[Comparative analysis of the parameters of left ventricular systolic and diastolic functions in patients with hypertension and patients with hypertrophic cardiomyopathy]. / Sravnitel'nyi analiz parametrov sistolicheskoi i diastolicheskoi funktsii levogo zheludocjka u bol'nykh gipertonicheskoi bolezn'iu i bol'nykh gipertroficheskoi kardiomiopatiei.

17 patients with essential hypertension and asymmetric, 12 ones with concentric left ventricular (LV) hypertrophy and 13 patients with asymmetric hypertrophic cardiomyopathy (HCM) were examined by M-mode and Doppler echocardiography. There were significant changes of LV diastolic volumes, mitral flow velocities and phase duration in all groups of patients compared to healthy subjects. Nevertheless, the hypertensive groups had noninvolved LV systolic function. The HCM group had impaired LV systolic function because of a decline in pump capacity of hypertrophic myocardium resultant from diminution of its cavity.

[Anomalous chordae tendineae]. / Ob anomal'nykh khordakh serdtsa.

ECG of 322 patients with various cardiovascular diseases allowed the conclusion on the occurrence of anomalous chordae of the heart in 21.7% of cases. The chordae had no effect on the disease diagnosis, running, hemodynamics, left ventricular myocardial mass.

[The prognosis of the disease course in patients with hypertension and coronary failure]. / O prognoze techeniia zabolevaniia u bol'nykh gipertonicheskoi bolezn'iu s koronarnoi nedostatochnost'iu.

The analysis of 3-year follow-up and treatment of 33 and 113 hypertensive subjects without and with coronary insufficiency, respectively, suggested the conclusion on an independent role of left ventricular hypertrophy as a risk factor of cardiac complications in hypertensive patients either with or without coronary insufficiency. A high risk of cardial complications can be expected in hypertensive patients without coronary insufficiency, but with systolic pressure above 200 mm Hg, thickness of the left ventricular posterior wall more than 1.3 cm, % delta S under 40. In the presence of coronary insufficiency hypertensive subjects have a high risk of the complications in case of stroke output over 50 ml, sigma max over 340 10(3) din/cm2, left ventricular myocardial mass over 220 g, history of myocardial infarction. No significant correlation was found between arterial pressure reduction due to antihypertensive treatment and development of cardial complications.

Silent myocardial ischemia in patients with essential hypertension.

The aim of this study was to determine the significance of the "coronary factor" in patients with essential hypertension (EH). Electrocardiogram Holter monitoring was performed in 61 patients with EH stage II (according to the World Health Organization criteria). Silent, ie, painless ST-segment depression, was found in 34 patients on whom echocardiography, a treadmill test, and transesophageal pacing were performed. In 21 patients with EH and silent ischemia, the examination included 201Tl stress scintigraphy, coronary angiography, and a platelet aggregation test. In 15 patients, catecholamines and beta-endorphins were obtained in blood samples during silent ischemia. 201Tl scintigraphy showed transient defects of perfusion without clearance abnormalities (group I) and with clearance abnormalities (group II). The patients in group I had more severe left ventricular hypertrophy (LVH) and a significantly higher platelet aggregation response to 0.5 mumol/L adenosine diphosphate; one patient in this group had coronary atherosclerosis. LVH and the platelet aggregation response was less pronounced in the patients in group II, but atherosclerotic lesions of a coronary artery were observed in four patients. In both groups, norepinephrine and beta-endorphin levels were increased during silent episodes of ischemia. The results suggest that there are different pathogenetic mechanisms of coronary insufficiency in patients with EH, a hypertensive heart, and silent ischemia.

[Silent myocardial ischemia in patients with essential hypertension]. / "Nemaia" ishemiia u bol'nykh gipertonicheskoi bolezn'iu.

