Transesophageal Echocardiography: Methodology, Indications, Opportunities

The objective was to study the relationship between the preoperative blood levels of the N-terminal segment of B-type natriuretic peptide precursor (NT-proBNP) and ultrasound and thermodilution indicators of cardiac function before and after on-pump surgery for aortic stenosis, as well as to evaluate the prognostic significance of the biomarker in relation to postoperative myocardial dysfunction.Materials and methods. The study involved 27 patients aged 57.7±2.5 years who underwent aortic valve replacement. NT-proBNP level was determined before surgery. The indicators of invasive hemodynamics and transesophageal echocardiography were analyzed at stages: I – after anesthesia induction, II – at the end of surgery. Correlation analysis, logistic regression and ROC analysis were used.Results. The preoperative NT-proBNP level was 2002.0 [540.8–4001.5] pg/ml. At I stage, NT-proBNP correlated with mean pulmonary artery pressure (rho = 0.468; p = 0.014), indices of left ventricular function (rho = –0.509; p = 0.007), end-diastolic and end-systolic volumes (rho = 0.737–0.757; p < 0.0001), as well as ejection fraction (rho = –0.556; p = 0.004) and area contraction fraction (rho = –0.783; p < 0.0001). At II stage, the level of NT-proBNP > 2000 pg/ml was a predictor of the left ventricular area contraction fraction < 50% (OR 1.0011, 95% CI 1.0002–1.0020, p = 0.028, AUC 0.799) , the left ventricular end-systolic area index > 9 cm2/m2 (OR 1.0007, 95% CI 1.0001–1.0013, p = 0.027, AUC 0.886), vasoactive-inotropic score > 10 (OR 1.0006, 95% CI 1.0001–1.0012, p = 0.032, AUC 0.876), duration of sympathomimetic therapy > 24 h (OR 1.0001, 95% CI 1.0000–1.0003, p = 0.049, AUC 0.889).Conclusions. NT-proBNP blood level was increased in 66.7% of patients with aortic stenosis before surgery. Moreover, the biomarker level directly correlates with the mean pulmonary artery pressure, the indices of end-diastolic and end-systolic volumes, end-diastolic and end-systolic areas of the left ventricle, and it inversely correlates with the left ventricular stroke work index, ejection fraction and left ventricular area contraction fraction. The preoperative NT-proBNP level was a predictor of the postoperative decrease to the pathological level of the ejection fractions and left ventricular area contraction, an increase in the left ventricular end-systolic area index, intensive and prolonged sympathomimetic therapy. Myocardial dysfunctions were most pronounced in patients with biomarker levels above 2000 pg/ml.

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Prognostic significance of the biomarker NT-proBNP in the surgical treatment of aortic stenosis (pilot study)

Kozlov

Krichevskiy

Rybakov

2023

Vestn. anesteziol. reanimatol.

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Endogenous uveitis as deuteropathy оf secondary acute infectious endocarditis

Фомин

Baranova

Куроедов

et al. 2020

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Uveitis is a heterogeneous polyetiological immune-mediated disease. Its common feature is inflammation of the choroid. The total prevalence of uveitis of various etiologies in the population varies from 15 to 38 people per 100 000. The cause of this pathology can be any infectious or somatic diseases (both endo- and exogenous in nature), when the body’s immune system is activated. The prevalence of the most common endogenous uveitis, caused by secondary foci of infection, is about 3% of the total number of diseases of this etiology. Uveitis, caused by Streptococcus bacteria, affects eyes due to dissemination from the foci of infection, being transmitted through the blood and lymph vessels. An important stage in the clinical diagnosis of uveitis is the determination of the etiological factor, which allows using of pathogenetic treatment regimens. The diagnosis is performed based on the totality of signs characterizing the specificity of the inflammatory process. Treatment and diagnosis of inflammation of the choroid are still one of the urgent tasks of modern ophthalmology.

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Echocardiographic picture of left atrial appendage thrombi in patients with atrial fibrillation

Shukurova,

Rakhmatulloev,

Odinaev

2024

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Aim. To present the echocardiographic picture of the presence of thrombi in the left atrial appendage in patients with atrial fibrillation in the outpatient stage.Material and research methods. The study involved 56 patients with permanent atrial fibrillation, observed in outpatient conditions at the National Medical Center of the Republic of Tajikistan “Shifobakhsh” between 2019 and 2022. All patients underwent transesophageal echocardiography using standard methodology.Research results. According to the results of transesophageal echocardiography, all patients (n=56) were divided into two groups: Group I - 42 (75%) with no thrombosis in the left atrial appendage; Group II - 14 (25%) with the presence of a thrombosis. Patients with thrombosis of the left atrial appendage had a high degree of thromboembolic, hemorrhagic risk, left atrial enlargement and a low level of peak blood flow velocity. At the same time, the phenomenon of spontaneous echo contrast in patients with thrombosis was on average 22% higher compared to the subgroup without thrombosis.Conclusions. Our data showed that during transesophageal echocardiography in patients with atrial fibrillation, peak blood flow velocity and spontaneous echo contrast can be taken as predictors of thrombosis of the left atrial appendage.

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Transesophageal Echocardiography: Methodology, Indications, Opportunities

Cited by 3 publications

References 27 publications

Prognostic significance of the biomarker NT-proBNP in the surgical treatment of aortic stenosis (pilot study)

Prognostic significance of the biomarker NT-proBNP in the surgical treatment of aortic stenosis (pilot study)

Endogenous uveitis as deuteropathy оf secondary acute infectious endocarditis

Echocardiographic picture of left atrial appendage thrombi in patients with atrial fibrillation

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