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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.

In 44 patients (3 women and 41 men, mean age 54 +/- 11 years) with malignant ventricular tachyarrhythmias (MVT) we assessed dependence of results of testing of antiarrhythmic drugs and efficacy of their long term use for prevention of recurrences of MVT on topography of derangement of local left ventricular (LV) contractility. Regional LV contractility was assessed with transthoracic echocardiography and radionuclide ventriculography (RNV). Testing of antiarrhythmic drugs was performed under control of repetitive intracardiac electrophysiological studies. Duration of follow-up was 28 (13 - 61) months. According to ROC-analysis most precise markers of positive results of drug testing were values of local ejection fraction (EF) in apical LV segment (10th segment on RNV) above 55%. Signs predisposing to absence of MVT recurrences during long term use of antiarrhythmic drugs were lack of mitral regurgitation (above I degree) according to echocardiography data, values of local EF in segment of lateral LV wall (4th segment on RNV) exceeding 42%, or value of LV end diastolic volume less than 365 ml according to RNV data. Parameters of local LV contractility are most precise markers of results of the use of antiarrhythmic drugs in patients with MVT, their diagnostic value is hair than that of global LVEF. Efficacy of antiarrhythmic drugs at electrophysiologic testing and long term follow-up are associated with different parameters of local LV contractility.

To study complex of pathogenetic changes arising during VVI mode single chamber ventricular pacing we temporarily (for 1 hour) switched pacing mode from dual (DDD) to single (VVI) chamber stimulation in 11 patients. Parameters studied were cardiac output (CO), total peripheral vascular resistance (TPVR), levels of precursors of atrial and inactive fragment of brain natriuretic peptides (pro-ANP and NT-pro-BNP, respectively), noradrenaline, aldosterone, and renin activity in blood plasma. Reprogramming of pacing mode was associated with 21.4% lowering of CO and 11.4% elevation of TPVR according to impedance cardiography data, and augmentation of pro-ANP secretion from 429.79 to 620.22 fmol/l. At the background of VVI pacing there was a tendency to increase of noradrenaline blood concentration without significant changes of aldosterone concentration and plasma renin activity.

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 prevalence of cardiac valvular lesions in patients with primary (P) antiphospholipid syndrome (APLS) and systemic lupus erythematosus (SLE) with and without secondary APLS., Material and Methods: Patients with PAPLS (n=56, 15 men and 41 women), SLE and APLS (n=88, 23 men, 65 women) and SLE without APLS (n=51, 19 men, 32 women) were followed up for 9 years. Serological markers of APLS were anticardiolipin antibodies and lupus anticoagulant., Results: Prevalence of various heart defects was the highest in PAPLS (43%) compared with SLE with APLS (c2=5.6, p=0.001) and SLE without APLS (c2=9.3, p=0.0002). In secondary APLS prevalence of valvular involvement was 27% what was substantially more than in SLE without APLS (4%) (c2=7.2, p=0.0007). Changes of mitral valve cusps and mitral regurgitation were found in 33, 41 and 50% of patients with SLE, SLE with APLS and PAPLS, respectively. Pronounced mitral regurgitation and valve defects were significantly more frequent in patients with any APLS compared with those with SLE without APLS. Thickening of aortic cusps was significantly more frequent in patients with PAPLS compared with patients with SLE (with and without APLS). Changes of tricuspid valve were significantly more frequent in patients with any APLS. Progression of valvular pathology was observed in 2 patients with SLE and APLS after 4 and 5 years of follow up. During 9 years thrombotic complications developed in 8 patients with APLS and valvular lesions (6 strokes, 2 retinal thromboses)., Conclusion: An association exists between presence of APLS and various cardiac valvular lesions. Lesions of aortic valve are associated with PAPLS: Development of valvular pathology in patients with SLE and PAPLS during follow up dictates the necessity to monitor echocardiographical parameters and titers of anticardiolipin antibodies.

