[The effect of an aortocoronary bypass on the physical capacity of drug-stabilized patients with unstable angina pectoris]. / Efekt na aorto-koronarniia bai-pas vurkhu fizicheskiia kapatsitet pri medikamentozno stabilizirani bolni ot nestabilna angina pectoris.

To 51 patients with unstable angina pectoris a submaximum symptom-limited bicycle ergometry [correction of veloergometric] test was performed 3 to 6 days after stabilization by medicamentous treatment was achieved and 2 to 6 months after an aortocoronary bypass had been accomplished. During the first veloergometric test myocardial ischemia was induced in all patients--9 patients were in the IV, 18--in the III and 24--in the II functional class according to NYHA. During the second veloergometric test myocardial ischemia was induced only in 5 patients. At the end of the first year after the aortocoronary bypass had been performed 45 (88.2%) of the patients were without complaints. The predictive value of the positive veloergometric test after an aortocoronary bypass for a poor prognosis is 80% and that of the veloergometric test without induced myocardial ischemia for a favorable prognosis is 95.6%. Aortocoronary bypass in combination with medicamentous treatment improves the symptomatic state, physical capacity and the prognosis of patients with unstable angina pectoris up to the end of the first year to a considerably greater degree than the medicamentous treatment alone.

[The early bicycle ergometry test in drug-stabilized patients with unstable angina pectoris; its risk and benefit]. / Ranen veloergometrichen test pri medikamentozno stabilizirani bolni ot nestabilna angina pectoris; risk i polza.

The risk of an early submaximum symptom-limited bicycle ergometry [correction of veloergometric] test and its prognostic value up to the end of the first year since the onset of unstable angina pectoris were studied in 258 patients with unstable angina pectoris who had been stabilized by medicamentous treatment. During the bicycle ergometry [correction of veloergometric] test no serious complications were observed. In 22 patients (35.7%) the test was negative and in 166 patients (64.3%) it was positive (angina pectoris and/or horizontal ST depression greater than or equal to 0.1 mV at 80 ms from the point J). In the patients with a positive test the prognosis is statistically worse (death, acute myocardial infarction, aortocoronary bypass, relapse of the unstable angina pectoris and angina pectoris of III and IV functional class according to NYNA/than in the patients with a negative bicycle ergometry [correction of veloergometric] test. The early bicycle ergometry [correction of veloergometric] test is with a high sensitivity (92.6%) and a lower specificity (66.7%) in recognizing the patients with a poor prognosis. The total prognostic accuracy of the test is 80.2%. It classifies the patients with unstable angina pectoris into two groups: with favourable and poor prognosis and helps in the selection of patients for surgical treatment.

[The early bicycle ergometry test in drug-stabilized patients with unstable angina pectoris--the correlation with coronary angiography]. / Ranen veloergometrichen test pri medikamentozno stabilizirani bolni ot nestabilna angina pectoris--korelatsiia s koronarnata angiografiia.

The relation between the results of the early submaximal symptom-limited bicycle ergometry [correction of veloergometric] test and coronary angiography were examined in 127 patients with unstable angina pectoris stabilized by medicaments. In 19 (15.0%) patients the test was negative and in 108 (85%) patients the test was positive (angina pectoris and/or ST depression greater than or equal to 0.1 mV at 80 ms after the point J of the ECG). Between the results of the early bicycle ergometry [correction of veloergometric] test and the coronary angiography, performed soon after the test, there was a close correlation. By using strict criteria or a combination of criteria for assessment of residual ischemia the test can with great accuracy differentiate the patients with multivascular from those with monovascular disease or with healthy coronary vessels.

[The regression of left ventricular hypertrophy during the treatment of hypertension with different classes of beta blockers]. / Regresiia na levokamernata khipertrofiia pri lechenie na khipertonichnata bolest s razlichni klasove beta-blokeri.

