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КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯ / CLINICAL INVESTIGATIONS
https://doi.org/10.29001/2073-8552-2022-37-4-124-128 УДК: 616.12-008.318:615.222
Traditional Criteria of Mechanical and Electrical Dyssynchrony as a Predictor of Super-Response in Patients with Cardiac Resynchronization Therapy
Nikita Е. Shirokov, Anna M. Soldatova, Dmitry V. Krinochkin,
Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences, 111, Melnikaite str., Tyumen, 625026, Russian Federation
Abstract
Aim: To evaluate clinical and morpho-functional predictors of super-response to cardiac resynchronization therapy (CRT) in patients with heart failure and reduced ejection fraction (HFrEF) in the short-term period after implantation. Material and Methods. The study enrolled 86 patients (88.4% men, 54.0 ± 8.9 years mean age, New York Heart Association (NYHA) class II—IV). Patients were examined at baseline and in dynamics (mean follow-up was 10.6 ± 3.6 months). According to the change in left ventricular (LV) end-systolic volume (ESV) patients were divided into two groups: Group I (n = 19) with a decrease in LV ESV > 30% (super-responders (SR) and Group II (n = 67) - decrease in LV ESV < 30% (non-super-responders (non-SR). Parameters of mechanical dyssynchrony (MD) were assessed in the two groups including LV pre-ejection period, interventricular mechanical delay (IVMD), intraventricular delay (IVD).
Results. At baseline, traditional parameters of MD were higher in SR: LV pre-ejection period (156.8 ± 35.4 ms vs 135.0 ± 35.6 ms; p = 0.021) and IVMD (73.0 [43.0; 108.0] ms vs 47.0 [19.5; 70.0] ms; p = 0.017). Logistic regression results showed that female gender (HR 7.048; 95% CI 1.496-33.206; p = 0.014) and QRS width (HR 1.017; 95% CI 1.000-1.034; p = 0.048) had an independent association with super-response.
Conclusion. In patients with HFrEF, more severe mechanical and electrical dyssynchrony is associated with super-response to CRT in a short-term follow-up period.
Vadim A. Kuznetsov
Keywords: mechanical dyssynchrony, super-response, cardiac resynchronization therapy.
Conflict of interest: the authors do not declare a conflict of interest.
Financial disclosure: no author has a financial or property interest in any material or method mentioned.
Adherence to ethical standards: the study was conducted in accordance with the ethical standards of the Local Institutional Review Board and with the 1964 Helsinki declaration and its later amendments. The study protocol was approved by the institutional review board. All patients gave their written informed consent before the study.
For citation: Shirokov N.E., Soldatova A.M., Krinochkin D.V., Kuznetsov V.A. Traditional Criteria of Mechanical and Electrical Dyssynchrony as a Predictor of Super-Response in Patients with Cardiac Resynchronization Therapy. The Siberian Journal of Clinical and Experimental Medicine. 2022;37(4):124-128. https://doi.org/10.29001/2073-8552-2022-37-4-124-128.
Традиционные признаки механической и электрической диссинхронии как предикторы суперответа на сердечную ресинхронизирующую терапию
Н.Е. Широков, А.М. Солдатова, Д.В.Криночкин,
Тюменский кардиологический научный центр, Томский национальный исследовательский медицинский центр Российской академии наук,
625026, Российская Федерация, Тюмень, ул. Мельникайте, 111 Аннотация
Цель: выявить морфофункциональные особенности сердца у больных с хронической сердечной недостаточностью (ХСН) и развитием суперответа на сердечную ресинхронизирующую терапию (СРТ) при коротком периоде наблюдения.
Н Широков Никита Евгеньевич, e-mail: shirokovne@infarkta.net.