Aim: To study antihypertensive efficacy of monotherapy with telmisartan and its action on left ventricular myocardium remodeling in patients with hypertension., Material and Methods: Telmisartan (40-80 mg/day) was given for 24 weeks to 24 patients aged 37-69 years with I-II degree of blood pressure (BP) elevation and hypertrophy of left ventricular myocardium. Antihypertensive action of telmisartan was assessed by 24-hour BP monitoring. Left ventricular myocardial mass was estimated by echocardiography before and after 24 weeks of therapy., Results: Telmisartan equally decreased both diurnal and nocturnal systolic and diastolic BP (by10.4-11.7%), lowered maximal BP during morning hours, and restored initially disturbed 24-hour BP rhythm. Target BP levels were achieved in 16 patients (70%). Therapy with telmisartan was associated with significant 10.9% reduction of left ventricular myocardial mass index (from 151.6-/+5.4 to 135.1-/+5.9 g/m2, p=0,02) at the account of decreased thickness of left ventricular wall., Conclusion: These results give reason for the use of telmisartan for the treatment of patients with hypertensive disease and left ventricular hypertrophy.

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.

This study assessed the diagnostic value of X-ray characteristics of the heart and pulmonary circulation in CHD patients with aggravated arterial hypertension in three age groups (22-40, 41-59, and 60 years or older). The study covered 246 patients with acute myocardial infarction (140 hypertensives and 106 normotensives) and 182 with postinfarct cardiosclerosis (88 patients with arterial hypertension and 94 without this condition). All the patients underwent teleradiography, 12-lead EGG, echocardiography, and coronary ventriculography. While comparing the two study groups, the X-ray criteria show deteriorated left and right cardiac functions and altered aorta due to both its atherosclerotic changes and lower left ventricular contractility.

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.

Long-term heart rate variability (HRV) data were obtained from 38 patients with arterial hypertension and 20 healthy persons. New method of HRV analysis based on calculation and estimation of variations of short rhythmogram intervals (SRV) was applied. This method showed that HRV level depends on number of factors. The most significant of them are patient's age, arterial hypertension form and duration, and left ventricular hypertrophy degree. Patients with these risk factors may be highly predisposed to rate variability decrease. (Tab. 8, Ref. 8.)

Antiphospholipid syndrome (APLS) is a clinicolaboratory symptom complex characterized by development of venous and/or arterial thromboses, thrombocytopenia, obstetric pathology arising in the presence of hyperproduction of antiphospholipid antibodies (APAB). APLS may occur not only in patients with systemic lupus erythematosus (SLE) or other autoimmune diseases as secondary APLS, but in those without the above diseases as the primary APLS. The authors have examined 34 patients with APLS versus 10 patients with a verified SLE free of APLS manifestations. Affection of the valves was found in 30 patients with APLS (88%). More frequent were additional structures on mitral and aortic valve cusps, thickening of mitral valve cusps in APLS patients. Evident valvular disease was seen only in APLS patients with high positive levels of APAB. Valvular lesions were similar in patients with primary and secondary APLS. The study has revealed a relationship between the presence of antibodies to phospholipids and valvular abnormalities in APLS patients.

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.

Preoperative myocardial ischemia seems to be a predictor of poor outcome when detected by electrocardiography, pulmonary capillary wedge/pressure measurement and echocardiography. It could be demonstrated, that regional wall motion abnormalities appear earlier and are more sensitive signs of myocardial ischemia than the ECG. Using intraoperative epicardial and transesophageal echocardiography, high quality 2-d echocardiographic images of the heart can be recorded. For monitoring of left ventricular function and wall motion the transesophageal approach is most often used. By the transesophageal approach the left ventricle can be scanned in the long axis and by the transgastric approach in cross sections. They correspond to the apical four-chamber and left parasternal cross sectional imaging of the heart. Using the transgastric approach in the papillary short axis view all segments representing the three coronary arteries can be imaged. Recording in this position have been found to be highly reproducible. Only localized ischemia of the apex of the ventricle may be missed. Methologically the rotation and translocation of the heart remain a problem using the cross section images of the heart. But the left ventricular papillary muscles and the septal-right ventricular boarders can be used as land marks. Wall motion is scored in five grades. In addition to the semiquantitative analysis also a quantitative calculation using computers is possible. Using the midd papillary short axis view in nearly 120 intraoperative transesophageal echocardiograms since 1989 analysis of the systolic wall thickening was possible in 73% of the patients. According to the literature review 87% of the patients undergoing coronary bypass surgery or non-cardiac surgery have signs of preoperative ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Whether transesophageal echocardiography may be used in the assessment of central hemodynamics has been studied in 40 patients undergoing direct cardiac revascularization in extracorporeal circulation. Changes in the mean values of end diastolic area (EDA) and end-diastolic anteroposterior dimensions, end-systolic myocardial stress (ESMS), anteroposterior size shortening fraction (SF), and area decrease fraction (ADF) of cross left ventricular section are outlined in the paper. It has been indicated that at the beginning of extracorporeal circulation EDA showed, on an average, a 22% decrease (p less than 0.001), after its termination, it practically returned to the baseline values. ESMS remained high at the beginning of the operation, but at the onset of extracorporeal circulation it also dropped by 26% (p less than 0.001), being rather low until the end of the operation. The highest SF and ADF values were observed after termination of extracorporeal circulation. The changes in the parameters in question were found in hypovolemia and decreased myocardial contractility. The application of transesophageal echocardiography along with direct blood pressure monitoring correctly and fully assesses central hemodynamics.

