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Aim: To determine informative value of quantitative parameters of orthogonal ECG repolarization phase in diagnosis of left ventricular hypertrophy (LVH) in hypertensive patients., Material and Methods: A total of 210 healthy subjects and 241 hypertensive patients with LVH (LV myocardium mass index > 125 g/m2 in males and > 110 g/m2 in women) comprised two groups--control and test. The study was made of quantitative parameters (components X, Y, Z, modules and angles of azimuth and elevation) of wave T integral vector, wave T maximal vector, ST vector, ventricular gradient; spatial and projection areas of wave T, the angle between integral vectors of spatial waves QRS and T (phi angle)., Results: The test group had reduced X, Y components and elevated vectors, their azimuth and phi angle. Most informative for repolarization were components X of T maximal and integral vectors being as informative as Rx+Sz and Cornel product. The method of multiple regression analysis was used to plot discriminant function taking account of most informative indices of depolarization and repolarization--Rx+Sz and X component of T maximal vector. The area under ROC curve for this function was greater than for the variables alone and Cornel product in both groups (0.90 +/- 0.02 and 0.86 +/- 0.02, p < 0.05 for the control and test group, respectively)., Conclusion: Quantitative parameters of repolarization phase can improve LVG diagnosis in hypertensive patients.

Aim: To compare different techniques of calculation of left ventricular myocardial mass (LVMM) by one-, two- and three-dimentional echocardiography (EchoCG) and by MRT., Material and Methods: We calculated LVMM by formulas Penn-cub and modified ASE in one-, two- and three-dimentional EchoCG regimes and MRT; evaluated structural-geometrical characteristics of the left ventricle at various stages of hypertension in 53 hypertensive patients (42 males and 11 females)., Results: Mean LVMM values calculated according to two formulas in one-dimentional regime did not differ significantly but were higher than in two- and three-dimentional regimes. LVMM value according to three-dimentional EchoCG was closer to the results of the summation estimation in MRT., Conclusion: Conventional EchoCG methods of LVMM calculation in M-regime (Penn-cub, ASE) overestimate the results. Most compatible with three-dimentional EchoCG results are those of EchoCG in two-dimentional regime (area-length).

Aim: To show possibilities of dipolar electrocardiography (DECG) in diagnosis of left ventricular hypertrophy (LVH)., Material and Methods: We made DECG in 151 healthy subjects and 158 hypertensive patients. To characterize DECG quantitatively, we used the integral activation duration index (IADI) calculated as a weighted sum of the areas with different duration of activation, module of the maximal vector QRS, QRSxIADI (IADIM)., Results: In patients with left ventricular myocardial mass index (LVMMI) under 150 g/m2, sensitivity of DECG was 38-49%, in the index over 150 g/m2 sensitivity reached 38-75%, specificity 89-98% compared to healthy examinees and 72-82% compared to hypertensive patients without LVH. The IADIM parameter correlates directly (moderate correlation) with duration of QRS complex and LVMMI., Conclusion: Possibilities of using parameters IADI and IADIM for assessment of electrophysiological myocardial remodeling and their correlation with other methods need further investigations.

Aim: To study a relationship between a carcadian blood pressure (BP) rhythm and cardiovascular events (CE) during 7-9 year follow-up in males with mild to moderate essential hypertension (EH)., Material and Methods: 50 males (mean age 48.6 +/- 0.7 years) with mild to moderate EH were prospectively followed up for 7-9 years (8.4 +/- 0.1 years). We analysed 24-h BP recordings and protocol of echocardiography performed during the first hospitalization. The patients were divided into three groups: group 1 (n = 18) with normal (10-20%) nocturnal fall of systolic BP (NF SBP) and normal left ventricular mass index (LVMI < 125 g/m2); group 2 (n = 16) with insufficient (< 10%) NF SBP and normal LVMI; group 3 (n = 16) with LVMI > 125 g/m2. In these groups we assessed the prevalence of CE: myocardial infarction (MI), stroke (S), sudden death (SD), new cases of angina pectoris (AP), transient cerebral ischemic attack (TIA)., Results: No significant differences were found between the groups by mean age, body mass index, duration of arterial hypertension, mean 24-h and awake systolic and diastolic BP while significant differences were by nighttime BP profile parameters. During the follow-up 16 CE in 12 patients were documented (3 fatal and 13 nonfatal). In group 1 CE were observed in 1 patient (twice MI), in group 2-7 cases of CE (1 S, 1 TCIA, 2 MI, 2 AP) in 6 patients, in group 3-7 cases (2 MI, 3 TIA, 2 AP) in 5 patients, 3 of them were fatal., Conclusion: Insufficient nocturnal fall of SBP (< 10%) is an adverse prognostic factor for cardiovascular morbidity in mild to moderate essential male hypertensives.

