Objective: We suggested: 1) patients with idiopathic pulmonary hypertension (IPAH) have active factors which could damage not only the pulmonary but systemic arteries too as in arterial hypertensive patients; 2) if these changes were present, they might correlate with other parameters influencing on the prognosis. This study is the first attempt to use cardioankle vascular index (CAVI) for the evaluation of systemic arterial stiffness in patients with IPAH. Methods: A total of 112 patients were included in the study: group 1 consisted of 45 patients with new diagnosed IPAH, group 2 included 32 patients with arterial hypertension, and in the control group were 35 healthy persons adjusted by age. Right heart catheterization, ECG, a 6-minute walk test (6MWT), echocardiography, blood pressure (BP) measurement and ambulatory BP monitoring, pulse wave elastic artery stiffness (PWVe; segment carotid-femoral arteries) and muscular artery stiffness (PWVm; segment carotid-radial arteries), CAVI, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) level were provided. The Spearman correlation, a linear regression and multivariable binary logistic analysis were performed to indicate the predictors associated with PWV and CAVI. Results: The groups were adjusted for principal characteristics influenced on arterial stiffness. IPAH patients had significantly (P<0.001 for all) shorter 6MWT distance and higher Borg dyspnea score than the patients with arterial hypertension (systolic/diastolic BP = 146.1 ±10.7/94.2±9.8 mmHg) and the control group = 330.2±14.6 vs 523.8±35.3 and 560.9±30.2 m respectively and 6.2±1.8 vs 1.2±2.1 and 0.9±2.8 points. The PWVm and PWVe were the highest in hypertensive patients (10.3±1.5 and 11.42±1.70 m/s). The control group and IPAH did not have significant differences in aorta BP, but PWVm/PWVe values were significantly (P<0.003/0.008) higher in IPAH patients than in the control group (8.1±1.9/8.49±1.92 vs 6.63±1.34/7.29±0.87 m/s). The CAVIs on both sides were significantly lower in the healthy subjects (5.91±0.99/5.98±0.87 right/left side). Patients with IPAH did not differ from the arterial hypertension patients by CAVIs in comparison with the control group (7.40±1.32/ 7.22±1.32 vs 7.19±0.78/7.2±1.1 PWVe) did not correlate with any parameters except uric acid. PWVm correlated with uric acid (r=0.58, P<0.001), NT-proBNP (r=0.33, P=0.03) and male gender (r=0.37, P=0.013) at Spearman analysis, but not at multifactorial linear regression analysis. The CAVI correlated with age and parameters characterized functional capacity (6MWT distance) and right ventricle function (NT-proBNP, TAPSE) at Spearman analysis and with age and TAPSE at multifactorial linear regression analysis. At binary logistic regression analysis CAVI > 8.0 at right and/or left side had a correlation with age, 6MWT distance, TAPSE, but an independent correlation was only with age (β=1.104, P=0.008, CI 1.026-1.189) and TAPSE (β=0.66, P=0.016, CI 0.474-0.925). Conclusion: In spite of equal and at normal range BP level, the age-adjuste...