156 patients with hypertension II stage according to the WHO classification and left ventricular hypertrophy proved by echocardiographic examination were treated in the course of one year with various class beta-blockers. At the end of the first month of treatment the thickness of the interventricular wall, of the posterior wall and of the left ventricular muscular mass does not change. Till the end of the 6th month the thickness of all these three decreases (p less than 0.0001). The additional decrease at the end of the 12-ve month of treatment is insignificant to that at the 6th month. The mean percentage decrease is greater by treatment with beta-blockers without inner sympathomimetic activity than with beta-blockers with such activity. There is no difference in relation to the cardioselectivity of the drug. Till the end of the 12-ve month of treatment the left ventricular muscular mass becomes normal in 35.9% of the patients on the background of normalized arterial pressure. In 6.4% of the patients the left ventricular muscular mass does not change in spite of the decrease of the arterial pressure. The percentage reduction of the left ventricular muscular mass correlates with the percentage decrease of the systolic (r = 0.603), diastolic (r = 0.457) arterial pressure and the heart rate (r = 0.636).

[Long-term treatment of hypertension with a selective beta-1-blockader without sympathomimetic activity. II. Changes in the structure and function of the left ventricle]. / Dulgotraino lechenie na khipertonichnata bolest sus selektiven beta-1-bloker bez simpatikomimetichna aktivnost. II. Promeni v strukturata i funktsiiata na liavata kamera.

The effect of the 6 months long treatment with the Hungarian selective beta-1-blocker Betaloc (Metoprolol) on the structure and function of the left ventricle was studied in 30 hypertensive patients--II stage (with echocardiographically proved left ventricular hypertrophy) by means of simultaneous recording of M-type echocardiogram, ACG, PCG and ECG. The telediastolic thickness of the septum and the posterior wall and the left ventricular muscular mass decrease at the end of the 6-th month (p less than 0.0001). The telesystolic dimension and volume decrease (p less than 0.0001) in the 6-th month without changes in the telediastolic dimension and volume (p greater than 0.32). The shortening fraction and the ejection fraction increase (p less than 0.0001), Vcf increases insignificantly (p greater than 0.05). The isovolumetric relaxation shortens (p less than 0.0001), the active suction period lengthens (p less than 0.0001) as well as the fast filling period (p less than 0.0027). By controlling the arterial pressure and suppressing the sympathetic stimulation of the heart the prolonged Betaloc treatment leads to reversion of the hypertrophy and improves the left ventricular function.

[Systolic pressure--left-ventricular telesystolic volume ratio in the treatment of hypertension with a cardioselective beta-blockader without inner sympathomimetic activity]. / Otnoshenieto sistolno naliagane--telesistolen obem na liavata kamera pri lechenie na khipertonichnata bolest s kardioselektiven beta-bloker bez vutreshna simpatikomimetichna aktivnost.

The ratio systolic pressure--telesystolic volume (SP-TV) was determined in 39 patients with II degree hypertension by M-type echocardiography and simultaneous measurement of the arterial pressure before and at the end of the I and VI month of treatment with a cardioselective beta-blocker without a sympathicomimetic activity. The initial values of the ratio SP-TV did not differ from those of healthy persons. At the end of the first month of treatment the ratio was reliably lower (p less than 0.001) and at the end of the sixth month it increased but remained reliably lower than that of healthy persons (p less than 0.045). At the end of the sixth month the left ventricular muscular mass was reliably reduced. A large up to significant negative correlation was established between the ratio SP-TV and the left ventricular muscular mass before and after the treatment. The left ventricular pump function showed favorable dynamics.

[An apex cardiographic method of determining the moment of mitral valve opening and duration of its isovolumetric relaxation]. / Apekskardiografski metod za opredeliane momenta na otvariane na mitralnata klapa i produlzhitelnostta na izovolumetrichnata relaksatsiia.

By analyzing the simultaneous recordings of M-type echocardiogram of the mitral valve, apexcardiogram (ACG) phonocardiogram (PCG) in 49 healthy persons, 30 patients with II stage hypertension and 39 patients with unstable angina pectoris was established that the opening of the mitral valve coincides with the moment in which the discending arm of the ACG deviates from its tangent (determined by two points--the first is the point of intersection of the ACG with the perpendicular raised from the initial highfrequency vibrations of the aortic component of the II tone: the second is 20 ms from the first on the discending arm of the ACG). The method allows the determination of the exact moment of the opening of the mitral valve and the duration of the isovolumetric relaxation and of the period of the active suction by the ACG and the PCG only. This increases the apexcardiographic potentialities in the functional diagnosis of the left ventricle.

