scholarly journals New approaches to assessing the contractile function of the left ventricular in patients with heart failure on the background of modulation of cardiac contractility.

2020 ◽  
pp. 4-13
Author(s):  
А.А. Сафиуллина ◽  
Т.М. Ускач ◽  
М.А. Саидова ◽  
С.В. Добровольская ◽  
С.Н. Терещенко
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Heart Failure ◽  
Left Ventricle ◽  
Left Atrium ◽  
Contractile Function ◽  
Cardiac Contractility ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Heart Contractility

Обзор посвящен роли современной трансторакальной эхокардиографии и новому способу неинвазивной оценки сократительной функции левого желудочка – исследованию эффективности миокардиальной работы у пациентов хронической сердечной недостаточностью. Освещаются актуальные аспекты ремоделирования левого желудочка и левого предсердия у данной категории пациентов. Обсуждается роль и важность метода спекл-трекинг эхокардиографии в оценке механической функции левого предсердия. Представлены сведения об относительно новом электрофизиологическом методе лечения - модуляции сердечной сократимости у пациентов с хронической сердечной недостаточностью, как с фибрилляцией предсердий, так и без нее. Анализируются результаты обратного ремоделирования левого желудочка по данным эхокардиографических параметров основных исследований, посвященных модуляции сердечной сократимости. В статье оцениваются перспективы применения метода оценки эффективности миокардиальной работы левого желудочка как инструмента возможного обратного ремоделирования у пациентов с хронической сердечной недостаточностью и фибрилляцией предсердий на фоне модуляции сердечной сократимости The review is devoted to the role of modern transthoracic echocardiography and a new method of non-invasive assessment of left ventricular contractile function-the study of the effectiveness of myocardial work in patients with chronic heart failure. The current aspects of left ventricle and left atrium remodeling in this category of patients are highlighted. The role and importance of speckle-tracking echocardiography in evaluating the mechanical function of the left atrium is discussed. Information is provided about a relatively new electrophysiological method of treatment-modulation of heart contractility in patients with chronic heart failure, both with and without atrial fibrillation. The results of reverse remodeling of the left ventricle are analyzed according to the echocardiographic parameters of the main studies devoted to the modulation of heart contractility. The article assesses the prospects for using the method of evaluating the effectiveness of left ventricular myocardial function as a tool for possible reverse remodeling in patients with chronic heart failure and atrial fibrillation against the background of heart contractility modulation

scholarly journals Hemodynamic and endotheliym-protective effects of beta-blockers in patients with chronic heart failure and atrial fibrillation ischemic origin

2020 ◽  
Vol 11 (2) ◽  
pp. 6-15
Author(s):  
Aliara N. Zakirova ◽  
Elvina R. Abdiukova ◽  
Vitalii V. Viktorov ◽  
Nelli E. Zakirova ◽  
Dinara F. Nizamova
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Heart Failure ◽  
Left Ventricle ◽  
Left Atrium ◽  
Contractile Function ◽  
Intercellular Adhesion ◽  
Metoprolol Tartrate ◽  
Basic Therapy ◽  
Left Ventricle Remodeling

