russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2020-2-3731russjcardiol-3731Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESДеформация миокарда при инфаркте правого желудочка и тромбоэмболии легочной артерииCardiac strain in right ventricular myocardial infarction and pulmonary embolismhttps://orcid.org/0000-0002-8879-3791МазурЕ. С.MazurE. S.

Мазур Евгений Станиславович — доктор медицинских наук, профессор, заведующий кафедрой госпитальной терапии и профессиональных болезней

Тверь

Evgeniy S. Mazur

Tver

mazur-tver@mail.ruhttps://orcid.org/0000-0003-4818-434XМазурВ. В.MazurV. V.

Мазур Вера Вячеславовна — доктор медицинских наук, профессор кафедры госпитальной терапии и профессиональных болезней

Тверь

Vera V. Mazur

Tver

vera.v.mazur@gmail.comhttps://orcid.org/0000-0002-1562-6212РабиновичР. М.RabinovichR. M.

Рабинович Роберт Михайлович — кандидат медицинских наук, заведующий отделением кардиологии с палатой реанимации и интенсивной терапии

Тверь

Robert M. Rabinovich

Tver

r_r_m@mail.ruhttps://orcid.org/0000-0002-0784-5845МясниковК. С.MyasnikovK. S.

Мясников Константин Сергеевич — врач отделения кардиологии с палатой реанимации и интенсивной терапии

Тверь

Konstantin S. Myasnikov

Tver

kostya_myasnikov@mail.ruhttps://orcid.org/0000-0001-9114-0436ОрловЮ. А.OrlovYu. A.

Орлов Юрий Александрович — кандидат медицинских наук, доцент кафедры госпитальной терапии и профессиональных болезней

Тверь

Yurij A. Orlov

Tver

orlov-tver@mail.ruФГБОУ ВО Тверской государственный медицинский университет Минздрава РоссииРоссияTver State Medical UniversityRussian FederationГБУЗ Областная клиническая больница Тверской областиРоссияRegional Clinical HospitalRussian Federation20201602202025237313731Copyright © Мазур Е.С., Мазур В.В., Рабинович Р.М., Мясников К.С., Орлов Ю.А., 20202020Мазур Е.С., Мазур В.В., Рабинович Р.М., Мясников К.С., Орлов Ю.А.Mazur E.S., Mazur V.V., Rabinovich R.M., Myasnikov K.S., Orlov Y.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/3731

Цель — изучить возможность использования показателей продольной систолической деформации миокарда правого желудочка (ПЖ) для дифференциальной диагностики инфаркта ПЖ (ИМПЖ) и тромбоэмболии легочной артерии (ТЭЛА).

Материал и методы

Материал и методы. Исследование продольной систолической деформации (стрейна) ПЖ в режиме двухмерного отслеживания пятен серой шкалы ультразвукового изображения (speckle tracking) проведено 30 больным ИМПЖ (1-я группа), 15 больным ТЭЛА высокого риска (2-я группа) и 38 больным ТЭЛА промежуточного риска (3-я группа).

Результаты

Результаты. Средние величины глобального стрейна ПЖ у больных 1-й и 2-й группы не различались (12,8±2,69 и 12,0±2,56 %) и были достоверно ниже, чем у больных 3-й группы (15,9±3,03 %). При этом отношение стрейна межжелудочковой перегородки (МЖП) к стрейну свободной стенки ПЖ (ССПЖ) в 1-й группе (1,04±0,43) в среднем было достоверно ниже, чем во 2-й (1,61±0,52) и 3-й (1,29±0,38). Отношение стрейна базального сегмента ССПЖ к стрейну апикального сегмента у больных 1-й группы (0,60±0,37) также было достоверно ниже, чем у больных 2-й (1,69±1,57) и 3-й (1,67±1,33) группы.

 Aim

 Aim. To study the prospects of using parameters of right ventricle (RV) longitudinal strain (LS) during systole for the differential diagnosis of RV myocardial infarction (RVMI) and pulmonary embolism (PE).

Material and methods

Material and methods. The study included 83 patients who were hospitalized with RVMI or PE in the period from December 2017 to May 2019. The study of RV LS using the two-dimensional speckle-tracking echocardiography was carried out in 30 patients with RVMI (group 1), 15 patients with high-risk PE (group 2), and 38 patients with intermediate-risk PE (group 3).

Results

Results. The mean values of RV global LS in patients of groups 1 and 2 did not differ (12,8±2,69 and 12,0±2,56%, respectively) and were significantly lower than in patients of group 3 (15,9±3,03%). The ratio of the interventricular septum (IVS) LS to the RV free wall (FW) LS in the group 1 (1,04±0,43) was significantly lower than in the groups 2 (1,61±0,52) and 3 (1,29±0,38). The ratio of the LS of the RVFW basal segment to the apical segment in group 1 (0,60±0,37) was also significantly lower than in groups 2 (1,69±1,57) and 3 (1,67±1,33).

Conclusion

Conclusion. In patients with RVMI, there is a comparable decrease in the LS of the RVFW and IVS, and the LS of the basal segment decreases to a greater extent than the apical one. In patients with PE, the decrease in the LS of the RVFW is more pronounced than in IVS, and the LS of the apical segment decreases to a greater extent than the basal one. These differences can be used for the differential diagnosis of RVMI and PE.

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The authors declare that there are no conflicts of interest present.