[Modified method for determining the normal values of the aortic root diameter in the focus of aortic pathology in individuals with congenital connective tissue disorders].

INTRODUCTION: Enlargement of the aortic root of occurs in many cases with cardiovascular disease, including congenital connective tissue disorders (CCTD), especially its differentiated and undifferentiated forms (UCCTD). A common deficiency of the generally accepted methods for diagnosing an aortic root dilation may be that persons with CCTD and cardiovascular diseases of potentially having a broader aortic root diameter could be included in the reference groups. The purpose of our study was to develop a modified method for determining the normal aortic root diameter in group of individuals without CCTD and cardiovascular diseases. MATERIALS AND METHODS: The study included 464 apparently healthy people, men and women aged 15 to 65 years. All patients underwent general clinical examination, echocardiography. On the basis of external and internal signs of CCTD, patients with UCCTD were identified - the UCCTD group (n = 208) and without this pathology - the main group (n = 256). The calculation of the normal aortic root diameter (NARD) was made in accordance with the methods of Roman M. J. et al. (1989) and Devereux R. B. et al. (2012). The upper limit values of NARD (UL NARD) were calculated according to the algorithms of Roman M. J. et al. (1989), Devereux R. B. et al. (2012), Campens L. et al. (2014). RESULTS: The data obtained in the main group was used to develop a modified method for the determination of NARD. The mean values by echocardiography and calculated values of the aortic root by modified method of this study were practically the same in the main group, whereas the mean value of NARD calculated by the methods of Roman M. J. et al. and Devereux R. B. et al. in this sample were significantly higher in relation to the listed values. As the NARD values, the UL NARD were significantly higher for all evaluated algorithms in comparison with the modified method. In the group of patients with UCCTD, 13 cases of aortic root dilation were found according to the method of Roman M. J., compared to 19 cases by the modified method. At the same time, 3 patients with aortic root enlargement by the mew method had 7 points of systemic involvement, thus corresponding to the Ghent criteria of Marfan syndrome. The methods of Campens L. and Devereux R. B. were less sensitive, revealing only 5 and 1 patients with aortic root dilatation, respectively. CONCLUSIONS: The results of the study demonstrate that, in order to obtain more reliable information on the condition of the root of the aorta and its proper values, the modified method obtained in the course of the study can be used. This method is more sensitive in detecting the enlargement of the aortic root in CCTD and in diagnosing syndromic CCTD.

[Comparative assessment of hypotensive, metabolic, and endothelial effects of indapamide-retard and hydrochlorothiazide in patients with essential hypertension].

AIM: To compare hypotensive, metabolic, and endothelial effects of indapamide-retard and hydrochlorothiazide. MATERIAL AND METHODS: Patients (n=50) with essential hypertension were given either indapamide-retard (1.5 mg/day, n=25) or hydrochlorothiazide (25 mg/day, n=25) for 12 weeks. Dynamics of the following parameters were studied: blood pressure, blood lipids and glucose, total coronary risk, carotid artery intima-media thickness, reaction of brachial artery to endothelium-dependent and endothelium-independent stimuli registered by high resolution ultrasound. RESULTS: Indapamide-retard and hydrochlorothiazide demonstrated similar hypotensive efficacy. Indapamide-retard turned out to be metabolically neutral while in patients receiving hydrochlorothiazide we observed significant elevation of triglycerides (+15.3%, p<0.05) and glucose (+12.2%, p<0.05). This resulted in the lack of lowering of total coronary risk during treatment with hydrochlorothiazide. Significant intergroup differences were revealed in effects on endothelium-dependent vasodilation with tendency to improvement and to significant worsening (-17%, p<0.05) in indapamide and hydrochlorothiazide treated patients, respectively. CONCLUSION: Despite similar hypotensive efficacy there were significant differences in metabolic and endothelial effects of 2 diuretics in favor of indapamide. This could potentially matter for long term cardiovascular prognosis.

[Effect of enalapril maleate on vascular endothelial function and platelet-endothelial interactions in patients with essential hypertension]. / Vliianie terapii énalaprila maleatom na funktsiiu sosudistogo éndoteliia i trombotsitarno-éndotelial'nye vzaimosviazi u bol'nykh gipertonicheskoi bolezn'iu.

AIM: Evaluation of endothelial function and platelet-endothelial interactions in patients with essential hypertension and dynamics of these changes in the course of treatment with enalapril maleate. MATERIALS AND METHODS: The study included 37 patients with essential hypertension and 22 normotensive volunteers. 17 of hypertensive patients received enalapril maleate (enap, KRKA) 5-20 mg/day during the period of 1.5 months. The complex of investigations included: measurement of total plasma cholesteroi, 12-lead ECG, echocardiography, high-resolution ultrasound investigation of brachio-cephalic arteries, evaluation of flow-mediated dilation, measurement of von Willebrand's factor, spontaneous and induced platelet aggregation. RESULTS: Patients with essential hypertension exhibited higher levels of von Willebrand's factor in plasma and degree of spontaneous and induced platelet aggregation as well as lower responses of vessel wall to hemodynamic stimuli compared to normotensive healthy individuals. There was a strong correlation between endothelial function markers and CAD risk factors, elevation of platelet activity. Treatment with enalapril maleate led to a statistically significant decrease of von Willebrand's factor in plasma and ex vivo platelet aggregation whereas flow-mediated dilatation increased. Values of endothelial function markers and platelet activity approached to those of normotensive subjects and these changes were accompanied by a decrease of ECG signs of left ventricular hypertrophy. CONCLUSION: Patients with essential hypertension were found to have compromised endothelial function. However, the degree of endothelial dysfunction depends not on hemodynamic parameters, but on the cumulative effect of CAD risk factors. Treatment with enalapril maleate may lead to normalisation of endothelial function and decrease of platelet activity.

[The results of the drug therapy of the ischemic syndrome in arteriosclerosis obliterans]. / Rezul'taty medikamentoznoi terapii ishemicheskogo sindroma pri obliteriruiushchem ateroskleroze.

A thorough investigation of 120 patients with obliterating atherosclerosis of lower extremities, treated conservatively at a hospital and observed for 5 years have shown that such a treatment was most effective in patients with the initial stages of the disease. The mechanisms of positive effects is based on the dilatation of the peripheral arteries and the resulting decrease of the peripheral resistance of the vessels, improved cardiac activity, activation of microcirculation and tissue respiration. An important result of the treatment is an increased rate of the oxygen consumption by the tissues in the ischemic zone. It determines the pathogenetic direction of the therapy which leads to a delayed progress of the disease in 20% of the patients and improves the patient's state in 57% of cases.

[Status of the myocardium and heart valves in funnel chest]. / Sostoianie miokarda i klapannogo apparata serdtsa pri kilevodnoi deformatsii grudnoi kletki.

Examinations of 70 patients with keeled deformation of the chest (KDC) have revealed signs of connective tissue dysplasia in all the examinees, as well as heart rhythm and conduction disorders. Echography has shown ventricular and atrial septal defects, mitral valve prolapse, dilatation of the aortic root, tricuspidal valve prolapse, abnormally located chorda. The development of KDC in the presence of external connective tissue stigmata, involvement of the cardiovascular system, changed dermatoglyphic pattern of the palms and fingers (as evidenced by dermatoglyphic analysis), as well as findings of histologic examinations of the cartilage removed in the course of thoracoplasty may indicate a generalized abnormality of the connective tissue in this patient population and KDC may be regarded as one of its manifestations.