[High-resolution ECG in assessment of myocardial functional state in patients with ischemic heart disease and resultant cardiac dilatation]. / EKG vysokogo razresheniia v otsenke funktsional'nogo sostoianiia miokarda u bol'nykh ishemicheskoi bolezn'iu serdtsa s iskhodom v dilatatsiiu serdtsa.

High resolution signal-averaged ECG (SAECG), echocardiography and 24-hour Holter ECG monitoring were used in the study of 30 patients (mean age 56-/+2 years) with coronary heart disease and stable class II-IV angina (group 1) and 66 patients (mean age 45-/+1 years) with dilated cardiomyopathy of ischemic origin (group II). SAECG was used for detection of late ventricular potentials and calculation of time-voltage and velocity parameters of P-waves. Disturbances of myocardial de- and repolarization indicative of pronounced hemodynamic left atrial overload associated with elevated left ventricular end diastolic pressure were revealed. These disturbances were more pronounced in patients of group II. Late ventricular potentials and arrhythmias were more frequent in patients with more severe cardiac failure. Sensitivity of SAECG for detection of arrhythmogenic substrate in the myocardium was 70 and 90% in groups I and II, respectively. Positive predictive power of ventricular late potentials for occurrence of ventricular arrhythmias in these groups was 86 and 91%, respectively.

[The connection between late ventricular potentials and ventricular arrhythmias in hypertension patients with different forms of myocardial hypertrophy]. / Sviaz' pozdnikh potentsialov zheludochkov s zheludochkovymi narusheniiami ritma u bol'nykh gipertonicheskoi bolezn'iu s razlichnoi formoi gipertrofii miokarda.

AIM: To estimate the incidence of late ventricular potentials (LVP) and their implication in cardiac arrhythmia. MATERIALS AND METHODS: 53 patients with blood hypertension stage II (mean age 50 +/- 1 years) having symmetric (n = 23) and asymmetric (n = 15) left ventricular hypertrophy as well as 15 patients free of hypertrophy underwent conventional 12-lead ECG, Holter monitoring, echocardiography and late potentials (LP) recording using signal-averaged high resolution ECG. RESULTS: LP occurred more often in asymmetric myocardial hypertrophy than in symmetric one. There was no strong correlation between LP and ventricular arrhythmias except patients with symmetric myocardial hypertrophy. CONCLUSION: In patients with hypertension stage II late potentials seem to arise due to increased hypertrophic myocardium depolarization time, myocardial fibrosis and local intramural blockades.

[The possibility for the presumed detection of the obstructive lesion of the coronary arteries in stenocardia patients by the data from circadian ECG monitoring and stress tests]. / Vozmozhnost' predpolozhitel'nogo vyiavleniia obstruktivnogo porazheniia koronarnykh arterii u bol'nykh stenokardiei po dannym sutochnogo monitorirovaniia EKG i nagruzochnykh prob.

Whether 24-h ECG monitoring (ECGM) may be used in detection of multiple arterial obstructions in anginal patients and to compare diagnostic efficacy of ECGM and bicycle exercise (BE) in prediction of 2 or 3 lesions was investigated in 137 patients subjected to ECGM and selective coronarography. 117 of them did bicycle exercise. The number of episodes of painful and painless myocardial ischemia in ECGM was related with the extension and depth of the coronary flow obstruction. The overall index of myocardial ischemia has been estimated warranting higher probability of detection of subjects with obstruction in 1 or more coronary arteries. Sensitivity and prediction value of ECGM was similar to those of BE, but the latter was more specific.

[Fluctuations in the stenocardia threshold of patients with ischemic heart disease]. / Kolebaniia poroga stenokardii u bol'nykh ishemicheskoi bolezn'iu serdtsa.

In twenty-eight men (the mean age 49.3 +/- 3.2 years) with different clinical varieties of angina pectoris, analysis was made of the heart rate and the grade of ischemic depression of the ST segment, associated with anginous attacks seen during bicycle ergometry and other physical exercises in the course of daily cardiomonitoring. The data obtained indicate that in the same patient, the same grade of ischemic depression of ST was recorded despite varying heart rate. On the contrary, in spite of the same heart rate the grade of ischemic depression of the segment could vary. Dynamic coronary obstruction determined by the mechanisms of adrenergic vasoconstriction is the most probable cause of changeability of the threshold of angina pectoris in patients belonging to functional classes III-IV. The probability of fluctuations in the threshold of angina pectoris should be taken into consideration in deciding expert problems and in the assessment of the efficacy of antianginal therapy.

[The hemodynamic effect of closed mitral recommissurotomy based on data from manometry in the heart chambers and from echocardiography]. / Gemodinamicheskii éffekt zakrytoi mitral'noi rekomissurotomii po dannym manometrii v kamerakh serdtsa i ékhokardiografii.

The hemodynamic effect of operation was studied in 181 patients after closed mitral recommissurotomy on the basis of findings of intraoperative manometry in the heart chambers and echocardiography. Lower pulmonary hypertension was noted in 87.9% and that of the diastolic gradient on the mitral valve in 86.4% of patients operated upon. The echocardiographic parameters were considerably improved. The use of this operation for treatment of patients with recurrent mitral stenosis was proved to be possible.

[Comparison of exercise test and ECG monitoring results in women with ischemic heart disease]. / Sopostavlenie rezul'tatov proby s fizicheskoi nagruzkoi i monitorivovaniia EKG u zhenshchin, stradaiushchikh ishemicheskoi bolezn'iu serdtsa.