[Hemodynamic changes and left ventricular function in patients with hypertension during an acute trial of urapidil]. / Khemodinamichni promeni i levokamerna funktsiia u bolni ot khipertonichna bolest pri ostur opit s urapidil.

The left ventricular hemodynamic changes were studied in 9 hypertensive patients (6 patients with hypertensive attack and 3 patients with a severe form of the disease) by simultaneous recordings of the M-type echocardiogram, apexcardiogram and phonocardiogram in an acute trial with Urapidil administered intravenously in a dose of 0,7 mg/kg body mass. The arterial pressure and the peripheral vascular resistance decrease. The stroke and the minute volume do not change. The heart rate increases. The telediastolic and telesystolic dimensions of the left ventricle decrease. The percentage amplitude of the aI-wave of the apexcardiogram also decreases. The fraction of the shortening of the left ventricular dimension increases with 23,0%, the ejection fraction increases with 13,5% and the average speed of the circumferential fibres shortening increases with 21,4%. Urapidil applied i.v. exerts a rapid hypotensive action and improves the left ventricular function.

[Long-term treatment of hypertension with a selective beta l-blocker without sympathomimetic activity. I. Antihypertensive and hemodynamic effects]. / Dulgotraino lechenie na khipertonichnata bolest sus selektiven beta 1-bloker bez simpatikomimetichna aktivnost. I. Antikhipertenziven i khemodinamichen efekt.

The antihypertensive and hemodynamic efficacy of Betaloc (Egys-Hungary) was studied in 30 hypertensive patients in the II stage of the disease. The drug was applied in a single daily dose of 100 mg in the course of 6 months. The systolic and diastolic pressure and the heart rate decreased reliably (p less than 0.0001) at the end of the first month. The stroke volume increased (p less than 0.045) at the end of the sixth month but the minute volume and the cardiac index did not change (p greater than 0.32). The peripheral vascular resistance dicreased reliably (p less than 0.02) at the end of the sixth month--the degree depending on the initial type of circulation--and it determined the longstanding antihypertensive efficacy of Betaloc. No untoward reactions were registered.

[Relaxation and rapid filling of the left ventricle in essential hypertension during treatment with a non-selective beta blocker]. / Relaksatsiia i burzo pulnene na liavata kamera pri khipertonichna bolest v khoda na lechenieto s neselektiven beta-bloker.

Some indices of relaxation and rapid filling were evaluated in the course of a six-month treatment with non-selective beta-blocker in 30 patients with hypertonic disease, (HD), degree II, with echocardiographically confirmed left-ventricular hypertrophy and normal systolic function. The phase analysis of the early diastole, performed according to Alvarez and Goodwin, reveals a progressive shortening of the period of isovolumetric relaxation and lengthening of the period of active suction with no change in the summed up period of rapid relaxation; the period of rapid filing is lengthened on account of the active suction. The evaluated via computer analysis (echo-computer--NIEMT-MA, Sofia) parameters of rapid filling of M-type echogram of left ventricle (maximum velocity of increase of left-ventricular dimension, mean velocity of fraction of rapid filling) increase progressively. The dynamics of the indices of diastolic function described, reflect the diminution of the restriction of ventricular filling and its shifting to the early diastole.

[Early diastolic changes in patients with unstable angina pectoris]. / Promeni v rannata diastola pri bolni ot nestabilna angina pectoris.

