[Tissue Doppler imaging of physiological asynchrony in intracardiac myocardium].

Tissue Doppler imaging (TDI) is one of the most widely used methods of quantitative assessment of asynchrony of ventricular myocardium movements. To study the parameters physiological asynchrony using TDI, we examined 32 healthy subjects (18 male, 14 female, mean age of 35.8 +/- 11.0) with no history and signs of cardiovascular disease. The putative relative parameters of systolic and diastolic asynchrony (intra- and interventricular heterogeneity at basal and mid level of 8 myocardial segments) and traditional absolute values (septolateral S-L delay, QE, TsSD, TESD intervals) were measured and compared. We have established the range of normal values of the relative physiological myocardium asynchrony factors in healthy persons, and found that systolic and diastolic asynchrony is more evident at the midventricular level compared to basal level, and diastolic asynchrony is more apparent than systolic; this fact is discussed in terms of single-layer spiral myocardium theory.

[Systolic and diastolic intraventricular asynchrony of the left ventricular myocardium in patients with pacemaker].

AIM: To study intraventricular asynchrony and effects of pacemaker implantation on asynchrony severity in patients with rhythm and conduction disorders. MATERIAL AND METHODS: The study of 46 patients with cardiac arrhythmia (atrial fibrillation, sick sinus syndrome, AB-block of the third degree) included such examinations as echocardiography, tissue dopplerography (PWTDI) before pacemaker implantation and 7 days after it. Electromechanic systolic and diastolic myocardial asynchrony was assessed by intraventricular heterogeneity index (IHb, IHm, TSD) in 8 segments of the left ventricle (LV) at the basal and mean levels. Values obtained in examination of 32 healthy volunteers were considered normal. RESULTS: Parameters of systolic and diastolic asynchrony in patients with cardiac arrhythmia significantly differ from normal ones. Basal LV diastolic asynchrony was detected in 41-48% patients, systolic one--in 62-100%, systolodiastolic--in 41% cases. Pacemaker implantation into the right heart significantly reduces LV systolic asynchrony while diastolic one was unaffected in an early postoperative period. The best sensitivity in detection of systolic asynchrony is achieved with TsSD index. Informative value of diastolic asynchrony parameters is much less than of the systolic one. CONCLUSION: Indices of systolic asynchrony (TsSD, IhbS, IhmS) can be used for heart condition control after pacemaker implantation.

[Blood pressure in night shift workers: circadian rhythms and levels, and their seasonal variation].

Average diurnal blood pressure (BP) profiles (DBPP) were studied in persons working at different hours of a day, including night workers. The results obtained in winter and summer seasons were compared. The study consisted of more than 497 000 pre-work BP measurement points for each of 30 566 locomotive drivers. It was found that average DBPP of persons working at different hours of a day is of the marked non-dipper type in spite of night wakefulness. BP was lower at night but not as low as that of night sleeping persons. In the cohort studied, the form of DBPP curve does not differ in winter and summer; however BP in winter is significantly higher.

[Possibility of optimization of hypertension control in operators of trains on the basis of automatic system of pre-work examination].

We have investigated possibility of the use of automatic systems for controlling arterial pressure in a specific occupational group - train\'s operators. This method is based on measurement and analysis of parameters of arterial pressure and pulse during pre-work (pre-haul) medical examinations of train\'s operators with subsequent entering of these results in computer data base. It allows to realize detection and registration of all operators with hypertension. The data obtained also show that the use of automated system of pre-work examination facilitates lowering of blood pressure levels.

[Increased QRS voltage during dehydrating].

