[Electrocardiographic diagnosis of rural emergencies, by applying a tele-ECG recording and analysis system].

AIM: To identify emergencies in rural dwellers during electrocardiographic examination using a tele-electrogram (ECG) analysis (Easy ECG) system. MATERIALS AND METHODS: The easy ECG system connected 4 therapeutic-and-prophylactic institutions of a rural area and the town of Uryupinsk with the Research Institute of Cardiology, Russian Cardiology Research-and-Production Complex (Moscow). A total of 1,027 ECGs were recorded and analyzed in March 25, 2013 to November 11, 2013. RESULTS: Based on complaints, data of physical examinations, and results of ECG analysis, the investigators detected 188 (18.3%) emergency cases; 39 (3.8%) rural dwellers were first diagnosed as having emergencies. There were new found cases of acute coronary syndrome (n = 2), focal cicatricial changes (n = 11), including focal injury in the presence of left bundle-branch block (LBBB) (n = 2), and ischemic cardiomyopathy (n = 1) due to prior extensive myocardial infarction (as high as 28.2%). The frequent finding was intraventricular blocks (46.1%), including LBBB (n = 4) and right bundle-branch block (n = 1) (as high as 12.8%); the signs of left ventricular hypertrophy were encountered in 12 cases, as well as in 2 cases in the presence of LBBB (as high as 38.5%). CONCLUSION: The findings show the value of bedside recording of ECG with its remote analysis in the absence of special diagnostic services. Each of the detected electrocardiographic syndromes is a risk factor of cardiac death.

[Effect of short term graded physical exercise on the level of glycemia in children and adolescents with type 1 diabetes mellitus: data of long term ECG monitoring and registration of motor activity].

Study aim was to elucidate effect of graded physical exercise on glycemia level and interval QT duration in children and adolescents with type 1 diabetes mellitus. We carried out 25-hours parallel monitoring of glycemia, ECG and physical activity in 15 children and adolescents aged 9-17 years. During monitoring these patients performed an exercise test (PWC170). We found that there were two periods of significant and prolonged lowering of glycemia: in 120-420 min and 19-21 hours after exercise. Lowering of glycemia after physical exercise was associated with prolongation of QT interval. Registration of motor activity allowed to exclude changes of glycemia due to physical activity unrelated to graded exercise.

[Changes in orthogonal ECG in hypertensive patients taking different antihypertensive therapy].

AIM: To ascertain changes in orthogonal ECG in hypertensive patients taking different antihypertensive treatment. MATERIAL AND METHODS: Orthogonal ECG parameters and those of 24-h blood pressure monitoring (BPM) were examined before and after antihypertensive treatment with different drugs in 95 hypertensive patients aged 47 +/- 1 years. Of them, 14 patients received trandolapril+verapamil SR for 2 months, 13 patients--candesartan for 3 months, 25 patients--ramipril for 5 months, 26 patients--carvedilol for 4 months, 10 patients--atenolol for 8 months, 7 patients--doxasozine for 5 months. RESULTS: 24-h BPM parameters improved in all the groups. Initially, conventional ECG evidence on left ventricular hypertrophy was not seen in 86% patients. Dynamics of orthogonal ECG showed that parameters which increase in left ventricular hypertrophy decrease in response to treatment in patients with baseline values above the median. Parameters G and Gx, which in left ventricular hypertrophy diminish, rise significantly in patients with baseline values under median due to therapy. Treatment with impact on renin-angiotensin system reduced voltage parameters of orthogonal ECG, improved G characterizing repolarisation. Treatment with adrenoreceptors blockers reduced IADI. CONCLUSION: The analysis of parameters of orthogonal ECG reveals positive dynamics in response to treatment in patients with insignificant changes on ECG in short follow-up. Drugs of different groups change different parameters of orthogonal ECG.

[Secondary repolarization changes in patients with left ventricular hypertrophy].

AIM: To estimate the detection rate of tension syndrome and nonspecific repolarization changes in patients with arterial hypertension (AH). SUBJECTS AND METHODS: The electrocardiograms of 234 patients with AH (104 males and 130 females) were analyzed, by taking into account the magnitude of blood pressure (BP) elevation, the degree of an overall cardiovascular risk, the grade of hypertensive disease (HD), the presence of coronary heart disease (CHD), as well as echocardiographic and electrocardiographic voltage criteria for left ventricular hypertrophy (LVH). RESULTS: The classical tension syndrome and nonspecific repolarization changes were observed in 7 and 26% of cases, respectively; no significant differences were found in their detection rates between the males and females. The frequency of repolarization changes were associated with the presence of CHD in the women and with the magnitude of BP elevation, the degree of a cardiovascular risk, the grade of HD, and the presence of both echocardiographic and electrocardiographic signs of LVH. CONCLUSION: Ventricular repolarization changes in patients with AH are a sign of severe cardiac lesion and determine the need for meticulous attention.

