Aim To compare diagnostic significance of different criteria for complete left bundle branch block (cLBBB) in prediction of reverse left ventricular (LV) remodeling associated with cardiac resynchronization therapy (CRT).Materials and methods This study included 93 patients (men, 81.7 %; mean age at the time of implantation, 56.6±9.3 years). Achievement of a maximum decrease in LV end-systolic volume (ESV) was recorded during the entire follow-up period for evaluation of LV reversibility by CRT. Based on the dynamics of LV ESV, patients were divided into two groups, non-responders (n=27) and responders (n=66). cLBBB was determined by 9 criteria (ESC 2006 and 2013, AHA 2009, Strauss, and MIRACLE, CARE-HF, MADIT-CRT, REVERSE, and RAFT used in large multicenter studies).Results Incidence of cLBBB was significantly higher in the group of responders as demonstrated by the AHA (p=0.001), ESC 2013 (p=0.014), Strauss (p=0.002), MADIT-CRT (p=0.014), REVERSE (p=0.013), and RAFT (p<0.001) criteria. The highest specificity was shown for the AHA and RAFT (92.6 %) criteria, and the highest sensitivity and overall accuracy were shown for the Strauss (80.3 % and 72.04 %, respectively) criterium. The criteria proposed in actual clinical guidelines (AHA and ESC 2013) demonstrated a strong consistency in detecting cLBBB (κ=0.818, 95 % CI, 0.7–0.936; p<0.001). However, the Strauss and ESC 2006 / AHA / ESC 2013 showed the least consistency in identifying cLBBB. For the criteria described in large multicenter studies, consistency in detecting cLBBB was minimal in most cases. However, criteria with moderate or strong consistency were used in the studies, which results have substantiated the use of cLBBB as a selection criterium (MADIT-CRT, REVERSE, and RAFT).Conclusion The reversibility of LV remodeling associated with CRT was different in patients with cLBBB determined by different criteria. All actual cLBBB criteria (AHA, ESC 2013, and Strauss) were significantly more frequently observed in the responder group. Nevertheless, these criteria differed in their sensitivity and specificity. A number of large multicenter studies have used criteria with minimal consistency in detecting cLBBB, which should be taken into account in interpreting results of these studies.

Aim. To develop and implement a decision support system for a software product – medical information system “1C: Medicine” in the form of calculator for assessment of the absolute risk of death from cardiovascular diseases (CVD) and to show the prospects of using this system for patients with coronary artery disease (CAD) after coronary stenting.Material and Methods. The medical information system “1C: Medicine” software interface was developed in Tyumen Cardiology Research Center. It was designed to assess 10-year absolute total mortality risk from CVD in males of working age (Tyumen Risk Scale (TRS)) to provide medical decision support. The program was tested in 764 male patients from the Prospective Registry of Percutaneous Coronary Interventions (PCI). The mean age of patients was 56.9 ± 8.8 years. All death cases, recorded within a year after PCI (n = 23), were used as the status check variable. The following algorithms were chosen to compare the predictive accuracy of the integrated model: PROCAM and FRAMINGHAM. The Schwarz information test and ROC analysis data were used to assess the predictive accuracy of the models.Results. The values of Schwarz’s criterion in males were 283 for TRS, 235 for PROCAM, and 490 for FRAMINGHAM model. AUC indicator for TRS was 0.655 (95% CI 0.510–0.800), suggesting the satisfactory quality of resulting model. AUC indicators for FRAMINGHAM and PROCAM algorithms were 0.599 (95% CI 0.442–0.757) and 0.653 (95% CI 0.509–0.796), respectively.Conclusion. The created TRS, integrated into the medical information system with psychosocial factors, may be quickly and successfully implemented to determine mortality risk in CAD patients within one year after coronary stenting. The TRS has an advantage over the traditional FRAMINGHAM risk scale and non-inferior to the PROCAM scale. Therefore, TRS may be used as a medical decision support program.

Aim. To investigate the agreement among different response criteria to cardiac resynchronization therapy (CRT) and long-term mortality in patients with congestive heart failure (CHF).Methods. The study enrolled 141 patients (men 77.3%; women 22.7%) with CHF (65.2% ischemic and 34.8% non-ischemic etiology). Mean age was 58.6 [53.0;66.0] years. All patients had NYHA II-IV, left ventricular ejection fraction (LVEF) ≤35%; QRS ≥130 мs and/or left bundle branch block. Mean follow-up period was 45.0±34.2 months. Response to CRT was defined according to dynamics of NYHA functional class, LVEF, and left-ventricular end-systolic volume (LVESV).Results. Moderate agreement was found among LVEF and LVESV (Cohen’s k coefficient 0.591±0.068) while we did not find the agreement among echocardiographic criteria and NYHA. Long-term mortality had moderate negative correlation with LVESV (r=-0.486; pConclusion. Agreement between different criteria to define response to CRT is poor. The strongest correlation with long-term mortality was found for LVESV. This inconsistency among different response criteria severely limits the ability to generalize results over multiple CRT studies.

Aim. To assess clinical and morpho-functional features of the heart in patients with congestive heart failure (CHF) after cardiac resynchronization therapy (CRT) depending on septal flash (SF).Materials and methods. The study enrolled 60 patients (92.0% men, 8.0% women; mean age 54.5 ± 10.4 years; 70.0% had left bundle branch block (LBBB) with II-IV NYHA functional class CHF. SF (mechanical anomaly of interventricular septum (IVS) movement) is determined according to speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI). Patients were divided into two groups: with SF (I group, n = 10) and without SF (II group, n = 50).Results. At baseline the groups did not differ in main clinical characteristics including QRS width and LBBB. Mechanical interventricular delay was higher in group I (65.5 ms [53.5; 95.5] vs 31.0 ms [15.0; 64.5]; р = 0.026). Basal segment of IVS longitudinal strain (LS) delay by STE (257.5 ms [156.3; 293.8] vs 323.5 ms [262.5; 377.8]; р = 0.024) and LS delay by TDI (204.0 ms [170.8; 260.3] vs 434.0 ms [370.0; 489.0]; р < 0.001) were significantly lower in group with SF. According to logistic regression a combination of LS apical segment of IVS by STE (HR 0.607; 95% Cl 0.369–0.989; р = 0.048) and LS delay basal segment of IVS by TDI (HR 0.969; 95% Cl 0.0945–0.993; р = 0.011) had a relationship with SF. According to ROC analysis sensitivity and specificity of this model in SF definition in patients with CRT were 87.5% and 86.5% (AUC = 0.939; p < 0.01). Mean changes in LV ESV (52.0 ml [32.5; 72.8] vs 19,0 ml [1.3; 40.0]; р = 0.002) and LV ejection fraction (EF) (13.0% [5.5; 18.8] vs 4.0% [2.0; 9.0]; р = 0.002) were significantly higher in patients with SF. All patients in group I had a superresponse to CRT (ESV LV decrease ≥30%); 42.0% patients in group II were superresponders (р < 0.001).Conclusion. SF could be determined by STE and TDI. SF is associated with severe mechanical interventricular dyssynchrony and superresponse to CRT. Patients with SF have significantly better LV EF dynamics after CRT.