Aim.To evaluate the effect ofb-blockers (BB) on myocardial remodeling and endothelial adhesive function in patients with chronic heart failure (CHF) and atrial fibrillation (AF) of ischemic origin. Material and methods.The study included 77 patients with functional class IIIII CHF and AF who had previously suffered a large-focalQ-myocardial infarction. Patients were randomized into 2 groups, comparable in clinical and instrumental characteristics and homogeneous in basic therapy of CHF and AF. Group 1 included 40 patients who took carvedilol for 24 weeks as part of the basic therapy of CHF and AF, and group 2 included 37 patients who received metoprolol tartrate. We used clinical and instrumental (echocardiography, 6-minute walking test, clinical assessment scale) and enzyme immunoassay (analysis of the level of soluble molecules of intercellular adhesion sVCAM-1 and sE-selectin) research methods. Results.The use of carvedilol a non-cardioselective BB that performsa1,b1andb2-adrenoblockade, andb1-selective, short- acting BB metoprolol tartrate as part of basic therapy improved the clinical condition and physical performance of patients with CHF and AF. It was found that carvedilol more significantly than metoprolol affects the state of intracardiac hemodynamics, slows down the processes of remodeling of the left atrium and left ventricle, increases the contractile function of the myocardium. Carvedilol as part of basic therapy reduces endothelial adhesion and inhibits the overexpression of intercellular adhesion molecules sVCAM-1 and sE-selectin, and when using metoprolol tartrate, there is only a tendency to decrease these indicators. Conclusion.Carvedilol as part of the basic therapy of CHF and AF has significant endothelial-protective and clinical-hemodynamic effects, positively affects the adhesive function of the endothelium and the processes of left atrium and left ventricle remodeling.

P1369Predictors of atrial fibrillation recurrence after radiofrequency ablation in patients with chronic heart failure with preserved ejection fraction

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Zolotarova
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Left Atrium ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Af Recurrence

Abstract Introduction. Randomized controlled trials and meta-analyzes have shown high efficacy of the radiofrequency ablation (RFA) for both initial and secondary strategies after unsuccessful drug therapy (DT) to maintain sinus rhythm (SR) and improve functional and morphological quality of life; in patients with chronic heart failure (CHF), RFA were associated with a significant relative reduction in the risk of overall mortality, atrial fibrillation (AF) recurrence, and hospitalization for cardiac pathology (compared with DT). High risk of arrhythmia recurrence (up to 45% within 6 - 12 months after intervention) remains a major RFA problem. Purpose. to evaluate predictive properties of demographic, hemodynamic and electrocardiographic parameters for recurrence after atrial fibrillation ablation in patients with chronic heart failure with preserved ejection fraction. Methods. We included 120 patients, aged 59.80 ± 10.08 years with CHF with preserved ejection fraction (EF) of left ventricle (LV) who underwent first time RFA for AF with LV EF(> 40%) I-III FC NYHA. Baseline clinical data, ECG before and after the procedure, ECHO parameters were collected Results Thirty-two patients had AF recurrence after a mean follow-up of twelve months. Those experiencing recurrence were more female (50% vs.39%, p <0,01), had a longer QTc interval before ablation than those without recurrence (387,23 ± 2,31 vs. 341,22 ± 8,91 ms, p < 0,01) and after ablation (439,01 ± 4,73 vs. 373,21 ± 7,92 ms, p < 0,001), lower LV EF (59% vs. 63%, p < 0,05), higher left atrium diameter (4,59 ± 0,45 vs. 4,08 ± 0,61 cm, p < 0,001) and higher mean pulmonary artery gradient (32,86 ± 9,67 vs. 25,15 ± 9,73, p < 0,01). Conclusions. QTc duration to radiofrequency ablation and its prolongation after intervention are independent predictors of arrhythmia recurrence in patients with chronic heart failure with a preserved left ventricular ejection fraction. The size of the left atrium before ablation is a highly sensitive predictor of recurrence of arrhythmia

scholarly journals Possibilities of Evaluating the Dynamics of Left Ventricular Perfusion and Contractility in Patients with Chronic Heart Failure after Implantation of a Heart Contractility Modulator Using Perfusion Single-Photon Emission Computed Tomography

2021 ◽  
Vol 17 (2) ◽  
pp. 263-269
Author(s):  
V. A. Amanatova ◽  
A. A. Safiullina ◽  
T. M. Uskach ◽  
A. A. Ansheles ◽  
V. B. Sergienko ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Nuclear Cardiology ◽  
Single Photon ◽  
Photon Emission ◽  
Cardiac Contractility ◽  
Left Ventricular ◽  
Emission Computed Tomography ◽  
Single Photon Emission ◽  
Heart Contractility