[24-hours monitoring of ECG and glucose level for detection of relations between glycemia and QT interval duration in patients with type 1 diabetes].

AIM: To study correlations between glycemia and duration of ventricular repolarization in children and adolescents with type 1 diabetes mellitus (DM). MATERIAL AND METHODS: Parallel monitoring of ECG and glycemia was conducted in 43 type 1 MD patients (age 7-17 years, 12.8 +/- 2.7) and 37 healthy children and adolescents. RESULTS: Glycemia under 3 mmol/l and over 19 mmol/l is associated with significantly longer QTc interval compare to other blood glucose levels (437 ms and 447 ms versus 430 ms, p < 0.01). Also, in these glycemia values QTc interval duration over 440 ms (46 and 62% versus 33%; p < 0.01) becomes more frequent. In healthy children and adolescents mean duration and frequency of a longer QTc interval were significantly less than in diabetic patients irrespective of glycemia degree in patients with type 1 DM (p < 0.01). A moderate correlation was found between a daily insulin dose and QTc duration (correlation coefficient 0.35, p = 0.02). CONCLUSION: Glycemia under 3 mmol/l and over 19 mmol/l can prolong QT interval and, therefore, raise the risk of cardiovascular death in patients with type 1 DM.

[Heart rate variability dynamics during treatment of arterial hypertension].

UNLABELLED: Investigation of the dynamics of heart rate variability (HRV) in anti-hypertension therapy can facilitate the evaluation of the effectiveness of treatment. AIM OF INVESTIGATION: to compare anti-hypertension effect of monotherapy with nebivolol and dilatrend with dynamics of HRV and the estimation of the state of patients with mild arterial hypertension (AH) and metabolic syndrome (MS). MATERIAL AND METHODS: HRV was studied in 42 patients with mild AH and MS at the age of 32-60. Eighteen of them were treated with 5 mg of nebivolol during 24 weeks, and twenty-four with 25-50 mg of dilatrend during 16 weeks. All the patients were subjected to 24-hour ECG monitoring with analysis of HRV and arterial pressure (AP) before and after treatment. The main feature of HRV analysis was investigation of dependence of sinus arrhythmia on the mean value of heart rate (HR) RESULTS: With nebivolol treatment AP decreased in 11 patients, HRV became better in 9 patients. 7 cases manifested coincidence of AP reduction and HRV improvement. In 6 cases out of 7 when AP did not decrease, HRV did not change. Worsened HRV was observed in 3 cases: in one case with growing AP and in 2 cases with decreasing AP. All the patients, except one, regarded their state as improved. With dilatrend treatment AP lowered in 16 cases. In 9 cases HRV became better, in 11 cases it remained the same, and in 4 cases it became worse. Positive HRV dynamics in 7 cases out of 9 was accompanied by lowering of AP, while negative dynamics was observed in one case with rise of AP and in three cases with very low AP or in the absence of AP dynamics. 14 patients felt better, 6 of them manifested better level both of AP and HRV. CONCLUSION: The method of 24-hour HRV analysis based on assessment of dependence of the value of sinus arrhythmia on HR is useful in evaluating the effectiveness of anti-hypertension therapy. As a rule, an effective decrease in AP is accompanied with improvement of HRV. The absence of improvement of deterioration of HRV in anti-hypertension therapy is a factor which should be taken into consideration when choosing the mode of therapy.

[Changes in ST segment on ECG of hypertensive patients].

AIM: To evaluate ST depression in hypertensive patients with electrocardiographic signs of left ventricular hypertrophy (LVH), correlation of ST segment changes with heart rate (HR) and blood pressure (BP) during Holter monitoring (HM) and bi-functional ECG and BP monitoring (BFM), and to compare ST depression and local left ventricular contractility during stress-echocardiography in hypertensive patients with unaffected coronary arteries according to the data of coronary angiography. MATERIAL AND METHODS: We examined 344 hypertensive patients without clinical signs of ischemic heart disease. Correlation between ST segment depression and ECG signs of LVH was evaluated in 192 patients. 180 patients underwent HM, 122--BFM and 30 hypertensive patients with normal coronary arteries according to the data of coronary angiography underwent stress-echocardiography. RESULTS: According to the data of 12 lead ECG 40 cases of ST depression were found, with LVH signs in 26 (65%) of these patients. During HM in 34 of 180 patients 2 types of ST depression were found: type 1--short periods of transient ST depression without persistent ST depression was fond in 8 patients; type 2--persistent ST depression more than 1 mm during the whole time of recording--in 26 patients. In 7 of 8 cases of type 1 and in 5 of 26 cases of type 2 ST depression had rhythm-dependent character. During BFM in 9 cases ST depression during HR or BP increase was found. In 2 cases ST depression during BP increase was unrelated to HR increase which may be consequence of systolic myocardial strain syndrome. In 7 of 30 hypertensive patients with normal coronary arteries and without local myocardial contractility disturbances according to the data of stress-echocardiography positive criteria of ischemia were found. CONCLUSION: The cause of ST segment depression in hypertensive patients more often are secondary disturbances of repolarizaion processes related with LVH development. In some cases such patients during HM show rhythm-dependent valuable ST depressions. In BFM cases of left ventricular myocardial strain syndrome are found, similar cases are also seen in stress-echocardiography. However, in some cases one fails to define the reason of ST changes even approximately. One of the factors leading to disturbances of repolarization processes in hypertensive patients may be disturbances of microcirculation at the level of prearteriols and capillaries.

