Introduction. Pulmonary hypertension (PH) in aortic stenosis (AS) worsens the prognosis. Vectorcardiographic parameters and functional tests can improve the informativeness of electrocardiography in detecting PH.

The aim of this study was to evaluate the potential of the spatial QRS-T angle (sQRS-Ta) and its changes during inspiration for diagnosing PH in patients with AS.

Materials and methods. The study included 170 patients with severe AS. Systolic pulmonary artery pressure (SPAP) was determined by echocardiography; sQRS-Ta was calculated as the spatial angle between the integral QRS and T vectors. Data are presented as median [Q25; Q75].

Results. SPAP was <45 mmHg in 138 (81%) patients and ≥45 mmHg in 32(19%) patients. Resting sQRS-Ta values had weak correlations with aortic valve area (r=- 0.3; p<0.0001), left atrium size (r=0.3; p<0.0001), and left ventricular myocardial mass index (r=0.3; p<0.0001). At SPAP<45 mmHg, inspiratory sQRS-Ta decreased (125° [95°; 150°] and 117° [86°; 142°], respectively, p<0.0001), while at SPAP≥45 mmHg it did not change (146° [106°; 158°] and 141° [101°; 163°], respectively, p=0.62). According to ROC analysis, both the resting sQRS-Ta (cutoff value > 151°, sensitivity 44%, specificity 78%) and the difference between inspiratory and resting sQRS-Ta (cutoff value ≤ 2°, sensitivity 63%, specificity 60%) allowed us to separate subgroups with SPAP ≥45 mmHg and <45 mmHg.

Conclusions. In patients with severe AS, inspiratory sQRS-Ta decreased with SPAP <45 mmHg, while it remained unchanged with SPAP ≥45 mmHg. Both the resting sQRS-Ta and the difference between inspiratory and resting sQRS-Ta allowed us to separate subgroups with SPAP ≥45 mmHg and <45 mmHg.

The relevance of the study is due to the limitations in the calculation and evaluation of the corrected QT interval (QTc) in patients with Holter monitoring (Holter ECG).

Aim: to formulate an algorithm for determining the duration of the QT interval at a stable heart rate of 60 beats per minute during Holter monitoring, and to determine its advantages and limitations.

Material and research methods. The study included 90 patients, the average age of which was 54,48±14,8 (M±σ) years, including 42 men and 48 women, who underwent Holter ECG for 24 hours.

Research results. The developed method for measuring QT60 consists of the fact that during post-processing of daily Holter ECG data, a stable heart rhythm with a heart rate of 60±3 beats per minute is found, at the end of a 10-second period of which the QT value is measured, which is the QT60 interval. The closest in value to QT60 was the Sagie method (p=0.386), while the Bazett and Fridericia formulas showed reliable differences from QT60. The average values of QTc scatter during the entire registration period, calculated by the Sagie formula (QTсS), are statistically significantly less than the scatter of values by Bazett and Fridericia, which shows the best stability of QTсS to changes in heart rate.

Conclusion. 1. The proposed QT60 parameter is free from the disadvantages associated with the use of various calculation formulas and does not require the use of automatic analysis, which leads to significant errors, especially when the patient has various rhythm disturbances, and we propose using the QT60 value as an additional parameter for assessing the QT interval in clinical practice. 2. If it is not possible to find a stable heart rhythm with a heart rate of 60 beats per minute during Holter ECG, we recommend evaluating the average daily QTc value calculated using the Sagie formula.

Reference values are required to interpret spirometry results. In the Russian Federation, the ECSC1993 reference equations are widely used, and only a small proportion of hospitals have implemented GLI2012 reference values. Objective was comparison of spirometry results in healthy adults using ECSC and GLI reference values. Spirometry in 380 healthy adults (170/210 M/F, mean age 40.0 ±17.4 years) was used to compare. We compare of z-scores obtained using ECSC to that using GLI reference equations applied on data from Russian healthy adults. Mean z-scores for FVC were 0.71±1.03 and 0.08±0.88 (<0.001); mean z-scores for FEV1 were 0.44±0.92 and 0.07±0.88 (<0.001); mean z-scores for FEV1/FVC were 0.17±0.86 and -0.03±0.90 (<0.001); according to predicted values of ECSC and GLI, respectively. Our results show that these GLI equations fit better than those of ECSC to our population sample and can be used for a Russian population.

The paper presents a comparative analysis of clinical findings from spirometric studies using different systems of predicted values (PV) in children (GLI-2012, 2021, R.F. Klement – N.A. Zilber (1994), I.S. Shiryaeva et al. (1990), Knudson R.J. (1976), Zapletal A. et al., (1976) and different methods for assessing the degree of deviation of measured values: in percent PV and z-score. The study involved 247 children aged 5 to 17 years with mild bronchial asthma (BA) and the risk of developing BA, divided into age groups: 5–6 years, 7–11 years, 12–17 years.