AIM: To assess QRS voltage changes with lower total amount of biological fluids under ultrafiltration during hemodialysis. MATERIALS AND METHODS: The study included 14 patients with chronic renal failure. An average of 2.5 +/- 0.24 liters of fluid were removed during a session. 12-lead standard ECG was continuously recorded by means of a computer-aided cardiac recorder throughout the session of hemodialysis. Changes in the amplitude of QRS waves were analyzed in each lead. RESULTS: Elevated QRS voltage was most pronounced in the anterior chest leads (v1-v4). Moreover, the potentials corresponding to the propagation of a predominant excitation front over the cardiac surface facing both the anterior chest wall--QRS+ (R wave) and the posterior chest wall--ORS-(S or Q waves) increased in most cases. Voltage changes in these leads were observed in 90% of patients, the amplitude of the waves being increased by more than 0.5 mV. CONCLUSION: During dehydration, lower chest tissue electroconductivity may cause a considerable increase in QRS voltage. This should be kept in mind while analyzing ECG data during both a session of hemodialysis and antihypertensive therapy resulting in some fluid loss, as well as in the treatment of cardiac and renal failure, leading to diminished concomitant edemas.

[Dynamics of ECG voltage in changing gravity].

Comparative analysis of the QRS voltage response to gravity variations was made using the data about 26 normal human subjects collected in parabolic flights (CNERS-AIRBUS A300 Zero-G, n=23; IL-76MD, n=3) and during the tilt test (head-up tilt at 70 degrees for a min and head-down tilt at-15 degrees for 5 min, n=14). Both the parabolic flights and provocative tilt tests affected R-amplitude in the Z lead. During the hypergravity episodes it was observed in 95% of cases with the mean gain of 16% and maximal--56%. On transition to the horizontal position, the Rz-amplitude showed a rise in each subject (16% on the average). In microgravity, the Rz-amplitude reduced in 95% of the observations. The voltage decline averaged 18% and reached 49% at the maximum. The head-down tilt was conducive to Rz reduction in 78% of observations averaging 2%. Analysis of the ECG records under changing gravity when blood redistribution developed within few seconds not enough for serious metabolic shifts still revealed QRS deviations associated exclusively with the physical factors, i.e., alteration in tissue conduction and distance to electrodes. Our findings can stand in good stead in evaluation of the dynamics of predictive ECG parameters during long-term experiments leading to changes as in tissue conduction, so metabolism.

[Structural and functional changes of coronary and carotid arteries in patients with ischemic heart disease].

AIM: To assess prevalence of atherosclerotic changes in coronary arteries by computed tomography (CT) and carotid arteries by ultrasound duplex scanning (UDS) in patients with ischemic heart disease (IHD); to analyse viscoelastic properties of the walls of the common carotid arteries and their correlation with the results of carotid artery UDS and coronary artery CT. MATERIAL AND METHODS: CT and UDS were made in 100 patients with clinically and coronarographycally verified diagnosis of IHD. RESULTS: Calcinates in coronary arteries were found in 96% patients. The mean coronary calcium index (MCCI) was 544.8 +/- 718.5 units (from 0 to 3954 units). Atherosclerotic affection of carotid arteries was registered in 89% patients. Mean thickness of intima-media complex (IMT) of the common carotid arteries was 0.96 +/- 0.02 mm (0.60 mm - 1.87 mm). A correlation was found between coronary MCCI and IMT of the common carotid arteries. The stepwide regression analysis determined such predictors of coronary calcinosis as increased value of IMT of the common carotid arteries and atherosclerotic plaques (ASP) in carotid arteries. Viscoelasticity of the walls of the common carotid arteries in IHD patients differ from that of healthy subjects. This demonstrates stiffness of arterial wall in patients with IHD. There is a correlation between these parameters and IMT of the common carotid arteries. CONCLUSION: Combination of UDS with CT in diagnosis of atherosclerotic lesions of different arteries provides more complete information about structural-functional changes in patients with IHD. Such non-invasive tests as measurement of IMT of common carotid arteries and detection of ASP in carotid arteries by UDS, determination of coronary MCCI may serve screening parameters in diagnosis of coronary atherosclerosis.

[Effect of granulocyte-macrophage colony stimulating factor on the function and regeneration of myocardium in rats with experimental infarction].