A total of 50 patients with arterial hypertension were examined. Group 1 included 28 patients with renovascular hypertension, 18 of them had unilateral renal artery stenosis, the remaining 10 had bilateral renal artery stenosis. Group 2 consisted of 16 patients with primary aldosteronism. Group 3 comprised 6 patients with pheochromocytoma. The examination was made with echocardiograph. Changes in left ventricular myocardial mass (LVMM) were studied 1 and 6 months after surgical intervention. The maximum hypertrophy was observed in the patients with primary aldosteronism, no changes occurred in any of the groups examined 1 month after surgical management. The LVMM was found to be significantly diminished by 13% in the patients with renovascular hypertension and by 23% in patients with adrenal tumors (pheochromocytoma, aldosteroma).

NMR-tomography using a spin-echo technique, ECG synchronization in exposure to 0.23 T magnetic field was performed in 13 patients with dilated cardiomyopathy (DCMP). The results were correlated with echocardiography findings. NMR-tomography provided a good image of cardiac chambers dilatation, their size being in agreement with that shown by echocardiography. No significant differences in myocardial relaxation time T2 was recorded in DCMP patients compared to normal subjects. NMR-tomography can be successfully employed in cardiac investigations in case of complicated echocardiography.

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.

New electrocardiographic criteria of left-ventricular hypertrophy (LVH) have been identified at automated analysis of ECG-35 cartograms (71 normal and 88 LVH recordings). Simultaneous application of 2 sums of S and R amplitudes (S32 + R14 and S30 + R19) obtained from the leads other than Wilsonian chest leads enabled a 1.5-fold increase in the sensitivity of electrocardiographic LVH diagnosis, as compared to the Sokolov-Lyon criteria, without loss of specificity. The use of summary R and S areas at the same points on the cartogram further improves the method's sensitivity.

In order to evaluate Doppler echocardiography (DEC) used for cardiac output (CO) measurement, 22 patients (7 with coronary heart disease, 6 with dilatation cardiomyopathy, 5 with primary pulmonary hypertension and 4 with rheumatic heart disease) were studied. In all patients, invasive CO determination was performed by right heart catheterization, using thermodilution (T). In DEC, CO was calculated as CO = IV.S.HR, where IV was integral velocity, estimated on the basis of flow areas under planimetric curves, S was aortic root cross-section area, and HR was heart rate. A close correlation was demonstrated between DEC and T results (r-0.74). Only in one case with severe aortic atherosclerosis was there a significant difference between the data. This case excluded, the correlation becomes even closer (r-0.86). It is concluded that: 1) DEC is a valuable and precise method of CO assessment, 2) DEC may be used to monitor treatment efficacy, and 3) its limitation is aortic lesions.

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).

Possible electrovectorcardiographic approaches to the diagnosis of hypertrophic cardiomyopathy (HCMP) are considered on the basis of a study of 85 HCMP patients, 44 coronary patients with postinfarction cardiosclerosis and arterial hypertension (CD + AH), and 83 normal subjects. Particular attention was paid to cases where myocardial scary changes and left-ventricular hypertrophy were detected electrocardiographically as their interpretation was difficult because of similar changes in the QRS complex being typical for postinfarction cardiosclerosis. An analysis of quantitative and qualitative changes in the end segment of the QRS complex demonstrated a specific pattern of repolarization shift in patients with HCMP and CD + AH. The demonstrated changes can be useful in differential diagnosis of these conditions, facilitating the interpretation of infarction-like curves that are quite common in HCMP patients.

