In the Russian Federation, according to official statistics, 154.2 million functional studies were conducted in 2021, which exceeded by more than 1.5 times the level of similar studies in 2011 – 86.4 million. The analysis of studies in all areas of functional diagnostics is presented. The Covid-19 pandemic caused a short-term decline in the number of studies in 2020, with a return to previous values in 2021. There was a decrease in the number of complex studies of the cardiovascular system using stress testing and complex diagnostic studies.

An overview of the new 2022 European Respiratory Society and American Thoracic Society technical standard on interpretive strategies for routine lung function tests: spirometry, body plethysmography and diffusing capacity is presented. The fi rst part discusses general issues, the choice of reference equations, defining normal range of parameters and bronchodilator response estimation.

Aim. To evaluate the correlation of values of left atrial (LA) strain in patients with atrial fibrillation (AF) who underwent cardioversion (CV) with AF recurrence, hospitalization or death in early and late periods after cardioversion.

Material and methods. 85 patients of the University Clinical Hospital No. 1 of Sechenov University were examined: 30 men (35.3 %) and 55 women (64.7 %), the average age was 70 ± 8 years. All patients underwent speckle tracking, the parameters of LA strain and LA stiffness index were determined upon admission to the hospital after CV; after 1, 3, 6 months, a relapse of AF, the fact of hospitalization for cardiovascular reasons, and death were detected.

Results. 4 people died during the follow-up, 37 hospitalizations were registered due to a relapse of AF, 7 developed a long-term persistent/

permanent form of AF. The predictors associated with the onset of adverse events at the 3rd month were: reduction of the negative peak in the 4-chamber position (risk ratio (HR) 1.26, 95 % confidence interval (CI) 1.05, 1.51; p=0.009), reduction of LA strain in the 4-chamber position (HR 0.85, CI 0.75, 0.96; p=0.007), reduction of positive strain peaks in the 4-chamber (HR 0.44, CI 0.25, 0.77; p<0.001) position. When analyzing the data of the sixth month of observation, the predictors were: reduction of negative strain peak in 4-chamber (HR 1.33, CI 1.05, 1.69, p=0.009) and 2-chamber (HR 1.23, CI 1.01, 1.5; p=0.029) positions, reduction of global longitudinal strain LA (HR 0.83, CI 0.72, 0.95; p=0.004), high left atrial stiffness index (HR 15.3, CI 6.56, 35.9; p<0.001).

Conclusion. Evaluation of LA strain parameters during speckle- tracking may be promising in patients with AF after CV, since their decrease correlates well with the risk of adverse events in the long-term periods (3 and 6 months after CV).

Purpose: search for criteria for assessing the relationship between the dynamics of the patient’s condition with pulmonary hypertension according to clinical and instrumental examination with the dynamics of the daily variability of his sinus rhythm.

Material and methods. The study included 25 patients with idiopathic pulmonary hypertension (IPH) and 25 patients with chronic thromboembolic pulmonary hypertension (CTPH), who were examined twice at two different hospitalizations: before treatment and after 6–18 months to assess the effectiveness of treatment (50 pairs of examinations). In all examinations, the daily HRV was evaluated according to the Holter ECG data. The functional state was determined comprehensively taking into account the FCLH and the distance covered in the 6-minute walk test. In all patients, the right atrium area (RAA) was determined according to EchoCG data. In 15 out of 50 patients, catheterization of the right parts of the heart (CRPH) was performed during two examinations with determination of pressure in the right atrium (PRA), in the right ventricle, in the pulmonary artery and jamming pressure in the pulmonary artery, as well as oximetry with determination of oxygen saturation of mixed venous blood (SvO2) and cardiac index (CI).The parameters of the daily HRV were determined using a modifi cation of the VSRA-SSR method, taking into account the presence of double fractures (DFR) on the rhythmogram. The dynamics of the parameters of the daily HRV were compared with the dynamics of the functional state, ARA, and also (in 15 cases) — with the dynamics of the average PRA (aPRA), SI and SvO2.

Results 1. The connection between the dynamics of the results of a comprehensive assessment of the functional state of patients with PH and the dynamics of the parameters of their daily HRV is traced. A reflection of this is both a large percentage of cases with unidirectional dynamics of the functional state and HRV, and a small number of cases with multidirectional dynamics. These trends are especially evident in the treatment of patients with IPH.

1. There is a high percentage of coincidences of HRV dynamics and right atrium area (RAA) according to EchoCG data, and this percentage is the highest (with a small number of cases with multidirectional dynamics) in the CTPH group.
2. In most cases, CRPH revealed the correspondence of HRV dynamics to the dynamics of oxygen saturation of SvO2 and SI.

