative way to increase the information value of the method for detection of ischemic wall motion abnormalities.

Aim    To develop a new, modified protocol for transesophageal atrial electric stimulation (TEAES), which would significantly enhance the diagnostic value of stress echocardiography and reduce the duration of the test in patients with ischemic heart disease (IHD).Material and methods    This study included 101 patients (80 men and 21 women aged 55±9 years) with suspected or documented diagnosis of IHD who were divided into two homogenous groups. Group 1 (51 patients) underwent stress echocardiography (stress-EchoCG) according to a standard protocol (SP) for TEAES and group 2 (50 patients), underwent stress-EchoCG according to a modified protocol (MP). In addition to stress-EchoCG with TEAES, selective coronary angiography was performed for all patients. The development of the new method for evaluating occult coronary insufficiency was based on comparison of SP and MP for TEAES with stress-EchoCG with data of coronary angiography.Results    In both groups, significant differences in values of systolic and diastolic blood pressure were absent. However, the values of achieved heart rate were significantly different: 141±11 (TEAES SP) and 155±10 (TEAES MP) bpm (p=0.01). There was also a difference in the duration of the TEAES protocols: 15±3 and 5±2 min, respectively (p=0.006). The use of the modified TEAES protocol for detecting transient disorders of left ventricular myocardial local contractility increased the sensitivity, specificity and accuracy of the test from 76 %, 87 %, and 80 % to 83 %, 92 %, and 86 %, respectively. The most significant differences were found in the area supplied by the circumflex artery: the SP and MP sensitivities were 63 % and 75 %, respectively (p<0.05) and the SP and MP accuracies were 81 % and 90 %, respectively (p<0.05).Conclusion    Evaluation of occult coronary insufficiency by stress-EchoCG with the TEAES MP as compared to the TEAES SP provides a gentler procedure regimen for the patient due to a shorter duration of the test and at the same time improves the diagnostic significance of this method in IHD patients.

[The role of diastolic transthoracic stress echocardiography with incremental workload in the evaluation of heart failure with preserved ejection fraction: indications, methodology, interpretation. Expert consensus developed under the auspices of the National Medical Research Center of Cardiology, Society of Experts in Heart Failure (SEHF), and Russian Association of Experts in Ultrasound Diagnosis in Medicine (REUDM)].

Diagnosis of heart failure with preserved ejection fraction (HFpEF) is associated with certain difficulties since many patients with HFpEF have a slight left ventricular diastolic dysfunction and normal filling pressure at rest. Diagnosis of HFpEF is improved by using diastolic transthoracic stress-echocardiography with dosed exercise (or diastolic stress test), which allows detection of increased filling pressure during the exercise. The present expert consensus explains the requirement for using the diastolic stress test in diagnosing HFpEF from clinical and pathophysiological standpoints; defines indications for the test with a description of its methodological aspects; and addresses issues of using the test in special patient groups.

[Evaluation of the effectiveness of the chronic heart failure therapy using the device cardiac contractility modulation according to the new non-invasive method of the myocardium work analysis].

Aim      To analyze echocardiographic parameters that reflect left ventricular (LV) myocardial contractility, using a novel method for evaluation of myocardial performance in patients with chronic heart failure (CHF) and atrial fibrillation (AF) during heart contractility modulation (HCM).Material and methods  Standard echocardiographic parameters and indexes of myocardial strain and work were analyzed for 66 patients (52 men and 14 women; median age, 60 [54; 66] years). 36 patients had paroxysmal AF and 30 patients had permanent AF. All patients had CHF with a duration of 17 [4; 60] months; duration of AF was 12 [6; 36] months. At baseline, the left ventricular ejection fraction (LV EF) was 33 [27; 37] %.Results After one year of HCM, LV EF significantly increased from 33 [27; 37] to 38 [33; 44] % (р=0.001). Also, there were improvements in the myocardial global longitudinal strain (from -6.00 [ - 8; - 4] to -8 [ - 10; - 6] %; р=0.001) and parameters of myocardial work, including the global work efficiency (from 74 [65; 79] to 80 [73; 87] mm Hg%; р=0.001), global constructive work (from 699 [516; 940] to 882 [714; 1242] mm Hg%; р=0.001), and global myocardial work index (from 460 [339; 723] to 668 [497; 943] mm Hg%; р=0.001). A segmentary analysis of LV work parameters showed positive changes in the myocardial constructive work in the area of the interventricular septal apical segment (at baseline, 844 [614; 1224]; after HCM, 1027 [800; 1520] mm Hg%; р=0.05) and the medium segment of the LV anteroseptal wall (at baseline, 593 [312; 1000]; after HCM, 877 [494; 1145] mm Hg%; р=0.05).Conclusion      This method for analysis of the myocardial work provides a more detailed examination of LV structural and functional remodeling and mechanisms for its effects on the LV contractile function in patients with CHF. This method is promising and merits further study in various clinical situations.