В.А. Кузнецов
Широков Н.Е., Солдатова А.М., Криночкин Д.В., Кузнецов В.А. Традиционные признаки механической и электрической диссинхронии как предикторы суперответа на сердечную
Материал и методы. В исследование было включено 86 пациентов (88,4% мужчин, средний возраст - 54,0 ± 8,9 года) с II—IV функциональным классом ХСН по NYHA. Обследование пациентов проводилось исходно перед постановкой кардиостимулятора и в динамике (срока наблюдения составил 10,6 ± 3,6 месяца). В соответствии с ответом на СРТ пациенты были разделены на две группы: I гр. (п = 19) с уменьшением конечно-систолического объема (КСО) левого желудочка (ЛЖ) > 30% от исходного (суперреспондеры) и II гр. (п = 67) — уменьшение КСО ЛЖ < 30% (несуперреспондеры). Результаты. Исходно параметры механической диссинхронии были выше у суперреспондеров (период аортального предызгнания (период аортального предызгнания (156,8 ± 35,4 мс и 135,0 ± 35,6 мс; р = 0,020); механическая межжелудочковая задержка (73,0 [43,0; 108,0] мс vs 47,0 [19,5;70,0] мс; р = 0,017). Сочетание женского пола (ОШ 7,048; 95% ДИ 1,496—33,206; р = 0,014) и ширины QRS (ОШ 1,017; 95% ДИ 1,000—1,034; р = 0,048) имело независимую связь с развитием суперответа на СРТ.
Заключение. У пациентов с ХСН более выраженная механическая и электрическая диссинхрония ЛЖ ассоциируются с суперответом на СРТ при коротком периоде наблюдения.
Ключевые слова: механическая диссинхрония, суперответ, сердечная ресинхронизирующая терапия.
Конфликт интересов: авторы заявляют об отсутствии конфликта интересов.
Прозрачность финансовой деятельности: никто из авторов не имеет финансовой заинтересованности в представленных материалах или методах.
Соответствие принципам этики: исследование было выполнено в соответствии со стандартами надлежащей клинической практики Локального этического комитета и принципами Хельсинкской декларации (1964 г.). До включения в исследование у всех участников было получено письменное информированное согласие.
Для цитирования: Широков Н.Е., Солдатова А.М., Криночкин Д.В., Кузнецов В.А. Традиционные признаки механической и электрической диссинхронии как предикторы суперответа на сердечную ресинхронизирующую терапию. Сибирский журнал клинической и экспериментальной медицины. 2022;37(4):124-128. https://doi.org/10.29001/2073-8552-2022-37-4-124-128.
Introduction
Asynchronous left ventricular (LV) function in patients with heart failure and reduced ejection fraction (HFrEF) with the presence of left bundle branch block (LBBB) and wide QRS complex are recognized as the main criteria for the selection to cardiac resynchronization therapy (CRT) by the current guidelines [1]. CRT is associated with the potential reversibility of cardiac remodeling [2]. Improvement of long-term survival in patients with HFrEF following CRT implantation are proportional to the degree of improvement of LV systolic function. Patients with pronounced reverse remodeling after CRT are identified as super-responders (SR) [3]. *
Non-ischemic etiology of cardiomyopathy, female sex, LBBB and QRS width among various factors are described to be associated with super-response to CRT [4, 5]. However, several studies have shown that the criteria of intraventricular and interventricular mechanical dyssynchrony (MD) are more accurate predictors of super-response to CRT [6, 7].
The purpose of this study is to evaluate clinical and morpho-functional features in patients with HFrEF and super-response to CRT and to determine predictors of super-response in a short-term follow-up period.
Material and Methods
The study enrolled 86 patients included in "The register of performed operations of cardiac resynchronization therapy"© (88.4% men, mean age 54.0 ± 8.9 years, 58.2% with LBBB, 54.7% with ischemic cardiomyopathy) [8]. The main criteria for the selection of patients were: NYHA functional class II-IV, LV EF <35%; markers of intraventricular and/or interventricular MD recorded with two-dimensional echocardiography (2D Echo). Standard echocardiography was performed using
a commercially available system Philips IE 33. The examination included 2D Echo grayscale, color and tissue Doppler imaging (TDI). Using 2D echocardiography, we evaluated LV end-diastolic volume (EDV), LV end-systolic volume (ESV) and LV ejection fraction (LVEF).
