Svetlana Ivanovna Sazonova

Aim. Intrasegmental and intersegmental analysis of thoracic aortic (TA) biomechanics in patients with ascending aortic (AA) aneurysms before and after TA repair using aortic wall ultrasound assessment. Material and methods.  Twenty-three patients with AA aneurysms (≥50 mm) were examined. Eleven (48%) patients had connective tissue dysplasia. All patients underwent 2D multiplane transesophageal echocardiography with the entire TA imaging before and after TA repair. Using 2D speckle-tracking technology, we calculated global peak systolic circumferential strain (GCS, %), GCS normalized to pulse pressure (PP) (GCS/PP), and the β ₂ aortic wall stiffness index in following three TA segments: sinuses of Valsalva, mid AA segment, and descending aorta (DA). Results. In patients with AA aneurysm, before surgery, a significant decrease in strain and increase in stiffness of the aortic wall in the direction from the aortic root to the DA with a maximum in the area of greatest dilation — the middle AA segment (GCS: -1,1% [-2,4; 2,9], p2 : 24 [15,7; 32,6], p2 : 33,5 [15,1; 50,2], pConclusion.  AA aneurysm is accompanied by a pronounced limitation of strain and an increase in aortic wall stiffness with a maximum in the greatest dilation area — the middle AA segment. AA repair creates a new biomechanical phenotype of the TA, manifested by an intersegmental imbalance of strain and aortic wall stiffness between the aortic root, the repair area AA and the arch, and DA.

Background. One of the key components of post-ischemic damage is impaired myocardial contractility and changes in left ventricular geometry, characterized by a decrease in ejection fraction (EF), an increase in left ventricular (LV) volume, a drop in cardiac output (CO), and the appearance of areas of local contractility impairment. Limiting damage, preserving LV contractile function are the main goals of modern cardioprotection. Aim: To assess the relationship between endogenous somatostatin (ES) and echocardiographic parameters during the experiment, as well as the effect of preventive administration of octreotide at doses of 20 and 40 μg/kg/day on systolic function indicators of the LV in an experimental model of prolonged coronary occlusion and reperfusion in rats. Material and Methods . The study included 35 male Wistar rats divided into 3 series of experiments. Series 1 consisted of 12 intact animals (control group), series 2 consisted of 11 rats that were administered octreotide (Pharmstandard JSC) at a dose of 20 mcg/kg/ day for 8 days prior to coronary occlusion, and the third series consisted of 12 animals that received octreotide at a dose of 40 mcg/ kg/day for 8 days prior to coronary occlusion. The model included 45 minutes of occlusion of the left coronary artery and 120 minutes of reperfusion. The animals underwent thoracotomy at the level of the 2nd-3rd ribs, and a ligature was applied to the left descending coronary artery a few millimetres below its origin from the aorta. The duration of coronary occlusion was 45 min. After 45 min of ischaemia, the ligature was removed, and the restoration of blood flow was confirmed by the appearance of epicardial hyperaemia. The duration of reperfusion was 120 minutes. To assess systolic function and changes in ventricular geometry during the experiment, transthoracic echocardiography was performed at 20 and 90 minutes of reperfusion. End-systolic (ESV) and end-diastolic volumes (EDV), ejection fraction (EF), cardiac output (CO), stroke volume (SV) and local contractility impairment index (WMSI) were assessed. Levels of CK-MB (MB fraction of creatine phosphokinase) and endogenous somatostatin were determined by immunoassay (ELISA). Results . Ischemic damage was confirmed by an increase in CK-MB in all series. In the control series, the ES level at 120 minutes of reperfusion increased statistically significantly compared to the baseline (p = 0.016), and a strong correlation was found between ES levels and EDV LV, CO, and SV indices at 90 minutes of reperfusion (r = 0.580; p = 0.048; r = 0.813; p = 0.001 and r = 0.879; p = 0.0001, respectively). The use of octreotide at a dose of 20 μg/kg contributed to an increase in EF by the 90th minute, but did not affect LVEF. The use of a dosage of 40 μg/kg/day led to a decrease in CK-MB levels (p = 0.018) and an improvement in the parameters of pump function and LV contractility. Conclusion. ES concentration is associated with echocardiographic parameters reflecting LV contractile and pumping functions at the end of reperfusion, and the use of the somatostatin analogue octreotide dose-dependently reduces post-ischaemic left ventricular myocardial contractile dysfunction in ischaemic and reperfusion injury.

