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Loeffler's endocarditis remains is a very rare disease, develops due to eosinophilic inflammation predominantly of the endocardium with an outcome in fibrosis and massive thrombus formation and. He is generally characterized by an unfavorable prognosis. Clinical case of a 42-year-old patient with Loeffler endocarditis is presented. The development of the disease was preceded by a polyvalent allergy, mild dry eye syndrome and pansinusitis with a single eosinophilia of blood up to 16%. The reason for the hospitalization was the appearance of biventricular heart failure. During the previous year, the level of blood eosinophils remained normal, a threefold increase in the level of eosinophilic cationic protein was observed once. A 20-fold increase in the pANCA level, a 2.5-fold increase in the level of antibodies to DNA, an antibody to the nuclei of cardiomyocytes 1:160 were detected. The diagnosis was made on the basis of electrocardiography data (low QRS voltage, atrial hypertrophy), echocardiography, multispiral computed tomography and magnetic resonance imaging of the heart (thickening and delayed contrasting of the endocardium, massive thrombosis of the left ventricular apex with obliteration of its cavity, encapsulated fluid in the pericardium with compression of the right ventricle). Systolic dysfunction, severe signs of restriction and arrhythmias were absent. Trombectomy, tricuspid valve plasty, pericardial resection, suturing of an open oval window were performed. Signs of active inflammation with single eosinophils, vasculitis, perimuscular sclerosis, endocardial sclerosis were detected in morphological and immunohistochemical studies of endo-, myo-, pericardium. Viral genome was not found. The therapy with methylprednisolone 24 mg/day, azathioprine 75 mg/day was started. Six months after the operation, the symptoms of heart failure are completely absent, the thrombosis did not recur.