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)

26 patients with combined heart defects were examined by means of ultrasound methods (one-dimensional, two-dimensional and Doppler echocardiography). The results were compared with the results of clinical and roentgenological examinations. Taking into account literary data on high sensitivity and specificity of Doppler echocardiography, its informative value was assessed in cases when affection of two or more valves results in a balancing of haemodynamic changes. It was documented that pulsed Doppler EchoCG makes possible to assess the character and the direction of blood flow in different phases of the cardiac cycle in the heart cavities and the great vessels, and thereby provides additional information on the involvement of the valvular apparatus and on the state of haemodynamics. The sensitivity of this method is particularly high in the detection of regurgitant flow.

The purpose of the study was to compare the haemodynamic effect of new antiarrhythmic preparations - ethmozine and its diethylamine analogue etacizine in 22 patients with heart failure (HF), stage IIa, of different etiology. The patients were given for one week ethmozine and then again for one week etacizine, during which periods they were followed echocardiographically, with pressure measurement in the pulmonary artery (PAP) and in the right atrium (RAP). Ethmozine in a daily dosis of 600-800 mg did not induce changes in left ventricular dimensions, percentual shortening of the anteroposterior left ventricular dimension (% delta S), in PAP, RAP, arterial pressure and heart rate. With application of etacizine in a dose of 150-200 mg/day, a clinically insignificant decrease was observed in % delta S (by 19.7%; p less than 0.05), which was not accompanied by a more marked augmentation of left ventricular dimensions, PAP, RAP or an intensification of clinical signs of heart failure. In spite of this, on administration of etacizine to patients with HF it is necessary to control haemodynamics, the most suitable method for this being echocardiography.

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.

Blood flow in the vicinity of the pulmonary-arterial valve was examined in 20 normal subjects and 42 patients with pulmonary hypertension. Four major types were identified in the flow spectrum. Six flow classes were further identified on the basis of their combinations in the same patients. These classes were correlated with a number of hemodynamic parameters. They were shown to be related to systolic pulmonary-arterial blood pressure and total vascular resistance, but unrelated to diastolic and mean blood pressure in the pulmonary artery. There was no correlation with the cardiac cycle duration, ejection time, and cardiac output either, although the latter parameters differed significantly between normal subjects and patients with pulmonary hypertension. The classes identified permit a semiquantitative assessment of systolic blood pressure in the pulmonary artery and total peripheral resistance.

A total of 249 patients with arterial hypertension taking a variety of clinical forms, primary pulmonary hypertension, dilatation cardiomyopathy, congenital heart diseases with secondary pulmonary hypertension were examined and allocated to 3 groups: 125 patients with left-ventricular hypertrophy (LVH) (group 1); 44 patients with right-ventricular hypertrophy (RVH) (group 2), and 80 patients with combined hypertrophy of both ventricles (CH). Eighty-one normal subjects were taken as controls. New parameters of diagnostic significance were identified by automated reproduction of vectorcardiographic spatial QRSxyz loop (the Macfee-Parungao system) and computer analysis of vectorcardiographic parameters, that improve electrocardiographic diagnosis of cardiac hypertrophies, as compared to the conventional criteria, bringing its accuracy to 88.8% for LVH, 100% for RVH, and 45% for CH. Typical features of myocardial hypertrophy at large are increased area enclosed by the spatial loop (SQRS greater than 3.4 mV2) and/or increased mean vector (LQRSxyz greater than 0.76 mV), while Lx greater than 0.6 mV and/or Lz less than -0.4 mV were specific for LVH; Lx less than 0.05 mV was specific for RVH, and the H angle ranging from -70 degrees to -140 degrees or H of -60 degrees to -140 degrees at Lz less than 1.1 mV, or -50 degrees to -140 degrees at Lz less than 1.5 mV were specific for CH.