[Effect of sex on informative power of various electrocardiographical criteria of left ventricular hypertrophy in patients with excessive body mass].

Aim of the study was to analyze dependence of various voltage parameters of QRS complex on increase of left ventricular myocardial mass (LVMM) in samples of men and women with excessive body mass or obesity. We included data from 223 patients with excessive body mass and diagnosis of stage I - II arterial hypertension. ECG was registered in 12 standard leads. Left ventricular hypertrophy (LVH) was certified if according to echoCG data LVMM exceeded 125 g/m2 in men and 110 g/m2 in women. Depending on sex and presence of LVH all patients were divided into 4 groups: M1 (men with LVH, n=74), M2 (men without LVH, n=74), W1 (women with LVH, n=55), anb W2 (women without LVH, n=20). We analyzed amplitudes of all waves of the QRS complex as well as Sokolow-Lyons voltage parameters and the Cornell index. The following intergroup differences were most significant: between groups M1 and M2 - in amplitudes of S waves in chest leads V3, V4; between groups W1 and W2 - in amplitudes of R-waves in limb leads I and aVL, and amplitudes of S-waves in lead III. Increases of the Cornell voltage index were observed both in men and women with LVH. The following criteria had greatest sensitivity at 95% specificity: in men - SV4 > 1,1 mV (34%) and RaVL+SV3 > 2,3 mV (32%); in women - RaVL > 0,8 mV (56%) and RI+SIII > 1,5 mV (56%). Informative power of electrocardiographical diagnosis of LVH can be augmented by the use of different voltage criteria in groups of men and women. In men most informative are chest leads (SV1 - V3, RaVL) while in women - limb leads (RI, RaVL, and SIII). The use of combination parameters RaVL+SV3 > 2,3 mV (in men) and RI+SIII > 1,5 mV (in women) allows to augment sensitivity with unchanged specificity. In patients with excessive body mass voltage the Sokolow-Lyons criterion is not informative. Most significant component of the Cornell voltage criterion in groups of men with excessive body mass is amplitude of SV3, in groups of women - amplitude of RaVL.

[Changes of QT-interval duration in children and adolescents suffering from type 1 diabetes mellitus].

We measured QT interval in 43 children and adolescents with type 1 diabetes mellitus and studied its dependence on age, disease duration, metabolic control, and dose of insulin. Control group consisted of 37 healthy children and adolescents. Duration of QT during 24 hours was longer in patients as compared with controls. Patients also more often had prolonged QT. Both in patients and controls there was no relation between age and QRc. There was no interrelationship in patients between glycated hemoglobin, diabetes duration and lenght of QTc. Moderate correlation was revealed between dose of insulin administered in 24 hours and length of QTc.

[Trends in heart rate variability in patients with ischemic heart disease and depression treated with antidepressant tianeptine].

AIM: To study heart rate variability (HRV) according to 24-h Holter monitoring of ECG in patients with ischemic heart disease (IHD) and to examine effects of tianeptine on HRV. MATERIAL AND METHODS: Twenty eight patients with IHD (17 males and 11 females aged 40-70 years) with a verified IHD diagnosis and atherosclerosis of the coronary arteries participated in the trial. Severity of depressive syndrome was assessed by CES-D questionnaire. HR V was assessed by weighted mean variation of the rhythmogram (WMVR) for 24 hours. RESULTS: Initial WMVR (m +/- sigma) in the study group (IHD with depression, n = 15) was 670 +/- 260 ms, in the control group (IHD without depression, n = 13) - 625 +/- 191 ms (the difference was insignificant (p = 0.72). Initial (m +/- sigma) WMVR in men of the study group (n = 6) before therapy was 460 +/- 139 ms that was less than in the control group (633 +/- 183 ms, n = 11). CONCLUSION: In men HRV depends on duration of the disease. There was a negative correlation between WMVR difference before and after treatment with tianeptine and difference of relevant depression indices with high correlation coefficient (-0.74, p = 0.03).