Background: Recent studies have demonstrated the feasibility and potential of using ECG-synchronized computed tomography (CT) to assess the elastic and deformation properties of the aorta. However, to date, there is insufficient evidence to support the practical use of this approach. We aimed to study the association of CT-derived indices, characterizing ascending aorta elasticity, with the biomechanical properties of intraoperative ascending aorta (AsAo) samples, and to assess its predictive potential in non-surgical patients with ascending aorta dilatation. Methods: In total, 71 patients with AsAo dilatation (>45 mm) and 29 control patients (AsAo diameter < 40 mm) underwent ECG-synchronized CT-aortography. In 42 surgical patients, CT-derived parameters (circumferential strain, compliance, stiffness) were compared with the tensile strength and relative strain of intraoperative aortic samples. In 29 non-surgical patients (diameter 45–50 mm), the predictive potential of CT-derived elasticity indices was determined over 36 months of follow-up. Results: A moderate correlation was found between CT-derived strain/distensibility and ex vivo relative strain. CT data confirmed that dilated aortas are stiffer and less elastic than those in controls. In 29 non-surgical patients, CT elasticity parameters did not demonstrate the ability to predict adverse aneurysm progression. Conclusions: While CT can assess aortic elasticity correlated with ex vivo aortic properties, these parameters lacked prognostic value for the growth in small aneurysms.

Platonov A. S. ¹ , Kunitsyn S. A. ¹ , Popov S. V. ¹ Aim. To assess the impact of coronary atherosclerosis in patients with atrial fibrillation (AF) on the radiographic density of epicardial adipose tissue (EAT), and to determine its prognostic value. Material and methods. The study included 69 patients (median age 47 (40; 58) years; 48 men) with AF (group 1) scheduled for radiofrequency ablation (RFA). The comparison group (group 2) included 37 patients with non-obstructive coronary artery disease (NOCAD) without arrhythmias, and the control group included 20 patients without coronary atherosclerosis and arrhythmias. All patients underwent computed tomography coronary angiography (CTCA), followed by EAT segmentation and calculation of EAT volume and radiographic density. Patients with AF were followed for 12 months after RFA to assess for arrhythmia recurrence. Results. In patients with AF, the EAT volume was significantly higher (141,0 (113,3; 187,5) cm ³ vs 107,5 (86,9; 126,1) cm ³ , pConclusion. In patients with AF and NOCAD, EAT radiographic density are lower compared to patients with AF without coronary atherosclerosis and the control group. In the studied sample of patients, EAT radiographic density did not demonstrate significance in the prognosis of AF recurrence after RFA of arrhythmia.

