[Renin-angiotensin-aldosterone system and vasopressin in adult and aged patients with acquired mitral valve defects]. / Renin-angiotenzin-al'dosteronovaia sistema i vazopressin u bol'nykh zrelogo i pozhilogo vozrasta s priobretennym mitral'nym porokom serdtsa.

Seventy four patients aged 35-74 years who had mitral valvular disease were examined for renin, angiotensin II, aldosterone, and vasopressin, of whom 49 patients were diagnosed as having a mitral valve defect with prevalent stenosis, 25 presented with a mitral valve defect with prevalent heart failure. Circulatory disorders, Stages I-II, were found in 41 patients, Stage IIB in 23, and Stage III in 10 patients. There were no significant differences in the parameters of the renin-angiotensin-aldosterone system (RAAS) and vasopressin in untreated adult and elderly patients with mitral valvular disease at rest. As circulatory disorders progressed, the RAAS parameters significantly increased in all the groups. However, the patients with prevalent stenosis showed higher blood renin levels than did those with prevalent heart failure, irrespective of its severity. In refractory heart failure, the significant differences remained to a greater extent only for renin. The treatment with peripheral vasodilators (isosorbide dinitrate and corinfar) resulted in compensatory activation of the neurohumoral vasoconstrictive system, thereafter the RAAS parameters significantly increased after the drugs.

[Transplantation of the heart-lung complex (the first clinical experience)]. / Transplantatsiia kompleksa serdtse-legkie(pervyi klinicheskii opyt).

The article deals with experience in the first transplantation of a heart-lung complex in the USSR. The recipient was a 34-year-old male with dilation cardiomyopathy. It was decided to perform the transplantation because the terminal stage of cardiac failure and secondary pulmonary hypertension developed (cardiac index 1.3 l/m, pressure in pulmonary artery 80/50 mm Hg, resistance of pulmonary vessels 10.4 units after Wood). The heart and lung were transplanted from a 19-year-old male who died from a craniocerebral injury. Cyclosporine, metipred , imuran, dopamine in small doses, cardiotonics, and antibiotics were given in the postoperative period; the patient was kept on artificial respiration for 48 hours. For up to 10 days the patient's condition was relatively stable and his consciousness was clear. Bilateral pneumonia developed, however, from which he died on the 12th postoperative day. The article discusses organizational problems and some questions of immunosuppressive therapy, immunological monitoring, and the management of patients after transplantation of a heart-lung complex.

[Magnetic resonance tomography of the heart in dilated cardiomyopathy]. / Magnitnaia rezonansnaia tomografiia serdtsa pri dilatatsionnoi kardiomiopatii.

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.

[Effects of digoxin on ventricular arrhythmias in patients with mitral valve defects]. / Vliianie digoksina na zheludochkovye narusheniia ritma u bol'nykh mitral'nymi porokami serdtsa.

A study was undertaken to examine 55 (27 females and 28 males) patients aged 25 to 74 years who had ventricular arrhythmias. Twenty five patients were diagnosed as having mitral valvular disease concurrent with predominant stenosis, 30 presented with prevalent mitral dysfunction. Twenty eight patients showed Stages I to IIA circulatory failure, and 27 had Stages IIB to III heart failure. All the patients displayed perpetual ciliary arrhythmia of various duration. More frequent and severe ventricular arrhythmias were recorded in mitral valvular disease patients with predominant mitral dysfunction than in those with stenoses. When the plasma digoxin concentration was less than 1.1 ng/ml in patients with a low end-diastolic volume and initial signs of circulatory failure, the agent produced an antiarrhythmic effects on ventricular arrhythmias in many cases, in mitral valvular disease patients with predominant stenosis in particular. The arrhythmogenic effect of digoxin was found in 47.6% patients with prevalent mitral dysfunction concurrent with Stages IIB-III circulatory failure. The agent may show arrhythmogenic action in mitral valvular disease patients with prevalent mitral dysfunction who had larger cardiac volumes and plasma digoxin concentrations of no more than 1.6 ng/ml in the absence of clinical signs of digitalis intoxication.

[Cellular beta-adrenergic receptor complex in patients with heart failure and its changes during digoxin therapy]. / Beta-adrenoretseptornyi kompleks kletok u bol'nykh s serdechnoi nedostatochnost'iu i ego izmeneniia pri terapii digoksinom.