Aim: To study a relationship of the magnitude of structural changes in the left ventricle (LV) to the mean daily pulse blood pressure (PBP) in patients with hypertensive disease (HD)., Materials and Methods: 70 male patients (mean age 49 +/- 1 years) with stages I (n = 54) to 11 (n = 16) HD. LV mass (LVM) was estimated by echocardiography according to the formula derived by R. B. Devereux et al. and normalized to body surface area [the LVM index (LVMI)]. The relative thickness index (RTI) for the posterior wall (PWRTI) and ventricular septum (VSRTI) was calculated as a ratio of the sum of PWRTI and VSRTI to the LV end-diastolic size. LVMI > 125 g/m2 was considered to be a criterion for LV hypertrophy (LVH). 24-hour blood pressure (BP) monitoring was performed with a Spacelabs-90207 device (USA). According to the 24-hour PBP value, the patients were divided into 2 groups: 1) those (n = 17) having PBP24 > 53 mm HG and 2) those (n = 53) having PBP24 < 53 mm Hg., Results: Group 1 patients were found to have significantly higher LVMI, LV WRTI, and incidence of LVH and a complex of changes in the BP profile as higher values of 24-hour systolic, diastolic and mean BP, PBP, and BP variations. Multiple regression analysis revealed a highly significant contribution of PBP24 to the development of LVH., Conclusion: The pedictive value of PBP as an index that characterizes a dynamic pressure load in regard to LV structural changes is higher than that of mean BP as a static load index and a BP variation index.

Aim: To study correlations between structural changes of the left ventricle (LV) in patients with mild and moderate arterial hypertension (AH) and severity of hypoxic night episodes., Material and Methods: The examination of 50 patients (mean age 52 +/- 1 year) with mild and moderate hypertension included echocardiographic measurement of LV myocardial mass, calculation of LV myocardial mass index. LV hypertrophy was stated in the index 125 g/m2 for men and 110 g/m2 for women. 24-h monitoring of arterial pressure (TM-2425) and night monitoring of hemoglobin saturation of arterial blood with oxygen (SaO2) using pulsoxymeter NONIN 8500M were made. The data processing was performed with the use of original program ARM-SaO2. Dissaturation was stated if SaO2 fell by 4% and more compared to the previous stable level at initial SaO2 level above 90%. The patients were divided into two groups according to the number of dissaturation episodes: group 1 (more than 20 dissaturation episodes) and group 2 (less than 20 episodes)., Results: The groups were comparable by gender, duration of hypertension, body mass index, systolic and diastolic arterial pressure, heart rate. In group I, pulse arterial pressure, systolic arterial pressure load for 14 hours, day and night were significantly higher. Patients with dissaturation had a significantly higher LV myocardial mass and more frequent LV hypertrophy (128 +/- 6 and 106 +/- 5 g/m2 and 56 and 20%, respectively). The correlation and multifactor regression analysis showed a predictive value not only of the pressor parameters but also of indices of night hypoxia in relation to structural changes of LV myocardium., Conclusion: The presence of significant hypoxic episodes in sleep in AH patients indicates risk to develop structural changes of LV myocardium.

Aim: To assess the state of target-organs in males with mild and moderate forms of essential hypertension (EH) in normal and disturbed 24-h rhythm of arterial pressure (AP)., Material and Methods: Target-organs were examined in 70 males aged 30-62 years (mean age 49 +/- 1 years) with mild (n = 54) or moderate (n = 16) EH. The following tests were performed: ophthalmoscopy, echo-CG with estimation of the left-ventricular myocardial mass index (LVMMI), duplex scanning of the carotid arteries (DS), AP monitoring, measurements of plasma creatinine, relative density of the urine, glomerular filtration rate, examination of the neurological status. Circadian rhythm of AP was evaluated by a night fall (NF) of systolic pressure (SP). Patients with inadequate NF of SP (< 10%) entered group 1, those with normal NF of SP (10% < NF SP < 20%) were allocated to group 2., Results: Patients of group 1 had a significantly higher LVMMI, more frequent occurrence of left ventricular hypertrophy and carotid artery affection (local thickening "intima-media"). In group 1 there was also a complex of unfavourable changes in AP circadian profile, especially at night., Conclusion: Mild/moderate EH with insufficient NF of SP is associated with more pronounced and frequent changes in the target-organs (left-ventricular hypertrophy, "intima-media" thickeing). Insufficient NF of AP initiates higher pressor load on the target-organs, on the one side, and reflects defective regulation which affects target-organs, on the other. Both these factors contribute to damage of the target-organs.

