scholarly journals Comparison of QRSarea and left ventricular activation time during left bundle branch pacing and left ventricular septal pacing

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
LIB Heckman ◽  
JGK Luermans ◽  
K Curila ◽  
AMW Van Stipdonk ◽  
S Westra ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Funding Sources ◽  
Septal Pacing ◽  
Ventricular Activation ◽  
Intrinsic Conduction ◽  
Qrs Morphology ◽  
Conversion Matrix ◽  
Qrs Duration ◽  
Normal Cardiac Function ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture). Objective To compare acute electrocardiographic (ECG) and vectorcardiographic (VCG) effects of LBBP and LVSP as compared to intrinsic conduction. Methods In 50 patients with normal cardiac function and pacemaker indication for bradycardia, ECG characteristics of LBBP and LVSP were evaluated during RVSP and pacing at various depths in the septum: starting at the RV side of the septum: the last position with QS morphology, the first position with r’ morphology, LVSP and – in patients where LBB capture was achieved – LBBP. From the ECG’s QRS duration and QRS morphology in V1, and the stimulus-LVAT interval were measured. After conversion of the ECG into VCG (Kors conversion matrix), QRS area was calculated. Results In LVSP, QRS area significantly decreased from 82 ± 29 µVs during RVSP to 46 ± 12 µVs during LVSP. In patients where LBB capture was achieved QRS area significantly decreased from 78 ± 23 µVs to 38 ± 15 µVs in LBBP. In patients with LBB capture, QRS area was significantly smaller during LBBP compared to LVSP (figure A), but LVAT was not significantly different (figure B, p = 0.138). In patients with normal ventricular activation where LBBP was achieved (n = 20), QRS area was significantly larger during LVSP (48 ± 17) compared to LBBP (37 ± 16), the latter being not significantly different from normal intrinsic ventricular activation (35 ± 19 µVs). Conclusions ECG and VCG indices demonstrate that ventricular dyssynchrony is comparable but slightly more synchronous during LBBP compared to LVSP. Abstract Figure. QRS area and S-LVAT in LVSP and LBBP

scholarly journals Comparing Ventricular Synchrony in Left Bundle Branch and Left Ventricular Septal Pacing in Pacemaker Patients

2021 ◽  
Vol 10 (4) ◽  
pp. 822
Author(s):  
Luuk I.B. Heckman ◽  
Justin G.L.M. Luermans ◽  
Karol Curila ◽  
Antonius M.W. Van Stipdonk ◽  
Sjoerd Westra ◽  
...  
Keyword(s):  
Left Ventricular ◽  
Activation Time ◽  
Ventricular Synchrony ◽  
Septal Pacing ◽  
Ventricular Activation ◽  
Qrs Morphology ◽  
Conversion Matrix ◽  
Qrs Duration ◽  
The Right ◽  
Electrophysiological Effects

Background: Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture). Objective: To investigate acute electrophysiological effects of LBBP and LVSP as compared to intrinsic ventricular conduction. Methods: Fifty patients with normal cardiac function and pacemaker indication for bradycardia underwent LBBAP. Electrocardiography (ECG) characteristics were evaluated during pacing at various depths within the septum: starting at the right ventricular (RV) side of the septum: the last position with QS morphology, the first position with r’ morphology, LVSP and—in patients where left bundle branch (LBB) capture was achieved—LBBP. From the ECG’s QRS duration and QRS morphology in lead V1, the stimulus- left ventricular activation time left ventricular activation time (LVAT) interval were measured. After conversion of the ECG into vectorcardiogram (VCG) (Kors conversion matrix), QRS area and QRS vector in transverse plane (Azimuth) were determined. Results: QRS area significantly decreased from 82 ± 29 µVs during RV septal pacing (RVSP) to 46 ± 12 µVs during LVSP. In the subgroup where LBB capture was achieved (n = 31), QRS area significantly decreased from 46 ± 17 µVs during LVSP to 38 ± 15 µVs during LBBP, while LVAT was not significantly different between LVSP and LBBP. In patients with normal ventricular activation and narrow QRS, QRS area during LBBP was not significantly different from that during intrinsic activation (37 ± 16 vs. 35 ± 19 µVs, respectively). The Azimuth significantly changed from RVSP (−46 ± 33°) to LVSP (19 ± 16°) and LBBP (−22 ± 14°). The Azimuth during both LVSP and LBBP were not significantly different from normal ventricular activation. QRS area and LVAT correlated moderately (Spearman’s R = 0.58). Conclusions: ECG and VCG indices demonstrate that both LVSP and LBBP improve ventricular dyssynchrony considerably as compared to RVSP, to values close to normal ventricular activation. LBBP seems to result in a small, but significant, improvement in ventricular synchrony as compared to LVSP.