To test the reparative capacity of stromal cells in myocardial infarction, rats were injected with granulocyte-monocyte-colony stimulating factor (GM-CSF) (leukomax), a cytokine known by its ability to raise a level of stromal cells in the blood, during first three days after coronary artery ligation. Only 10 of 17 rats (59%) survived 4 weeks in this group compared with 16 of 24 (67%) among rats not treated with leukomax. Echocardiographic and electromanometric studies showed that in both groups ventricular (LV) dilatation which developed during first hours after surgery persisted throughout 6-8 weeks and was combined with decreased ejection fraction and elevated LV end diastolic pressure. These alterations correlated with infarct size which varied from 0 to 28% of left ventricular weight in both groups. There were no statistically significant differences in functional and morphometric measurements between groups receiving and not receiving GM-CSF. However this result may be inconclusive due to small number of investigated animals and broad variation of ischemic zone size in each group.

[Long-Term Therapy With Indirect Anticoagulants in Patients With Nonvalvular Atrial Fibrillation (Prospective Follow-Up Study). Part II. Effectiveness and Safety]. / Dlitel'naia terapiia nepriamymi antikoaguliantami bol'nykh s mertsatel'noi aritmiei bez porazheniia klapanov serdtsa (prospektivnoe nabliudenie). Chast' II. Effektivnost' i bezopasnost' 3-letnei terapii.

AIM: To assess efficacy and safety of long-term international normalized ratio (INR) guided therapy with acenocoumarol in patients with nonvalvular atrial fibrillation. MATERIAL: Patients (n=100) with nonvalvular atrial fibrillation and at least 1 risk factor of thromboembolic complications. METHODS: Ischemic strokes, episodes of systemic thromboembolism and hemorrhagic complications were registered during 3 years of treatment with acenocoumarol (target INR 2.0-3.0). RESULTS: Annual rates of ischemic strokes, hemorrhagic complications and major bleeding were 0.7, 14.4 and 1.1%, respectively. No episodes of thromboembolism were registered in patients with history of thromboembolic complications. Basing on data collected predictors of bleeding complications in patients with atrial fibrillation during long term treatment with acenocoumarol were elucidated.

[Long-term therapy with anticoagulants in patients with nonvalvular atrial fibrillation (prospective follow-up). Part I. Effect of 12-month therapy with acenocoumarol on content of d-dimer, frequency of thrombosis and parameters of hemodynamics of left auricle]. / Dlitel'naia terapiia nepriamymi antikoaguliantami u bol'nykh s mertsatel'noi aritmiei bez porazheniia klapanov serdtsa (prospektivnoe nabliudenie). Chast' I. Vliianie 12-mesiachnoi terapii atsenokumarolom na soderzhanie D-dimera, chastotu tromboza i pokazateli gemodinamiki ushka levogo predserdiia.

AIM: To assess frequency of left auricular thrombosis and effect of long-term therapy with acenocoumarol on auricular hemodynamics and system of hemostasis and to elucidate predictors of effective therapy with acenocoumarol in patients with nonvalvular atrial fibrillation. MATERIAL: Patients (n=100) with nonvalvular atrial fibrillation and at least 1 risk factor of thromboembolic complications. METHODS: Transesophageal echocardiography and measurement of blood D-dimer levels were carried out before and after 1 year of acenocoumarol therapy. RESULTS: Initial prevalence of left auricular thrombosis was 75%. The use of acenocoumarol for 12 months resulted in significant reduction of frequency of left auricular thrombosis. This was associated with improvement of parameters of intraatrial hemodynamics and lowering of elevated blood D-dimer levels. Clinical-instrumental predictors of presence of left auricular thrombosis and its dynamics during therapy with acenocoumarol were also elucidated.

[Atorvastatin in the treatment of patients with hereditary hypercholesterolemia]. / Atorvastatin pri lechenii bol'nykh s nasledstvennoi giperkholesterinemiei.