[Myocardial remodeling in patients with chronic heart failure and implanted cardiac contractility modulators].

AIM: To study the effect of cardiac contractility modulation on reverse remodeling and myocardial function in patients with chronic heart failure (HF) according to echocardiography (EchoCG). MATERIALS AND METHODS: In a group of 40 patients with a combination of chronic HF and atrial fibrillation (AF), the dynamics of standard EchoCG parameters and the effectiveness of myocardial work of the left ventricle (LV) against the background of 12-month therapy of cardiac contractility modulation (CCM) were analyzed. RESULTS: The results obtained indicate a statistically significant positive effect of CCM on LV remodeling parameters and the effectiveness of myocardial work according to EchoCG. CONCLUSION: Transthoracic echocardiography is the main imaging method and provides great opportunities for evaluating the effectiveness of HF treatment, including non-drug methods such as CCM. Evaluation of LV myocardial function in patients with HF and implanted CCM devices is a promising scientific and practical research method.

[Influence of demographic characteristics on the clinical course and results of therapy in patients with precapillary pulmonary hypertension].

AIM: To assess the clinical course of the disease and the features of the treatment goals achievement in patients with IPAH and inoperable CTEPH depending on gender and age at the time of diagnosis verification. MATERIALS AND METHODS: The study included 88 patients with IPAH and 38 patients with inoperable CTEPH with a PAWP 12 mm Hg and the duration of PAH-specific therapy treatment more than 12 months. IPAH/CTEPH patients were divided into groups depending on age at the time of diagnosis verification: age 50 years (n=69)/ 50 years (n=57), and gender: 106 women/20 men. RESULTS: Patients with age 50 years at the time of diagnosis verification have significantly more severe functional class (WHO). In IPAH/CTEPH male patients a significant hemodynamic disorder also as significantly higher level of NT-proBNP at the time of diagnosis verification were observed. In men with IPAH/CTEPH and patients aged 50 years more pronounced deterioration of right ventricular systolic function was observed (ECHO). Patients with IPAH younger than 50 years were significantly more likely to achieve the treatment goals by the median 26.5 months of treatment compared to the patients aged 50 years (21% vs 6.45%). Men with IPAH/CTEPH were significantly more likely to have a high risk of death (90%) at baseline compared to the women (61%). CONCLUSION: IPAH/inoperable CTEPH patients with male sex, as well as the age 50 years and older at the time of diagnosis verification, compared with younger ones, are associated with a less favorable course of the disease.

[Takotsubo syndrome after palliative transcatheter treatment of acquired aortic stenosis in patient with congenital ventricular septal defect. Case report].

The authors report the clinical case of secondary Takotsubo syndrome developed after transcatheter aortic valve replacement that was performed in compassionate manner in female patient with combination of congenital ventricular septal defect and acquired severe aortic stenosis. In the teams view, Takotsubo syndrome was triggered with profound changes of intracardial hemodynamics subsequent to iatrogenic impairment of preexisting interventricular shunt.

[The assessment of right ventricular structure and function in patients with different cardiovascular diseases using modern echocardiographic technologies and magnetic resonance imaging].