Holter monitoring was performed in 61 patients with essential hypertension. Painless, silent ST segment depression was found in 34 patients. Exercise myocardial scintigraphy indicated the occurrence of transient perfusion defects without abnormal clearance (Group 1) and those with abnormal clearance (Group 2). The patients from Group 1 showed more severe myocardial hypertrophy, higher platelet aggregation, coronary atherosclerosis was detected in 1 case. The patients from Group 2 exhibited less myocardial hypertrophy, lower platelet aggregation. Coronary atherosclerosis was revealed in 4 cases. The patients from the two groups had elevated plasma norepinephrine levels at the onset of silent myocardial ischemia.

[Hypertension and "silent" myocardial ischemia. I. The results of stress scintigraphy of the myocardium in patients]. / Gipertonicheskaia bolezn' i "nemaia" ishemiia miokarda. Soobshchenie I. Rezul'taty nagruzochnoi stsintigrafii miokarda u bol'nykh.

As many as 24 patients suffering from essential hypertension (EH) were examined. The patients were subjected to Holter ECG monitoring, echocardiography, coronary angiography, exercise scintigraphy of the myocardium with transesophageal pacing of the atria and the dipyridamole test. The patients manifested defects of thallium accumulation during exercise scintigraphy of the myocardium. They were transitory defects of accumulation with clearance impairment recorded in EH patients with atherosclerosis of the coronary arteries; transitory defects of accumulation without clearance impairment recorded in EH patients with the angiographically unchanged coronary arteries. In Holter ECG monitoring, the patients with a silent depression of the ST segment demonstrated transitory defects of thallium accumulation by the myocardium in all the cases during exercise scintigraphy of the myocardium.

[The ST-segment-dependent indices of patients with left ventricular hypertrophy and coronary failure]. / Zavisimye ot segmenta ST pokazateli u bol'nykh s gipertrofiei levogo zheludochka i koronarnoi nedostatochnost'iu.

As many as 40 men suffering from essential hypertension (EH) and left ventricular hypertrophy (LVH) or hypertrophic cardiomyopathy (HCMP) were examined. All the patients exercised on a treadmill according to the Cornell protocol taking into consideration the ST/HR slope and the ST/HR index, underwent echocardiography with measurements of the left ventricular mass (LVM), and coronary ventriculography. Coronary insufficiency was revealed in all the patients. Of these, 11 patients suffered from it due to associated EH and coronary heart disease (CHD), 31 had relative coronary insufficiency in the presence of associated EH and LVH phenomena with no stenosis of coronary vessels, and 7 patients showed up relative coronary insufficiency in the presence of HCMP. The ST/HR slope and the ST/HR index correlated well with the LVM and the asymmetry index of the left ventricle but in patients with associated relative coronary insufficiency and EH. In patients with associated EH and CHD, the ST-dependent parameters correlated well neither with the degree of atherosclerosis spreading nor with the LVM. This may indicate that both factors influence the gravity of coronary insufficiency at a time. In case a patient suffering from associated EH and coronary insufficiency phenomena has the ST/HR slope greater than or equal to greater than or equal to 4.5 microV/stroke/min and/or the ST/HR index greater than or equal to greater than or equal to 2.5 microV/stroke/min, it is more likely that myocardial ischemia is provoked by concomitant atherosclerosis of coronary arteries (sensitivity 28%, specificity 71%).

[A painless decrease in the ST segment during the 24-hour ECG monitoring of hypertensive patients]. / Bezbolevoe snizhenie segmenta ST pri sutochnom monitorirovanii EKG u bol'nykh gipertonicheskoi bolezn'iu.

The daily Holter ECG monitoring and echocardiography were conducted in 61 men aged on the average 50.5...1.2 years with a diagnosis of stage II essential hypertension. 55.7% of the patients manifested episodes of painless depression of the ST segment. Such parameters as the patients' age, duration and intensity of arterial hypertension, the painful syndrome pattern did not afford revealing persons at high risk for instability of the ST segment of the ECG. Only initial disorders of the repolarization phase of the ECG at rest, so-called ECG with the signs of left ventricle hypertrophy with "strain" were in this respect of prognostic importance. 2/3 of the patients with the left ventricle mass exceeding 200 g manifested episodes of "silent" depression of the ST segment, with those episodes being encountered more frequently in left ventricle hypertrophy with an asymmetry index greater than or equal to 1.5.