Perfusion scintigraphy and single-photon emission tomography of the myocardium are promising methods for complex assessment of the state of the left ventricle myocardium in patients with chronic heart failure. These methods of nuclear cardiology can be performed in patients with reduced renal function, as well as the presence of implanted devices such as implantable cardioverters-defibrillators, resynchronizing devices and cardiac modulating therapy, which is their undeniable advantage. The reproducibility of the method is ensured bu fully automated calculation of parameters of myocardial perfusion and contractility. To date, there are no data in the literature on the use of nuclear cardiology methods as an imaging technique in patients with cardiac contractility modulation devises. This paper describes the current possibilities and prospects of nuclear medicine methods in patients with chronic heart failure after implantation of a heart contractility modulator.

scholarly journals Dynamics of Holter electrocardiogram monitoring in patients with chronic heart failure and atrial fibrillation on the background of cardiac contractility modulation

2021 ◽  
Vol 93 (9) ◽  
pp. 1044-1051
Author(s):  
Alfiya A. Safiullina ◽  
Tatiana M. Uskach ◽  
Yulduz S. Sharapova ◽  
Anatolii G. Kochetov ◽  
Oleg V. Sapelnikov ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Heart Failure ◽  
Cardiac Arrhythmias ◽  
Cardiac Contractility ◽  
Reverse Remodeling ◽  
Ecg Monitoring ◽  
Cardiac Contractility Modulation ◽  
Optimal Drug

Aim. To evaluate the dynamics of cardiac arrhythmias on the background of cardiac contractility modulation (MCC) in patients with chronic heart failure (CHF) and various forms of atrial fibrillation (AF) on the basis of daily electrocardiogram (ECG) monitoring. Materials and methods. In 100 patients with CHF and AF, the following studies were performed before implantation of the MCC device and after 12 months of follow-up: 12-channel ECG with an estimate of the width of the QRS complex, transthoracic echocardiography (EchoCG), and Holter ECG monitoring. All patients received long-term optimal drug therapy for CHF before surgery. Results. The results obtained indicate that there is no effect of MCC on the development and progression of ventricular arrhythmias in patients with CHF and AF during the year of follow-up, both extrasystole and tachyarrhythmias, regardless of the etiology and LVEF (less than 35% or more than 35%), and a decrease in the frequency of AF paroxysms in patients with CHF during treatment. These results are due to the reverse remodeling of the LV myocardium under the influence of the MCC device. Conclusion. The use of MСС in patients with CHF and AF is a safe method of therapy that does not induce cardiac arrhythmias, including ventricular extrasystole. Large-scale comparative studies are required to evaluate these results.

scholarly journals PARAMETERS OF THE HEMODYNAMIC AFTER ABLATION ATRIAL FIBRILLATION AND/OR FLUTTER DEPENDING ON THE FUNCTIONAL CLASS OF CHRONIC HEART FAILURE

2018 ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Chronic Heart Failure ◽  
Left Ventricle ◽  
Left Atrium ◽  
Independent Predictor ◽  
Functional Class ◽  
Acute Period ◽  
Left Atrium Size

Evaluated parameters of the hemodynamic before and after ablation atrial fibrillation and/or flutter depending on the functional class of chronic heart failure in 74 patients. It was found that patients with the I functional class of chronic heart failure have significantly lower left atrium size compared to III functional class, which is associated with the better efficiency of the radiofrequency ablation in the remote period. Patients with the I and III functional class of chronic heart failure are having increasement of QTc duration in acute period of radiofrequency ablation that could be used as an independent predictor of arrhythmia recurrence. Patients with the I functional class chronic heart failure who failed drug therapy for atrial fibrillation and/or flutter alternative treatment in the form of the radiofrequency ablation should be considered as choice therapy. The levels of heart rate and pulse decreases in I and III functional class of the chronic heart failure in the acute period radiofrequency ablation; systolic and diastolic blood pressure, QRS, left ventricle end-diastolic and left ventricle end-systolic diameter do not change after radiofrequency ablation. Patient I and III functional class of the chronic heart failure are having increasement of QTc duration in acute period of radiofrequency ablation that could be used as an independent predictor of arrhythmia recurrence. Patients with I functional class of the chronic heart failure have significantly lower left atrium size compared to III functional class of the chronic heart failure, which is associated with the best outcome of effectiveness of radiofrequency ablation in the late period.

