[Hepatic function in circulatory insufficiency. Mathematical modeling of 137I-labelled rose bengal transport in the body]. / Funktsiia pecheni pri nedostatochnosti krovoobrashcheniia. Matematicheskoe modelirovanie transporta bengal'skogo rozovogo-137I v organizme.

131I-labelled bengali pink was used to perform radiohepatography in patients with circulatory failure. Both amplitude-time parameters of blood clearance curves and hepatograms and the generalized index of parameters of the linear 3-chambered reversible model of this tracer transport in the body indicate that the decrease of hepatic absorptive and excretory function in the presence of 131I-labelled bengali pink occurs in a direct relationship to the degree of circulatory insufficiency and developed in parallel with bilirubin metabolic disturbances. In some patients, hepatic lesion in the presence of Stages IIB-III circulatory insufficiency with signs of hepatocellular failure and cholestasis was accompanied only by moderate hepatic absorptive and excretory dysfunction against 131I-labelled bengali pink and by an increase in blood total bilirubin levels no more than that in Stage IIA circulatory insufficiency.

[Myocardial necrosis in chronic course of ischemic heart disease]. / Nekrozy v miokarde pri khronicheskom techenii ishemicheskoi bolezni serdtsa.

The possibility of myocardial necrosis occurrence in coronary failure proceeding as atypical myocardial infarction was examined in 176 patients with chronic types of coronary heart disease and in experiments with 16 dogs with reversible coronary failure simulated in chronic tests. 99mTe-labeled pyrophosphate myocardial scintigraphy was used in the clinical studies. Myocardial pyrophosphate accumulation was recorded in 37% of patients with angina pectoris without a history of myocardial infarction and 73% myocardial infarction survivals. Histological evidence for small myocardial necroses at various stages of their development was found in 12 dogs. Recurrent transient myocardial ischemias were shown to be able to lead to myocardial necroses that are not always followed by a typical course of acute myocardial infarction.

[A non-invasive method of determining the severity of coronary insufficiency in various forms of ischemic heart disease]. / Neinvazivnyi sposob opredeleniia tiazhesti koronarnoi nedostatochnosti pri nekotorykh formakin ischemicheskoi bolezni serdtsa.

Myocardial pyrophosphate accumulation was examined in various forms of coronary heart disease. The status of the coronary reserve in the myocardial lesion foci where pyrophosphate is accumulated has been shown to determine the severity of coronary failure in various uncomplicated forms of the disease, such as angina without prior myocardial infarction, myocardial infarction in the early phase of its healing, and postinfarction cardiosclerosis. In postinfarction cardiosclerosis, the dimensions of such foci are significant in the development of clinical events of coronary failure.

[Prognosis of the clinical course of post-infarction cardiosclerosis on the basis of pyrophosphate-labeled myocardial scintigraphy]. / Prognozirovanie klinicheskogo techeniia postinfarktnogo kardioskleroza po dannym stsintigrafii miokarda s mechenym pirofosfatom.

Predictive value of myocardial 99mTc-pyrophosphate scintigraphy was assessed in 122 patients with postinfarction cardiosclerosis. In those cases where clinical and scintigraphic complication risk estimates considered, further evidence was shown to be redundant. Prognosis in patients with positive scintigraphic results and asymptomatic postinfarction cardiosclerosis or first-to-second class stable angina should take into account the size of myocardial pyrophosphate accumulation focus and the pattern of stress-induced changes in blood supply of the sites of myocardial damage. Negative scintigraphic results have no predictive value in those postinfarction cardiosclerosis patients who show clinical signs of heart failure and/or severe coronary insufficiency at the time of investigation.

[Accumulation of pyrophosphate in the myocardium in post-infarction cardiosclerosis]. / Nakoplenie pirofosfata v miokarde pri postinfarktnom kardioskleroze.

A study of the relationship between the frequency of labelled pyrophosphate detection in the heart muscle and the incidence of clinical signs of heart failure or angina in 185 postmyocardial-infarction patients demonstrated that the distribution of patients with postinfarction cardiosclerosis among the positive and negative 99mTc-pyrophosphate scintigraphy groups was governed by the presence of heart failure in these patients, a finding suggestive of the scarry fields within the myocardium as the principal cause of myocardial accumulation of labelled pyrophosphate in postinfarction cardiosclerosis. Pyrophosphate accumulation in patients with postinfarction cardiosclerosis can be regarded as an indicator of unfavorable developments, as confirmed by one-year follow-up results in 114 patients.

[Clinical importance of 99mTc-pyrophosphate scintigraphy in the bicycle ergometry test]. / Klinicheskoe znachenie stsintigrafii s 99mTc-pirofosfatom pri veloérgometricheskoi probe.

