Aim To study ultrasonic characteristics of lung tissue in patients with heart failure with left ventricular (LV) mid-range ejection fraction (HFmEF) and predictive value of these characteristics after reversing acute decompensated heart failure (ADHF).Material and methods Ultrasonic characteristics of lung tissue were studied by prospective observation in 71 patients (mean age, 65.2±3.6 years; men, 64.3 %) with HFmEF (LVEF from 40 to 49 %) following ADHF reversal. Semiquantitative evaluation of B-lines was performed by the E. Picano (2016) method at 5+2 days after hospitalization and on discharge from the hospital. The distance between B-lines was 3 mm (В3 lines) and 7 mm (В7 lines). Patients’ catamnesis was studied for determining the predictive value of lung tissue ultrasonic characteristics for two years since the index hospitalization. Statistical analysis was performed using the McNemar’s χ2 test (for evaluation of linked samples and of changes in the presence/absence of B-lines as determined by lung ultrasound examination (USE)) and the Wilcoxon test (for evaluation of quantitative changes). Differences were considered significant at p<0.05.Results B7-lines characteristic of interstitial component of pulmonary parenchymal edema prevailed in patients with HFmEF. В3-lines characteristic of alveolar edema were found in a small amount. In the anterior-superior segment, B7-lines predominated over B3-lines (80 % vs. 20 %, p<0.01) on the right; however, on the lest, significant differences were not observed (64 % vs. 36 %, p>0.05). In the anterior-inferior segment, В7-lines prevailed over В3-lines on the right (75 % vs. 25 %, p<0.05); however, on the left, the difference was not significant (67 % vs. 33 %, p=0.05). In the lateral superior segment on the right, В7-lines predominated over В3-lines (75 % vs. 25 %, p<0.01); in contrast, on the left, there were no differences (67 % vs. 33 %, p>0.05). In lateral-basal segments on both sides, significant differences were present (73 % vs. 27 % on the right, p<0.05; 72 % vs. 28 % on the lest, p<0.05). The results of lung ultrasound were also used for evaluation of the B-line predictive value in patients with ADHF and mid-range EF on discharge from the hospital after reversal of X-ray and clinical symptoms of pulmonary congestion. In the next two years, 35 patients (49.2 % of sample) were rehospitalized with signs of ADHF (39 hospitalizations, 1.1 hospitalizations per patient). The rehospitalized patients were divided into two subgroups, with an increased number of B-lines and small congestion on discharge (6–15 В-lines) and without signs of congestion (<5 В-lines). For patients with a minimal (small) congestion on pulmonary ultrasound but regression of clinical and X-ray congestion, the number of rehospitalizations was 25 vs. 11 in patients with the number of B7-lines <5. In the ROC-analysis, the area under the curve was 0.706, which corresponded to the expert assessment as “good”. The position sensitivity was 78.6 % and the specificity was 79.7 %.Conclusion “Ultrasonic pulmonary edema syndrome” in patients with LV mid-range ejection fraction after reversing ADHF was characterized by predomination of the interstitial component, despite the absence of X-ray congestion, correlated with the blood level of NT-proBNP measured at the same time, and was associated with rehospitalizations.
Abstract. Clinical and epidemiological and electrocardiographic features of Wolf Parkinson White syndrome in men of military age were studied. The study was a retrospective study with a solid sample of patients. Of the 1,9056 men residents of St. Petersburg between the ages of 18 and 27, Wolf-Parkinson-White syndrome was identified in 107 (0,56%) people. The disease was asymptomatic in 38 (35,5%) patients. All identified individuals with Wolf Parkinson White syndrome, in addition to asthenic Constitution type, which was observed in 68,2% of cases, were assessed for signs of systemic connective tissue involvement. It was found that flat feet, scoliosis or kyphosis, myopia, as well as mitral valve prolapse and abnormally located chords in the left ventricle of the heart are detected in almost every second man of military age. Due to the inability to assess the presence of all signs of systemic connective tissue involvement, the isolation of specific variants of dysplastic phenotypes in patients with Wolf Parkinson White syndrome was not performed. It was found that in the presence of increased dysplastic stigmatization, the clinical course of Wolf Parkinson White syndrome is characterized by a lower number of asymptomatic cases (6,3 and 16,7%, respectively; p0,05), an increase in the frequency of paroxysmal tachyarrhythmias (81,5 and 63,1%, respectively; p0,05) and a high incidence of vegetative-vascular disorders (82,8 and 15,4%, respectively; p0,05).
