ORCID Profile
0000-0002-6668-1545
Current Organisations
UNSW Sydney
,
Prince of Wales Hospital
,
College of Intensive Care Medicine of Australia and New Zealand
,
Novosibirsk State Medical University
,
Australasian Society for Ultrasound in Medicine
,
University of Sydney
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Publications
Intracardiac Echocardiography for Point-of-Care Guided Left Ventricular Assist Device Implantation: Surgical Implications for COVID-19
Publisher: SAGE Publications
Date: 08-08-2021
DOI: 10.1177/15533506211037787
Abstract: Data from animal models is now available to initiate assessment of human safety and feasibility of wide-angle three-dimensional intracardiac echocardiography (3D ICE) to guide point-of-care implantation of percutaneous left ventricular assist devices in critical care settings. Assessment of these combined new technologies could be best achieved within a surgical institution with pre-existing expertise in separate utilization of ICE and Impella.
Ultrasound‐guided point‐of‐care ablation for atrial fibrillation in intensive care
Publisher: Wiley
Date: 10-01-2021
DOI: 10.1002/JOA3.12503
Invariant NKT cells dictate antitumor immunity elicited by a bispecific antibody cotargeting CD3 and BCMA
Publisher: American Society of Hematology
Date: 06-09-2022
DOI: 10.1182/BLOODADVANCES.2022008118
Abstract: CD3-engaging bispecific antibodies (BsAbs) have emerged as powerful therapeutic approaches by their ability to redirect T cells to eliminate tumor cells in a major histocompatibility complex–independent manner. However, how we can potentiate the efficacy of BsAbs remains largely unknown. To address this question, we investigated immunological mechanisms of action of a BsAb cotargeting CD3 and B-cell maturation antigen (BCMA) in syngeneic preclinical myeloma models. Treatment with the CD3/BCMA BsAb stimulated multiple CD3-expressing T-cell subsets and natural killer (NK) cells in the myeloma bone marrow (BM), highlighting its broad immunostimulatory effect. Notably, the BsAb-mediated immunostimulatory and antitumor effects were abrogated in mice lacking invariant NKT (iNKT) cells. Mechanistically, activation of iNKT cells and interleukin-12 production from dendritic cells (DCs) were crucial upstream events for triggering effective antitumor immunity by the BsAb. Myeloma progression was associated with a reduced number of BM iNKT cells. Importantly, the therapeutic efficacy of a single dose of CD3/BCMA BsAb was remarkably augmented by restoring iNKT cell activity, using adoptive transfer of α-galactosylceramide-loaded DCs. Together, these results reveal iNKT cells as critical players in the antitumor activity of CD3 engaging BsAbs and have important translational implications.
Right Ventricular Loop Indicating Malposition of J-wire Introducer for Double Lumen Bicaval Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) Cannula
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.HLC.2013.05.643
Abstract: The key to safe placement of a bicaval double lumen cannula for Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) is to visualise correct guide wire placement in the inferior vena cava (IVC), thus aiding subsequent correct advancement of the cannula. Transoesophageal (TOE) and transthoracic (TTE) echocardiography, as well as fluoroscopy, have been described as aiding imaging techniques. We report a case of guide wire malposition into the right ventricle, despite echocardiographic confirmation of guide wire position deep into the IVC. This malposition, if undetected, may have resulted in potential life threatening complications.