Efficacy and tolerability of atorvastatin (20 mg/day) were assessed in a 3 month study on 19 patients (5 men, 14 women, mean age 52.3 years) with familial hypercholesterolemia. Average baseline levels of total cholesterol (CH) and low density lipoprotein (LDL) CH were 10.7 and 8.6 mmol/l, respectively. By the end of 3 months levels of CH, LDL CH, triglycerides and atherogeneity index decreased by 32, 41, 16 and 45%, respectively. This was accompanied by 21% increase of high density lipoprotein CH level. There were no cases of AST or ALT activity elevation above 3 upper limits of normal values. However 1 patient had asymptomatic elevation of ALT activity up to 53 U/l which did not cause interruption of therapy. Creatine kinase remained normal throughout the study period. Three patients (16%) stopped taking atorvastatin because of side effects. Thus in patients with familial hypercholesterolemia the dose of atorvastatin 20 mg/day was sufficiently well tolerated and provided effective control of lipid levels.

[Effect of atorvastatin on endothelial function in patients with familial hypercholesterolemia]. / Vliianie atorvastatina na funktsional'noe sostoianie éndoteliia u bol'nykh s nasledstvennoi giperkholesterinemiei

AIM: To study the influence of treatment with HMG-CoA reductase inhibitor atorvastatin on endothelial function in patients with familial hypercholesterolemia type IIa. MATERIALS AND METHODS: Sixteen patients (5m/11w, 51-/+3 years) with familial hypercholesterolemia were studied before and after 3 months of therapy with atorvastatin 20 mg/day. EDRF release test (D.Celermajer, 1992) was used to assess flow-mediated endothelium-dependent vasodilatation (FMD) of the brachial artery in response to reactive hyperemia. Plasma nitrite/nitrate (NOx) levels were measured as an indirect index of nitric oxide (NO) production in vivo using HPLC. RESULTS: Atorvastatin treatment resulted in a 32% reduction in total serum cholesterol (CH), 41% reduction in low density lipoprotein (LDL) CH, 16% reduction in triglycerides and a 21% increase in high density lipoprotein CH. Flow mediated dilatation (FMD) was impaired at baseline (5.8-/+0.9%) and significantly improved up to 9.5-/+0.9% after 3 month atorvastatin therapy (p<0.002). Change in FMD inversely correlated with baseline FMD (r = -0.58, p<0.05). There was no significant correlation between FMD and neither total serum CH nor LDL CH levels at baseline. During atorvastatin therapy significant reduction of plasma NOx levels occurred from 53.4-/+5.1 mcmol/l at baseline (range 42.6-86.2 mcmol/l) to 35.5-/+5.1 mcmol/l (18.4-46.0 mcmol/l) after treatment (p<0.02, n=7). CONCLUSION: In patients with familial hypercholesterolemia atorvastatin produced beneficial effect on endothelial function (increase in flow-mediated dilatation, decrease in NOx).

[Noninvasive investigation of endothelial function in patients with hypertension and hypercholesterolemia (HCE)]. / Neinvazivnoe opredelenie funktsii éndoteliia u bol'nykh gipertonicheskoi bolezn'iu v sochetanii s giperkholesterinemiei.

AIM: Functional assessment of endothelium by endothelium-dependent and non-endothelium dependent response of the brachial artery (BA) in patients with risk factors for atherosclerosis. MATERIALS AND METHODS: The ACUSON 128 XP/10 unit furnished with linear meter with phase grid (7.0 MHz) was employed in two-direction scanning mode to measure BA diameter at rest, under reactive hyperemia (endothelium-dependent response) and after sublingual intake of 0.01 mg of nitroglycerin (non-endothelium-dependent response) in 12 patients with blood hypertension (group 3), 10 subjects with family hypercholesterolemia (group 2) and 10 healthy subjects (group 1, control). RESULTS: The flow-dependent dilatation remained unchanged in BH patients (9.4%) and lowered in HCE patients (3.0%) compared to controls (9.5%). Nitroglycerin-induced dilatation was not significantly different in patients with family hypercholesterolemia (16.6%), hypertensive subjects (14.5%) and healthy controls (20.5%). CONCLUSION: The ultrasound method of detection of endothelial dysfunction is demonstrated. Endothelial dysfunction in patients with familial hypercholesterolemia may contribute to development of atherosclerosis.