To investigate whether intravenous contrast-enhanced multislice spiral computed tomography (computed tomography) (MSCT) versus myocardial morphological examination can diagnose myocarditis and the non-inflammatory causes of dilated cardiomyopathy (DCM) and evaluate prognosis in patients with the latter.A study group consisted of 130 patients, including 95 men (46.8±11.9 years), with DCM (mean left ventricular (LV) end-diastolic dimension (EDD), 6.6±0.8 cm; mean LV ejection fraction (EF), 29.8±9.3%; NYHA functional class (FC) III (II; III)). All the patients underwent intravenous contrast-enhanced 320-slice CT of the heart; myocardial morphological examination was made in 48 patients (endomyocardial biopsy in 29 patients, intraoperative biopsy in 7, and autopsy in 9, and study of the explanted heart in 3). In addition, cardiotropic viral DNA in the blood and myocardium and the level of anticardiolipin antibodies were determined; echocardiography (in all the patients), scintigraphy (n = 45), magnetic resonance imaging (MRI) (n = 21), and coronary angiography (CG) (n = 46), and a genetic consultation were performed. A comparison group comprised 20 patients, including 14 men (69.3±9.2 years), with coronary atherosclerosis (40% or more stenoses) according to MSCT findings in the absence of criteria for DCM (mean LV EDD, 4.8±0.5 cm; mean LV EF, 59.4±4.6%).Morphological/comprehensive examination showed that myocarditis as a cause of DCM was diagnosed in 76 (65%) patients; its concurrence with genetic cardiomyopathies was in 17 more patients (17%). MSCT of the heart revealed lower accumulation areas in 2 (1.5%) patients (type 1 based on the proposed rating scale), delayed myocardial contrast agent accumulation (DMCAA) in 81 (62.3%): subendocardial accumulation (type 2) in 8, intramyocardial accumulation in 4 (type 3), subepicardial accumulation in 52 (type 4), and transmural accumulation in 15 (type 5); DMCAA was not noted in 49 patients. DMCAA was not found in the comparison group. As compared with biopsy, the sensitivity, specificity, predictive value of positive and negative results of the tests in detecting active myocarditis for all the types of DMCAA were 77.4, 47.1, 72.7, and 53.3%, respectively; those for types 3-5 of DMCAA were 77.4, 52.9, 75.0, and 56.3%; those in detecting all the morphological types of myocarditis were 68.3, 28.6, 84.8, and 13.3%, and those for types 3-5 were 65.9, 28.6, 84.4, and 12.5%, respectively. Comparison of the data of MSCT and those of comprehensive examination in all the patients with DCM, the diagnostic significance in detecting myocarditis for all the types of DMCAA was 70.6, 67.9, 88.9 and 38.8%, respectively; that for DMCAA types 3-5 was 60.8, 67.9, 87.3, and 32.3%. In the study group, MSCT also identified the non-compacted myocardium (n = 31 (23.8%)), coronary atherosclerosis (n = 31 (23%)), which is confirmed by CG findings in 15 patients. The patients with DMCAA significantly more frequently showed a relationship with previous infection, acute onset, significantly higher NYHA FCs, end-diastolic and end-systolic LV volumes, and insignificantly lower LV EF. During a mean follow-up periods of 12 (6; 37.25) months, the overall mortality rate was 17.7% (23 deaths); the death + transplantation index was 20% (n = 26). All the types of DMCAA were found to be significantly related to prognosis: in the DMCAA group, the mortality rate was 21.5% versus 7.8% in the non-DMCAA group (odds ratio 3.22; 95% confidence interval, 1.02 to 10.21; p0.05).MSCT with the assessment of delayed contrast enhancement (and simultaneous CT coronary angiography) can be used for the non-invasive diagnosis of myocarditis in patients with DCM, including that in the presence of contraindications to MRI. DMCAA correlates with the presence of myocarditis, its activity, the degree of functional disorders, and prognosis.Цель исследования. Изучение возможности мультиспиральной компьютерной томографии (МСКТ) сердца с внутривенным контрастированием у больных с синдромом дилатационной кардиомиопатии (ДКМП) в диагностике миокардита (в сопоставлении с морфологическим исследованием миокарда), невоспалительных причин ДКМП и оценке прогноза. Материалы и методы. В основную группу вошли 130 пациентов (95 мужчин, средний возраст 46,8±11,9 года) с синдромом ДКМП: средний конечный диастолический размер (КДР) левого желудочка (ЛЖ) 6,6±0,8 см, средняя фракция выброса (ФВ) 29,8±9,3%; III (II; III) функциональный класс (ФК) по классификации NYHA. Всем проведена 320-срезовая МСКТ сердца с внутривенным контрастированием; 48 пациентам выполнено морфологическое исследование миокарда (эндомиокардиальная биопсия у 29, интраоперационная у 7, аутопсия у 9, исследование эксплантированного сердца у 3). Кроме того, определяли ДНК кардиотропных вирусов в крови и миокарде, уровень антикардиальных антител, проводили эхокардиографию (всем пациентам), сцинтиграфию (у 45), магнитно-резонансную томографию - МРТ (у 21), коронарографию - КГ (у 46), консультацию генетика. Группу сравнения составили 20 пациентов (14 мужчин, средний возраст 69,3±9,2 года) с коронарным атеросклерозом (стенозы 40% и более) по данным МСКТ в отсутствие критериев ДКМП (средний КДР ЛЖ 4,8±0,5 см, средняя ФВ 59,4±4,6%). Результаты. По данным морфологического комплексного обследования, миокардит как причина синдрома ДКМП диагностирован у 76 (65%) пациентов, его сочетание с генетическими кардиомиопатиями - у 17 (17%). При МСКТ сердца участки пониженного накопления выявлены у 2 (1,5%) больных (1-й тип по предложенной шкале оценки), отсроченное накопление контрастного препарата (ОНКП) в миокарде - у 81 (62,3%): у 8 субэндокардиальное (2-й тип), у 4 интрамиокардиальное (3-й тип), у 52 субэпикардиальное (4-й тип), у 15 трансмуральное (5-й тип); у 49 больных ОНКП не отмечено. В группе сравнения ОНКП не выявлено. В сопоставлении с биопсией чувствительность, специфичность, прогностическая ценность положительного и отрицательного результатов тестов всех типов ОНКП в выявлении активного миокардита составили 77,4, 47,1, 72,7 и 53,3%, 3-5-го типа ОНКП - 77,4, 52,9, 75 и 56,3%, в выявлении всех морфологических типов миокардита - 68,3, 28,6, 84,8 и 13,3%, 3-5-го типов 65,9, 28,6, 84,4 и 12,5% соответственно. При сопоставлении данных МСКТ и комплексного обследования у всех больных с ДКМП диагностическая значимость всех типов ОНКП в выявлении миокардита составила 70,6, 67,9, 88,9 и 38,8%, 3-5-го типа ОНКП - 60,8, 67,9, 87,3 и 32,3%. При МСКТ в основной группе выявлены также некомпактный миокард (n=31, или 23,8%), коронарный атеросклероз (n=31, или 23%), который подтвержден данными КГ у 15 пациентов. У больных с ОНКП достоверно чаще определялись связь дебюта с перенесенной инфекцией, острое начало, достоверно более высокие ФК по классификации NYHA, конечный диастолический и конечный систолический объемы ЛЖ, недостоверно более низкая ФВ ЛЖ. Общая летальность при среднем сроке наблюдения 12 (6; 37,25) мес составила 17,7% (умерли 23 больных), показатель смерть + трансплантация - 20% (26 больных). Выявлена достоверная связь всех типов ОНКП с прогнозом: в группе ОНКП летальность составила 21,5% по сравнению с 7,8% в группе без ОНКП (отношение шансов 3,22 при 95% доверительном интервале от 1,02 до 10,21; p0,05). Заключение. МСКТ с оценкой отсроченного контрастирования (и одновременной КТ-ангиографией коронарных артерий) может использоваться для неинвазивной диагностики миокардита у пациентов с синдромом ДКМП, в том числе при наличии противопоказаний к проведению МРТ. ОНКП в миокарде коррелирует с наличием миокардита, его активностью, степенью функциональных нарушений и прогнозом.

