Irina A. Kondratyeva

The aim of the study was to investigate the relationship between a decrease in the left ventricular ejection fraction (EF) and traditional ECG signs associated with structural changes of the myocardium (pathological Q wave, ventricular arrhythmias) and relatively new and poorly understood (fragmented QRS complex (fQRS), early repolarization pattern (ERP)) and evaluate their significance for identifying patients with mildly reduced EF (mrEF). The study included 148 patients who were treated and examined at the Almazov Medical Research Center. FQRS, ERP, pathological Q wave, and premature ventricular contractions (PVC) were described in the analysis of the ECG, and the results of echocardiography and statistical data were analyzed: Fisher’s test and chi-square, correlation analysis, and ROC analysis. According to the level of EF, patients were divided into three groups: group 1—patients with low EF (lEF) (less than 40%), group 2—patients with mildly reduced EF (mrEF) (40–49%); group 3—patients with preserved EF (pEF) (more than 50%). In the first group (EF), fQRS was registered in 16 (51.6%) patients, in the mrEF in 16 (18.2%). Pathological Q wave was detected in lEF in 20 (65%), in mrEF in 10 (35%), 15 (18%), in pEF in 15 (18%). The fQRS has been found to be more important in identifying patients with mrEF. In lEF in 2 (6.5%) patients, in mrEF in 2 (6.9%), in pEF in 11 (12.5%). There was no relationship between ERP, the amount of PVC, and the presence of ventricular tachycardia with EF. FQRS is significantly more common occurred with a decrease in EF and may be a marker of a mrEF. Thus, fQRS is associated with mrEF and pay close attention in routine clinical practice to identify patients at high risk of developing systolic dysfunction.

Aim. To study the relationship between a decrease in left ventricular (LV) ejection fraction (EF) and conventional electrocardiographic (ECG) signs associated with myocardial structure changes (pathological Q wave, ventricular arrhythmias), and relatively novel and less studied (fragmented QRS (fQRS), early ventricular repolarization (EVR)) and to evaluate their significance for identifying patients with mildly-reduced EF (mrEF).Material and methods. The study included 148 patients who were treated and examined at the Almazov National Medical Research Center. During the ECG analysis, fQRS, EVR, pathological Q wave, and ventricular arrhythmias (VAs) were assessed. Echocardiography data were analyzed. Statistical processing was carried out, including Fisher and chi-squared test, as well as correlation and ROC analysis.Results. Depending on the EF level, patients were divided into three groups: group 1 — patients with reduced EF (rEF) (50%). In the 1st group (with rEF), fQRS was registered in 16 (51,6%) patients, in the 2nd (with mrEF) — in 13 (44,8%), in the 3rd (with EF >50%) — in 16 (18,2%). Pathological Q wave was detected in the 1st group (rEF) in 20 (65%) patients, in the 2nd (mrEF) — in 10 (35%); in the 3rd (pEF) — in 15 (18%) (p50%) — in 11 (12,5%); the differences were not significant (p=0,5). The relationship of EVR, the number of PVCs and the presence of ventricular tachycardia with EF was not revealed.Conclusion. FQRS is significantly more often observed with a decrease in EF and may be a marker of an mildly-reduced EF. There were no significant correlations between EVR and EF. There was also no relationship between VAs and LV systolic dysfunction.

Isolated sphenoid sinusitis (ISS) is a group of pathologies characterized by inflammation in one or both sphenoid sinuses. The gold standard for analyzing and diagnosing ISS is computer tomography. Many researchers have discussed the treatment of patients with ISS variants such as fully opacified sinus, mostly with surgery. A retrospective analysis of clinical data of 59 patients (21 male (35%), 38 female (65%)) with ISS, who were treated in the Otorhinolaryngological Department of Pavlov First Saint Petersburg State Medical University between January 2017 and January 2020, was conducted. All patients were in the first stage of the same medical therapy. In cases where there was no recovery, these patients were referred to surgery. For the control group, we analyzed patients without any disorders according to CT-scan examination. After analyzing the obtained clinical and radiological data, we found indicators that were common in patients who did not recover after medical therapy. According to the reverse regression method statistical model, in male patients with a diffuse headache and nasal discharge it was shown that medical therapy was highly effective (more than 78%). The presence of nasal septum deviation and adenoids in male and female patients leads to the highest risk of surgical treatment (83% probability of the logistic model). The detailed analysis of CT-scans and the complaints of patients with ISS can be the key to determining the preferred therapy choice. Not all cases need to have an endoscopic opening of the sphenoid sinus, according to our research.

The article analyzes the data of elderly patients with airway cancer before and after surgery. To reduce the mortality of cancer patients in the postoperative period, it is necessary to identify markers that can predict the deterioration of the patient's condition. The study involved 83 patients, who recorded 216 parameters before and 47 parameters after surgery. The data contain not only general laboratory parameters, but also blood gas parameters, hemodynamic data and autonomic indices, metabolic parameters and cardiorespiratory stress tests at various levels of exercise. Statistical data analysis is carried out using the SPSS program and is based on the following methods: one-sided Kolmogorov-Smirnov test, Mann-Whitney test, chi-square test and the use of logistic regression to build a multivariate model. The investigated variable is the result of the operation, which can take the following values: no complications, complications after surgery, death. The result of this analysis, namely the determination of mortality markers, will determine which of the patients should not undergo surgery, and who need special medical supervision in the postoperative period.