AIM: To perform comparative analysis of right ventricular (RV) structure and function in patients with various cardiovascular diseases using modern echocardiographic technologies in comparison with magnetic resonance imaging (MRI). MATERIALS AND METHODS: The study included 85 patients. Group 1 consisted of 32 patients with idiopathic pulmonary hypertension (IPH) (mean age 35.910.2 years). Group 2 included 27 patients with arterial hypertension (AH) grade 3 (mean age 58.612.3 years). Group 3 consisted of 26 patients with chronic heart failure (CHF) (mean age 56.115.3 years). Control group included 28 healthy volunteers (mean age 38.710.9 years). The main method was transthoracic echocardiography (TTE) using modern technologies, such as three-dimensional echocardiography (3DE), tissue Doppler imaging (TDI), and speckle tracking echocardiography (STE). In some patients and healthy volunteers 3DE data were compared with MRI data. RESULTS: Patients with IPH and CHF had minimal RV ejection fraction (EF) both according to 3DE and MRI. Correlation analysis revealed close correlation between RV volumes and EF according to 3DE and MRI. Minimal values of systolic indicator STV according to TDI were observed in patients with CHF. In all groups, including control group, the highest values of STV were obtained at the level of the basal segments and the lowest values at the level of apical segments. STE revealed the same pattern as TDI. According to STE minimal RV strain was observed in IPH and CHF groups and significantly differed not only from control group, but also from AH group. CONCLUSION: The lowest values of RV EF and strain were observed in IPH and CHF groups. There were no significant differences in these indicators between the groups, that dictates the need for thorough assessment of RV structure and function not only in patients with precapillary, but also with postcapillary pulmonary hypertension. The results of the study confirm good comparability of 3DE and MRI in assessing RV volumes and EF.

[Comparison of myocardial contrast stress-echocardiography and standard stress-echocardiography in detecting myocardial ischemia in patients with different severity of coronary artery stenoses].

AIM: To compare diagnostic value between standard stress-echocardiography and myocardial contrast stress echocardiography in detection of myocardial ischemia in patients with different severity of coronary artery stenoses. MATERIALS AND METHODS: Myocardial contrast stress-echocardiography and standard stress-echocardiography were performed in 38 patients with coronary artery stenoses over 50% by angiography. Of all lesions 39 were intermediate (5075%) and 33 over 75% stenoses. Fractional flow reserve (FFR) was measured in 12 coronary arteries. During myocardial contrast stress-echocardiography wall motion and myocardial perfusion was assessed. RESULTS: Adequate visualisation increased from 81.6% in unenhanced segments to 96.1% in contrast-enhanced segments. The sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography in intermediate (5075%) coronary stenoses were 44%, 83%, 56% and 56%, 94% и 64% respectively compare to angiography. Taking into account the 12 arteries with evaluated FFR, these parameters increased to 52%, 93% и 65% in standard stress-echocardiography and to 68%, 100% and 75% in myocardial contrast stress-echocardiography. In coronary stenoses over 75% the sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography were 78%, 88%, 80% and 86%, 100%, 92% respectively Conclusion. Use of contrast-enhanced stress-echorardiography significantly increased the diagnostic value of this method by improving endocardial border visualization and possibilities of myocardial perfusion assessment.

[LEOPARD syndrome].

LEOPARD syndrome with multiple lentigines (cardiomyopathic lentiginosis) is a rare, genetically predetermined disease with autosomal dominant inheritance. Prevalence of this syndrome is unknown. One of pathognomonic clinical manifestations of this syndrome is the presence of multiple lentiginous pigment spots all over the body. The most common cardiac manifestation (approximately 80%) is myocardial hypertrophy. We presented a rare clinical case of detecting LEOPARD syndrome with multiple lentigines in a 32-year old female patient with major manifestations evident as pronounces morpho-functional alterations, myocardial hypertrophy, and heart rhythm disorders.

[Experience with tafamidis in a patient with transthyretin amyloidosis].

Transthyretin amyloidosis (ATTR) is a threatening and severe genetic disease characterized by damages to organs and systems caused by a pathological protein transthyretin produced in the liver. Clinical manifestations of this disease vary from injuries of the nervous system to injuries of the cardiovascular system. Prognosis for ATTR-amyloidosis remains unfavorable. The absence of pathognomonic symptoms complicates diagnostics of this disease, which tends to simulate other conditions. At present, medicines exist, which are pathogenetic in the treatment of ATTR-amyloidosis. The article describes a clinical case of ATTR-amyloidosis with primary heart injury complicated with functional class III chronic heart failure during the tafamidis treatment.

