Introduction.The cardiac dysfunction in sepsis (septic cardiopathy) diagnosis is an actual problem. Objectives. To study the correspondence between the indicators obtained with aitical care echocardiography and transpulmonary thermodilution, and to assess their predictive significance in relation to the risk of mortality. Materials and methods. The study involved 25 patients aged 45 (31-68) years with abdominal sepsis or septic shock. The severity of the condition upon admission to the intensive care unit was 13 (11-16) points on the APACHE II scale, and 8 (6.59.5) points on the SOFA scale. Septic shock was diagnosed in 52 % of patients. Results. Cardiac index, stroke volume index, left ventricular ejection fraction and global cardiac ejection fraction, as well as heart filling volumes established by echocardiography and transpulmonary thermodilution were moderately correlated with each other (rho 0.408-0.538; p < 0.05). Dilation of the left ventricle (end-diastolic volume index 80-115 ml/m²) was detected in 16 % of patients. A decrease of the left ventricle ejection fraction (48-23 %) was registered in 24 % of cases. Transpulmonary thermodilution indices were not associated with a left ventricular ejection fraction value below 50 %. Neither left ventricular ejection fraction nor left ventricular filling volumes were predictors of adverse sepsis outcomes. The predictor of mortality was the cardiac function index determined with transpulmonary thermodilution (OR 0.3361; 95 % CI 0.1351-0.8363; p = 0.019), the value of which < 5.8 min^-1 predicted mortality with sensitivity of 85.7 % and specificity of 72.2 % (AUC 0.817; p = 0.0057). Conclusions. Ultrasound assessment of cardiac activity with the calculation of left ventricular filling volumes and left ventricular ejection fraction should not be considered as a non-invasive alternative to transpulmonary thermodilution in patients with sepsis. The heart function index can diagnose abnormal heart function that increases the risk of mortality in abdominal sepsis.

This article analyzes the frequency and features of cardiac amyloidosis in the elderly. The morphology and pathogenesis of amyloid cardiomyopathy are presented. The features of the clinical picture of the heart and aortic lesions in systemic and local variants of amyloidosis are analyzed. Polymorbidity in older people, which complicates the diagnosis of cardiac amyloidosis and leads to a delay in treatment, is reviewed. The diagnostic methods of various types of cardiac amyloidosis are evaluated. Modern trends in the treatment of amyloidosis are presented.

Objective Comparative analysis of structural and functional specific features of the heart in patients with toxic cardiomyopathy (TCMP) with a low left ventricular ejection fraction (LVEF) and severe, chronic heart failure (CHF) and in patients with idiopathic dilated cardiomyopathy (DCMP) and similar LVEF and CHF severity.Materials and Methods This observational, single-site study included 15 patients with TCMP (12 of them received treatment including anthracycline antibiotics and 3 patients received targeted therapies) and 26 patients with idiopathic DCMP. Data of echocardiography were compared for patients with TCMP and DCMP with comparably low LVEF of <40 %.Results In patients with severe heart damage associated with antitumor therapy with low LVEF, volumetric and linear indexes of left and right ventricles and the left atrium (left atrial volume index (LAVI), 33.7 (21.5–36.9) ml / m2; right ventricular end-diastolic dimension (RVDd), 2.49 (1.77–3.53) cm; and end-diastolic volume index (EDVI), 78.0 (58.7–90.0) ml / m2) were considerably less than in the DCMP group (LAVI, 67.1 (51.1–85.0) ml / m2; RVDd, 4.05 (3.6–4.4) cm; and EDVI, 117.85 (100.6–138.5) ml / m2, p<0.0001). Furthermore, LV wall thickness and pulmonary artery systolic pressure did not differ in these groups. Both in men and women with TCMP, LAVI and EDVI were significantly less than in men and women with DCMP.Conclusion The study showed significant differences in parameters of cardiac remodeling. In TCMP patients as distinct from DCMP patients, despite a pronounced decrease in LVEF, LV dilatation was absent or LV volumetric parameters were moderately increased with a more severe somatic status.