Direct capture of the left bundle branch compared to left bundle branch area pacing deteriorates interventricular synchrony but improves left ventricular lateral wall depolarization duration

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
K Curila ◽  
P Jurak ◽  
P Waldauf ◽  
J Halamek ◽  
J Karch ◽  
...  
Keyword(s):  
Lateral Wall ◽  
Left Ventricular ◽  
Public Institution ◽  
Research Centre ◽  
Direct Capture ◽  
Funding Sources ◽  
Lead Placement ◽  
Septal Pacing ◽  
Ventricular Activation ◽  
Ventricular Depolarization

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This paper was supported by the Charles University Research Centre program No. UNCE/MED/002 and 260530/SVV/2020 Background Direct and indirect pacing of the left bundle branch are novel pacing techniques preserving LV synchrony. Aim of the study was to compare differences in ventricular activation between them using an UHF-ECG. Methods The left septal lead placement was done in 68 patients with bradycardia. Four distinct ventricular captures were described; nonselective LBBp (nsLBBp), selective LBBp (sLBBp), paraLBBp and left bundle branch area capture (LBBap). The timings of local ventricular activations and local depolarization durations were displayed by the UHF-ECG. e-DYS was calculated as a difference between the first and last activation. Results There were 35 nsLBBp, 21 paraLBBp, 12 sLBBp and 96 LBBap obtained in 68 patients.  The nsLBBp compared to LBBap caused worse interventricular synchrony (e-DYS -23 ms (-28;-18) vs -12 ms (-17;-8), p < 0.001), but improved LV lateral wall depolarization duration. The sLBBp, nsLBBp and paraLBBp differed in e-DYS; -31 ms (-38;-24) vs -23 ms (-28;-17) vs -13 ms (-20;-7), p < 0.01 between each of them. Their left ventricular depolarization durations were the same, but they were longer when pacing resulted in the left axis deviation. If the direct capture of the LBB was not confirmed (LBBap), LV depolarization duration was deteriorated irrespective of the QSR morphology in the V1 or RWPT in the V5. Examples of UHF-ECG maps during LBBap, paraLBBp and nsLBBp are shown in Figure 1. Conclusions The direct capture of the left bundle branch deteriorates interventriclar synchrony but improves the depolarization duration of the left ventricular lateral wall compared to left ventricular myocardial septal pacing. Abstract Figure 1

Feasibility and cardiac synchrony of permanent left bundle branch pacing through the interventricular septum

EP Europace ◽  
2019 ◽  
Vol 21 (11) ◽  
pp. 1694-1702 ◽  
Author(s):  
Xiaofeng Hou ◽  
Zhiyong Qian ◽  
Yao Wang ◽  
Yuanhao Qiu ◽  
Xing Chen ◽  
...  
Keyword(s):  
Interventricular Septum ◽  
Left Ventricular ◽  
Spect Myocardial Perfusion ◽  
Septal Pacing ◽  
Pacing Lead ◽  
Qrs Duration ◽  
Mechanical Synchrony ◽  
R Wave Amplitude ◽  
Normal Cardiac Function