Prevalence of ultrasound use and attitudes towards training among fellows of the College of Intensive Care Medicine of Australia and New Zealand
Publisher: Wiley
Date: 02-2019
DOI: 10.1002/AJUM.12110
Semiquantification of Systemic Venous Admixture During Venovenous Extracorporeal Oxygenation Via Bicaval Double-Lumen Cannula in Critically Ill Patients
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2020
Splitting the anterior mitral leaflet impairs left ventricular function in an ovine model
Publisher: Oxford University Press (OUP)
Date: 28-11-2022
Abstract: During mitral valve replacement, the anterior mitral leaflet is usually resected or modified. Anterior leaflet splitting seems the least disruptive modification. Reattachment of the modified leaflet to the annulus reduces the annulopapillary distance. The goal of this study was to quantify the acute effects on left ventricular function of splitting the anterior mitral leaflet and shortening the annulopapillary distance. In 6 adult sheep, a wire was placed around the anterior leaflet and exteriorized through the left ventricular wall to enable splitting the leaflet in the beating heart. Releasable snares to reduce annulopapillary distance were likewise positioned and exteriorized. A mechanical mitral prosthesis was inserted to prevent mitral incompetence during external manipulations of the native valve. Instantaneous changes in left ventricular function were recorded before and after shortening the annulopapillary distance, then before and after splitting the anterior leaflet. After splitting the anterior leaflet, preload recruitable stroke work, stroke work, stroke volume, cardiac output, left ventricular end systolic pressure and mean pressure were significantly decreased by 26%, 23%, 12%, 9%, 15% and 11%, respectively. Shortening the annulopapillary distance was associated with significant decreases in the end systolic pressure volume relationship, preload recruitable stroke work, stroke work and left ventricular end systolic pressure by 67%, 33%, 15% and 13%, respectively. Shortening the annulopapillary distance after splitting the leaflet had no significant effect. Splitting the anterior mitral leaflet acutely impaired left ventricular contractility and haemodynamics in an ovine model. Shortening the annulopapillary distance after leaflet splitting did not further impair left ventricular function.
Point‐of‐care ultrasonography—An essential skill for medical graduates?
Publisher: Wiley
Date: 23-07-2023
DOI: 10.1002/AJUM.12355
Abstract: The recent proliferation of point‐of‐care ultrasonography (POCUS) in the clinical practice of many medical specialties has exposed persistent barriers to education, training and standardisation. Specialist training curriculums are already overwhelming, having grossly insufficient time available for the specialist trainees and for the small number of available trainers alike to incorporate POCUS into postgraduate education. The logical solution to overcome these barriers could be to incorporate basic POCUS education and training into the undergraduate university curriculums, introducing longitudinal integration with other relevant medical sciences. The Australasian Society of Ultrasound in Medicine already has well‐established educational programmes in POCUS with standardised assessment of competency, which could potentially offer the basis for symbiosis with the Australian and New Zealand medical schools.
3D echocardiography in intensive care
Publisher: Oxford University Press
Date: 02-2020
DOI: 10.1093/MED/9780198749288.003.0029
Abstract: Three-dimensional echocardiography (3DE) is a rapidly expanding modality with great potential. 3DE, as with 2D, is based on basic principles of ultrasound physics. Sequential ultrasound beams are emitted from piezoelectric elements and received echoes are analysed by computers using specialized algorithms, creating pictures on a screen. Current routine utilization and research of 3DE in intensive care is limited. Technical problems, lack of equipment and training among intensive care practitioners are the major limiting factors. This chapter examines the main principles of 3DE, specific terminology, current advantages and limitations, as well as projected future applications. Application areas of three-dimensional transthoracic echocardiography (3D TTE) and three-dimensional transoesophageal echocardiography (3D TOE) in intensive care are outlined.
Myocardial stiffness and the timing difference between tissue Doppler imaging Ea and peak mitral valve opening can distinguish physiological hypertrophy in athletes from hypertrophic cardiomyopathy
Publisher: Oxford University Press (OUP)
Date: 12-2006
DOI: 10.1016/J.EUJE.2005.09.008
Abstract: To differentiate between physiological and pathological left ventricular hypertrophy in athletes using echocardiography. Eleven patients with mild hypertrophic cardiomyopathy were compared against 17 international rowers with mild left ventricular hypertrophy, and 30 age matched controls. The time difference between peak Ea (Doppler tissue imaging) and peak mitral valve opening (using M-mode) was measured simultaneously. A novel index (E/Ea)/LVEDD, as a measure of left ventricular stiffness was recorded. In athletes the peak Ea preceded peak mitral opening by: median (interquartile range) 20 ms (10,20), control group 15 ms (0,30), compared with HCM where Ea followed peak mitral opening by 10 ms (0,20), P<0.0001. In athletes the index of left ventricular stiffness was lower than controls 1.2 (0.93,1.4) versus 1.5 (1.3,1.6), and HCM 2.2 (2.0,2.3), P<0.0001. Physiological hypertrophy can be differentiated from hypertrophic cardiomyopathy in athletes using the Ea-peak mitral opening difference, and our index of ventricular stiffness.