Twenty eight males with dilated cardiomyopathy, 5 males with coronary heart disease concurrent with postinfarction cardiosclerosis, 4 males and 2 females with rheumatic heart disease were examined. The findings suggest desensitization of the cellular beta-adrenoreceptor complex in patients with circulatory failure, which appeared as lower beta-adrenoreceptor density with cardiac decompensation progression and impaired transmission of a hormonal signal in the cell, particularly in patients with dilated cardiomyopathy. Digoxin therapy let to an increase in beta-adrenoreceptor density with its initial decrease and to adenylate cyclase activity enhancement. The absence of a positive ++clinico-hemodynamic effect and time course of plasma catecholamine levels in some patients with severe circulatory failure during digoxin use, as well as no changes in the values of the beta-adrenoreceptor adenylate cyclase complex indicate that the abnormalities in beta-adrenergic regulation play an important role in the pathogenesis of refractoriness at the cellular level. Retention of forskolin's stimulant effect allows one to expect a significant positive therapeutic response to be shown with the usage of drugs whose load point is a catalytic subunit of adenylate cyclase.

Relationship between the inhibition of receptor-induced increase in cytosolic free calcium concentration and the vasodilator effects of nitrates in patients with congestive heart failure.

Nitroglycerin, isosorbide dinitrate and sodium nitroprusside, like nifedipine, were found to inhibit the receptor-provoked increase of cytosolic free calcium concentration in human platelets loaded with 2-[(2-amino-5-methylphenoxy)methyl]-6-methoxy-8-aminoquinoline-N,N,N',N' - tetraacetate. Sodium nitroprusside and nitroglycerin induced elevation of cyclic guanosine 3',5'-monophosphate content in platelets which correlated with their calcium-blocking activity. Methylene blue and epinephrine decreased the calcium-blocking effect and the influence of nitroglycerin on cyclic guanosine 3'-5'-monophosphate content, but failed to suppress the inhibitory effect of sodium nitroprusside. Ascorbic acid increased the calcium blocking effect of sodium nitroprusside and its influence on cyclic guanosine 3'-5'-monophosphate content, but did not alter the inhibitory effect of nitroglycerin. In order to evaluate the relationship between the mode of action of nitrates at cellular level and their vasodilatory effectiveness, we studied the circulatory response of the forearm to isosorbide dinitrate and the influence of nitroglycerin on free calcium concentration in the platelets in 10 patients with chronic heart failure. We established a significant positive correlation between the basal values for venous tone and its peak decrease after administration of the 10-mg dose of isosorbide dinitrate. A correlation was also found between the deviation of maximal decrease of venous tone by this dose of isosorbide dinitrate from the regression line (the relationship between the basal venous tone and its lowering by the drug) and mean inhibitory concentration values for nitroglycerin in blocking that proportion of the rise of calcium ion concentration in platelets due to blocking of the platelet-activating factor. Thus, nitrates, like calcium antagonists, inhibit the receptor-provoked calcium supply to the contractile system of the cells so neutralizing the effects of increased concentrations of vasoconstrictors. This suggests that the effectiveness of nitrates appears to be positively related to the contribution of receptor-induced increase of cytosolic free calcium concentration in vasoconstriction together with their capacity to raise cyclic guanosine 3',5'-monophosphate.

[The sympathetic-adrenal system in mitral heart defects in patients of different ages studied by the use of a specific L-DOPA test]. / Izuchenie simpatiko-adrenalovoi sistemy pri mitral'nykh porokakh serdtsa u bol'nykh raznogo vozrasta s primeneniem spetsificheskogo testa s L-DOFA.

As many as 59 patients aged 35 to 74 years suffering from mitral valvular disease (MVD) were examined for excretion of dopamine (DA), noradrenaline (NA) and adrenaline, parameters indicating the activity of the sympathoadrenal system. Administration of L-DOPA brought about a significant increase of excretion of all catecholamines in all the patients under 59 years and in those aged 60 to 74 years. In patients with stage I and IIA heart failure, DA excretion rose 50-fold in response to L-DOPA administration, in those with stage IIB and III, 17-fold (p less than 0.001). In patients suffering from MVD, no age-associated differences were revealed in the levels of catecholamines and ICM. In patients suffering from MVD with the predominance of stenosis and in those with stage I and IIA heart failure, background excretion of NA was significantly higher than in patients suffering from MVD with the predominance of heart failure (p less than 0.01). Administration of L-DOPA was followed by an appreciable increment of NA exactly in patients suffering from MVD with the predominance of stenosis (p less than 0.001). In the majority of patients with stage III heart failure refractory to multimodality treatment, the L-DOPA test revealed the smallest increment of DA; its excretion rose only 12-fold. Therefore, the progress of heart failure entails a decrease of the reserve potentialities of the sympathoadrenal system, marked by less output of its mediators.