[HLA-associated predisposition to dilated cardiomyopathy]. / Assotsirovannaia s HLA predraspolozhennost' k dilatatsionnoi kardiomiopatii.

HLA-antigens grade I and II were studied by tissue typing in 60 Russians and 40 Georgians suffering from dilated cardiomyopathy (DCMP), and 40 Georgians with virus myocarditis. 267 test-donors Russians and 579 Georgians served as control. Markers of DCMP predisposition were found different for Russians and Georgians: DR4 (relative risk 2.96) and A11 (RR = 3.07), R12 (RR = 5.5), respectively. Georgians have a marker of resistance to DCMP--B35 (RR = 0.15). Antigen B12 marks a severe DCMP course in Georgians. Markers of virus myocarditis predisposition were distinct from those of DCMP: A1 (RR = 3.78) and B27 (RR = 3.62). This shows different etiology of the two diseases. The conclusion is made on nonidentical genetic markers of predisposition and resistance to the same disease in various populations.

[A comparative evaluation of loading tests for the diagnosis of ischemic heart disease at the prehospital stage]. / Sravnitel'naia tsennost' prob s nagruzkoi dlia diagnostiki ishemicheskoi bolezni serdtsa na dogospital'nom étape.

Bicycle ergometry, the treadmill test, transesophageal pacing of the left atrium and 24-h monitoring of the ECG were performed on an outpatient basis in 82 persons (all men) with angina pectoris of effort and stenosing atherosclerosis of the coronary arteries verified with the aid of selective coronarography and in 17 men with intact coronary arteries. Transesophageal pacing and the treadmill test exhibited the highest sensitivity (94 and 89%, respectively) in the diagnosis of the latent forms of coronary failure. The sensitivity of bicycle ergometry (77%) was significantly lower which was caused by a considerable number (21%) of tests completed before the appearance of diagnostic criteria. Meanwhile the results of 24-h monitoring of the ECG (65% sensitivity) depended on the degree of the patients' physical activity and way of life. All the four methods did not significantly differ in the specificity. Proceeding from the data obtained it is recommended that the treadmill test and transesophageal pacing of the heart may be widely used on an outpatient basis to diagnose coronary disease.

"Silent" myocardial ischaemia in essential hypertension.

During 16-h electrocardiographic monitoring of 29 patients with stage II (WHO) essential hypertension and left ventricular hypertrophy, the episodes of painless "silent" myocardial ischaemia were registered in 12. In these patients a bicycle ergometry test, transoesophageal atrial pacing, isotope ventriculography at rest and during isometric exercise, and coronary angiography in 3 cases, were performed. A comprehensive evaluation of findings revealed the presence of coronary insufficiency not accompanied by pain syndrome. Absence of angiographic signs of coronary stenosis in 3 patients subjected to coronary angiography suggests the presence of relative coronary insufficiency at least in these patients.

[Functional status of the hypertrophic left-ventricular myocardium in patients with hypertension]. / Funktsional'noe sostoianie gipertrofirovannogo miokarda levogo zheludochka u bol'nykh gipertonicheskoi bolezn'iu.

27 patients with IIB stage of essential hypertension (EH) and left ventricular hyperthropy (LVH), 14 of them with IHD, were studied. In all of them coronaro- and ventriculography was performed. In 14 cases atherosclerotic alterations of coronary arteries were present. Nobody had abnormal pump function or contractility of myocardium. End-systolic, end-diastolic and stroke volume indexes in EH patients with pronounced coronary atherosclerosis were significantly increased. The examined patients demonstrated significant alteration of the left ventricular myocardium relaxation function. The conclusion is drawn that on a certain stage LVH is of compensatory character and plays an important role in supporting adequate myocardial pump function.

