An acceleration of blood flow in the diastasis phase with the formation of the so-called L-wave may be found in some patients. The transmitral blood flow is transformed into a triphasic in the presence of L-wave.

Objective: to assess the frequency of L-wave presence and to evaluate the relationship between the presence of L-wave in Doppler imaging of left ventricular blood flow, transmitral blood flow at the level of the mitral valve leaflets, and modern criteria for assessing left ventricular diastolic function.

Material and methods. The study included 105 patients (age 62.21 ± 11.97 (29–91) years, 61 men) with sinus rhythm. From a total of examined patients, 30 were conditionally healthy, 64 patients suffered from coronary heart disease, and 11 suffered from arterial hypertension. Pulsed-wave Doppler ultrasound of transmitral flow was performed in the apical 4-chamber view with the sample volume located at the level of the ends of the mitral valve leaflets, as well as at the level of the basal and middle segments of the left ventricle. The distinct positive wave on the spectrogram during the diastasis phase with a speed exceeding 20 cm/s was considered an additional L-wave, and such blood flow in diastole was considered triphasic.

Results. Triphasic transmitral blood flow was found in 9 patients (8.5%), and triphasic intraventricular blood flow in another 30 patients (28.5%). Patients with triphasic transmitral blood flow were older, with a greater left atrial volume index, and LV diastolic dysfunction was more often detected compared to patients with triphasic intraventricular blood flow (66.7% compared to 23.3%, p = 0.042).

Conclusion. Triphasic transmitral blood flow is revealing significantly less frequently than triphasic intraventricular blood flow (8.5% compared to 28.5%, p < 0.001). Triphasic transmitral blood flow is more often observed in patients with left ventricular diastolic dysfunction.

Purpose. To compare a semi-automatic strain analysis of the left ventricle and left atrium with a manual method in speckle-tracking echocardiography.

Materials and methods. A strain of left ventricle and left atrium was assessed in 110 patients by two methods: manual (Q-Analysis) and semi-automatic (AutoStrain). The following parameters were evaluated: LV global longitudinal strain (LV GLS), LA longitudinal strain during the reservoir phase (LASr), LA longitudinal strain during the conduit phase (LAScd), and LA longitudinal strain during the contraction phase (LASct).

Results. The ROI correction was carried out significantly more often with the semi-automatic method of measuring LV GLS than with manual (40.1% vs. 16.4%, p < 0.05). There were significant differences in LV GLS average values, LASr values, and LAScd values obtained by the semi-automatic and manual methods. LV GLS average values obtained by the semi-automatic method were lower (18.8 ± 2.8% vs. 20.0 ± 3.1%, p < 0.001), and the values of LASr and LAScd obtained by the semi-automatic method were higher (LASr 31.6 ± 9.8% vs. 30.3 ± 10.8%, p = 0.038; LAScd 17.1 ± 7.1% vs. 15.4 ± 6.8%, p < 0.001) than in manual. Semi-automatic method takes more time for LV strain analysis and less time for LA strain analysis than manual method.

Conclusion. The semi-automatic method of LV and LA strain evaluation showed higher reproducibility compared with the manual method. With the semi-automatic method, the values of the LV GLS were lower, and the correction of ROI was required more often and took more time than with manual. The semi-automatic method of LA strain evaluation was characterized by higher values in the reservoir and conduit phases and required less time compared to the manual method. The LA longitudinal strain in the reservoir phase showed the highest values of  reproducibility compared to other LA strain paremeters.

Computational vector electrocardiography (vECG) is a method for visualizing the total heart vector output in 3-dimensional mode based on 12 lead and distributed computational procedures. This method can be an additional to assess severity and prognosis in patients with acute decompensated heart failure (ADHF).

Objective: to investigate the vECG parameters associated with poor prognosis in patients with ADHF.

Materials and methods. ECG data of 100 patients with ADHF were analyzed. All patients underwent baseline clinical examination, echocardiography, and a natriuretic peptide (NT-proBNP) test. Mortality was recorded during follow-up for 12 months. The correlation of vECG and NT-proBNP parameters with the prognosis of patients was evaluated.