Aim: To study severity of left ventricular hypertrophy (LVH) and left ventricular function in patients with primary aldosteronism (PA) in comparison with hyperaldosteronemia and preoperative arterial hypertension, to follow the dynamics of these parameters early and late after surgical removal of aldosteroma., Materials and Methods: Concentration of aldosterone (AC), plasma renin activity (PRA) were measured in 28 PA patients aged 26-58 years before removal of aldosteroma and 1 month, 1 year and 2-5 years after the surgical treatment. Myocardial status was assessed by echocardiography, Doppler echocardiography. 30 healthy subjects aged 25-55 years served control., Results: All the PA patients showed initial or moderate LVH. Index of left ventricular myocardial mass was influenced at the first regression step by primarily diastolic pressure, at the second step--by basal PRA. The diastolic function was affected. One month after unilateral adrenalectomy PRA level and arterial pressure decreased but regression of LVH was noted only 1 year and later after the surgery. Diastolic function improved 1 year after the operation but without normalization within 2-5-year follow-up., Conclusion: The lack of a complete normalization of diastolic function of the left ventricle late after the surgery despite regression of LVH and preoperative correlation of the isometric relaxation time with PRA level may be caused by fibrous changes in the myocardium and by hyperaldosteronemia effects.

The purpose of this study was to evaluate the influence of different factors, among them left ventricular hypertrophy (LVH) on long-term heart rate variability (HRV) in patients with hypertension. 38 patients with arterial hypertension of different genesis were included in the study. Ischemia was excluded in all the patients by the data of clinical and instrumental methods of investigation. LVH data obtained from HRV of 20 healthy subjects was used as control. HRV was evaluated by estimating variations for short intervals of a rhythmogram (VSI). A HRV decrease did not depend on sex, but essentially depended on patients'a age, disease duration and the form of hypertension. A marked tendency leading to the rate variability decrease was observed only in moderate LVH. In cases of original LVH variability data did not differ from those in patients without signs of LVH. Low or marginal HRV was more often observed in patients with essential hypertension and in those with hypertension of endocrine genesis. As far as renal hypertension is concerned low variability was less frequent. There were a lot of factors which affect the change of HRV. The more significant of them were the patients' age, hypertension genesis and form of hypertension. Factors leading to the rate variability decrease were the following age above 40, endocrine or essential hypertension and moderate form of hypertension.

Of 20 patients with antiphospholipid syndrome 6 were found clinically and upon special tests to have signs of ischemic heart disease. All the 6 had shifts in lipid spectrum of plasma. It is important to study coronary pathology in antiphospholipid syndrome to elucidate mechanisms underlying thrombosis and vascular atherosclerosis in human diseases.

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 paper is concerned with some potentialities of transesophageal echocardiography (TE echoCG) in diagnostic and cardiosurgical practice. Four examples are provided (interatrial septal defect, a new growth in the right atrial cavity, vegetation on the cusps of the aortal valve, left atrial thrombus), illustrating that the use of TE echoCG was of help in the establishment of a correct diagnosis. The method is described as holding promise for observation over heart activity in cardiosurgery. In addition, the authors mark difficulties encountered during interpretation of the data obtained.

The phasic structure of heart activity was explored in 50 patients suffering from symptomatic arterial hypertensions before and after the operative treatment with the aid of impulse Doppler echocardiography. Of these, 28 patients had renovascular hypertension (RVH), 16 primary aldosteronism (PA), and 6 pheochromocytoma of the adrenals. The data obtained were compared with the polycardiographic readings in patients with essential hypertension (EH). As in the case of EH, the period of left ventricular tension, the phase of asynchronous and isometric contraction, and the phase of isometric relaxation became significantly longer in patients with RVH and PA. In the postoperative period, some phases of heart activity return to normal whereas other phases remained altered throughout the entire observation period, which may be due to the disease standing and irreversibility of myocardial alterations. Therefore, Doppler echocardiography is a sufficiently accurate method of estimating phasic activity of the left ventricle, allowing computation of the period of cardiac cycle phases even in the presence of only one lead of the ECG mounted into an ultrasonic outfit.

In 50 patients undergoing direct revascularization of the myocardium, an attempt was made to carry out transesophageal echocardiography. In 5 of them, visualization of the myocardium appeared unsatisfactory, 2 patients were excluded from the investigation in view of the fact that they were operated on in the acute phase of myocardial infarction. Among 43 patients who were entered into the investigation, the areas of abnormal local contractility of the myocardium (AILC) occurred during surgery in 14 (33%). In 3 patients, the newly occurring disorders of local contractility of the myocardium persisted till the end of the operation. In the remaining cases, the presence of the AILC was temporary. The sensitivity of the newly occurring stable AILC in the diagnosis of perioperative myocardial infarction and acute coronary death amounted to 75%, specificity was 100%.