Super-response was defined as a decrease of LV ESV > 30% at the follow-up visit. According to the change in LV ESV, patients were divided into two groups: group I (n = 19) with a decrease in LV ESV >30% (SR); and group II (n = 67) with a decrease in LV ESV < 30% (non-super-re-sponders, non-SR).
As for dyssynchrony parameters, two MD indexes were quantified by 2D echocardiography: interventricular mechanical delay (IVMD), defined as the delay in onset of outflow between the left and right ventricle (abnormality cut-off > 40 ms); and LV pre-ejection period (PEP) (abnormality cut-off > 140 ms) (Figure 1). IVD was assessed by TDI, based on the difference between time to onset of systolic velocity spectrum recorded from lateral and septal mitral annulus from 4-chamber apical view asynchrony (abnormality cut-off > 60 ms) [9].
The patient examination was performed at baseline and during the follow-up (10.6 ± 3.6 months). All patients were on optimal drug therapy according to current guidelines [1].
Statistical analyses were performed using SPSS for Windows version 23.0 (SPSS Inc., Chicago, IL, USA). Categorical variables were reported as count and percent and compared by x2 exact test. Continuous variables were tested for normality by the Kolmogorov-Smirnov test and reported as mean and SD or median and quartiles as appropriate. Student's t-test and Mann - Whitney Wilcoxon test were used for comparing continuous variables expressed as means and medians, respectively. P value < 0.05 was considered statistically significant.
Q'l Сибирский журнал клинической и экспериментальной медицины The Siberian Journal of Clinical and Experimental Medicine
2022;37(4):124-128
Fig. 1. Increase of left ventricular pre-ejection period in patient with super-response to cardiac resyncronuzation therapy.
Рис. 1. Увеличение периода аортального предызгнания у пациента с суперответом на сердечную ресинхронизирующую терапию.
Results
Compared to Group II (non-SR), Group I (SR) were less likely to be males (63.2% vs 95.5%; р < 0.001). There were no significant differences between the groups with respect to the 6 minute walk test (6MWT) (SR 315.6 vs non SR 295.1; р = 0.461), NYHA functional class (SR 1.8 vs non SR 2.0; p = 0.178) and all other characteristics (Table 1).
At the follow up visit, there was still no statistically significant difference with respect to the 6MWT (SR 414.9 vs non SR 379.9; р = 0.183) and NYHA functional class (SR 1.8 vs non SR 2.0; р = 0.178).
The SR group exhibited more pronounced manifestations of MD and QRS duration. The LV PEP and IVMD were significantly higher (Table 2).
During the follow-up, a statistically significant improvement in echocardiographic parameters was noticed in both groups, with comparing initial data, along with LV ESV, which was used as the separation criterion. Significantly lower values of LV EDV and greater LV EF were found in Group I on the follow-up visit (Table 2).
Table 1. Baseline characteristics of study participants (n = 86) Таблица 1. Клинико-функциональная характеристика пациентов
Feature Показатель Group I (n = 19) Группа I Group II (n = 67) Группа II р
Age, years Возраст, годы 54.7 ± 8.5 53.9 ± 9.1 NS нд
Gender, % male Пол, % мужчины 63.2 95.5 < 0.001
Ischemic CMP, % ИБС, % 52.6 55.2 NS нд
Atrial fibrillation, % ФП, % 15.8 40.3 NS нд
Diabetes, % СД, % 21.1 11.9 NS нд
Arterial hypertension, % А, % 84.2 68.7 NS нд
History of MI, % ИМ в анамнезе, % 26.3 44.8 NS нд
LBBB, % БЛНПГ, % 73.7 52.2 NS нд
QRS, ms 165.7± 42.7 136.3 ± 33.7 0.006
CRT-D, % СРТД, % 52.6 71.6 NS нд
Note: CMP - cardiomyopathy; MI - myocardial infarction; LBBB -left bundle branch block; CRT-D - combined system for cardiac resynchronization therapy with cardioverter-defibrillator function; NS -non significant (p > 0.05).