Results. Due to the period of follow-up, 17 patients died. According to vECG data, the surviving patients had a smaller spatial QRS-T angle compared to the deceased patients (p = 0.039). Statistically insignificant values (p = 0.076) of the planarity index in the group of deceased patients were revealed. ROC-analysis revealed the cut-off value of QRS-T spatial angle equal to 164.5°with sensitivity of 53% and specificity of 71%. The QRS-T spatial angle values above the cut-off value indicate a higher probability of lethal outcome. The cut-off value of 999.35 pg/ml of NT-proBNP in patients with the value of QRS-T angle of 164.5° associated with an unfavorable prognosis was revealed.

Conclusions. vECG can be used as a simple method to predict and assess the risk of fatal outcome in patients with ADHF and reduced left ventricular ejection fraction. The most significant parameter is the value of QRS-T spatial angle. An increase in the QRS-T spatial angle is associated with an increased risk of fatal outcome. Thus, vECG analysis may be a useful tool for identification of high-risk patients and influence the treatment strategy.

These guidelines may have been translated, from the originals published by ISUOG, by recognized experts in the field and have been independently verified by reviewers with a relevant first language. Although all reasonable endeavors have been made to ensure that no fundamental meaning has been changed the process of translation may naturally result in small variations in words or terminology and so ISUOG makes no claim that translated guidelines can be considered to be an exact copy of the original and accepts no liability for the consequence of any variations. The guidelines are only officially approved by the ISUOG in their English published form.

Purpose to evaluate the value of the embryo/fetus heart rate (HR) in early pregnancy assessed by ultrasound for the formation of a group at high risk of adverse pregnancy outcomes.

Materials and methods. A retrospective analysis of ultrasound examinations of 1073 pregnant women at 5⁺⁰–10⁺⁶ weeks was carried out. The embryo/fetus heart rate was compared with the gestational age calculated by the crown rump length (CRL) and the date of the last menstruation period (LMP). Retrospectively, all examined pregnant women were divided into two groups: group 1—with intrauterine embryo death before 14 weeks of pregnancy (n = 107); group 2—with prolongation of pregnancy until the second trimester (n = 966). When analyzing the data array using a decision tree, the embryo heart rate was assessed at various stages of pregnancy by LMP, CRL, and regardless of the exact period of pregnancy.

Results. Analysis of heart rate values at different stages of pregnancy by LMP showed significant differences in heart rate between groups, the cases of later embryo loss characterized by lover heart rate values. There were no significant differences in heart rate between the groups at different stages of pregnancy by CRL (significant differences were obtained only at 8⁺⁰–9⁺⁶ weeks). Cut-off values of embryo heart rate for prediction of adverse pregnancy outcomes have been proposed for different stages of pregnancy, as well as a universal cut-off for the entire embryonic period.

Conclusion. The proposed cut-off values of embryo heart rate for different stages of pregnancy, calculated by LMP, may be used for timely prediction of adverse pregnancy outcomes. When the exact gestational age is unknown, a universal heart rate cut-off value of <116 bpm may be used. All proposed HR cut-off values were characterized by high specificity, but none of them by high sensitivity. A sensitivity of HR cut-off values can be increased by the use in combination with other ultrasound and clinical signs of adverse pregnancy outcome.

Objective: to compare 2D ultrasound and 3D with HDlive mode ultrasound in the diagnosis of endometrial polyps in infertility.

Material and methods. The retrospective cohort study included 116 women aged 29 to 43 years (mean age 36.9 ± 3.78) with infertility who were observed at the Nova Clinic Center for Reproduction and Genetics from January 2021 to June 2024. 2D and 3D ultrasounds were performed in all patients. The final conclusion on the presence or absence of pathology was based on the results of the 3D study with HDlive mode. The histological verification of polyps was carried out after hysteroscopy.

Results. Hysteroscopy revealed no signs of pathology in 5 (4.3%) patients; moreover, the results of 2D imaging were also negative, and the results of 3D imaging were positive. In other 111 cases (95.7%), the diagnosis of a polyp was confirmed on hysteroscopy. Among them, no signs of pathology were found on 2D ultrasound in 19 (16.4%) patients. According to the obtained results, the use of 3D imaging with HDlive mode leads to overdiagnosis and false positive results with a chance of 4.5%. On the contrary, 2D imaging leads to underdiagnosis and false negative results with a chance of 19.6%, which is statistically significantly higher than the chance of a false positive result using the 3D method (p = 0.008). Thus, the chance of a false result using the 2D mode is 4.4 [1.57; 12.09] times higher than using the 3D mode.

Conclusions. The study demonstrated a higher accuracy of the 3D ultrasound compared to 2D ultrasound in diagnosing endometrial polyps.