AIM To develop an algorithm for optimization of rate-adaptive pacing settings in heart failure patients with preserved ejection fraction (HFpEF) and permanent cardiac pacing. METHODS This is a prospective randomized controlled study. A total of 54 patients with HFpEF, permanent atrial fibrillation (AF), and VVIR pacing were randomized to an intervention group with optimization of rate-adaptation parameters by using cardiopulmonary exercise testing (CPET) and pacemaker stress echocardiography (PASE), and to a control group with conventional programming. CPET, 6-min walk test (6-mwt), echocardiography (echo), Duke Activity Status Index (DASI), and Minnesota questionnaire (MLHFQ) were performed at baseline and after 3 months. PASE was used to exclude exercise-induced ischemia and to determine safe upper sensor rate. Pacing parameters were corrected to achieve optimal heart rate increments of 3-6 bpm for 1 mL/min/kg of VO2 (oxygen uptake). RESULTS After 3 months, the intervention group demonstrated significant improvement of VO2 peak by 1.64 ± 1.6 mL/min/kg, anaerobic threshold by 1.33 ± 1.3 mL/min/kg, exercise time by 170 ± 98 s, 6-mwt distance by 75 ± 63 m (P

Differential diagnostics of apnea regarded as an equivalent to angina or a manifestation of cardiac failure in patients with permanent electrocardiostimulation (PECS) encounters difficulties. Stress-EchoCG is the most adequate method of programmed high-frequency cardiac stimulation with the implanted pacemaker (PM) for excluding stress-induced myocardial ischemia in patients undergoing continuous stimulation of the right ventricle. The aim of the study was to assess the effectiveness and safety of stress-EchoCG by means of programmed high-frequency cardiac stimulation with the implanted PM for patients with single-chamber PECS and complaints of apnea.The study included patients with single-chamber PECS in the VVIR mode (rate-responsive pacing), complaints of apnea under physical load, and suspected coronary heart disease. All of them underwent stress-EchoCG by means of programmed high-frequency cardiac pacing with the implanted PM. Positive results of the test served as indications for coronary angiography (CAG).The study included 31 patients. In 24 (77.4%) of them with a pacing rate of 90-120/min disturbances of left ventricular local contractility were induced. 18 patients underwent CAG. 15 (83%) of them had normal coronary arteries while 3 (17%) suffered hemodynamically significant stenosis. In other words, 3 patients presented with angina, in the remaining ones apnea was regarded as a manifestation of heart failure.In patients undergoing permanent stimulation of the right ventricle, stress-induced disturbances of left ventricular local contractility may be attributed to constrictive lesions of coronary arteries on the one hand and impaired myocardial perfusion due to disordered physiological sequence of cardiac stimulation on the other hand. Coronary atherosclerosis in patients with positive results of stress-EchoCG needs to be confirmed by CAG.