Abstract Aims Left bundle branch pacing (LBBP) recently emerges as a novel pacing modality. We aimed to evaluate the feasibility and cardiac synchrony of permanent LBBP in bradycardia patients. Methods and results Left bundle branch pacing was successfully performed in 56 pacemaker-indicated patients with normal cardiac function. Left bundle branch pacing was achieved by penetrating the interventricular septum (IVS) into the left side sub-endocardium with the pacing lead. His-bundle pacing (HBP) was successfully performed in another 29 patients, 19 of whom had right ventricular septal pacing (RVSP) for backup pacing. The QRS duration, left ventricular (LV) activation time (LVAT), and mechanical synchrony using phase analysis of gated SPECT myocardial perfusion imaging were evaluated. Paced QRS duration in LBBP group was significantly shorter than that in RVSP group (117.8 ± 11.0 ms vs. 158.1 ± 11.1 ms, P < 0.0001) and wider than that in HBP group (99.7 ± 15.6 ms, P < 0.0001). Left bundle branch potential was recorded during procedure in 37 patients (67.3%). Left bundle branch pacing patients with potential had shorter LVAT than those without potential (73.1 ± 11.3 ms vs. 83.2 ± 16.8 ms, P = 0.03). Left bundle branch pacing patients with potential had similar LV mechanical synchrony to those in HBP group. R-wave amplitude and capture threshold of LBBP were 17.0 ± 6.7 mV and 0.5 ± 0.1 V, respectively at implant and remained stable during a mean follow-up of 4.5 months without lead-related complications. Conclusion Permanent LBBP through IVS is safe and feasible in bradycardia patients. Left bundle branch pacing could achieve favourable cardiac electrical and LV mechanical synchrony.

scholarly journals Prospective evaluation of the learning curve and electrical characteristics of left bundle branch area pacing

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L I B Heckman ◽  
J G L M Luermans ◽  
M Jastrzebski ◽  
A M W Stipdonk ◽  
S Westra ◽  
...  
Keyword(s):  
Learning Curve ◽  
Pearson Correlation ◽  
Peak Time ◽  
Electrical Characteristics ◽  
Funding Sources ◽  
Narrow Qrs ◽  
Av Conduction ◽  
Ventricular Activation ◽  
Conversion Matrix ◽  
Qrs Duration

Abstract Background Left bundle branch area pacing (LBBAP) has recently been introduced as a physiological pacing technique with a synchronous ventricular activation. Objective To prospectively evaluate the feasibility and learning curve, as well as the electrical characteristics of LBBAP. Methods In 80 consecutive LBBAP pacemaker patients, ECG characteristics during intrinsic rhythm, RV septum pacing (RVSP) and LBBAP were evaluated. From the ECG's QRS duration and LVAT (stimulus to V6 R-wave peak time, RWPT) were measured. Also, the left bundle branch potential (LBBpot) to V6 RWPT interval was measured and compared to the LVAT. After conversion of the ECG into VCG (Kors conversion matrix), QRS area, as measurement for electrical dyssynchrony, was calculated. Results Permanent lead implantation was successful in 77/80 patients (96%) undergoing an attempt at LBBAP. LBBAP lead implantation time as well as fluoroscopy time were significantly shorter during last 25% of implantation compared to first 25% of implantations (17±5 min vs. 33±16 min and 12±7 min vs. 21±13 min, respectively, panel A and B). LBB capture was obtained in 54/80 patients (68%). In 36/45 patients (80%) with intact AV conduction and narrow QRS an LBBpot was present. The mean interval between the LBBpot and the onset of QRS was 22±6 ms. In the patients with narrow QRS (n=45), QRS duration increased significantly during both RVSP (139±24 ms) and LBBAP (123±21 ms), compared to intrinsic rhythm (95±13 ms). QRS area on the other hand, increased during both RVSP (73±20 μVs) but decreased during LBBAP (41±15 μVs), to values close to intrinsic rhythm (32±16 μVs, panel C). For all patients, QRS area was significantly lower in patients with LBB capture compared to patients without capture (43±18 μVs vs 54±21 μVs, respectively). In patients with LBB capture (n=54), LVAT was significantly shorter compared to patients without LBB capture (75±14 vs. 88±9 ms, respectively). In the patients with LBB capture, there was a significant correlation between the LBBpot – V6 RWPT and S – V6 RWPT intervals (Pearson correlation 0.739, P&lt;0.001). Conclusion LBBAP is a safe and feasible technique, with a clear learning curve that seems obtained after ± 40–60 implantations. LBB capture is obtained in two-thirds of patients. Although QRS duration remains prolonged, LBBAP largely restores ventricular electrical synchrony to values close to intrinsic (narrow QRS) rhythm. FUNDunding Acknowledgement Type of funding sources: None.