The stop‐flow arm equilibrium pressure in preoperative patients: Stressed volume and correlations with echocardiography
Publisher: Wiley
Date: 15-01-2019
DOI: 10.1111/AAS.13318
Abstract: The distending intravascular pressure at no flow conditions reflects the stressed volume. While this haemodynamic variable is recognised as clinically important, there is a paucity of reports of its range and responsiveness to volume expansion in patients without cardiovascular disease and no reports of correlations to echocardiographic assessments of left ventricular filling. Twenty-seven awake (13 male), spontaneously breathing patients without any history of cardiopulmonary, vascular or renal disease were studied prior to induction of anaesthesia. The no-flow equilibrium pressure in the arm following rapid circulatory occlusion (P P Preoperative measurements of P
Implantation of Impella CP left ventricular assist device under the guidance of three-dimensional intracardiac echocardiography
Publisher: Springer Science and Business Media LLC
Date: 15-10-2020
DOI: 10.1038/S41598-020-74220-8
Abstract: Impella CP is a percutaneously inserted left ventricular assist device indicated for temporary mechanical cardiac support during high risk percutaneous coronary interventions and for cardiogenic shock. The potential application of Impella has become particularly relevant during the current COVID-19 pandemic, for patients with acute severe heart failure complicating viral illness. Standard implantation of the Impella CP is performed under fluoroscopic guidance. Positioning of the Impella CP can be confirmed with transthoracic or transoesophageal echocardiography. We describe an alternative approach to guide intracardiac implantation of the Impella CP using two-dimensional and three-dimensional intracardiac echocardiography. This new technique can be useful in selected groups of patients when fluoroscopy, transthoracic and transoesophageal echocardiography is deemed inapplicable or limited for epidemiological or clinical reasons. Intracardiac three-dimensional echocardiography is a feasible alternative to the traditional techniques for implantation of an Impella CP device but careful consideration must be given to the potential limitations and complications of this technique.
Minimum standards for ultrasound equipment in intensive care. Recommendations from CICM Ultrasound Special Interest Group
Publisher: Wiley
Date: 02-2017
DOI: 10.1002/AJUM.12041
Abstract: Critical care ultrasonography allows rapid bedside assessment and monitoring of severely ill patients. It provides important information on a real‐time basis for patients' management and clinical decision‐making, leading to improvements in delivered quality of care. Provision of this service is not possible without appropriate equipment. This document recommends minimum standards for ultrasound equipment required for use in intensive care units in Australia and New Zealand.
Pearls and pitfalls in comprehensive critical care echocardiography
Publisher: Springer Science and Business Media LLC
Date: 17-11-2017
Mediastinal Hematoma as a Rare Life-Threatening Complication of Thrombolysis for Pulmonary Embolism Detected by Transthoracic Echocardiography
Publisher: Elsevier BV
Date: 06-2018
Right atrial lymphoma in a patient with hypoxemia
Publisher: Elsevier BV
Date: 08-2002
Dynamic echocardiography in evaluation of platypnoea-orthodeoxia
Publisher: Wiley
Date: 05-2012
Reflections on Australian critical care echocardiography
Publisher: Elsevier BV
Date: 06-09-2022
DOI: 10.51893/2022.3.SA2
Abstract: The four authors of this article share a combined century of experience in critical care echocardiography (CCE). Having seen its birth, adolescence and subsequent maturity, it is with considerable interest that we anticipate further evolution of its everyday clinical application, and can only guess at how the next generation’s energy and interests will be directed. Trained to intervene when a patient’s physiology becomes unstable, intensivists search for effective strategies to tackle acute problems while simultaneously considering complex underlying chronic ailments. Echocardiography is a valuable tool for the diagnosis and monitoring of a patient’s response, or perhaps lack of response, to our interventions. The evolution of critical care echocardiography from being an outcast to that of a mainstream “darling” over the past 30 years led us to give a personal perspective on this journey.
State of the Art Techniques in Critical Care Echocardiography
Publisher: Springer Singapore
Date: 2020
Ejection fraction - A number to be interpreted with caution!