The length of the time intervals of the early diastole was studied by the method of Alvares and Goodwin in 30 patients with unstable angina pectoris by means of simultaneous recordings of M-type echocardiogram, ACG,PCG and ECG before and after medicamentous treatment (beta blockers, nitrites with prolonged action, calcium antagonists). The control group was of 33 healthy men. The isovolumetric relaxation period was greatly prolonged in the patients and the active aspiration period was shortened (p less than 0.001). At the end of hospital treatment the interrelations between these two periods changed--the isovolumetric relaxation period shortened (p less than 0.001) and the active aspiration period lengthened (p less than 0.01) without change of the total period of fast relaxation. The slow relaxation period during the time of fast filling and the total fast filling period before and after treatment did not differ from those of the control group. The changes of the time intervals are probably related to the diminished compliance due to myocardial ischemia. The dynamic changes in the course of medicamentous treatment of unstable angina pectoris reflect the lowered restriction of left ventricular filling.

[Clinical study of the beta-blocker chlorpropanol (tobanum) in hypertension patients]. / Klinichno prouchvane na beta-blokera khlorpropanol (tobanum) pri bolni ot khipertonichna bolest.

The antihypertensive effect and tolerance of chlorpropanol was determined in 30 patients with hypertonic disease. The treatment was carried out only with tobanum as an open experiment with a dose from 10 to 30 mg. Before and towards the end of the treatment, the following indices were calculated from the simultaneous record of M-echocardiogram of left ventricle, ACG, PhCG and ECG: stroke volume (SV), minute volume (MV) cardiac index (CI), ejection fraction (EF), mean velocity of circumferential fibres shortening (Vcf), and peripheral vascular resistance (PVR). Chlorpropanol normalized the pressure in 83.3% of the treated, reducing the systolic pressure with 14.9%, and the diastolic--with 15.1%. The reduction of the pressure in hyperkinetic type of circulation is associated with the reduction of CI (p less than 0.05) as result from the slowed down cardiac rate (p less than 0.001), in hypokinetic type--with the reduction of PVR (p less than 0.05), and in eukinetic--with the normalization of the ratio between those two parameters. EF was not changed during the treatment, Vcf was reduced (p less than 0.045), but remained within the physiological limits. Chlorpropanol is with pronounced negative chronotropic effect. It has a good tolerance.

[Treatment of hypertension with urapidil (Ebrantil)]. / Lechenie na khipertonichnata bolest s urapidil (Ebrantil).

Ebrantil has been added to the beta-blockers and/or diuretics in the treatment of 32 patients with moderate and severe hypertension under the conditions of 3-month open clinical experiment. A very good antihypertensive effect was obtained in 31.3% of the treated, moderate--in 65.6% and unsatisfactory--in 3.1%. Ebrantil does not change the heart rate and is, in fact, without any adverse effects.

[Treatment of hypertension with obsilazin]. / Lechenie na khipertonichnata bolest s obsilazin.

Obsilazin was established to have a good to moderate hypotensive effect in 75% of the treated 36 patients with moderate and severe hypertension under the condition of a 6-month open clinical experiment, not changing the heart rate. The adverse effects are often 69.4%), usually transitory but in 11.1% they proved to be the cause for discontinuation of the treatment.

Plasma renin activity in diabetic patients.

Plasma renin activity (PRA) in 40 diabetic patients and 42 healthy controls was investigated using the method of Pickens in modification of Serebrovskaja et al. (1967). PRA was slightly lower in the whole group of diabetes but the difference was not significant. The subgroup of 20 maturity-onset diabetics had significantly lower PRA in comparison with 22 controls of similar age, while PRA in juvenile diabetics did not differ significantly from matched controls. In patients without clinical signs and symptoms of microangiopathy PRA was as high as in the controls. In diabetics with microangiopathy PRA was significantly lower. PRA was also lower in patients with longer duration of the disease. The stimulation of juxtaglomerular apparatus with sodium free diet and diuretic drugs resulted in an increase of PRA both in controls and diabetics. This suggests a functional depression of PRA in diabetic patients. In diabetics with ketoacidosis PRA was higher than in control subjects and decreased after disappearance of ketoacidosis. A high level was recorded in a patient with hyperosmolar coma and a very low level in a patient with polyneuropathy and severe orthostatic hypotension. The possible mechanisms involved in the changes of PRA in diabetic patients are discussed.