Aim To study the right ventricular (RV) myocardial longitudinal systolic strain in patient with RV myocardial infarction (MI), and pulmonary embolism (PE) with and without McConnell’ phenomenon.Material and methods This study included 53 patients with PE (mean age, 59.0±15.1 years; men, 58.5 %) and 30 patients with RVMI (mean age, 61.8±10.9 years; men, 90 %). Longitudinal strain of basal, medial and apical segments of the RV free wall (RVFW) and the interventricular septum (IVS) was determined in the mode of two-dimensional speckle tracking. Ratio of the IVS apical strain to the RVFW strain (apical ratio) was calculated. Systolic excursion of the RVFW apical segment (apical excursion) was measured in the anatomical M-mode from the apical four-chamber view.Results The McConnell’s sign was observed in 23 (43.4 %) of 53 patients with PE and in 16 (53.3 %) of 30 patients with RVMI (p>0.05). Irrespective of the cause for the RV damage, patients with the McConnell’s sign had higher values of the apical ratio (1.69±0.50 vs. 0.95±0.22; p<0.001; cutoff point, 1.18) and apical excursion (7.9±1.7 vs. 2.6±1.4 mm; p<0.001; cutoff point, 5.0 mm). Apical excursion closely correlated with the value of apical ratio (r=0.65; p<0.001) but not with the RVFW apical segment strain (r= –0.07; p>0.05).Conclusion Incidence of the McConnell’s sign was similar in patients with PE and RVMI. McConnell’s sign is based on a passive systolic shift of the RVFW apical segment, which develops during contraction of the IVS apical segment. The greater the ratio of IVS apical segment to RBFW global strain the greater the amplitude of this shift. With the ratio value of 1.18 or more, the systolic shift of RVFW apical segment was >5 mm, which was visually perceived as the McConnell’s sign.
The article describes a case of isolated right ventricular myocardial infarction induced by proximal occlusion of the right coronary artery in a patient with the left type of heart blood supply. A specific feature of the case was detection of the McConnell’s sign, which is considered characteristic of pulmonary artery thromboembolism.
Aim To compare the incidence of cardiovascular complications (CVC) in patients with persistent atrial fibrillation (AF) following thrombus dissolution in the left atrial appendage (LAA) and in patients with persistent AF without preceding LAA thrombosis.Material and methods The main group included 43 patients who had been diagnosed with LAA thrombosis on the first examination, transesophageal echocardiography, and who showed dissolution of the thrombus on a repeated study performed after 7.1+2.0 weeks of the anticoagulant treatment. The control group consisted of 123 patients with a risk score >0 for men without LAA thrombosis and score >1 for women without LAA thrombosis according to the CHA2DS2‑VASc scale. The patients were followed up for 47.3±17.9 months. The following unfavorable outcomes were recorded: all-cause mortality, ischemic stroke or systemic thromboembolism, hemorrhagic stroke or severe bleeding, and myocardial infarction (MI).Results Unfavorable clinical outcomes were observed in 39.5 % of patients in the main group and in 3.3 % of patients in the control group (p<0.001). Furthermore, the incidence of ischemic stroke (relative risk (RR), 12.9; 95 % confidence interval (CI), 2.89–57.2), and MI (RR, 5.72; 95 % CI, 1.09–30.1) was higher in the main group. However, the number of MI cases in both groups and the number of stroke cases in the control group increased during the entire follow-up period, while the number of stroke cases rapidly increased only during the first year of follow-up.Conclusion In patients with persistent AF, the risk of CVC after LAA thrombus dissolution remains significantly higher than in patients with AF without LAA thrombosis.
Aim To study a possibility of using the left atrial strain (LAS) for predicting results of the noninvasive diastolic stress test (DST) in patients with arterial hypertension (AH).Material and methods The study included 98 patients previously diagnosed with AH. As a part of evaluation for complaints of dyspnea, palpitation or pain in the area of the heart, DST and transthoracic echocardiography were performed. Echocardiography included measurements of LAS in the reservoir phase, left atrial volume index (LAVI), pulmonary artery systolic pressure (PASP), and ratio of early filling transmitral flow velocity to mitral annular velocity (Е / е’).Results The DST was negative in 52 patients (group 1) and positive in 46 patients (group 2). Group 2 had greater values of mean Е / е’ (11.0 [9.4; 12.6] vs 9.0 [7.9; 11.1], р=0.0003); LAVI (33.8 [29.0; 40.0] ml /m2 vs 28.0 ml /m2 [25.0; 32.9], р=0.0001); and PASP (29.0 mm Hg [28.0; 30.0] vs 26.0 mm Hg [25.0; 28.0], р<0.0001 were greater, but LAS values were lower (19.0 % [18.0; 21.0] vs 24.0 % [22.0; 28.0], р<0.0001. The predictive capability of LAS with respect of heart failure was higher than of other echocardiographic parameters. The area under the ROC curve (AUC) for the reservoir strain was 0.922 (95 % confidence interval, CI, 0.851–0.967), which was significantly greater than for Е / е’: 0.713 (0.613–0.800); the LAVI was 0.724 (0.624–0.809); and the PASP was 0.764 (0.668–0.844). A LAS value in the reservoir phase less than 22 % predicts a positive result of DST with a probability of 88.9 % (76.5–95.2 %). Higher values of the strain allow expecting a negative DST result with a probability of 88.7 % (77.4–94.7 %).Conclusion If the DST cannot be performed for a noninvasive diagnosis of heart failure with preserved ejection fraction, a positive result of this test can be predicted by a decrease of LAS in the reservoir phase to 21 % or lower. The diagnostic accuracy of this criterion is 88.8 % (81.0–93.6 %).
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