[HLA antigens in hypertension patients with myocardial hypertrophy of the left ventricle]. / Antigeny HLA u bol'nykh gipertonicheskoi bolezn'iu s gipertrofiei miokarda levogo zheludochka.

As many as 34 patients with essential hypertension (EH) and 66 with hypertrophic cardiomyopathy (HCMP) were examined. Concentric hypertrophy of the myocardium was identified in 14 patients with EH and 35 patients with HCMP. Asymmetric hypertrophy of the myocardium was diagnosed in 20 EH patients and 31 HCMP patients. Distribution of class I and II HLA antigens was examined in all the patients. The high rate of DR1 antigen demonstration was established in patients with associated EH and asymmetric hypertrophy of the myocardium. The patients with associated HCMP and hypertrophy of the myocardium showed the high rate of B40 and DR4 antigen demonstration, those with associated HCMP and asymmetric hypertrophy of the myocardium the high rate of DR1 and DR4 antigen demonstration. The data obtained may be of importance for the formation of the groups at risk for the development of the diseases in question and for their differential diagnosis in doubtful cases.

The hypertensive heart: pathogenesis, variants, and prognostic value.

We examine the heart's involvement in arterial hypertension, reporting on several studies of hypertensive patients showing that left ventricular myocardial mass is a significant prognostic indicator of essential hypertension and that left ventricular hypertrophy (LVH) correlates with an induced increase in Ca2+ concentration in platelets. We also consider the LVH variant of asymmetric hypertrophy and the role of the hypertensive heart in coronary insufficiency, and we speculate on the significance of the degree of LVH and asymmetric hypertrophy as risk factors for predicting cardiac complications of essential hypertension.

[Comparative aspects of the structural and functional status of the myocardium in left-ventricular asymmetrical myocardial hypertrophy in patients with hypertension and cardiomyopathy]. / Sravnitel'nye aspekty strukturno-funktsional'nogo sostoianiia miokarda pri asimmetricheskoi gipertrofii miokarda levogo zheludochka u bol'nykh gipertonicheskoi bolezn'iu i gipertroficheskoi kardiomiopatiei.

23 patients with hypertrophic cardiomyopathy (HCMP) and 19 patients with stage II of essential hypertension (EH) with left ventricular asymmetric hypertrophy (ASH) were examined. Echocardiography demonstrated significantly more manifest hypertrophy of interventricular septum and higher coefficient of asymmetry in patients with HCMP compared to those with EH while left ventricular myocardium mass was equal in both groups. Phase-volumetric analysis exhibited in all the patients deterioration of myocardial relaxation processes. EKG-monitoring showed a significant increase in frequency of supraventricular rhythm disturbances in patients with HCMP while no reliable differences in total frequency of rhythm and conduction disturbances were registered. Regular adequate antihypertensive therapy resulted in patients with EH in decrease of ASH degree caused by regression of interventricular septum hypertrophy. In natural course of EH the ASH degree also decreased, but in this case because of increased hypertrophy of left ventricular posterior wall. The patients with HCMP were followed for 1-1.5 years. Drug therapy produced no significant changes in left ventricular myocardium mass as well as character of degree of ASH.

[Origin of the pain syndrome in asymmetric myocardial hypertrophy in patients with stable hypertension]. / O geneze bolevogo sindroma pri asimmetricheskoi gipertrofii miokarda u bol'nykh stabil'noi gipertonicheskoi bolezn'iu.

A study of 20 patients with essential hypertension, stage IIB, asymmetrical myocardial hypertrophy and chest pains has suggested that the pain syndrome, presenting as "possible angina", positive functional tests and reduced label accumulation around the ventricular septum may be indicative of coronary insufficiency.