862Syncav with multipoint pacing improves acute left ventricular hemodynamics

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Chow ◽  
P Waddingham ◽  
T Betts ◽  
J Mangual ◽  
N Badie ◽  
...  
Keyword(s):  
Biventricular Pacing ◽  
Pressure Change ◽  
Left Ventricular ◽  
Maximum Pressure ◽  
Conduction Time ◽  
Multipoint Pacing ◽  
Surface Ecg ◽  
Intrinsic Conduction ◽  
Qrs Duration ◽  
Incremental Improvement

Abstract Funding Acknowledgements Abbott Introduction SyncAV has been shown to improve electrical synchronization by automatically adjusting atrioventricular delay (AVD) according to the intrinsic atrioventricular conduction time. Additional incremental electrical synchronization may be gained by the addition of second left ventricular (LV) pulse with MultiPoint Pacing (MPP). While the electrical synchronization benefits of SyncAV have been previously explored, there has been no assessment of the acute hemodynamic impact of SyncAV with or without MPP. Objective  Evaluate the acute LV hemodynamic impact of SyncAV with and without MPP. Methods Heart failure patients with LBBB and QRS duration (QRSd) &gt; 140 ms undergoing CRT-P/D implant with a quadripolar LV lead were enrolled in this prospective study. A guidewire or catheter with pressure transducer was placed in the LV chamber and the maximum pressure change (dP/dtmax) was recorded during the following pacing modes:  intrinsic conduction, conventional biventricular pacing with SyncAV (BiV + SyncAV), and MPP with SyncAV (MPP + SyncAV). Twelve-lead surface ECG was used to determine the patient-tailored SyncAV offset that minimized QRSd. Results Twenty-seven patients (67% male, 44% ischemic, 30 ± 7% ejection fraction) completed the acute recordings. Relative to the intrinsic QRSd of 163 ms, BiV + SyncAV reduced QRSd by 21.5% to 124 ms (p &lt; 0.001 vs. intrinsic) and MPP + SyncAV reduced QRSd by 26.6% to 120 ms (p &lt; 0.05 vs. BiV + SyncAV). Beyond electrical synchronization, SyncAV significantly improved acute hemodynamics. Relative to the intrinsic dP/dtmax of 842 mmHg/s, BiV + SyncAV elevated dP/dtmax by 6.3% to 900 mmHg/s (p &lt; 0.001 vs. intrinsic) and MPP + SyncAV elevated dP/dtmax by 8.8% to 926 mmHg/s (p &lt; 0.005 vs. BiV + SyncAV). Despite both QRSd and dP/dtmax improvement with SyncAV and MPP, correlation between electrical and hemodynamic measurements was poor (R2 = 0.0 for BiV + SyncAV, R2 = 0.1 for MPP + SyncAV). Conclusion SyncAV may significantly improve acute LV hemodynamics in addition to electrical synchrony in LBBB patients. Further incremental improvement was achieved by combining SyncAV with MPP. Abstract Figure.

P1242ECG predictors of outcome in non-left bundle branch block cardiac resynchronization therapy patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A M W Van Stipdonk ◽  
M Dural ◽  
F Salden ◽  
I A H Ter Horst ◽  
H J G M Crijns ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Patient Selection ◽  
Primary Endpoint ◽  
Left Bundle Branch Block ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Qrs Morphology ◽  
Qrs Duration

Abstract Background The effectiveness of cardiac resynchronization therapy (CRT) in patients without left bundle branch block (non-LBBB) QRS morphology is limited, compared to those with LBBB. Still, a substantial part of these patients can benefit from therapy and additional selection criteria are needed to identify these patients. Purpose To evaluate the association of additional baseline 12-lead ECG features; with clinical and echocardiographic outcomes in CRT-treated non-LBBB patients. Methods Pre-implantation 12-lead ECGs from 790 consecutive non-LBBB CRT patients from 3 implanting centres in the Netherlands were evaluated for the presence of predefined ECG parameters. QRS morphology (right bundle branch block and intraventricular conduction delay), QRS duration (≥/<150ms), QRS area (≥/<109μVs), left ventricular activation time ((≥/<125ms), and the presence of fragmented QRS (fQRS). The association with the primary endpoint, the combination of left ventricular assist device implantation, cardiac transplantation and all-cause mortality, was evaluated. Results There was a significantly lower occurrence of the primary endpoint in non-LBBB patients with QRS area ≥109 μVs (p<0.001) and in those without fQRS present (p=0.004) (figure 1). Figure 1 Conclusion A large QRS area and the absence of fQRS are positively associated to event free survival in non-LBBB patients treated with CRT. Whereas currently used patient selection cut-off QRS duration is not associated to outcome in these patients. These data may provide additional value for the non-LBBB patient selection for CRT and warrant prospective evaluation of these ECG features. Acknowledgement/Funding None

