[Focus ultrasound for cardiology practice. Russian consensus document]

This document is a consensus document of Russian Specialists in Heart Failure, Russian Society of Cardiology, Russian Association of Specialists in Ultrasound Diagnostics in Medicine and Russian Society for the Prevention of Noncommunicable Diseases. In the document a definition of focus ultrasound is stated and discussed when it can be used in cardiology practice in Russian Federation.

P1510Values of left ventricular area strain during 4D-strain-stress echocardiography with adenosine triphosphate in healthy subjects

Background

Use of adenosine triphosphate (ATP) instead of adenosine in stress echocardiography is more cost-effective. Earlier we have proposed new ATP stress echocardiography algorithm (Figure). This modified algorithm includes 1) stepwise increase in dose of ATP in the absence of signs of adequate vasodilation (decrease in systolic blood pressure and increase in heart rate), 2) triple registration of echocardiographic data sets (before ATP infusion, during phase of adequate vasodilation and 5 minutes after the termination of ATP infusion).

Purpose

In this study we aimed to a) assess the safety of ATP high doses infusion algorithm, b) determine the values of left ventricular (LV) systolic global and segmental area strain (AS) during 4D-strain-stress echocardiography with ATP in healthy volunteers.

Material and methods

13 healthy subjects (male 9, mean age 35.3±11.0 years) underwent ATP LV 4D strain-stress-echocardiography (Vivid E95, AFI technology). Mean values of global and regional (16 segments model) AS were determined.

Results

4 subjects appeared to be “non responders” to initial dose of ATP 140 μg/kg/min. In three subjects it was necessary to increase the dose of ATP to 175 and in one to 210 μg/kg/min in order to achieve adequate vasodilation. No major side effects of ATP infusion (complete heart block, bronchospasm, myocardial infarction) were registered and no aminophylline injections were required. In all cases interpretable 4D LV Echo data sets for automatic strain analysis were obtained. Mean values of global systolic AS in healthy individuals before, at time and after ATP infusion were −25.8±4.8, −27.2±4.4 and −25.7±4.8%, respectively. Mean values of systolic AS in each of 16 segments were also calculated (Table).

LV segment AS before ATP (%) AS ATP infusion (%) AS after ATP (%) LV segment AS before ATP (%) AS ATP infusion (%) AS after ATP (%) 1 −29.6±11.3 −31.2±11.1 −28.6±8.3 9 −27.8±6.5 −29.3±6.8 −30.8±6.0 2 −26.6±8.5 −28.2±4.9 −26.2±7.3 10 −26.1±5.2 −274±5.5 −25.8±6.0 3 −25.6±6.8 −29.6±5.2 −27.2±7.2 11 −25.3±6.1 −26.1±7.5 −24.9±5.3 4 −26.2±7.2 −24.9±9.1 −25.2±6.7 12 −28.1±7.3 −28.5±6.1 −25.3±5.6 5 −26.5±6.8 −29.3±10.9 −24.3±7.7 13 −22.9±6.5 −23.4±6.5 −23.2±6.4 6 −25.2±6.7 −26.0±7.9 −25.5±7.0 14 −25.7±7.6 −28.5±6.0 −26.2±6.8 7 −24.8±7.3 −25.6±6.1 −22.8±6.0 15 −26.5±6.5 −29.8±6.0 −28.5±5.5 8 −25.8±6.6 −26.5±5.6 −25.8±5.5 16 −24.2±7.1 −25.4±6.2 −25.1±6.6

Conclusions

4D strain-stress-echocardiography ATP infusion algorithm is safe and well tolerated by patients. Values of LV systolic global and segmental AS in healthy subjects were determined.

[Ultrasonic diagnosis of subpleural parietal formations of the lung]

The article generalizes experiences with ultrasonic scanning of the chest in patients with subpleural parietal formations of the lungs of inflammatory and tumorous etiology. The technique of the investigation and criteria of the assessment of the pathological focus are described. The normal echoscopic picture of the chest was determined. The ultrasonic images of the abscesses were compared with those of the peripheral lung carcinoma. The echoscopic pictures typical of each disease were revealed.

[Ultrasound study of the liver and kidneys after different types of resection]

The ultrasound pattern of hepatic and renal changes after different types of resection is depicted. Ultrasound studies were performed in 335 patients operated on for focal hepatic masses and in 72 patients operated on for focal renal masses. The authors identified 3 patient groups after hepatic resection (segment-oriented liver resection (99 patients), portal hemihepatectomy (n=163), and extended hemihepatectomy (n=73)) and 3 patient groups after renal resection (planar (n = 83), wedge (n = 104), and frontal (n = 66)). It has been established that the number and location of hepatic veins in the liver stump, which the authors have designated as a hepatic vein rule, are of basic value in defining the type of hepatic resection. To determine the type of renal resection, it is essential to assess the shape of the organ and the area of its resection. The found echosemiotic patterns allow the type of performed resection of parenchymatous organs to be correctly determined in the majority of cases.

P1550 Detection of symptom related coronary arteries in patients with coronary artery disease by 4D stress echo with adenosine triphosphate

Background

In previous publications, we have proposed new algorithm of pharmacologic Stress Echo with possibility of stepwise adenosine triphosphate (ATP) i/v dose increase (Figure 1).

Purpose

In this study we decided to compare the effectiveness of detection of symptom related coronary arteries in patients with coronary artery disease (CAD) by ATP 4D Stress Echo of left ventricle (LV) and a) traditional visual evaluation of LV segmental hypokinesis b) Automatic Function Imaging (AFI) technology longitudinal LV strain (LS) analysis.

Material and methods. 26 patients with CAD (male 24, mean age 63.1 ± 7.5 years, single vessel obstructive disease 7, multivessel - 19) underwent ATP LV 4D Stress Echo (Vivid E95, GE). Number of cases when it was possible to detect symptom related arteries by visual analysis of LV segmental hypokinesis and by AFI LV LS analysis were compared.

Results

In 11 (42.3%) patients expansion of existing hypokinetic areas and appearance of new LV segments with hypokinesis during stress test were detected by visual analysis. Using AFI technology expansion of initial areas of LS disturbances and appearance of new LV segments with LS disturbances were found in 21 (80,7%) patients (р=0.0044).

Conclusion

Utilization of AFI LV LS analysis during ATP LV 4D Stress Echo significantly increases the frequency of symptom related coronary arteries detection in patients with CAD.

Abstract P1550 Figure1