Results: the degree of deviation of the indicators had varying degrees of severity when using both different systems of reference values and the method of assessing deviations. A differences was revealed in the frequency of detection and the severity of obstruction when using different PV systems and different methods for assessing. Moreover, the differences and their severity varied across age groups.

Conclusion. When conducting each spirometric study, it is necessary to indicate both the reference value system used and the method for assessing deviations in the results. This is especially important during dynamic monitoring of a child and when transitioning from one age group to another.

The respiratory muscles are a vital component of the respiratory system. The most available diagnostic tools in clinical practice for the functional examination of the respiratory muscles are measurement of pulmonary volumes, assessment of the maximum inspiratory and expiratory pressures, phrenic nerve conduction studies, as well as radiographic and ultrasound methods. The ability to carry out gas exchange mainly depends on a «breathing pump» that moves air into and out of the lungs. The respiratory muscles, an integral and vital component of the respiratory process, serve as an important link between the various components of the «respiratory pump», which consists of the respiratory center, peripheral nerves, chest wall and lungs. To ensure effective breathing, all these links must be well coordinated. The most common methods for assessing the function of the respiratory muscles in various diseases and injuries are discussed in the article. The authors consider a number of widely used functional tests that can be applied in clinical practice or scientific research, pay special attention to the assessment of the respiratory muscles strength, as well as phrenic nerve conduction studies, provide clinical cases.

Left ventricular (LV) myocardial remodeling after myocardial infarction (MI) is associated with worse prognosis in most cases. In some cases, inaddition to optimal drug therapy, surgical revascularization can be used to stop or slow down the remodeling process. The aim of this study was to identify structural and functional parameters of cardiac remodeling that affect the prognosis and survival of patients after coronary revascularization performed by anyone method, and to compare these parameters in groups of patients who underwent coronary artery bypass grafting (CABG) and coronary artery stenting (CAS). A total of 104 patients with coronary artery disease and reduced ejection fraction (EF) were examined before, shortly after (5–10 days), and 6–12 months after myocardial revascularization. The average age of patients was 58 [54; 66] years old, including 85% men and 15% women. 82% of patients were operated on, of which 62 (59.6%) patients underwent CABG and 23 (22.1%) patients underwent CAS. Complete revascularization was achieved in 24 (28.2%) cases. In addition to the standard linear and volumetric dimensions, the sphericity index was calculated in diastole (end-diastolic diameter, EDD/longitudinal dimension of the LV in diastole) and systole (end-sistolic diameter, ESD/longitudinal dimension of the LV in systole), as well as the integral systolic remodeling index (ISRI), as the ratio of EF to the diastolic sphericity index of the LV in units. The remodeling parameters of interest for assessing the results of revascularization include EDVI, LVEF, diastolic sphericity index and integral systolic remodeling index. In patients who underwent CABG, these parameters reflected a lower degree of left ventricular remodeling: lower left ventricular end-diastolic volume index, diastolic sphericity index, and integral systolic remodeling index, and higher left ventricular ejection fraction.

Purpose of the study: exchange of experience in the diagnosis and treatment of severe pneumonia complicated by right ventricular thrombosis and the formation of an acute pulmonary heart.

Materials and methods. The clinical observation of the patient during inpatient treatment is presented on the basis of diagnostic studies, a comprehensive study of the medical history and an archive of medical documents.

Results. A clinical case of a 19-year-old patient is presented, in whom the initial symptoms of septic pneumonia were regarded as a manifestation of acute respiratory viral infection, but subsequently signs of rapidly increasing respiratory failure and manifestations of septic shock appeared.

Conclusion. Severe pneumonia remains a difficult disease to treat, requiring a multidisciplinary approach to diagnose and determine patient management tactics.

Background. Thrombosis in the inferior vena cava (IVC) system complicates the course of various pathological processes and is one of the most common vascular diseases. The most dangerous complication of venous thrombosis is pulmonary embolism (PE). An analysis of a late complication of cava filter implantation (CF) (thrombosis and inferior vena cava syndrome), which poses a threat to the patient’s life, was carried out using the patient’s example. In the long term, the disadvantages of CF implantation may dominate their therapeutic role.

Clinical case description. A variant of clinical and laboratory-instrumental diagnostics, therapeutic tactics in the development of CF thrombosis and their results are described.

Conclusion. Cava filters are in demand medical devices for the prevention of pulmonary embolism. However, a large number of complications after the installation of CF are understood as dynamic monitoring of the CF condition. Ultrasound is the preferred imaging method as a non-invasive and the most accessible method for assessing the degree of CF patency.