The authors provide the results of the use of magnetic resonance tomography (MRT) in examining 20 patients suffering from hypertrophic cardiomyopathy (HCMP). MRT was made using an apparatus with a field force of 0.23 synchronized with the ECG. The MR-sections were performed both in transverse and inclined planes oriented along the long axis of the left ventricle. MRT made it possible to identify and to assess with a high accuracy asymmetric hypertrophy of the left ventricle myocardium including the cases with apical localization of hypertrophy. Analysis of the data showed a certain decrease of the left ventricle cavity in the systole, dilatation of the left atrium and pronounced hypertrophy of the myocardium (mainly of the interventricular septum). The asymmetry coefficient amounted to 2.1. Correlation of the MRT data and two-dimensional ultrasound cardiography readings demonstrated good comparability of the results obtained with the use of both methods. MRT can be applied in the diagnosis of HCMP in cases where it is difficult to carry out ultrasound cardiography as well as for diagnosis verification provided the results derived with the use of other research methods are inconclusive.

Eight versions of ECG alterations were identified in 84 patients with hypertrophic cardiomyopathy (HCMP). As for the most prevalent version (60.7 percent of the cases), the pathological Q waves or QS were recorded in the presence of the voltage signs of ventricular hypertrophy or without such signs. The use of ultrasound cardiography and roentgenocardiography made it possible to distinguish 3 groups of patients with different myocardial hypertrophy. The first group included 20 patients with isolated hypertrophy of the interventricular septum (IVS), the second group 40 patients with IVS and left ventricle hypertrophy, and the third group included 24 cases of IVS hypertrophy and combined hypertrophy of the ventricles. The main features of ECG alterations were determined in accordance with the types of hypertrophy under consideration. In the first group, Q waves were mainly recorded (in 71.4 percent of the cases). In the second group, the signs of left ventricle hypertrophy were recorded in 50 percent of the cases while Q/QS in 62.5 percent of the cases. In the third group, the voltage signs of ventricular hypertrophy were observed in 62.5 percent of the cases, whereas the Q and QS were recordable less commonly (in 41.7 percent of the cases).

Doppler's echocardiography was employed in 25 healthy persons aged 26 to 38 years to establish that normal flows from the atrioventricular valves (two-peak and diastolic ones) are directed towards the monitor. The first peak (of early filling) shows on the synchronously recorded electrocardiogram a certain period after the T wave occurrence, whereas the second one (of later filling) after the P wave. The flow from the tricuspid valve varied with respiration. In 8 persons (32%), the systolic turbulent flow was recorded in the ostium of the tricuspid valve and in one person, in the ostium of the mitral valve. The velocity of the flows did not exceed 2 m/s. The flows via the main vessels (aorta and pulmonary artery) were of one peak and systolic. The spectrum of the aortal flow was more pointed and reached the maximum velocity more rapidly. In the efferent tract of the left ventricle, no reverse diastolic flow was obtained, whereas in the efferent tract of the right ventricle, it could be obtained in 15 persons (60%). The velocity of the flow did not exceed 1 m/s. The maximum and integral velocities of the flow via the mitral valve exceeded those of the flow via the tricuspid valve. Besides, the flows were different as regards the magnitude of the mean acceleration and the mean deceleration of the early filling of the ventricles. The velocities of the flow in the aorta exceeded those of the pulmonary flow. The phase of the pulmonary flow acceleration accounted for 40.7% of expulsion, that of the aortal flow only for 29%. (ABSTRACT TRUNCATED AT 250 WORDS)

The potentialities and importance of methods of ultrasonic investigation including two-dimension and Doppler echocardiography were demonstrated in the diagnosis of hypertrophic obstructive cardiomyopathy and in the detection of hemodynamic characteristics of the disease in different patients. Hemodynamic characteristics revealed by echocardiography could serve as a basis for an individual choice of therapy and assessment of its effectiveness during long-term treatment.

Three-day ECG monitoring before and after digitalization of 55 patients with heart failure (HF) was performed. Digoxin did not make a considerable effect on the frequency of detection of high gradations of ventricular arrhythmias. Nevertheless it significantly reduced the mean number of ventricular extrasystoles (VES) per hour and the mean number of complex VES per hour in 8 (33.3%) patients out of 24 with frequent extrasystoles. A significant increase in the VES mean number per hour and in the complex VES mean number per hour was observed in 6 (25%) patients out of 24 with basal frequent extrasystoles. In patients with the antiarrhythmic effect of digoxin indices of the central hemodynamics (diastolic pressure in the pulmonary artery and ejection fraction) were significantly better and in patients with the arrhythmogenic effect of digoxin significantly worse in the absence of a significant difference between digoxin and K+ concentration in the plasma. Digoxin possessed a moderately pronounced antiarrhythmic effect mainly in the patients with HF early stages and in moderately pronounced disturbances of the central hemodynamics. In patients with severe manifestations of HF and with considerable deterioration of indices of the central hemodynamics digoxin in therapeutic concentrations can make an arrhythmogenic effect.