This retrospective study analyzed the structure of complications and mortality cases in 351 patients (men, n = 199; women, n = 152) aged 3389 years with locally advanced abdominal cancer and different cardiovascular risks in the early postoperative period, and two patient groups were formed. The main group consisted of 81 (23.1%) patients who died in the early postoperative period. The comparison group included 270 (76.9%) patients. In total, 311 (88.6%) patients underwent radical surgical intervention, whereas 40 (11.4%) underwent minimally invasive surgical treatment. Perioperative cardiovascular risk was stratified by calculating cardiac risk indices and using the database of the National Program for Improving the Quality of Surgical Care Myocardial Infarction and Cardiac Arrest. Fatal complications in the early postoperative period after surgical treatment of locally advanced abdominal cancer is significantly more often observed in patients with a more pronounced degree of tumor invasion, lymph node lesions, high class according to the standards of the American Society of Anesthesiologists, reduced functional status, prior hormone therapy, and combined anesthesia. The majority of fatal cases were associated with three complications, i.e., ventricular arrhythmias (53%), acute decompensation of heart failure (46%), and multiple organ failure (43%). Approximately 95% of deaths were associated with increased postoperative cardiovascular risk, and 52% were medium-risk cases. Hospital mortality at low risk was noted in 4.9%, average in 27.8%, and high in 32.7% of the patients. In cases with a favorable course, surgical complications were predominant over cardiovascular ones. The use of calculated cardiac risk indices and database of the National Program for Improving the Quality of Surgical Care Myocardial Infarction and Cardiac Arrest confirmed their high ability to predict the development of cardiovascular complications, which are the leading causes of death in the early postoperative period in patients who underwent surgical interventions for locally advanced abdominal cancer.
РезюмеМиокардиальный «мостик» (ММ) -врожденная аномалия развития коронарных артерий (КА), при которой эпикардиальный сегмент сосуда проходит в толще миокарда. При данной аномалии могут поражаться любые КА, однако наиболее часто она затрагивает переднюю межжелудочковую артерию. Большинство ММ ассоциировано с бессимптомным течением, однако в доступной научной литературе, посвященной проблеме ММ, имеется большое число публикаций, описывающих и доказывающих связь между ММ и симптомами ишемии миокарда, включая случаи развития острого коронарного синдрома и внезапной сердечной смерти.В настоящем обзоре авторами обобщены и представлены современные данные о частоте распространения, патофизиологических механизмах, анатомо-функциональной и клинической оценке, а также лечению ММ. У пациентов с симптомными ММ медикаментозное лечение обычно является эффективной терапией. При ее неэффективности должна проводиться комплексная анатомическая и функциональная оценка ММ для выбора наиболее безопасной и эффективной методики реваскуляризации. Чрескожное коронарное вмешательство с помощью стентов нового поколения в настоящее время рассматривается как стратегия лечения ММ. Аортокоронарное шунтирование проводится при глубоком залегании туннельного сегмента КА под миокардом или при осложнениях, связанных со стентированием. Миотомия является высокоэффективным методом лечения пациентов с ММ при поверхностном залегании интрамиокардиального сегмента КА и выполнении операции в условиях специализированных кардиохирургических центров.Отсутствие общепринятых рекомендаций, очевидно, делает необходимым проведение дальнейших исследований в области рассматриваемой проблемы для разработки и валидизации единых алгоритмов по диагностике и лечению пациентов с ММ.
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