Introduction. Radionuclide imaging of somatostatin receptor type 2 (SSTR-2) shows great promise as a novel marker of cardiovascular inflammation. However, it is still unclear whether local inflammation and high levels of macrophages in the infarct area that overexpress SSTR-2 are positive or negative factors for myocardial healing. Aim: To assess the relationship between inflammatory biomarkers as indicators of the systemic response to ischemic injury and the local inflammatory response in the myocardium, as measured by SSTR-2-targeted imaging, during the early post-infarction period. Material and Methods . Twenty-three patients with acute primary anterior wall myocardial infarction and ST-segment elevation myocardial infarction (STEMI) were included in the study. On the first day (before percutaneous intervention) and on the fifth day after acute myocardial infarction (AMI), venous blood was collected from all patients to determine hsCRP and IL-6 levels. Five to six days after the acute coronary event, all patients underwent single-photon emission computed tomography (SPECT)/computed tomography (CT) with 99mTc-Tektrotyd. Seven days after the acute coronary event, they underwent myocardial perfusion scintigraphy with 99mTcMIBI at rest. Results . The results of the study indicated a negative correlation between hs-CRP and IL-6 levels on days 1 and 5 with left ventricular ejection fraction (LVEF) and a positive correlation with the summed rest score (SRS). Concurrently, SUVmax exhibited no correlation with hsCRP and IL-6 levels. At the same time SUVmax exhibited a moderate correlation with SRS (r = 0.517, p = 0.011). In the context of univariate linear regression, SUVmax demonstrated no statistically significant impact on hs-CRP and IL-6 levels. Concurrently, the total resting perfusion defect score (SRS) exerted an influence on the alteration in the levels of inflammatory biomarkers. It is also noteworthy that no regression relationship was identified between SUVmax and SRS Conclusion . The findings indicated that the intensity of accumulation of somatostatin analog 99mTc-Tectrotyd in the left ventricular myocardium during the early postinfarction period is not associated with the levels of inflammatory biomarkers. Our findings indicate the activation of cellular and biochemical pathways of the inflammatory cascade. Conversely, the study identified a potential antiinflammatory function of somatostatin receptor type 2 hyperexpression.

Aim. To evaluate the association of computed tomography measurements (volume and density) of epicardial adipose tissue (EAT) with the blood concentration of adipokines, proinflammatory cytokines and catecholamines in patients with atrial fibrillation (AF).Methods. We included 32 patients (median age 58.5 (52.5; 64.0); 18 men) with AF scheduled for radiofrequency ablation. All patients underwent multispiral computed tomographic coronary angiography and segmentation of the EAT. In addition, the concentration of adiponectin, leptin, resistin, interleukins 1b, 6, 8 and methanephrine in the blood was determined by enzyme immunoassay.Results. А negative correlation was established between the volume and the density of EAT (r= - 0.5, pConclusion. The results of the study showed an association between EAT X-ray density and the concentration of leptin, interleukin-8 and metanephrine in AF patients.

Aim. To study the significance of ^99mTc-MIBI washout rate as a scintigraphic marker of mitochondrial dysfunction in predicting the effectiveness of cardiac resynchronization therapy (CRT), and to evaluate the long-term effect of CRT on 99mTc-MIBI clearance and myocardial perfusion.Material and methods. The study included 30 patients with heart failure of non-ischemic origin and indications for CRT. Before CRT, patients underwent ^99mTc-MIBI myocardial perfusion scintigraphy (MPS) at rest. To assess the ^99mTcMIBI washout rate, scanning was performed twice (after 1 hour and 3 hours). In addition, we assessed the severity of perfusion defects, contractility and mechanical desynchrony of the left ventricle (LV). All patients were rehospitalized after six months to assess the effectiveness of treatment and to perform MPS to assess the changes of scintigraphic parameters. According to echocardiography data, patients were divided into responders and non-responders. The criterion for a positive response to CRT was a decrease in LV end-systolic volume by 15% or more and/or an increase in LV ejection fraction by 10% or more.Results. Of all patients included in the study group, 23 (77%) were CRT responders. In this group of patients, the initial LV contractility indices were higher, and mechanical cardiac desynchrony was less pronounced compared to nonresponders. There were no significant differences in the ^99mTc-MIBI washout rate and the severity of LV perfusion defect between responders and non-responders. Only in the responder group a significant decrease in the perfusion defect size was noted 6 months after CRT from 6 (3-9) points to 3 (3-4) points (p=0,0001), in contrast to non-responders (from 5 (4-8) to 6 (4-7), p=0,55). ^99mTc-MIBI clearance decreased in both groups.Conclusion. Baseline ^99mTc-MIBI washout rates did not demonstrate predictive value in determining CRT responders. This intervention has a positive effect on LV perfusion and contractility.