To diagnose myocardial ischemia and differentiate the chest pain syndrome in 20 females with coronary heart disease and effort angina pectoris, exercise test and ECG monitoring were performed. Their results were then compared. The informative value of 24-hour ECG monitoring was higher than that of bicycle ergometry in detecting the objective signs of ischemia in patients with effort angina. The indisputable advantage of long-term ECG recording is that one can identify silent ischemia in females with routine physical activity in the outpatient settings. The method of 24-hour ECG monitoring cannot be considered to be sufficiently effective in the differential diagnosis of the atypical chest pain syndrome.

[Painless episodes of ST segment displacement and the possibility of their prevention in patients with exertion-induced stenocardia]. / Bezbolevye épizody smeshcheniia segmenta ST i vozmozhnost' preduprezhdeniia pristupov u bol'nykh so stenokardiei napriazheniia.

Sixty patients with stable exercise-induced angina were examined by 24-hour Holter monitoring. It was found that an average of 51.7% of significant episodes of ischemic ST-segment depression failed to be accompanied by anginal episodes during the whole day. The number and length of painless episodes of ST-segment depression exceeded those observed in painful episodes. The range in the values seen in ST-segment depression was great during the episodes, while its threshold values were far stable at the onset of pain. Usage of analyzing cardiac monitors with a signalling system switched on by the preset values of ST-segment depression prevented the evolution of myocardial ischemia and the development of exercise-induced anginal episodes.

[Disorders of cardiac rhythm and conduction during attacks of stenocardia]. / Narusheniia ritma i provodimosti vo vremia pristupov stenokardii.

Heart rhythm and conductivity disorders, developing during anginal attacks, and their relation to the pattern of myocardial ischemia have been studied, using 24-hour ECG monitoring, in 60 patients with stable angina, and in 67 patients with unstable angina. Heart rhythm and conductivity disorders at the ventricular level were much more common in Prinzmetal's angina (73%), as compared to the attacks involving ST depression (10%). Their incidence depended both on the direction and magnitude of ST displacement. The probability of supraventricular arrhythmias was unrelated to the magnitude and direction of ST displacement. They tended to develop during the attacks, accompanied by slanting ST depressions (43%) rather than flat ones (8%). Arrhythmias were considerably more common as a complication of the attacks of unstable angina (42%) rather that stable angina (15%) owing to more severe myocardial ischemia.

[Determining the vasospastic origin of stenocardia attacks on the basis of 24-hour ECG monitoring]. / Opredelenie vazospasticheskogo geneza pristupov stenokardii po dannym sutochnogo monitorirovaniia EKG.

The pattern of anginal attacks was evaluated, using 24-hour ECG monitoring, in 67 patients with angina at rest, as compared to 60 patients with angina of effort. In most patients, ischemic ECG changes developed in the presence of unchanged heart rate at rest or heart rate increment of less than 0.25 of the daily peak, and disappeared as heart rate increased. A U-like pattern of ST displacement was noted. These features were found to be typical for the vasospastic mechanism of anginal attacks developing at rest. Therefore, the origin of anginal attacks can be identified by means of ECG monitoring.

[Myocardial electrical activity and hemodynamic indices in the early stage of the rehabilitation of myocardial infarct patients]. / Issledovanie élektricheskoi aktivnosti miokarda i pokazatelei gemodinamiki na rannem étape reabilitatsii bol'nykh infarktom miokarda.

Available indirect methods were employed to examine 52 patients with a history of myocardial infarction and 18 normal subjects by the end of the early rehabilitation period. Hemodynamic overload of the left atrium was revealed. The main hemodynamic parameters and processes marking contractile and electrical myocardial functions did not return to normal. The symptoms of left ventricle failure persisted thus requiring treatment continuation.

[Wedge pressure in the pulmonary vein and artery]. / Davlenie zaklinivaniia v legochnoi vene i arterii.

Analysis of the results of measurements of the pressure in pulmonary veins and left auricle in 143 patients with mitral stenosis during the operation and the registration of the wedge pressure in the pulmonary veins during catheterization in 62 of 105 patients of another group enabled the authors to conclude that there was no autonomous pulsation of the pulmonary veins. The pressure after occlusion with a catheter of the pulmonary vein branches and the pulmonary artery does not reflect the true hemodynamic condition in the occlusion basin. The data obtained should be considered as artificial phenomena determined by the method islet.

[Myocardial contractile capacity of the right ventricle in lesser circulation hypertension and in right ventricular insufficiency]. / Sokratitel'naia sposobnost' miokarda pravogo zheludochka u bol'nykh s gipertenziei malogo kruga krovobrashcheniia i pri pravozheludochkovoi nedostatoch-nosti.

The informative value of some indices of myocardial contractility, calculated from curves of pressure in the right ventricle and pulmonary artery, was determined in 119 patients suffering from mitral heart disease with various grades of pulmonary hypertension in 25 patients who did not have a heart disease. The dependence of these indices on the grade of pulmonary hypertension and severity of the clinical symptoms of right-ventricular insufficiency was also studied. The Siegel-Sonnenblick contractility index proved to be the most informative index of myocardial contractile function. It was reduced in patients with right-ventricular insufficiency. With an increase in pulmonary hypertension, the average rate of increase in intraventricular pressure in the phase of isovolumic contraction grows sharply, which indicates to considerable hyperfunction of the right ventricle.