Примечание. ИБС - ишемическая болезнь сердца, ФП - фибрилляция предсердий, СД - сахарный диабет, АГ - артериальная гипер-тензия, ИМ - инфаркт миокарда, БЛНПГ - блокада левой ножки пучка, СРТ-Д - комбинированная система для сердечной ресинхро-низирующей терапии с функцией кардиовертера-дефибриллятора, нд - нет достоверных различий, (р > 0,05).
Table 2. Echocardiography parameters of study participants (n = 86) Таблица 2. Динамика эхокардиографических параметров (n = 86)
Feature Показатель Group I (n = 19) I группа (n = 19) Group II (n = 67) II группа (n = 60) р
LV EF, % at baseline исходно 30.6 ± 6.2 30.6 ± 5.2 NS нд
ФВ ЛЖ, (%) control контрольно 45.3 ± 7.2* 34.9 ± 6.2* < 0.001
LV EDV, ml КДО ЛЖ, (мл) at baseline исходно 240.7 ± 59.4 239.9 ± 58.2 NS нд
контрольно 190.9 ± 48.6* 230.4 ± 59.1* 0.002
LV ESV, ml КСО ЛЖ, (мл) at baseline исходно 172.4 ± 52.2 168.1 ± 48.8 NS нд
контрольно 104.6 ± 31.9* 152.9 ± 50.3* < 0.001
LV pre-ejection period, ms Период аортального предызгнания, (мсек) at baseline исходно 156.8 ± 35.4 135.0 ± 35.6 0.021
Mechanical interventricular delay, ms Механическая межжелудочковая задержка, (мсек) at baseline исходно 73.0 [43.0; 108.0] 47.0 [19.5; 70.0] 0.017
Intraventricular delay by TDI, ms Максимальная межсегментарная задержка, TDI, (мсек) at baseline исходно 78.0 [40.0; 110.0] 55.5 [28.8; 100.0] 0.149
Note: LV - left ventricular; EF - ejection fraction; EDV - end-diastolic volume; ESV - end-systolic volume; TDI - tissue Doppler; * - significant relationship of control from initial (p < 0,05); NS - non significant, (p > 0.05).
Примечание: ФВ ЛЖ - фракция выброса левого желудочка; КДО ЛЖ - конечно-диастолический объем левого желудочка; КСО - конечно-систолический объем; КДД - конечно-диастолический диаметр; КСД - конечно-систолический диаметр; тканевая допплерография - TDI; * - значимая достоверность контроля от исходных данных (р < 0,05); нд - нет достоверных различий, (р > 0,05).
Широков Н.Е., Солдатова А.М., Криночкин Д.В, Кузнецов В.А. Традиционные признаки механической и электрической диссинхронии как предикторы суперответа на сердечную
Logistic regression results showed that female gender (HR 7.048; 95% CI 1.496-33.206; p = 0.014) and QRS width (HR 1.017; 95% CI 1.000-1.034; p = 0.048) had an independent association with super-response. According to the ROC analysis, sensitivity and specificity of this model in the prediction of super-response to CRT were 73.7% and 81.7%, respectively. The area under the curve (AUC) was 0.746; p = 0.002, which indicates that the predictive model is of good quality (Fig. 2).
Discussion
Currently, there is no consensus on the follow-up period when the response to CRT should be assessed [10, 11]. In our study, changes in echocardiographic parameters were evaluated during the first year after implantation [11]. Besides
References
1. Mareev V.Yu., Fomin I.V., Ageev F.T., Begrambekova Yu.L., Vasyuk Yu.A., Garganeeva A.A. et al. Clinical recommendations SSHF-RSC-RSMST. Heart failure: congestive (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(6S):8-158. (In Russ.). DOI: 10.18087/cardio.2475.