To specify the prognostic value of parameters of cardiopulmonary exercise testing (CPET) in patients with chronic heart value (CHF) on optimal medical treatment depending on gender, age, left ventricular ejection fraction (LVEF), cardiac rhythm and achievement of target respiratory exchange ratio (RER)or = 1.0.111 patients (83 male, mean age 60.6 +/- 12.8 years) with CHF NYHA class I-III on optimal treatment were included in the study. One third had preserved EF, 27.9%--permanent atrial fibrillation (AFib). Average followup was 19.4 +/- 9.6 months. Prognostic value of CPET indices and Heart Failure Survival Score (HFSS) for cardiovascular mortality (CVM) and combined endpoint including CVM or CHF hospitalization were evaluated using logistic regression analysis.CVM amounted 14.4%, combined endpoint was observed in 46.8% of patients. HFSS had the highest predictive value for CVM (in all subgroups of patients) and for combined endpoint (except patients with AFib). In men, patients younger than 65 years, with reduced LVEF and with Afib CVM was also related to ventilatory indices (VE/VCO2, ventilatory class and PetCO2 peak), and combined endpoint was related to VO2peak and its derivativatives. Only HFSS and VE/VCO2 had prognostic value for CVM in patients with AFib. Ventilatory parameters were associated with combined endpoint in all subgroups except Afib. Blood pressure response and heart rate recovery had prognostic significance only in patients with sinus rhythm. Target RERor = 1.0 was achieved only in 40.5% patients. In patients with RER1.0 significant relationship between VO2 peak and combined endpoint was observed. CONCLUSIONS; Heart Failure Survival Score, VE/VCO2, ventilatory class and PetCO peak are the strongest predictors of cardiovascular mortality and heart failure hospitalizations in all subgroups of patients with CHF. CPET has the highest significance for men, age65 years, patients with LVEF45% and sinus rhythm. In these subgroups VO2 peak and Weber class have predictive value for decompensation of CHF whether RERor = 1.0 or not. Blood pressure response and heart rate recovery have prognostic significance only in patients with sinus rhythm.

We observed 15 patients with arrhythmogenic right ventricular dysplasia (ARVD): 9 with definite and 5 with probable ARVD (modified European Criteria, 2010). Eight patients had typical ARVD (frequent right ventricular extrasystoles, nonsustained right ventricular tachycardia without heart failure with or without myocarditis). Five patients had ARVD with progressive heart failure (right- or biventricular with or without myocarditis). Two patients had full scale arrhythmic form (sustained right ventricular tachycardia without or with right ventricular dilation, with or without myocarditis). In 3 cases diagnosis was confirmed morphologically or with DNA-diagnostics. This material allowed us to highlight the following specific points related to diagnostics of ARVD. Detection of fat at MRT is not obligatory for diagnosis, fat can be detected by MSCT; ventricular arrhythmias can move backwards in the picture of the disease; leading clinical manifestation can be unexplained right ventricular insufficiency; ARVD can be combined with other genetic cardiomyopathies as well as with infectious immune myocarditis (up to 50% of patients); elevated titer of anticardiac antibodies is not characteristic for isolated ARVD; myocardial biopsy allows to verify both ARVD and concomitant myocarditis. The paper also contains discussion of the role of myocarditis in various forms of ARVD and possibilities of its diagnosis and treatments.