Conclusion. HRV analysis over long periods of time in patients with hypertension can be used not only to assess the functional state of the patient, but also to assess the dynamics of the functional state of the patient, reflecting the effectiveness of the treatment.

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.

Aim. To study features of atherosclerosis and signs of instability of atherosclerotic plaque in the carotid arteries by ultrasound duplex scanning of elderly patients with myocardial infarction or unstable angina.

Material and methods. The study included 87 patients with ACS and 78 patients without ACS aged 75 and over. Ultrasound duplex scanning of carotid arteries was carried out with Philips EPIQ5 ultrasound system and L12–3 linear array transducer on the 2–5 day from the moment of hospitalization. Quantitative and structural indicators of atherosclerosis of the carotid arteries were assessed .

Results. The frequency of detection of atherosclerotic plaques in carotid arteries in elderly patients with ACS was signifi cantly higher than in patients without ACS – 78 and 67 % (p=0,179). Patients with ACS compared with the group without ACS more often had signs of instability of atherosclerotic plaque: heterogenous structure – 28,8 and 19,3 % (p=0,017), hypoechogenic component – 39,2 and 9,9 % (p<0,001), irregular surface – 46,3 and 8,2 % (р<0,001), local calcifi cation –14,2 and 7 % (р=0,001). At the same time, ulcerated atherosclerotic plaques were found only in the group of patients with ACS – 1,9 % (р=0,412). The incidence of atherosclerotic plaques in carotid arteries among men was higher in the group with ACS compared to patients without ACS – 36,2 and 23,4 % (р=0,003); among women the data are higher in the group without ACS compared with the group of patients with ACS – 76,6 and 63,8 % (р=0,003).

Conclusion. Atherosclerotic plaques in carotid arteries among elderly patients are more common in the group of patients with ACS. As the same time, among this group atherosclerotic plaques with signs of instability were significantly more common found.

Introduction. Peripheral nerve ultrasound helps in the differential diagnosis of amyotrophic lateral sclerosis (ALS) and treatable diseases with a similar clinic. The cross–sectional area (CSA) values of the nerves of the hands and spinal nerves in ALS is normal or even reduced in comparison with control. The CSA of the nerves in a clinically similar condition – multifocal motor neuropathy (MMN) increases and has a characteristic ultrasound pattern of changes in the form of an increase in CSA in the proximal parts of the nerves of the hands and spinal nerves of the brachial plexuses.

Materials and methods. Cervical root and peripheral nerve CSA on both sides was performed in 31 patients with ALS and 25 patients with MMN, using a 8–15 MHz linear array probe (ultrasound scanner «Sonoscape S20» (China). The control group included 92 healthy people without diseases of the nervous system, as well as conditions potentially causing damage to the peripheral nervous system.

Results. The average values of the CSA of cervical roots and peripheral nerves in the upper limb in ALS patients were normal. However, there was an increase in the CSA of the median nerve at the shoulder level on the left by 23 %, the radial nerve on the right by 24 %, and the ulnar nerve on the left at the wrist level by 33 % in the ALS group compared with the control group. The CSA of nerves in MMN patients was significantly higher than in ALS and compared with the control group. In MMN nerve trunks increase was observed in the proximal parts of the nerves in the upper limb and cervical roots on both sides.

Conclusions. Peripheral nerve ultrasound is a reliable tool for differential diagnosis ALS and ALS mimics. It can be widely used in routine clinical practice.

Modern functional diagnostics methods for the respiratory system in children (Part 1. Methods based on the study of tidal breathing in children) This review provides up-to-date information on practically significant functional diagnostics methods of the respiratory system in children, taking into account their physiological capabilities. In the published first part of the review, attention is paid to methods based on the study of tidal breathing in young children (tidal breathing flow-volume, computer bronchophonography, pulse oscillometry); this information is intended for functional diagnostics doctors, pulmonologists, neonatologists and pediatricians.

Electroencephalography (EEG) remain the key method to assess the functional state of the brain. In outpatient practice one of the most widespread EEG types is short-term or 'routine EEG', that means the registration of cerebral activity up to 30 minutes with carrying out of activation tests. The previously published 'Survey among Russian doctors on routine electroencephalography' has shown huge variability of methodology of routine EEG and caused a vibrant discussion. Thus, in the letter to editor 'Crisis of quantitative electroencephalography' by L. B. Ivanov, critical opinion was expressed about the requirement of such surveys, about the reference parameters of activation tests, and about insufficient education of functional diagnostic doctors, especially in the sphere of using quantitative EEG for diagnostics of psychiatric pathology.

The manuscript presents new arguments regarding the expediency of a clear definition of the EEG terms and conditions and importance to develop official methodological guidelines for various EEG types in accordance with clinical guidelines.