P6017Permanent left bundle branch area pacing for atrioventricular block: feasibility, safety and acute effect

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
X F Li ◽  
H Li ◽  
X H Fan ◽  
W T Ma ◽  
X H Ning ◽  
...  
Keyword(s):  
Acute Effect ◽  
Left Ventricular ◽  
Ventricular Pacing ◽  
Pacing Threshold ◽  
Lead Perforation ◽  
Echocardiographic Parameters ◽  
Qrs Morphology ◽  
Adequate Evaluation ◽  
Qrs Duration

Abstract Background Left bundle branch area pacing (LBBAP), lacks adequate evaluation for AVB. Purpose We aimed to assess the feasibility, safety, and acute clinical outcomes of permanent LBBAP in patients with AVB. Methods We retrospectively recruited AVB patients with indication for ventricular pacing who had underwent LBBAP from May to Sep. 2018. ECG characteristics, pacing parameters, echocardiographic parameters and adverse events were evaluated during follow-up. Successful LBBAP was defined as the paced QRS morphology of RBBB pattern and QRSd less than 130ms. Results A total of 33 patients were involved in this study (mean age: 55.1±18.5 years; 66.7% male, 48.4% with bundle branch block,BBB). LBBAP was successfully performed in 90.9% (30/33) of all patients. The mean capture threshold of LBBAP was 0.76±0.26 V/0.4 ms during the procedure and 0.64±0.20 V/0.4ms at 3-month follow-up. The paced QRSd was 112.8±10.9 ms during the procedure and 116.8±10.4ms at 3-month follow-up. Baseline left or right BBB was corrected by LBBAP (153.3±27.8 ms vs. 122.2±9.9 ms) with a success rate of 68.7% (11/16). One ventricular septal lead perforation occurred soon after the procedure and LBBAP was successfully repeated by lead revision. Cardiac function and left ventricular synchronization at three-month follow-up presented slightly improvement as compared with baseline. Table 1. Complications and changes in pacing parameters within 3 months after LBBAP Pacing parameters LBBAP (N=30) During the procedure Before discharge 3-month follow up Sensing amplitude, mV 14.4±5.1 15.8±11.7 14.6±4.6 Pacing [email protected], V 0.76±0.26 0.59±0.16 0.64±0.20 Pacing impedance, Ω 691.7±133.8 588.0±79.3 554.7±93.7 Paced QRSd at [email protected] ms output, ms 112.8±10.9 114.4±14.2 116.8±10.4 VP, % NA NA 79.4±24.6 Complications, n (%) 1 (3.3) 0 (0.0) 0 (0.0) Infection, n (%) 0 (0.0) 0 (0.0) 0 (0.0) Septal perforation, n (%) 1 (3.3) 0 (0.0) 0 (0.0) Dislodgement, n (%) 0 (0.0) 0 (0.0) 0 (0.0) QRSd, QRS duration; VP, ventricular pacing percentage. Figure 1. Characteristics of LBBAP Conclusion Permanent LBBAP yielded stable threshold, narrow QRSd and preserved left ventricle synchrony with few complications. Our preliminary results indicate that LBBAP holds promise as an attractive physiological pacing strategy for AVB.

Causes of sudden cardiac death in young athletes and nonathletes: systematic review and meta-analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
F D"ascenzi ◽  
F Valentini ◽  
S Pistoresi ◽  
F Frascaro ◽  
P Pietro ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Ventricular Hypertrophy ◽  
Total Population ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Normal Heart ◽  
Funding Sources ◽  
Artery Disease ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. The etiology of sudden cardiac death (SCD) in young people is still debated. The aim of this meta-analysis was to identify the most frequent causes of SCD in individuals aged ≤35 years, the differences between athletes and nonathletes and among geographic areas. Methods.  Studies published between 01/01/1990 and 01/31/2020 and evaluating post-mortem the etiology of SCD in young individuals (≤35 years) were included. Individuals were divided in athletes and nonathletes. Studies that did not report separately data between athletes and nonathletes were excluded. Results. Thirty-four studies met the inclusion criteria and a total population of 5,060 victims of SCD were analysed (2,890 athletes, 2,170 nonathletes). Structurally normal heart, hypertrophic cardiomyopathy (HCM), idiopathic left ventricular hypertrophy, and anomalous origin of coronary arteries (AOCA) were the most frequent causes of SCD in athletes while coronary artery disease (CAD), arrhythmogenic cardiomyopathy (ACM), and channelopathies were frequent causes of SCD in nonathletes. The number of SCDs due to ischemic heart disease (19.6% vs. 9.1%, p = 0.009), ACM (11.5% vs. 4.7%, p = 0.03) and channelopathies (8.4% vs. 1.9%, p = 0.02) was higher in nonathletes comparing with athletes. SCD due to non-ischemic left ventricular scar (5.1% vs. 1.1%, p = 0.01) was more frequent in athletes. HCM (p = 0.01) and AOCA (p = 0.004) were more frequently cause of SCD in US while ACM (p = 0.001), structurally normal heart (p = 0.02), and channelopathies (p = 0.02) in Europe. Conclusions. Structurally normal heart, HCM, AOCA were frequent causes of SCD in athletes while CAD, ACM and channelopathies in nonathletes. The causes of SCD differ between US and Europe.