To study possibility of nosological diagnosis in patients with dilated cardiomyopathy (DCMP) with use of myocardial biopsy.The trial enrolled 62 patients (23 females) with DCMP syndrome (end diastolic left ventricular size5.5 cm, ejection fraction55%). Mean age of the patients was 46.0 +/- 12.8 years. The examination included diagnosis of viral infections (Herpes virus, parvovirus B19), measurement of anticardial antibodies titer, 99Tc-MIBI single photon emission computed tomography of the myocardium, multislice computed tomography, MRT of the heart, coronarography, morphological study of the myocardium (n=20) with application of polymerase chain reaction (PCR) for H.simplex viruses of types 1, 2 and 6, herpes zoster, Epstein-Barr, cytomegalovirus, parvovirus B-19, adenoviruses. The control group (20 operated patients with valvular heart disease and coronary heart disease) was examined for viral genome in the blood and myocardium.Complex examination of DCMP patients showed the following distribution by nosological entuities: myocarditis (n=41, 66.1%) including virus-positive (n=14), primary DCMP (n=16, 25.9%) including with non-compact myocarditis (NCM) in 3, with debute at delivery of the child--in 3. Arrhythmogenic right ventricular dysplasia combined with viral myocarditis (n=2), genetic myopathy (n=1) and Takayasu disease (n=1) combined with NCM, isolated NCM (n=1) were diagnosed in the rest cases. Morphological investigation of the myocardium was made in 20 patients: diagnosis of myocarditis and primary DCMP were made in 70% (including in 2 patients with CHD) and 20%. Detection of viral genome was 20 and 15% in the study and control group, respectively, in the myocardium--in 57.9 (test for parvovirus B19 was not made in 26%) and 65.0% (complete diagnosis). All the virus-positive patients with DCMP were diagnosed to have signs of active/borderline myocarditis. Diagnostic criteria and poor prognosis factors were defined.The nosological diagnosis of DCMP was made in all the examinees basing on the complex of clinical, case history and device evidence. The diagnosis was morphologically verified in 33.9% patients. Treatment approaches are developed.

Infectious endocarditis (IE) is an inflammatory disease of cardiac valves and endocardium of different origin. Subacute IE is a specific form of sepsis associated with the presence of the site of infection in the heart responsible for recurrent septicemia, embolism, and progressive changes in the immune system leading to nephritis, vasculitis, synovitis, and polyserositis. This form develops in response to a low-virulent pathogen (e.g.fungi) or as a result of inefficient antibacterial therapy. A patient is described presenting with fibrous body, aortic and mitral valve infection by the alga Prototheca wickerhamii associated with primary (myeloperoxidase) immunodeficiency. Recent data on diagnostics and treatment of subacute IE are presented.

Primary lymphoma of the heart (non-Hodgkin's lymphoma primarily of B-cells affecting first the heart and pericardium) is a rare disease which accounts for 1.3-2.0% of all primary tumors of the heart. A case is reported of a 43-year-old male patient with a cardioverter-defibrillator implanted at the age of 38 years for management of ventricular tachycardia paroxysms and AB-block of the second-third degree. The patient also had hypertrophic cardiomyopathy, moderate pressure gradient on the pulmonary artery valve and pericardial effusion. Later he had two cardiac tamponades (serous punctuate). From the age of 42 years breathlessness, right ventricular wall thickness, right heart pressure and pulmonary artery pressure aggravated. The patient has undergone ballon plastic surgery of the pulmonary artery valve. At the age of 43 computed tomography detected massive tumor of the heart and mediastinum first diagnosed as sarcoma but later specified as lymphoma. Endobronchial biopsy specimens contained the tissue of diffuse large B-cell lymphoma, the liver and lymph nodes were also involved. After the first course of effective polychemotherapy (CHOP) the patient died of mesenterial thrombosis. Diagnostic difficulties and problems of treatment policy are discussed.