2. Brignole M., Auricchio A., Baron-Esquivias G., Boriani G., Breithardt O.A., Cleland J. et al. ESC Guidelines on cardiac pacing and cardiac resynchronization therapy 2013: The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur. Heart J. 2013;34(29):2281-2329. DOI: 10.1093/eurheartj/ eht150.
3. Rickard J., Cheng A., Spragg D., Bansal S., Niebauer M., Baranows-ki B. et al. Durability of the survival effect of cardiac resynchroniza-tion therapy by level of left ventricular functional improvement: Fate of "nonresponders". Heart Rhythm. 2014;11(3):412-416. DOI: 10.1016/j. hrthm.2013.11.025.
that, the reverse LV remodeling in SR after CRT remains stable with long-term follow-up [3]. Despite the different definitions for super-response time, patients with super-response demonstrated better survival, better dynamics of clinical and functional features, and more significant increase in LVEF [12].
A subanalysis of the PROSPECT study showed that SR before the pacemaker implantation had more pronounced traditional criteria of electrical dyssynchrony and MD than responders, non-responders and patients with negative dynamics [6]. Compared with males, female patients were found to have more frequent electromechanical abnormalities at shorter QRS width [13]. In recent years, new methods of visualizing the myocardium (speckle tracking echocardiography) facilitate our understanding of the electromechanical background of LBBB [14]. It should be noted that baseline MD was shown to be a significant predictor of CRT efficiency [15-17]. While previous studies demonstrated that greater response was associated with LBBB and QRS width [18].
Of note in our study, at baseline, both groups were comparable in QRS morphology. Groups differed in the duration of QRS width, LV PEP and IVMD, which were significantly higher in the SR group.
Conclusion:
In patients with HFrEF, more severe mechanical and electrical dyssynchrony is associated with super-response to CRT.
Limitations
Enrollment began in January 2005 until July 2017. During this period, the selection criteria for CRT in current guidelines changed.
At baseline for implantation of biventricular pacemaker two main criteria were identified: decreased LVEF and the presence of MD. One of the first examples of use such an approach was the Protocol of St. Mary's Hospital in London. The results of the MADIT-CRT study are reflected in the clinical guidelines of ESC in 2013. There was a requirement for a presence of QRS morphology by LBBB; which was not a criterion before. Clinical guidelines of ESC in 2016 confirm QRS width more than 150 ms; increasing from a previous cut-off of 120 ms.
In general, we used our experience of patient selection for CRT, from 2005 until the update to the guidelines for CRT in 2013, in our practice the protocol of St. Mary's Hospital (London) for recommendation for CRT [9].
4. Ghani A., Delnoy P.P.H., Adiyaman A., Ottervanger J.P., Ramdat Mis-ier A.R., Smit J.J.J. et al. Predictors and long-term outcome of su-per-responders to cardiac resynchronization therapy. Clin. Cardiol. 2017;40(5):292-299. DOI: 10.1002/clc.22658.
5. Jackson T., Sohal M., Chen Z., Child N., Sammut E., Behar J. et al. A U-shaped type II contraction pattern in patients with strict left bundle branch block predicts super-response to cardiac resynchronization therapy. Heart Rhythm. 2014;11(10):1790. DOI: 10.1016/j. hrthm.2014.06.005.
6. Van Bommel R.J., Bax J.J., Abraham W.T., Chung E.S., Pires L.A., Tavazzi L. et al. Characteristics of heart failure patients associated with good and poor response to cardiac resynchronization therapy: A PROSPECT (Predictors of Response to CRT) sub-analysis. Eur. Heart J. 2009;30(20):2470-2477. DOI: 10.1093/eurheartj/ehp368.