scholarly journals Influence of plasma ST2 level on myocardial remodeling in NSTEMI

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
VI Maslovskyi ◽  
IA Mezhiievska
Keyword(s):  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Functional Condition ◽  
Left Ventricular ◽  
Myocardial Remodeling ◽  
World Medical Association ◽  
Ventricular Contractility ◽  
Funding Sources ◽  
The World ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Objective to establish a relationship between types of myocardial remodeling and plasma ST2 levels in NSTEMI. Methods. 90 patients with NSTEMI were examined. Features of structural and functional condition of the myocardium were determined by echocardiography in M-, B, and D-modes. All of research corresponding to the principles of the Declaration of Helsinki of the World Medical Association. Results. It is established, that relatively low level (RL) corresponded to 24, the relatively moderate level (RM) to 44, and the relatively high (RH) level of ST2 to 24 individuals, respectively. For patients in the main group, these levels were &lt; 26 and &gt; 56 ng / ml, respectively. Instead, the relatively moderate (or intermediate) ST2 level (RM) for these patients was 26-56 ng / ml. It was determined that in patients with explosives in comparison with RH levels of ST2 in blood plasma there is a significant increase in the value of LA (42 mm vs. 38 mm, p-0.03), iLA (20.3 mm / m2 vs. 18.3 mm / m2, p-0.04), ESS (36 mm vs. 32 mm, p-0.008), EDS (52 mm vs. 49 mm, p-0.04), Ve / Va ratio (0.79 vs. 0.74, p-0.03), iLC (2.72 vs. 2.06, p = 0.03), iMMLV (121 g / m2 vs. 108 g / m2, p = 0.04), a decrease in the ratio of RV to EDS (0.49 vs. 0.54, p = 0.01) and the value of EF (56% vs. 61%, p = 0.03) (Tab. 1). The ratio of LA to RA was 1.13 against 1.06, p= 0.04. In addition, in patients with RH level compared with patients with RM level, there was a significant increase in the value of ESS (36 mm vs. 34 mm, p = 0.05). The ratio of Ve / Va was 0.79 vs. 0.66, p =0.01, iLC -2.72 vs. 2.43, p-0.0006. Conclusion. Elevated ST2 levels greater than 56 ng / ml in patients with NSTEMI were found to be associated with more severe structural left ventricular remodeling, left atrial overload, and decreased left ventricular contractility. The latter is manifested by a decrease in the value of PV and an increase in the value of Ve / Va, which changes in the direction of the formation of a restrictive type of diastolic transmitral blood flow. In turn, the ratio of RV to EDS shows the advantage of LV dilatation over RV. Tab. 1Echo indicatorsRL level ST2RM level ST2RH level ST2PLA, mm38 (35; 39)39 (37; 41)42 (37; 42)Р1-3 = 0,03EDS, mm49 (46; 52)50 (48; 53)52 (48; 54)Р1-3 = 0,04EF, %61 (59; 64)59 (53; 62)56 (58; 60)Р1-3 = 0,03Ve/Va0,64 (0,56; 0,78)0,66 (0,58; 0,74)0,79 (0,60; 1,20)Р1-3 = 0,03 Р2-3 = 0,01іММLV, g/m2108 (91; 117)115 (100; 127)121 (106; 130)Р1-3 = 0,04

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