scholarly journals The effect of angiotensin receptors and neprilysin inhibitors on myocardial remodeling in patients with chronic heart failure and atrial fibrillation

Kardiologiia ◽  
2019 ◽  
Vol 59 (10S) ◽  
pp. 64-72
Author(s):  
T. M. Uskach ◽  
A. A. Safiullina ◽  
M. I. Makeev ◽  
M. A. Saidova ◽  
M. A. Shariya ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Heart Failure ◽  
Left Ventricle ◽  
Left Atrium ◽  
Angiotensin Receptors ◽  
Myocardial Remodeling ◽  
Treatment And Prevention ◽  
Patients With Heart Failure ◽  
Positive Effect

Aim. To evaluate the effect of angiotensin-neprilysin receptor inhibitors on myocardial remodeling in patients with chronic heart failure and atrial fibrillation. Materials and methods. We studied dynamics of the parameters of ultrasound structural and functional parameters of the left atrium and left ventricle of the heart was during 3-month therapy with sacubitryl-valsartan in a group of 15 patients with a combination of chronic heart failure due to dilated and paroxysmal paroxysmal forms of atrial fibrillation. Results. Showed a statistically significant positive effect of the use of angiotensin receptors and neprilysin inhibitors on the parameters of remodeling of the left atrium (according to transthoracic and transesophageal echocardiography), left ventricle, as well as levels of natriuretic peptides ANP and NT-pro-BNP. Conclusion. The use of ARNI may be promising in terms of treatment and prevention of AF in patients with heart failure.

Predictive value of atrial fibrillation catheter ablation on cognitive functions in patients with chronic heart failure

2021 ◽  
Vol 42 (2) ◽  
pp. 75-81
Author(s):  
T. V. Zolotarova ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cognitive Function ◽  
Catheter Ablation ◽  
Chronic Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Cognitive Functions ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Atrial fibrillation (AF) directly leads to a cognitive function decline regardless of the cerebrovascular fatal events, but it is unclear whether the sinus rhythm restoration and reducing the AF burden can reduce the rate of this decreasement. Data on the effect of radiofrequency ablation on patients’ cognitive functions are conflicting and need to be studied. The aim of the study was to evaluate the prognostic value of atrial fibrillation radiofrequency catheter ablation on cognitive functions in patients with chronic heart failure with preserved left ventricular ejection fraction. The impact of AF radiofrequency catheter ablation on cognitive function in 136 patients (mean age 59.7 ± 8.6 years) with chronic heart failure with preserved left ventricular ejection fraction and compared with 58 patients in the control group (58.2 ± 8.1 years), which did not perform ablation and continued the tactics of drug antiarrhythmic therapy was investigated. Cognitive function was assessed using the Montreal Cognitive Test (MoCA) at the enrollment stage and 2 years follow-up. Decreased cognitive function was defined as a MoCA test score < 26 points, cognitive impairment < 23 points. Two years after the intervention, there was a positive dynamics (baseline MoCA test — 25,1 ± 2,48, 2-year follow-up — 26,51 ± 2,33, p < 0,001) in the ablation group and negative in the control group (25,47 ± 2,85 and 24,57 ± 3,61, respectively, p < 0,001). Pre-ablation cognitive impairment was significantly associated with improved cognitive function 2 years after AF ablation according to polynomial regression analysis. The obtained data suggest a probable positive effect of AF radiofrequency ablation on cognitive functions in patients with preserved left ventricular ejection fraction.

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