Objective This study is the first attempt to use cardio-ankle vascular index (CAVI) for the evaluation of systemic arterial stiffness in patients with IPAH. Methods 112 patients were included in the study: group 1 – 45 patients with new diagnosed IPAH, group 2 – 32 patients with arterial hypertension, control group – 35 healthy persons adjusted by age. Right heart catheterization, ECG, a 6-minute walk test (6 MWT), echocardiography, blood pressure (BP) measurement and ambulatory BP monitoring, pulse wave elastic artery stiffness (PWVe) [segment carotid-femoral arteries] and muscular artery stiffness (PWVm) [segment carotid-radial arteries], CAVI, N-terminal pro-B-type natriuretic peptide (NT-proBNP) level were provided. The Spearman correlation, a linear regression and multivariable binary logistic analysis were performed to indicate the predictors associated with PWV and CAVI. Results The PWVm and PWVe were the highest in hypertensive patients – 10.3±1.5 and 11.42±1.70 m/s. The control group and IPAH did not have significant differences in aorta BP, but PWVm/PWVe values were significantly (P&lt;0.003/0.008) higher in IPAH patients than in the control group - 8.1±1.9/8.49±1.92 vs 6.63±1.34/7.29±0.87 m/s. The CAVIs on both sides were significantly lower in the healthy subjects (5.91±0.99/5.98±0.87 right/left side). Patients with IPAH did not differ from the arterial hypertension patients by CAVIs in comparison with the control group - 7.40±1.32/7.22±1.32 vs 7.19±0.78/7.2±1.1. PWVe did not correlate with any parameters except uric acid. PWVm correlated with uric acid (r=0.58, P&lt;0.001), NT-proBNP (r=0.33, P=0.03) and male gender (r=0.37, P=0.013) at Spearman analysis, but not at multifactorial linear regression analysis. The CAVI correlated with age and parameters characterized functional capacity (6 MWT distance) and right ventricle function (NT-proBNP, TAPSE) at Spearman analysis and with age and TAPSE at multifactorial linear regression analysis. At binary logistic regression analysis CAVI &gt;8.0 at right or/and left side had a correlation with age, 6MWT distance, TAPSE, but an independent correlation was only with age (β=1.104, P=0.008, CI 1.026–1.189) and TAPSE (β=0.66, P=0.016, CI 0.47–0.93). Conclusion In spite of equal and at normal range BP level the age adjusted patients with IPAH had significantly stiffer arteries than the healthy persons and they were comparable with the arterial hypertensive patients. Arterial stiffness evaluated by CAVI correlated with age and TAPSE in IPAH patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Academy of Medical science of Ukraine

The article is devoted to cardiac resynchronization therapy (CRT) – the method for chronic heart failure treatment with biventricular pacing. The article examines the history of the method development from the first attempts to eliminate heart dyssynchrony to the present. Over the past 20 years, the method has been improved both in technical terms and in terms of the formation of modern indications for its application. Based on the results of randomized clinical trials to study the effectiveness of the method, the improvement of the testimony and criteria for the selection of patients for the CPT is shown. A clinical case of successful CRT in a patient with cardiomegaly, severe heart failure and complete left bundle brunch block is described.

Прогноз та його предиктори при легеневій гіпертензії, асоційованій із захворюваннями сполучної тканини (дані першого українського реєстру) Резюме. Метою дослідження було: провести аналіз структури пацієнтів, які обстежувалися у спеціалізованому центрі; оцінити українську реальність щодо виживання хворих на легеневу артеріальну гіпертензію (ЛАГ) та хронічну тромбоемболічну легеневу гіпертензію (ХТЕЛГ), які проходили лікування в референтному центрі (раніше ми не мали українських даних); визначити предиктори смерті.

Nowadays the diagnosis and prognosis of myocarditis is one of the most pressing, complex and incompletely solved problems in modern cardiology, that exist due to the large polymorphism of clinical manifestations of this disease and because of the lack of specific symptoms and diagnostic criteria. In most cases, the occurrence of heart failure, pain, heart rhythm and conduction disorders or other clinical manifestations are observed on the 2nd week after the onset of infectious disease, but inflammatory heart disease may not have a clear connection with the infection. Among the main methods used to diagnose myocarditis in clinical practice are electrocardiography (ECG), Holter monitoring (HM) ECG, echocardiography (echocardiography) and speckle-tracking (ST) echocardiography, cardiac magnetic resonance (CMR) imaging and endomyocardial biopsy. ECG and HMECG are highly informative methods for detection, prediction and dynamic monitoring of frequent complications of myocarditis – arrhythmias and conduction disorders. Two-dimensional echocardiography is a mandatory technique for assessing myocardial contractility that allows to assess the size of the heart chambers, systolic and diastolic function, global and regional contractility, the presence of thrombosis in the cavities, pericardial effusion and, most importantly. In recent years, there has been increasing data on the use of CT echocardiography for the diagnosis of myocarditis, based on the assessment of myocardial deformation and its rate in the longitudinal, radial and circular directions. Contrast-enhanced magnetic resonance imaging of the heart is non-invasive and one of the most informative methods for detecting signs of inflammatory myocardial damage. CMR allows to visualize the anatomy, study the structure and characterize the tissue of the heart, determine the functional features of the atria and ventricles. However, the gold standard for verifying the diagnosis of myocarditis to this day remains endomyocardial biopsy. Laboratory methods of diagnosis are additional researches, that in a complex with instrumental methods allow to estimate changes of myocardial inflammatory process at long supervision.