Evaluation of right and left ventricular function in patients with ischemic heart disease complicated by mitral insufficiency.

Aim      To evaluate the right and left ventricular function and their interaction in patients with ischemic heart disease (IHD) complicated with mitral valve insufficiency (MVI) according to data of echocardiography (EchoCG) with the strain in gray scale, vector and diagram analyses.Material and methods  The study included 118 patients evaluated with EchoCG at the preoperative stage of treatment; 71 of these patients had ischemic MVI (group 1) and 47 patients had uncomplicated IHD (group 2 or comparison group). Mean age of patients was 64±10 years. All patients underwent a surgery in an appropriate volume for myocardial revascularization supplemented with mitral valve plasty or replacement in patients with MVI.  Standard EchoCG parameters and data obtained by postprocessing the EchoCG gray-scale images using the strain in gray scale, vector and diagram analyses were evaluated.Results In patients with complicated IHD, both global and local left ventricular (LV) systolic function and the right ventricular (RV) fractional area change (FAC) were significantly decreased. At the same time, there were no significant differences in the tricuspid annular plane systolic excursion (TAPSE) measured in M-mode and in the tricuspid annular systolic wave velocity (VSta), which also characterize the RV systolic function. The global longitudinal strain, the velocities of LV volume change and RV area change, and the long axis change velocity were informative for the right and left chambers, whereas the velocities of LV volume and RV area changes better detected RV disorders. The Pearson's correlation analysis used to identify the most significant parameters of interventricular interaction showed the presence of a strong inverse correlation, in the group of MVI patients, between the RV FAC and the degree of LV diastolic dysfunction (Е / e') - r= -0,62; p=0.000, as well аs the degree of MVI (vena contracta) - r= -0.58; p=0.001. In the comparison group of IHD patients without MVI, the correlation of RV FAC with E / e' was absent (r=0.28; p=0.192). The volume change velocity (dVol / dt) moderately correlated with the RV end-systolic and end-diastolic area in IHD patients but not in IHD patients with MVI. The RV area change velocity (dS / dt) evaluated during systole and diastole moderately significantly correlated with the LV end-diastolic volume.Conclusion      Additional overload of left heart chambers in ischemic MVI is a factor that influences the development of the systemic and pulmonary circuit disorders. Recording and evaluation of global longitudinal strain, LV volume change velocity, and long axis change velocity with simultaneous recording of the segmental myocardial displacement velocity serve as highly informative criteria for disorders of LV and RV function. The vector analysis allows quantitative estimation of the local segmental myocardial function. Decreased velocities of the free RV wall segmental displacements during systole and diastole are characteristic of systolic and diastolic dysfunction in patients with IHD complicated with mitral regurgitation.

[Echocardiography in the Assessment of Intraventricular Flows and Pressure Gradients in Obstructive Hypertrophic Cardiomyopathy].

Aim      To evaluate results of myomectomy by intraventricular pressure gradients (IVPG) and blood flows in patients with obstructive hypertrophic cardiomyopathy (OHCMP).Material and methods  The study included a total of 76 subjects, 42 patients with OHCMP (mean age, 39±7 years) and 34 healthy volunteers (mean age, 41±3 years). Prior to and after myomectomy, transthoracic echocardiography was performed and followed by digital image processing and calculation of IVPG and left ventricular (LV) vortex flows. Vector analysis was used to estimate the myocardial displacement rate (V), vortex flows, and LV apex-to-base pressure gradients.Results The study showed a dynamic decrease in the LV apex-to-outflow IVPG by more than 50% and recovery of myocardial contraction velocity in the septal area (р<0.001). The decrease in LV cavity pressure gradient serves as an index for evaluating the effectiveness of OHCMP correction. Myomectomy reduces the load on the myocardium and abolishes mitral valve regurgitation with improvement of LV blood flows as also evidenced by the dynamics of long axis velocity change during the cardiac cycle (dL / dt) and the myocardial contraction velocity (V).Conclusion      Effectiveness of the surgical correction of OHCMP is based on the dynamics of myocardial contraction velocities, vortex blood flows, and a decrease in LV apex-to-base IVPG.

[PREDICTORS OF RISK OF SURGERIES IN PATIENTS WITH FAILURE OF THE CORONARY CIRCULATION].

The paper analyzes the study of the myocardium in patients with coronary artery disease to identify new predictors of reduction of myocardial contractility. Research carried out on the basis of transthoracic echocardiography and transesophageal on Vivid 7 unit and Vivid-E9 with multifrequency array sensor (3.5-5.5 MHz) by method with the obligatory registration ofstandard ECG. All studies in the form of static and moving images (3-5 cardiocycles Cine-loop) is stored in workstation memory Echopac 7 (GE Vingmed Ultrasound, USA). To assess the functional state of left ventricular myocardium was measured geometry of the cavities of the heart and determines the main central hemodynamics: end-diastolic and end-systolic volume qf the left ventricle, the si:e of the left atrium, the rate of displacement of the myocardium ofivector analysis, stroke vohne, duration of the phases ofthe cardiac cycle, the pressure in the pulmonary circulation. In patients with low reserves, changes are observed during the period of contraction and relaxation. The maximum rate peaks do not coincide, and are significantly reduced compared with the outcome. Acceleration, velocity of bloodflow in the left ventricular cavity shows changing the direction of blood flow--this is nothing other than the power characteristic, which reflects energy during the contraction. Determination of the eddy currents and the velocity characterizes the acceleration of change in the direction of blood flow