Publisher: Wiley
Date: 05-2016
DOI: 10.1002/AJUM.12007
Prevention of pathogen transmission during ultrasound use in the Intensive Care Unit: Recommendations from the College of Intensive Care Medicine Ultrasound Special Interest Group (USIG)
Publisher: Wiley
Date: 05-2020
DOI: 10.1002/AJUM.12205
Broadening the frequencies of clinical sound: another lesson from COVID-19
Publisher: Korean Society of Ultrasound in Medicine
Date: 04-2022
DOI: 10.14366/USG.21228
Comparison of dynamic changes in stressed intravascular volume, mean systemic filling pressure and cardiovascular compliance: Pilot investigation and study protocol
Publisher: Public Library of Science (PLoS)
Date: 28-08-2020
COVID‐US: A simplified approach to cardiopulmonary ultrasound in suspected and confirmed COVID‐19 patients in surge crisis
Publisher: Wiley
Date: 05-2020
DOI: 10.1002/AJUM.12209
Subjective right ventricle assessment by echo qualified intensive care specialists: assessing agreement with objective measures
Publisher: Springer Science and Business Media LLC
Date: 07-03-2019
Comparison of echocardiographic and invasive measures of volaemia and cardiac performance in critically ill patients
Publisher: Springer Science and Business Media LLC
Date: 17-03-2020
DOI: 10.1038/S41598-020-61761-1
Abstract: Echocardiographic measurements are used in critical care to evaluate volume status and cardiac performance. Mean systemic filling pressure and global heart efficiency measures intravascular volume and global heart function. This prospective study conducted in fifty haemodynamically stabilized, mechanically ventilated patients investigated relationships between static echocardiographic variables and estimates of global heart efficiency and mean systemic filling pressure. Results of univariate analysis demonstrated weak correlations between left ventricular end-diastolic volume index (r = 0.27, p = 0.04), right atrial volume index (rho = 0.31, p = 0.03) and analogue mean systemic filling pressure moderate correlations between left ventricular ejection fraction (r = 0.31, p = 0.03), left ventricular global longitudinal strain (r = 0.36, p = 0.04), tricuspid annular plane systolic excursion (rho = 0.37, p = 0.01) and global heart efficiency. No significant correlations were demonstrated by multiple regression. Mean systemic filling pressure calculated with cardiac output measured by echocardiography demonstrated good agreement and correlation with invasive techniques (bias 0.52 ± 1.7 mmHg, limits of agreement −2.9 to 3.9 mmHg, r = 0.9, p 0.001). Static echocardiographic variables did not reliably reflect the volume state as defined by estimates of mean systemic filling pressure. The agreement between static echocardiographic variables of cardiac performance and global heart efficiency lacked robustness. Echocardiographic measurements of cardiac output can be reliably used in calculation of mean systemic filling pressure.
Levels of training in critical care echocardiography in adults. Recommendations from the College of Intensive Care Medicine Ultrasound Special Interest Group
Publisher: Wiley
Date: 12-01-2019
DOI: 10.1002/AJUM.12127
Analogue Mean Systemic Filling Pressure: a New Volume Management Approach During Percutaneous Left Ventricular Assist Device Therapy
Publisher: Springer Science and Business Media LLC
Date: 11-05-2022
DOI: 10.1007/S12265-022-10265-6
Abstract: The absence of an accepted gold standard to estimate volume status is an obstacle for optimal management of left ventricular assist devices (LVADs). The applicability of the analogue mean systemic filling pressure (Pmsa) as a surrogate of the mean circulatory pressure to estimate volume status for patients with LVADs has not been investigated. Variability of flows generated by the Impella CP, a temporary LVAD, should have no physiological impact on fluid status. This translational interventional ovine study demonstrated that Pmsa did not change with variable circulatory flows induced by a continuous flow LVAD (the average dynamic increase in Pmsa of 0.20 ± 0.95 mmHg from zero to maximal Impella flow was not significant ( p = 0.68)), confirming applicability of the human Pmsa equation for an ovine LVAD model. The study opens new directions for future translational and human investigations of fluid management using Pmsa for patients with temporary LVADs.
3D Echocardiography in Critical Care
Publisher: Springer Singapore
Date: 23-11-2019
Myocardial Tissue Characterization with Echocardiography in Critical Care
Publisher: Springer Singapore
Date: 23-11-2019
Intraoperative management: carotid endarterectomies
Publisher: Elsevier BV
Date: 06-2004
Implantation of Impella CP® left ventricular assist device under the guidance of three-dimensional intracardiac echocardiography.