[Comparative analysis of parametric images in patients with dilated cardiomyopathy and coronary heart disease by radionuclide ventriculography]. / Sravnitel'nyi analiz parametricheskikh izobrazhenii u bol'nykh dilatatsionnoi kardiomiopatiei i ishemicheskoi bolezn'iu serdtsa po dannym radionuklidnoi ventrikulografii.

After equiponderant radionuclide ventriculography the parametric images (phasic and amplitude) of heart function were estimated in 20 patients with dilated cardiomyopathy and in 17 patients with coronary heart disease associated with cardiomegaly. The patients with dilated cardiomyopathy and those with coronary heart disease showed principal differences in local disturbances of the amplitude of movements of left ventricle myocardium walls. While assessing synchronism of myocardial contraction in the patients with dilated cardiomyopathy the presence of the zones of myocardial asynchronism appeared to be a suggestive sign. At the same time the phenomena of asynchronism were not directly connected with impairment of heart conduction and became aggravated as dilatation of the left ventricle progressed, being often coupled with the ECG signs of cicatrical alterations in the myocardium, which came on the phasic images in the form of dyssynergia areas.

[Antibodies to the myelin major protein in patients with dilated cardiomyopathy. Determination and diagnostic significance]. / Antitela k osnovnomu belku mielina u bol'nykh dilatsionnoi kardiomiopatiei. Opredelenie i diagnosticheskoe znachenie.

IgG and IgM antibodies to the myelin major protein (MMP) have been measured by solid-phase enzyme immunoassay (EIA) in the blood sera of 31 patients with dilatation cardiomyopathy (DCMP), 4 ones with coronary disease (CD), and 20 normal subjects. Nonspecific binding of the native and aggregated human gamma-globulin with the MMP has been examined, as well as the correlation between the blood serum concentrations of circulating immune complexes, IgG and IgM, and the rheumatoid factor, and the titers of IgG and IgM antibodies to MMP; no correlation has been detected (p greater than 0.05). The activities of bovine and porcine MMP in EIA have been under study and found identical (p less than 0.001). No anti-MMP antibody has been detected in CD patients, whereas in DCMP IgG antibodies have been present in 55% and IgM ones in 49% of the cases, and 52% of the patients had both types of antibodies. Dynamic titration of anti-MMP antibody carried out in 9 DCMP patients has revealed a 4-fold and higher elevation of the titers in 4 patients and a reduction of these titers in other 4 patients. Comparison of the titers of IgG and IgM antibodies to MMP and the peripheral blood lymphocyte ability to spontaneous synthesis of immunoglobulins and Phytolacca mitogen-stimulated Ig synthesis by the MMP has revealed a correlation between these parameters. The findings permit a hypothesis on the involvement of the nerve fiber myelin-containing cells, possibly of the afferent system of the heart, in half the examinees with DCMP.

[Effect of hemodynamic changes on cardiac rhythm disorders: experience with long-term intravenous administration of nitroglycerin in patients with chronic heart failure]. / Vliianie izmenenii gemodinamiki na narusheniia ritma serdtsa: opyt dlitel'nogo vnutrivennogo vvedeniia rastvora nitroglitserin bol'nym s khronicheskoi serdechnoi nedostatochnost'iu.

In 15 patients with chronic congestive heart failure (CHF), heart rhythm was analysed in normal haemodynamics achieved by 24-hour nitroglycerin (NG) infusion. The NG dose was titrated until the pulmonary wedge pressure (PWP) was reduced up to less than 15 mm Hg; during further 24 hours the infusion rate was unchanged (mean 144 +/- 16 mgk/min). The control group included 12 patients with CHF to whom no NG infusions were performed. There was no significant difference between the groups in mean daily number of ventricular extrasystoles (VE), coupled VE, runs of ventricular tachycardia and maximal gradation of ventricular rhythm disturbances (VRD). VRD in the first 12 hours, i. e. during greatest haemodynamics alterations, and in the next 12 hours of the infusion were compared separately as well as VRD in every 3 hours of the infusion. The groups did not differ significantly in number and degree of VRD. It is thus supposed that VRD in patients with severe CHF are independent of haemodynamic factors.