Electrical and mechanical dyssynchrony (MD) underlies left ventricular (LV) contractile dysfunction in patients with heart failure (HF) and left bundle branch block (LBBB). In some cases, cardiac resynchronization therapy (CRT) almost completely reverses LV contractile dysfunction. The LBBB electrocardiographic Strauss criteria and MD assessment were proposed to improve CRT response. However, using these techniques separately does not improve LV contraction in 20–40% of patients after CRT device implantation. We aimed to evaluate whether the combined use of electrocardiography (ECG), speckle-tracking echocardiography (STE) and cardiac scintigraphy could improve the prognosis of CRT super-response in patients with HF and Strauss LBBB criteria during a 6-month follow-up period. The study prospectively included patients with HF, classified as New York Heart Association (NYHA) functional class (FC) II–III in sinus rhythm with Strauss LBBB criteria and reduced left ventricular ejection fraction (LVEF). Before and 6 months after CRT device implantation, ECG, STE and cardiac scintigraphy were performed. The study’s primary endpoint was the NYHA class improvement ≥ 1 and left ventricle end systolic volume decrease > 30% or LVEF improvement > 15% after 6 months of CRT. Based on collected data, we developed a prognostic model regarding the CRT super-response. Out of 54 (100.0%) patients, 39 (72.2%) had a CRT super-response. Patients with CRT super-response were likelier to have a greater S wave amplitude in V₂ lead (p = 0.004), higher rates of global longitudinal strain (GLS) (p = 0.001) and interventricular delay (IVD) (p = 0.005). Only three indicators (S wave amplitude in V₂ lead, GLS and IVD) were independently associated with CRT super-response in univariable and multivariable logistic regression. We created a prognostic model based on the logistic equation and calculated a cut-off value (>0.73). The resulting ROC curve revealed a discriminative ability with an AUC of 0.957 (sensitivity 87.2%; specificity 100.0%). The electrical and mechanical dyssynchrony assessment using ECG, STE and cardiac scintigraphy is useful in the prediction of CRT super-response in patients with HF and Strauss LBBB criteria during a 6-month follow-up period. Our prognostic model can identify patients who are super-responders to CRT.

The article presents an analysis of our own experience in the light of world literature on a wide range of methods for assessing electrical and mechanical cardiac dyssynchrony. Over the past decades, various options have been proposed, ranging from simple and easily performed ones, such as 12-lead electrocardiography, to more complex and expensive methods, such as invasive electroanatomical mapping. Despite promising results, none of the methods has yet become universal, capable of answering all questions. In this regard, the multifaceted process of assessing dyssynchrony continues.

Aim. Search for predictors of early recurrence of atrial tachyarrhythmias after radiofrequency ablation (RFA) of atrial fibrillation (AF).Methods. The study included 57 subjects with persistent (n = 17; 30%) and paroxysmal (n = 40; 70%) forms of AF, admitted for the RFA. All patients underwent transthoracic echocardiography, assessment of deformation of both atria using 2D Strain, computed tomography (CT) with 3D reconstruction of the left atrium (LA). Intraoperatively, high-density voltage mapping of LA was performed before RF pulmonary vein isolation. All patients underwent follow-up after 3 months.Results. Recurrence of atrial tachyarrhythmia after 3 months was recorded in 17.5% of patients. High prevalence of low-amplitude activity zones in the LA and persistent AF were the strongest predictors. The LA reservoir function below 21.7%, the conduction function below 15.7%, the LA stiffness index above 0.314 relative units, the LA volume with the appendage above 121.7 ml, and the LA vertical size according to CT data above 65.5 mm statistically significantly predicted early recurrences of atrial tachyarrhythmias with high sensitivity and specificity.Conclusion. The decreased LA deformation in the reservoir and conductor phase, increased LA stiffness index, the prevalence of low-amplitude activity zones, vertical size and volume of the LA with an auricle according to CT data and persistent AF are significant predictors of early relapses after interventional treatment of AF.