INFLUENCE OF ESSENTIAL HYPERTENSION ON RIGHT VENTRICULAR MORPHOLOGY AND FUNCTION.

Right ventricular (RV) morphologic and functional changes still remain a mystery in patients with AH. The aim of this study was to evaluate the influence of essential hypertension on RV function and morphology. 75 nonsmoker hypertensive male patients (mean age 57.13±7.27) and 25 normotensive control subjects (mean age 57.56±7.55) were recruited in a study. All participants underwent 24-hour ambulatory blood pressure monitoring. Heart ultrasonography was performed to assess RV morphology and its systolic and diastolic function. In comparison with normotensive subjects, hypertensive patients had significantly higher RV wall thickness and significantly lower TAPSE (5.36±0.98 and 19.86±2.68 vs 4.11±0.50 mm and 22.52±2.02, P<0.0001). RV hypertrophy was found in 38.66% of hypertensive subjects. EF of RV in normotensive subjects was significantly higher than in hypertensives (62.73±12.81 vs 57.58±7.53%, respectively). RV mean E/A was significantly lower in hypertensive group (1.41±0.13 vs 0.89±0.15, P<0.001). RV diastolic dysfunction was found in 54.6% and systolic dysfunction in 7% of hypertensive subjects. The RV E/e' ratio was increased in hypertensives (4.84±0.97 vs. 3.88±0.32 in the control group, P<0.05). Tricuspid and mitral E'/A' ratio was decreased in hypertensive group (0.79±0.13 and 0.90±0.19 in hypertensive vs. 1.21±0.15 and 1.29±0.15 in the control groups, respectively, P<0.001 for both). According to study data, AH affects both ventricles simultaneously and causes concentric remodeling, hypertrophy, and functional disturbances in both ventricles; hence, in comparison with systolic dysfunction, existence of diastolic dysfunction was more prevalent in hypertensive population.

Influence of mildronat on left ventricular systolic, diastolic functional parameters, pulmonary arterial flow and systolic dyssynchrony in patients with congestive heart failure.

The aim of the study was to investigate the influence of metabolic treatment with Mildronat on left and right ventricular function, pulmonary flow and systolic synchrony in patient with heart failure. We studied 16 persons with 2-3-d NYHA class Heart Failure, 8 male and 8 female (age 69.2±9.3). All where in stable condition at last for 3 months and take traditional medical treatment (ACE inhibitors or AT2-blockers, beta-blockers, Furosemide, Spirolactone). It was added Mildronat (500 mg 2x daily per os) for 2 months. All patient undergone standard EchoCG, PW and Color Tissue Doppler (TD) examination before and after 2 months of treatment with Mildronat. It was noted significant decrease LV end systolic volume and increase of Ejection Fraction and Fractional Shortening of LV after 2 month treatment with Mildronat. LV Tissue Doppler parameters did not change significantly, it was noted only tendency of increasing Right Ventricular systolic velocity. Pulmonary Arterial Acceleration Time significantly increased, right ventricular (RV) isovolumic relaxation time and RV TEI index (Systolic-Diastolic Index) on Tissue Doppler was significantly decreased after the treatment, which indicates improvement of RV function and decrease of Pulmonary Arterial Pressure. There was improvement of Intraventricular synchrony, systolic delay time between intraventricular septum and lateral wall became shorter after 2 month treatment with Mildronat but interventricular delay did not change significantly. Addition of Mildronat to traditional medical treatment improves left ventricular systolic function in patients with Heart Failure. Mildronat improves left ventricular systolic dissynchroni in patients with Heart Failure. Mildronat increases the pulmonary arterial flow acceleration time and shortens Right Ventricular isovolumic relaxation time and TEI index, this means that it reduces the Pulmonary Arterial Pressure and improves right ventricular function.

"Comet tail" artefact in diagnosis of pulmonary congestion in patients with diastolic heart failure.

The aim of this study was to evaluate the importance of thoracic ultrasound examination in diagnosis of DHF. Total of 380 patients with HF were evaluated. 86 patients had diastolic HF (I group) and 294 patients had systolic HF (II group). The control, III group consisted of 155 patients with left ventricular diastolic dysfunction but without HF. HF patients did not take any medication before ultrasound examination. All patients underwent thoracic X ray and ultrasound examination. Sonographic examination of a lung was done with 3.0-4.0 MgHz convex or sector probe, from 10 points on thoracic wall (cross points of midclavicular line II, IV and V intercostal spaces and anterior axilar line with IV and V spaces), which corresponded to the projection of lower, middle and upper lobes of right lung and upper and lower lobes of left lung. During pulmonary ultrasound examination 95.5% of patients with HF had "Comet tail phenomenon", which was registered only in 35.5% patients without HF (p>0.001). In DHF group "Comet tail phenomenon" was registered in 91.9% and in systolic HF group in 96.6% patients. In 81.4% of patients with DHF "Comet tail phenomenon" was registered from 3 and more registration points. In control group "Comet tail" was registered from more than 3 points only in 2 (1.3%) patients. The best results in diagnosis of DHF can be achieved if we take "3 and more registration points" as a reference point for diagnosis of pulmonary congestion (sensitivity - 0.911, specificity - 0.942, positive predictive value 0,975). In patients with diastolic HF during pulmonary ultrasound examination significantly often was registered "Comet tail phenomenon". The count of registration points from the thoracic wall of "Comet tail phenomenon" 3 and > is sensitive and specific sign of HF. We think that lung sonography offers a new method for the diagnosis of decompensated diastolic HF at bedside and may provide important information.