7. Cazeau S.J., Dauber J., Tavazzi L., Frohlig G., Paul V. Responders to cardiac resynchronization therapy with narrow or intermediate QRS complexes identified by simple echocardiographic indices of dyssynchrony: the DESIRE study. Eur. Heart J. 2008;10(3):273-280. DOI: 10.1016/j.ejheart.2008.02.007.
Fig. 2. Sensitivity and specificity of model in the prediction of super-response to CRT were 73.7% and 81.7%, respectively Рис. 2. Чувствительность и специфичность модели прогнозирования суперответа на СРТ: 73.7% и 81.7% соответственно
Q^ Сибирский журнал клинической и экспериментальной медицины The Siberian Journal of Clinical and Experimental Medicine
2022;37(4):124-128
8. Kuznetsov V.A., Kolunin G.V., Kharats V.E. et al. Register of performed operations of cardiac resynchronization therapy. Electronic database, state registration №2010620077 from 01.02.2010. (In Russ.).
9. Kuznetsov V.A. Cardiac resynchronization therapy: selected questions. Moscow: Abys; 2007:128. (In Russ).
10. Yanagisawa S., Inden Y., Shimano M., Yoshida N., Fujita M., Ohguchi S. et al. Clinical characteristics and predictors of super-response to cardiac resynchronization therapy: a combination of predictive factors. Pacing Clin. Electrophysiol: РАСЕ. 2014;37(11):1553. DOI: 10.1111/pace.12506.
11. Vukajlovic D., Milasinovic G., Angelkov L., Ristic V., Tomovic M., Jurcev-ic R. et al. Contractile reserve assessed by dobutamine test identifies super-responders to cardiac resynchronization therapy. Arch. Med. Sci. 2014;10(4):684. DOI: 10.5114/aoms.2014.40790.
12. Cay S., Ozeke O., Ozcan F., Aras D., Topaloglu S. Mid-term clinical and echocardiographic evaluation of super responders with and without pacing: the preliminary results of a prospective, randomized, single-centre study. Europace. 2016;18(6):842. DOI: 10.1093/europace/euv129.
13. De Pooter J., Kamoen V., El Haddad M., Stroobandt R., De Buyzere M., Jordaens L. Gender differences in electro-mechanical characteristics of left bundle branch block: Potential implications for selection and response of cardiac resynchronization therapy. Int. J. Cardiol. 2018;257:84-91. DOI: 10.1016/j.ijcard.2017.10.055.
14. Shirokov N.E., Kuznetsov V.A., Todosiychuk V.V., Soldatova A.M., Kri-nochkin D.V. Relationship between left bundle branch block patterns and super-response to cardiac resynchronization therapy in patients with heart failure. Russian Journal of Cardiology. 2021;26(7):4227. (In Russ.). DOI: 10.15829/1560-4071-2021-4227.
15. Cleland J.G., Daubert J.C., Erdmann E., Freemantle N., Gras D., Kap-penberger L. et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N. Engl. J. Med. 2005;352(15):1539-1549. DOI: 10.1056/NEJMoa050496.
16. Kuznetsov V.A., Soldatova A.M., Krinochkin D.V., Enina T.E. Cardiac resynchronisation therapy for congestive heart failure: whether we should expect for an "early" response? Russian Heart Failure Journal. 2017;18(3):172-177. (In Russ). DOI: 10.18087/rhfj.2017.3.2341.
17. Gold M.R., Yu Y., Wold N., Day J.D. The role of interventricular conduction delay to predict clinical response with cardiac resynchroniza-tion therapy. Heart Rhythm. 2017;14(12):1748-1755. DOI: 10.1016/j. hrthm.2017.10.016.
18. Van der Bijl P., Khidir M., Leung M., Mertens B., Ajmone Marsan N., Delgado V. et al. Impact of QRS complex duration and morphology on left ventricular reverse remodeling and left ventricular function improvement after cardiac resynchronization therapy. Eur. J. Heart Fail. 2017;19(9):1145-1151. DOI: 10.1002/ejhf.769.