The paper describes a clinical case of congenital cardiomyopathy (left ventricular noncompaction) concurrent with secondary amyloidosis and renal involvement that develops at the outcome of long existing brochoectatic disease.

Dominating factor of development of functional mitral insufficiency in patients with ischemic heart disease and dilated cardiomyopathy is deformation of atrioventricular valve leaflets due to traction by chordae apparatus. In patients candidates for left ventricular reconstruction because of its postinfarction aneurism the problem of preexisting or recurrent dysfunction of mitral valve acquires special value as operation itself implies surgical ventricular remodeling and therefore change of mitral valve geometry. Supplementation of the volume of surgical intervention with resection of chordae responsible for impaired coaptation of mitral valve leaflets in some cases appears to be effective and simple method of correction of mitral insufficiency.

The informative value of dipyridamole test, transesophageal cardiac pacing, bicycle ergometer and treadmill exercise tests were compared in 65 patients suspected for coronary heart disease and Functional Classes I-III angina pectoris. The sensitivity, specificity, positive and negative predictive values of the techniques alone and in various combinations were evaluated. The incoincidence of results from exercise tests was ascertained to be 40-48%. The significance of diagnosis increased with combined functional examination and reached the maximum when all the four tests were performed. The use of the sensitivity, specificity, and predictive value of the techniques in assessing the individual test results allows the optimal scope of studies to be determined on an individual basis in order to make or exclude the diagnosis of coronary heart disease.

Pre- and posttreatment indices of platelet and plasma hemostasis, parameters of long-term ECG-ST monitoring were measured in 30 coronary patients on long-term verapamil regimens. ++Anti-ischemic effect of the drug was dependent on clinical pattern of the disease and initial function of the platelets. Plasma hemostasis was found unaffected. Long-term verapamil treatment is indicated in stable angina pectoris class II and III provided platelets demonstrate enhanced functional activity.

A diastolic turbulent flow of pulmonary regurgitation with the maximum velocity of no more than 1.5 m/sec and prevalence in the exit portion of the right ventricle up to 17 mm was detected in 36 patients with cardiac and pulmonary diseases and apparently healthy individuals without organic pulmonary valve lesion and diastolic localization at the respective site, by using pulsed Doppler echocardiography. The highest diastolic transpulmonary pressure gradient estimated by a modified Bernulli's equation was no more than 9 mm Hg (within the range of normal values for diastolic pulmonary artery-right ventricle pressure gradient). Asymptomatic subclinical pulmonary regurgitation of physiological and functional nature without substantial hemodynamic significance which has been detected in these patients cannot be regarded as a manifestation of pulmonary valve defect.

Changes in left diastolic filling which had been caused by treatment with the beta-adrenoblocker atenolol given in a dose of 50-100 mg/day were studied in 66 patients with Functional Class I-II exercise-induced angina pectoris. Echocardiography was performed during isometric exercise tests before and 7-9 days after drug administration. It was ascertained that not only ino- and chronotropic mechanisms, but redistribution in diastole patterns in the direction of increasing atrial systole were involved to adequately maintain cardiac output during exercise. Ejection fraction became higher in response to exercise with predominant myocardial mass, whereas atrial systolic fraction, with predominant dilatation. The drug produced its negative inotropic effect in the patients with predominant left ventricular dilation; a decrease in the rapid filling fraction was not followed by an increase in the atrial systolic fraction, which may be regarded as an early sign of myocardial failure.

201Tl myocardial scintigraphy was performed in 29 patients with coronary heart diseases and silent myocardial ischemic episodes revealed during a long-term monitoring of ST segment. The painless ST segment depression episodes and long high-amplitude painless ST segment elevations were found to be indicative of a significant severity of pathological processes in the myocardium. A 12-day nicardipine monotherapy produced antianginal and hypotensive effects and contributed to decrease in the frequency, duration, and amplitude of silent ST-segment depressions and in the duration of silent ST-segment elevations.