[Magnetic resonance tomography of the heart in hypertrophic cardiomyopathy]. / Magnitnaia rezonansnaia tomografiia serdtsa pri gipertroficheskoi kardiomiopatii.

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.

[Electrovectorcardiographic characteristics of shifting repolarization phase curves in patients with hypertrophic cardiomyopathy and ischemic heart disease with arterial hypertension]. / Elektrovektorkardiograficheskie osobennosti v sdvigakh repoliarizatsionnoi fazy krivykh u bol'nykh s gipertroficheskoi kardiomiopatiei i ishemicheskoi bolezn'iu serdtsa s arterial'noi gipertoniei.

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.

[Long-term use of the calcium antagonist nifedipine (corinfar) in the treatment of patients with primary pulmonary hypertension]. / Dlitel'noe primenenie kal'tsievogo antagonista nifedipina (korinfara) pri lechenii bol'nykh pervichnoi legochnoi gipertoniei.

Sixteen patients on long-term treatment for primary pulmonary hypertension were studied. The results were compared after a single 20 mg dose, a two-week course and long-term (13.9 months on the average) use of the drug (40 mg/day). Pulmonary arterial catheterization, thermodilution and occlusion plethysmography were used. Changes in central and peripheral hemodynamic parameters were unidirectional and similar at all stages of the study. Nifedipine improved hemodynamics, as evidenced by selected criteria, in 80% of patients exposed to acute tests, in 91% after a course of treatment and in 58% after long-term use. Therefore, considering the ability of nifedipine to improve pulmonary hemodynamics as well as stable effect over more than one year of treatment, and the absence of marked side effects, this drug can be regarded as the most effective vasodilating agent for the treatment of primary pulmonary hypertension.

[Systemic design of a new complex of diagnostic cardiological equipment]. / Sistemnoe postroenie novogo kompleksa diagnosticheskoi apparatury dlia kardiologii.

The authors give a brief description of 6 new diagnostic cardiologic devices designed in the USSR. A concept of systemic design of a perspective complex of diagnostic equipment is under discussion. Type of organization of automated working places for a specialist in noninvasive diagnostics and a cardiologist using personal computers is proposed. Such an approach to the design and use of new diagnostic equipment has been shown promising.

[The role of the natriuretic factor in the genesis of water-electrolyte disorders in patients with chronic circulatory failure]. / Rol' natriiureticheskogo faktora v geneze vodno-élektolitnykh narushenii u bol'nykh s khronicheskoi nedostatochnost'iu krovoobrashcheniia.

The paper is concerned with the results of a study of volume regulation in 102 patients with CHD complicated by heart failure. Disorder of the volumetric natriuretic reflex at the early stages of heart failure was shown. A conclusion was made of disorder of all links of volume regulation in patients with heart failure.

[Renal effects of captopril in chronic heart failure]. / Renal'nye éffekty kaptoprila pri khronicheskoi serdechnoi nedostatochnosti.

The effect of captopril on renal function, central hemodynamics and the hormonal status was studied in 14 patients with chronic congestive heart failure in single administration of the drug at a dose of 25 mg and during short-term course therapy at a daily dose of 75 mg for 7 days. Captopril single administration was shown to cause an increase in natriuresis by 121% and diuresis by 120%. Correlation analysis showed that the natriuretic effect of captopril resulted from a decrease in tubular sodium reabsorption which, in its turn, was determined by a decrease in the production of angiotensin II and changes of pritubular circulation. Seven-day course therapy was accompanied by the patients' improved general status, improved indices of hemodynamics, and better tolerance to physical exercise. At the same time diuresis and renal excretion of sodium were above the basal level by 113 and 86%, respectively. It can be assumed that this natriuretic effect was determined by the suppression of angiotensin II, aldosterone and probably norepinephrine and vasopressin production. The analysis has shown that a favorable captopril renal effect is not mediated through improved central hemodynamics but results from changes of the hormonal and neurohumoral status.