Information on author contributions
Kuznetsov V.A. - contributed to the concept and research design. Shirokov N.E. and Krinochkin D.V. - acquisition and analysis of data. Kuznetsov V.A. and Shirokov N.E. - statistics. Nikita E. Shirokov and Soldatova A.M. - interpretation of data. All the authors contributed to drafting and critically revising the manuscript and approving the submitted version of the manuscript.
Information about the authors
Nikita E. Shirokov, Cand. Sci. (Med.), Research Scientist of the Laboratory of Instrumental Diagnostics of the Scientific Department of Instrumental Research Methods, Tyumen Cardiology Research Center, Branch of Tomsk National Research Medical Center, Russian Academy of Sciences. ORCID 0000-0002-4325-2633.
E-mail: shirokovne@infarkta.net.
Anna M. Soldatova, Dr. Sci. (Med.), Research Scientist of the Laboratory of Instrumental Diagnostics of the Scientific Department of Instrumental Research Methods, sonographer, Tyumen Cardiology Research Center, Branch of Tomsk National Research Medical Center, Russian Academy of Sciences. ORCID 0000-0001-5389-0973.
E-mail: amsoldatova@mail.ru.
Dmitry V. Krinochkin, Cand. Sci. (Med.), Head of the department of ultrasound diagnostics, Senior Research Scientist of the Laboratory of Instrumental Diagnostics of the Scientific Department of Instrumental Research Methods, Tyumen Cardiology Research Center, Branch of Tomsk National Research Medical Center, Russian Academy of Sciences. ORCID 0000-0003-4993-056X.
E-mail: krin@infarkta.net.
|Vadim A. Kuznetsov, | Dr. Sci (Med.), Professor, Honored Worker of Science of the Russian Federation, Scientific consultant of Tyumen Cardiology Research Center, Tomsk National Research Medical Center of the Russian Academy of Sciences. ORCID: 0000-0002-1970-2606.
H Nikita E. Shirokov, e-mail: shirokovne@infarkta.net.
Received March 31, 2022
Информация о вкладе авторов
Кузнецов В.А. внес вклад в концепцию и утверждение дизайна исследования.
Широков Н.Е. и Криночкин Д.В. - получение и анализ данных. В.А. Кузнецов и Широков Н.Е. - статистическая обработка. Широков Н.Е. и Солдатова А.М. - интерпретация результатов. Все авторы внесли свой вклад в составление, проверку и утверждение представленной версии рукописи.
Сведения об авторах
Широков Никита Евгеньевич, канд. мед. наук, научный сотрудник, лаборатория инструментальной диагностики научного отдела инструментальных методов исследования, Тюменский кардиологический научный центр, Томский национальный исследовательский медицинский центр Российской академии наук. ORCID 0000-0002-4325-2633.
E-mail: shirokovne@infarkta.net.
Солдатова Анна Михайловна, д-р мед. наук, научный сотрудник, лаборатория инструментальной диагностики научного отдела инструментальных методов исследования, врач ультразвуковой диагностики. ORCID 0000-0001-5389-0973.
E-mail: amsoldatova@mail.ru.
Криночкин Дмитрий Владиславович, канд. мед. наук, заведующий отделением УЗИ, старший научный сотрудник, лаборатория инструментальной диагностики научного отдела инструментальных методов исследования, Тюменский кардиологический научный центр, Томский национальный исследовательский медицинский центр Российской академии наук. ORCID 0000-0003-4993-056X.
E-mail: krin@infarkta.net.
¡Кузнецов Вадим Анатольевич, | д-р мед. наук, профессор, заслуженный деятель науки РФ, научный консультант Тюменского кардиологического научного центра, Томский национальный исследовательский медицинский центр Российской академии наук. ORCID 0000-0002-19702606.
S Широков Никита Евгеньевич, e-mail: shirokovne@infarkta.net.
Поступила 31.03.2022