[Electrocardiographic diagnosis of hypertrophy of the left ventricular myocardium in patients with arterial hypertension and overweight].

AIM: To study efficacy of different ECG criteria of hypertrophy of left ventricular myocardium (LVH) in hypertensive patients with reference to overweight and obesity. MATERIAL AND METHODS: The authors analyse data on 100 patients (42 males and 58 females) aged 19-79 with diagnosis of arterial hypertension stage I-II. ECG was conducted in 12 leads. LVH by ECG was determined according to the following criteria: Sokolov-Lyon (S-L): Sv1+Rv5(v6) > 35 mm; Cornell voltage (Crn V): R avL +Sv3 > 28 mm (> 20 mm for females; Cornell product (Crn P): (RavL+Sv3)xQRSduration > 2440 mm x ms (for females RavL+Sv3 amplitudes + 0.6 mm). To verify L VH by echoCG, the authors used threshold values of left ventricular myocardium mass index (LVMMI) 125 g/m(2) for males and 110 g/m(2) for females. LVMMI was calculated by two methods: LVMM to body surface area (BSA) 2) LVMM to BSA of an ideal figure of a relevant height. Depending on the BMI all the patients were divided into 3 groups: with normal weight (BMI under 25 kg/m2), with overweight (BMI between 25 and 30 kg/m(2)), with obesity (BMI over 30 kg/m(2)). RESULTS: Sensitivity of the criterion Crn-P was the highest. The S-L criterion had the least sensitivity (under 10%) in groups with overweight by more than 25 kg/m(2). In these groups sensitivity of all ECG criteria of L VH depends on some factors: on indexation of LVH by body size, gender and overweight. S-L criterion sensitivity is higher in subgroups of males irrespective of overweight and obesity. CONCLUSION: Informative value of LVH ECG criteria depends on the method of LVMM indexation by body size, overweight and gender of the patients.

[Dynamics of heart rate variability in ischemic heart disease patients after coronary artery bypass grafting]. / Dinamika variabel'nosti ritma serdtsa u bol'nykh ishemicheskoi bolezn'iu serdtsa posle operatsii koronarnogo shuntirovaniia.

AIM: To study dynamics of 24-hour heart rate variability (HRV) after coronary artery bypass grafting (CABG) and to elucidate relationship between HRV dynamics and clinical course of the disease. METHODS AND MATERIAL: A novel methodological approach to evaluation of HRV based on measurement of mean weighted rhythmogram variation (MWRV) was implemented. Ninety patients were studied before CABG. Then HRV was assessed in 2 weeks (61 patients), 2 (45 patients), 6 (24 patients)and 12 (33 patients) months after surgery. RESULTS: At all study points HRV was lower in CHD patients than in healthy persons. Substantial lowering of average MWRV 2 weeks after surgery was followed by return to preoperative level by the end of 2 months, leveling off until 6 months and some decline by the end of a year. Individual changes of MWRV were assessed in 29 patients in whom HRV was evaluated at 5 or 4 study points. Three types of MWRV changes were distinguished: type 1 - "normal" dynamics (9 patients) - elevation of MWRV 2, 6 and 12 months; type 2 (10 patients) - elevation of MWRV after 2 and 6 months with subsequent lowering by the end of 1 year; type 3 (10 patients) - lowering of MWRV In 2 and/or 6 months. The following relationships between MWRV changes and clinical course after surgery were observed: there were no complications among patients with type 1 MWRV dynamics; 8 of 10 type 2 patients had signs of heart failure, or blood pressure elevation, or recurrence of angina by the end of 1 year: among 10 type 3 patients 6 experienced various complications. Recurrence of angina at various intervals after CABG occurred in 5 patients and in all it was associated with MWRV decrease. CONCLUSION: Pronounced decrease of MWRV between 2 and 12 months after CABG is associated with worse clinical course and its detection should trigger additional investigation and care of a patient.

[Heart rate variability before and after coronary artery bypass surgery in patients with ischemic heart disease]. / Variabel'nost' ritma serdtsa do i posle operatsii koronarnogo shuntirovaniia u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Short term heart rate variability (HRV) was studied in 44 patients before, in 2 weeks and 2 months after coronary artery bypass grafting (CABG). Prior to surgery the patients were divided into 2 groups: with normal and substantially lowered HRV parameters. In 2 weeks after CABG lowering of HRV was registered in all patients. In 2 months parameters of HRV returned to preoperative level almost in all patients but did not exceed it despite restoration of coronary blood flow and improvement of myocardial contractility. Intergroup differences of characteristics of HRV remained the same as before CABG.