Publisher: Research Square Platform LLC
Date: 27-04-2020
DOI: 10.21203/RS.3.RS-23212/V1
Abstract: Impella CP® is a percutaneously inserted left ventricular assist device indicated for temporary mechanical cardiac support during high risk percutaneous coronary interventions and for cardiogenic shock. The potential application of Impella has become particularly relevant during the current COVID-19 pandemic, for patients with acute severe heart failure complicating viral illness. Standard implantation of the Impella CP® is performed under fluoroscopic guidance. Positioning of the Impella CP® can be confirmed with transthoracic or transoesophageal echocardiography. We conducted translational study in ovine model describing an alternative approach to guide implantation of the Impella CP® using two-dimensional and three-dimensional intracardiac echocardiography. This new technique can be useful in selected groups of patients when fluoroscopy, transthoracic and transoesophageal echocardiography is deemed inapplicable or limited for epidemiological or clinical reasons. Intracardiac three-dimensional echocardiography is a feasible alternative to the traditional techniques for implantation of an Impella device.
Publisher Correction: Implantation of Impella CP left ventricular assist device under the guidance of three-dimensional intracardiac echocardiography
Publisher: Springer Science and Business Media LLC
Date: 25-02-2021
DOI: 10.1038/S41598-021-82890-1
Abstract: An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Implantation of Impella CP left ventricular assist device under the guidance of three-dimensional intracardiac echocardiography.
Publisher: Research Square Platform LLC
Date: 24-08-2020
DOI: 10.21203/RS.3.RS-23212/V2
Abstract: Impella CP is a percutaneously inserted left ventricular assist device indicated for temporary mechanical cardiac support during high risk percutaneous coronary interventions and for cardiogenic shock. The potential application of Impella has become particularly relevant during the current COVID-19 pandemic, for patients with acute severe heart failure complicating viral illness. Standard implantation of the Impella CP is performed under fluoroscopic guidance. Positioning of the Impella CP can be confirmed with transthoracic or transoesophageal echocardiography. We describe an alternative approach to guide intracardiac implantation of the Impella CP using two-dimensional and three-dimensional intracardiac echocardiography. This new technique can be useful in selected groups of patients when fluoroscopy, transthoracic and transoesophageal echocardiography is deemed inapplicable or limited for epidemiological or clinical reasons. Intracardiac three-dimensional echocardiography is a feasible alternative to the traditional techniques for implantation of an Impella CP device but careful consideration must be given to the potential limitations and complications of this technique.
Contrast Echocardiography in Critical Care
Publisher: Springer Singapore
Date: 23-11-2019
Three-dimensional intracardiac echocardiography and pulmonary embolism
Publisher: Springer Science and Business Media LLC
Date: 20-08-2020
DOI: 10.1186/S12947-020-00220-3
Abstract: Three-dimensional intracardiac echocardiography (3D ICE) with wide azimuthal elevation is a novel technique performed for assessment of cardiac anatomy and guidance of intracardiac procedures, being able to provide unique views with good spatial and temporal resolution. Complications arising from this invasive procedure and the value of 3D ICE in the detection and diagnosis of acute cardiovascular pathology are not comprehensively described. This case illustrates a previously unreported iatrogenic complication of clot displacement from the intra-vascular sheath upon insertion of a 3D ICE catheter and the value of 3D ICE in immediate diagnosis of clot in transit through the heart with pulmonary embolism. We conducted a translational study of 3D ICE with wide azimuthal elevation to guide implantation of a left ventricular assist device (Impella CP®) in eight adult sheep. A large-bore 14 Fr central venous sheath was used to enable right atrial and right ventricular access for the intracardiac catheter. Insertion of the 3D ICE catheter was accompanied by a sudden severe cardiorespiratory deterioration in one animal. 3D ICE revealed a large highly mobile mass within the right heart chambers, determined to be a clot-in-transit. The diagnosis of pulmonary clot embolism resulting from the retrograde blood entry into the large-bore sheath introducer, rapid clot formation and consequent displacement into venous circulation by the ICE catheter was made. The sheep survived this life-threatening event following institution of cardiovascular support allowing completion of the primary research protocol. This report serves as a serious warning to the researchers and clinicians utilizing long large-bore sheath introducers for 3D ICE and illustrates the value of 3D ICE in detecting clot-in-transit within right heart chambers.
Related Organisations
College Of Intensive Care Medicine Of Australia And New Zealand
Location: Australia
Related Funding Activities
No related grants have been discovered for Konstantin Yastrebov.