In 47 patients with coronary heart disease, the function of platelet was studied and ECG ST-segment was monitored. It was found that lower platelet function was more common in patients with severe coronary heart disease if they had long episodes of transient myocardial ischemia. Following 12 days of dilzem monotherapy, the most marked ++anti-ischemic and antianginal effects were observed in patients who had had higher platelet function.

Consanguineous relatives of a patient with hypertrophic cardiomyopathy (HCMP) were examined. Asymmetric hypertrophy of the interventricular septum with signs of obstruction of the left ventricular outflow tract was detected in the patient's brother. Hypertrophy of the left ventricular posterior wall and Wolff-Parkinson-White syndrome (WPW, type A) was detected in the patient's daughter. This case demonstrated a diversity of HCMP clinical, electrocardiographic and echocardiographic signs among the members of the same family.

Two hundred and seventy seven patients with coronary heart disease, including 182 with postinfarction cardiosclerosis underwent 24-hour Holter monitoring. A significant correlation was found between the number of coupled ventricular arrhythmias, ventricular tachycardia paroxysms and development of congestive heart failure in patients with postinfarct cardiosclerosis. With evolving metabolic deficiency as evidenced by thallium-201 myocardial scintigraphy, the incidence of congestive heart failure and ventricular arrhythmias increased among the patients.

A study of 37 children and 32 adults with abnormally located chords in the left ventricular cavity detected by ultrasonic investigation of the heart, revealed a number of minor developmental defects of connective tissue which served as the basis for establishing diagnosis of connective tissue systemic involvement (probably, congenital).

The paper describes the main signs of the rupture of chordae tendineae as a cause of mitral incompetence. The main place is given to the echocardiographic signs of this syndrome. The rupture of chordae tendineae is characterized by a certain combination of symptoms including the etiological factors of rupture, the clinical picture of cardiac insufficiency, a tendency to atrial fibrillation, auscultative picture of papillochordal insufficiency and the typical echocardiographic signs of this condition.

Nifangin (nifedipine), manufactured by the Laakepharmos Co., Finland, was used in 75 patients with congestive heart failure due to ischemic heart disease and chronic obstructive bronchitis. The effect of a single 20 mg dose and a course of treatment (60 mg daily for 18 days) was assessed by monitoring with the help of echocardiography, venous occlusion plethysmography, laser Doppler flowmetry as well as external respiration and blood gases partial tension measurement. In patients with chronic obstructive bronchitis, the drug was used in combination with cardiac glycosides and diuretics. A single dose of nifangin reduced regional vascular resistance by 33%, and increased volumetric blood flow rate by 51%. The treatment course increased the stroke index and the cardiac index (by 21 and 23%, respectively) and improved blood oxygenation and external respiration parameters. The absence of side effects makes nifangin one of the most effective vasodilating agents, indicated for patients with congestive heart failure.

Six morphologic variants of hypertrophic cardiomyopathy (HCMP) have been identified on the basis of the echocardiographically-documented extent and localization of left-ventricular hypertrophy in 34 patients with HCMP. More than half of the patients had no complaints. The more characteristic echocardiographic features of the disease included a considerable thickening of one or more departments within the left ventricle, the size of its cavity being diminished. In most cases, HCMP was associated with considerably enlarged R waves on the electrocardiograms from 35 precordial leads that were usually combined with ST segment depression and T wave inversion. The latter two features often provided grounds for a hyperdiagnosis of coronary heart disease (CHD). What distinguishes HCMP from CHD is the discrepancy between marked and persistent pathologic electrocardiographic changes and a relatively uneventful clinical picture of the disease. The comparison of echocardiographic and ECG charting data allows a more detailed assessment of the kind of left-ventricular hypertrophy in HCMP patients, and can be used in the differential diagnosis of HCMP vs. CHD.

A study of 55 children with accidental systolic and diastolic heart murmurs demonstrated that abnormal chorda position (ACP), detected at echocardiography in various heart cavities, was the principal contributing factor. The relationship between the intensity and other parameters of systolic murmurs and abnormal chorda topography is discussed. Abnormal position of the chordae was not associated with any deviations from basic morphometric characteristics of the heart and should therefore be regarded as a normal variant.