No abstract

According to the modern statistics, the isolated atherosclerotic lesion in one arterial region occurs twice less often, than the combined lesion in several regions. Among the last, significant stenoses (>50 %) make up to 25 % of cases. Vascular surgeons need high-informative and noninvasive diagnostic methods for detection of way of surgical treatment of these lesions. So far the X-ray contrast angiography (AG) remains a method of «the gold standard» whereas the screening part is assigned to the duplex scanning (DS). The aim of present study was to compare results of ultrasonic DS and angiography in patients with multifocal atherosclerosis. Sensitivity and specificity of these methods had been evaluated. By means of screening of 565 men of 45-59-years-old, 64 patients with multifocal atherosclerotic lesions in coronary, carotid and low extremity arteries were identified. They were examined using DS and AG. The degree of carotid stenosis was accurately measured both by means of ultrasonic duplex scanning and angiography. Sensitivity and specificity of DS were 86 and 71 %, sensitivity of AG was 97 %, specificity was 86 %. Furthermore duplex scanning provided more information in detecting of unstable plaques compared with angiography. Thus ultrasound diagnostic may be considered a useful method for detecting different characteristics of multifocal atherosclerotic lesion, including the preoperative noninvasive assessment.

No abstract

Purpose Identification of subclinical dysfunction of the right ventricular (RV) using modern exercise stress echo. Methods The main group consists of 66 patients with I-II stage of histologically verified pulmonary sarcoidosis: 42 men (63.6%) and 24 women (36.4%); mean age 31.9±5.59 years. The control group included 33 healthy, non-smokers: 24 men (72.7%) and 9 women (27.3%); average age 30.18±5.3 years. Stress-echo was performed on US system Vivid E9 (GE, USA), on a GE “e-Bike” horizontal bicycle ergometer, according to the “50x25” protocol with an increase in load every 2 min. In addition to the standard protocols, the global longitudinal RV strain (GLS RV) and systolic pressure in the pulmonary artery (SPAP, mm Hg) were assessed at rest and at the peak of exercise. Results RV GLS values in patients with sarcoidosis at the peak of exercise didn't increase, but rather decreased from −22.8±3.4% to 21.2±4.7% (p=0.004), unlike increased in healthy volunteers: from −24.1±2.7% to −25.1±3% (p=0.002), the whole values were within the normal range. An important fact is the decrease in the level of GLS RV in patients with pulmonary sarcoidosis (7%, p=0.00001). The estimated rest SPAP in patients with sarcoidosis was slightly higher than in healthy people (28.5±8.3 and 24.8±5.21 mm Hg.; p=0.03), but these values also didn't accede norms. At the peak of exercise, it increased greater than in the control group (32.9±10.1 and 48.36±14.4 mm Hg; p=0.000001). It was additionally revealed that in patients with sarcoidosis, GLS RV decrease by −0.8% was accompanied by an increase in SPAP by 8 mm Hg. In the control group the lower quartile of SPAP was 29 mm Hg, at the peak of exercise – 38 mm Hg. In the main group the value of SPAP exceeded the upper quartile of the control group (38 mm Hg) in 79% of cases. So we confirmed the presence of subclinical pulmonary hypertension in asymptomatic patients at the early stages of pulmonary sarcoidosis. To cut he limits of pathology in the main group, threshold GLS RV values were obtained at the peak of exercise by the method of classification trees. Values less than −21.6% were correlated with the presence of subclinical RV dysfunction with 90% rang; in combination with increase in SPAP more than 39.5 mm Hg – 100% rang. 50 patients (75% of the main group) showed an increase in SPAP at the peak of exercise more than 39.5 mm Hg. 37 patients (56%) showed GLS RV decrease less than −21.6%. Combination of these two parameters was detected in 42% of cases. Conclusions Thus, in 42% of young patients with sarcoidosis, latent right ventricular dysfunction was revealed at the absence of symtoms and pathological changes in resting echocardiography. Therefore, GLS RV decrease at the peak of exercise less than −21.6% with an increase in SPAP more than 39.5 mm Hg may be a predictor of subclinical cardiac dysfunction in patients with pulmonary sarcoidosis. Funding Acknowledgement Type of funding source: None

The first hemodynamic definition of pulmonary hypertension (PH) was given at the World Symposium on PH (WSPH, 1973) in Geneva as an increasebin resting mean pulmonary artery pressure (mPAP) >25 mm Hg by heart chamber catheterization. Since 2004, in the definition of PH, in addition to an increase in resting mPAP, an 'exercise' criterion has also been included: mPAP at the peak of exercise >30 mm Hg. However, at the 4th WSPH Symposium in 2008, due to uncertainty of the relationship between age-related changes in cardiac output (CO) and pulmonary vascular physiology, in particular pulmonary vascular resistance (PVR) under exercise, this criterion was excluded.Resting PH manifests only at the absence of ≥50 % of pulmonary microcirculation, so for the earliest diagnosis of the disease, it’s necessary to use factors that provoke an increase in CO and PVR. Moreover, in clinical practice, manifestations of PH are not uncommon on exercise. In the absence of consensus the definition of stress- induced PH is defined in individuals with normal mPAP (< 25 mm Hg) at rest and elevated mPAP (>30 mm Hg) and PVR> 3 WU at the peak of exercise.