[Blood pressure variability (based on 24-hour monitoring data) in mild arterial hypertension]. / Variabel'nost' arterial'nogo davleniia (po dannym 24-chasovogo monitorirovaniia) pri miagkoi arterial'noi gipertonii.

To evaluate the condition of target organs in patients with mild arterial hypertension (MAH) under normal and high arterial pressure variability (APV), the authors examined 84 MAH males aged 40-60 and 14 matched healthy controls. At 24-h monitoring it was revealed that 32% of MAH patients had high variability of daytime and night arterial pressure which occurred more frequently in atherosclerotic lesion of extracranial carotid artery portions. MAH patients with high APV against those with normal APV develop carotid artery atherosclerosis 3.5 times more frequently, vascular disorders of the fundus of the eye stage II with angiosclerosis and thickening of the interventricular septum 2.5 and 1.8 times more frequently, respectively.

[The clinical characteristics of ischemic heart disease in patients with arterial hypertension of different origins]. / Osobennosti kliniki ishemicheskoi bolezni serdtsa u bol'nykh s arterial'noi gipertenziei razlichnogo geneza.

To study the clinical picture of coronary heart disease with concomitant arterial hypertension of various genesis, 172 patients were examined, out of them the cause of arterial hypertension was hypertensive disease in 54, chronic pyelonephritis in 40, chronic glomerulonephritis in 37, and stenotic atherosclerosis of renal arteries in 29, endocrine disease in 12 patients. The patients were divided into 2 groups: (1) 148 with stenotic atherosclerosis of coronary arteries and (2) 24 patients with intact coronary arteries. Comparison of these patient groups revealed no clear-cut correlation between the age and the detection of exercise-induced angina, as well as the duration of arterial hypertension. There was no correlation between the detection of the anginal syndrome and ECG changes. The incidence of the anginal syndrome was 62.2% in Group 1 and 47.7% in Group 2. It was established that the detection of the anginal syndrome correlated well with the severity of left ventricular hypertrophy and values of blood pressure, despite nosological entities.

[A comparative evaluation of the importance of transesophageal electrical stimulation of the left atrium and of bicycle ergometry in the diagnosis of ischemic heart disease in patients with arterial hypertension]. / Sravnitel'naia otsenka znacheniia chrespishchevodnoi élektricheskoi stimuliatsii levogo predserdiia i veloérgometrii v diagnostike ishemicheskoi bolezni serdtsa u bol'nykh arterial'noi gipertoniei.

To make a comparative assessment of transesophageal left atrial pacing (TLAP) and bicycle ergometry (BE) in the diagnosis of coronary heart disease (CHD) in patients with arterial hypertension (AH) of different origin, the authors examined 56 patients. The patients underwent TLAP and selective coronary angiography, of them 39 patients had BE testing. No significant differences were found in their specificity (73 and 78%) and sensitivity (92 and 81%) between TLAP and BE, respectively. The maximum heart rate in CHD patients with AH was significantly higher (130 +/- 6 per min) during TLAP than that in BE (112 +/- 5 per min, p > 0.05), ischemic changes occurring at the same value of double product despite the mode of myocardial ischemia induction in these functional tests (240 +/- 10 and 236 +/- 12 arbitrary units, respectively; p < 0.05). The mean systolic blood pressure was higher in TLAP and in BE (210 +/- 10 and 185 +/- 8 mm Hg). This follows that TLAP and BE finding are comparable and no profound changes occur in TLAP, hence it can be recommended for wide application in the diagnosis of CHD in AH patients.