[Ischemic Mitral Regurgitation: Echocardiographic Algorithm, the Place of Three-Dimensional Transesophageal Echocardiography].

Objective Identify the diagnostic markers of the severe MV changes in patients with ischemic mitral regurgitation (IMR) and suggest a modification of the echocardiography (EchoCG) algorithm.Materials and Methods A two-stage examination of 65 patients with mild (n=22), moderate (n=22), and severe (n=21) IMR was performed using two-dimensional (2D) transthoracic EchoCG with dopplerography, 2D and three-dimensional (3D) transesophageal EchoCG (TEE). 4D MV-Assessment in off-line mode was made in TomTec Imaging Systems GmbH, Germany. Statistical analysis (SAS 9.4) included Student's t-test, Kruskal-Wallis method, Pearson correlation, multivariate regression analysis, and ROC-analysis.Results According to 3D TEE the significant changes in MV annulus, leaflets and tenting are detected. 3D parameters of MV geometry are related to IMR severity, left ventricle (LV) remodeling (global and regional), and they are different in symmetric and asymmetric variants. In symmetric variant MV reconstruction is correlated with LV dilatation and contractility decrease, in asymmetric variant it's correlated with regional remodeling parameters. Severe IMR is characterized by a decrease in MV annulus displacement (27,0±6,6 mm/s versus 32,4±10,8 mm/s in mild IMR; р<0,05), tenting volume fraction (32,5±14,8% versus 56,2±16,8% in mild IMR; p<0,05), and annulus area fraction (4,7±2,7% versus 6,6±4,5% in mild IMR; р<0,05). Vena contracta width (VCW), Proximal Isovelocity Surface Area (PISA) radius, Effective Regurgitant Orifice Area (EROA), Regurgitant Volume (Rvol), LV end systolic dimension (LV ESD), and central large jet >50% of left atrium (LA) area have a predictive value in the diagnosis of MV geometry severe changes. If thresholds are reached these 2D TTE parameters can be used as indications for the 3D TEE.Conclusion 3D TEE allows for detailed assessment of MV geometry and function depended on IMR severity and variant. To make decision of MV surgery 3D TEE is recommended if the following indicators are presented: (1) VCW ≥0,7 cm; PISA radius ≥1,0 cm; central large jet >50% of LA area; LV ESD ≥4,0 cm; (2) VCW ≥0,6 cm; PISA radius = 0,6-0,99 cm; EROA ≥0,3 cm2; RVol≥45 cm; IMR eccentric jet + IMR elliptical orifice.

[Comparative capabilities of the speckle-tracking echocardiography technologiesin two-dimensional and three-dimensional modes in the detection of subclinical cardiotoxicity in patients with breast cancer].

AIM: The study was to assess the deformation properties of the left ventricle (LV) myocardium in patients with breast cancer initially and after anthracycline chemotherapy according to 2D and 3D speckle-tracking echocardiography (STE). MATERIAL AND METHODS: the study included 99 patients with triple negative breast cancer with hypertensionandnormotension. All patients underwent standard transthoracic echocardiography with assessment of systolic function of the LV. To assess the indicator of global longitudinal strain (GLS), as a marker of cardiotoxicity, STE was used in two-and three-dimensional modes. In the three-dimensional STE mode, a new strain parameter, the global area strain (GAS) was evaluated. RESULTS: The study showed that in patients with breast cancer for a more accurate assessment of LV systolic function (ejection fraction) it is advisable to use 3D-echocardiography. A comparative analysis revealed statistically significantly lower values of the GLS according to the three-dimensional mode of STE compared to two-dimensional. The study also evaluated a new strain parameter GAS (%). In patients with breast cancer during ROC analysis with a value of -14.0, the GAS indicator for the development of subclinical cardiotoxicity showed a sensitivity of 81.5% and a specificity of 73.3%. Сonclusion.the advantage of the STE in the three-dimensional mode, in contrast to the two-dimensional mode, is the simultaneous and more accurate assessment of LVEF. The value of the additional parameter of LV deformation the area of deformation requires further study.