The clinical value of myocardial scintigraphy with 99mTc-pyrophosphate in conjunction with bicycle ergometry was assessed through the correlation of the latter's results with the clinical course of coronary heart disease over 1 year in 21 patients with first myocardial infarction during its early healing stage and 17 anginal patients without a history of myocardial infarction. The disease ran a stable course at the time of the testing in all the patients; later on, 11 of those developed various complications associated with coronary heart disease, or died. Three scintigraphic recordings were made: prior to, at the peak of, and after the exercise. Thirteen scintigraphic patterns were identified. They are interpreted on the basis of presumed variation in the degree of myocardial damage and blood supply to affected areas under the effect of exercise; a relation is also noted with predicted risk of complications. The method has proved reliable in identifying patients at low risk for complications. Providing indirect evidence of the quality of blood supply to damaged myocardial areas during rationed exercise, it furnishes additional criteria for the assessment of the patients' working capacity.

[Indicators of scintigraphy using technetium Tc 99m pyrophosphate in angina pectoris in relation to the activity of the pituitary-adrenal system]. / Pokazateli stsintigrafii s 99mTc-pirofosfatom pri stenokardii v zavisimosti ot aktivnosti sistemy gipofiz-kora nadpochechnikov.

The effect of exercise on the parameters of the scintigraphy of the myocardium with labelled pyrophosphate was studied in 35 patients with coronary heart disease and angina of effort and at rest with regard to the activity of the pituitary-adrenal cortex system. The functional status of this system was evaluated on the basis of data on the blood changes in somatotrophic hormone and cortisol. The use of a scoring system made it possible to identify four types of the pattern of the scintigraphic parameters. Type I and II of the pattern of the scintigraphic parameters indicating the normal ratios between the requirements of the cardiac muscle in oxygen and myocardial perfusion were characteristic of the patients with angina pectoris in the presence of an increased activity of the pituitary-adrenal cortex system. When the coronary heart disease patients with angina had a lower activity of this system, the authors more frequently recorded types III and IV of the pattern of scintigraphy which reflected a decreased perfusion and myocardial damage during exercise.

[Phenomenon of pyrophosphate accumulation in the prognosis of different forms of ischemic heart disease]. / Fenomen nakopleniia pirofosfata v prognoze razlichnykh form ishemicheskoi bolezni serdtsa.

The results of pyrophosphate 99mTc scintigraphy of the myocardium during exercise were compared with the parameters of the tolerance and adaptation to the load and the frequency of manifestations of myocardial ischemia during bicycle ergometry in relation to the prognostic value with regard to coronary heart disease (CHD) development. The studies involved 21 patients with myocardial infarction at the early recovery period and 23 CHD patients without a history of myocardial infarction. Manifestations of myocardial ischemia and the pattern of pyrophosphate build-up in the myocardium during exercise are approximately equally informative with regard to the prognosis of a high risk of complications in CHD patients. As regards the capacity to detect patients with a low risk of CHD complications, the finding of pyrophosphate 99mTc scintigraphy of the myocardium are more reliable than the electrocardiographic manifestations of myocardial ischemia or chest pain during bicycle ergometry. The parameters of the tolerance and adaptation to the load were found to be of little use in predicting CHD complications.

[Radiocardiogram interpretation by estimating the average transit time of a tracer]. / Interpretatsiia radiokardiogramm na osnove opredeleniia srednego vremeni prokhozhdeniia indikatora.

A new method for the interpretation of the radiocardiographic (RCG) data is proposed. As distinct from the widely used method developed by Donato et al. based on the exponential extrapolation of the terminal zones of the RCG peaks and the calculation of the mean time of the indicator general circulation in the body, this one is based on the approximation of both RCG peaks by gamma-image function, measurement of the indicator maximum level in the field of interest of the vena cava superior and calculation of the time indices that characterize the mean-transit time of radioactivity through the right cardiac regions and through the heart and lungs in general. On examination of practically healthy persons and 62 patients with ischemic heart disease 10 different RCG time indices were identified. The correlation matrix of the interrelationships of these indices and the matrix of the coefficients of respective regression equations were calculated. It has been established that the mean time of general circulation results in the distorted evaluation of myocardial pump function whereas time indices determined by the above method give a more adequate evaluation of the central hemodynamics.

[Determination of the temporal characteristics of tracer transport in hemodynamics studies]. / Opredelenie vremennykh kharakteristik transporta indikatora pri issledovanii gemodinamiki.

A novel method designed for processing the findings obtained from radionuclide studies of hemodynamics is proposed. This technique is based on the establishment of the mean time needed for the transit of the indicator through the studied physiological structure which is done by determining its transport function. Temporal division of information concerning the right and left departments of the heart suggested by the authors for the preliminary processing of radiocardiographic data has a number of advantages over the current techniques. The application of the proposed method for interpreting radiocardiograms in 74 patients with compromised circulation showed that the determination of the mean time of the indicator transit whose magnitude alters significantly depending on the severity of the disease enables the objective evaluation of the state of the physiological system studied.

[Role of somatotropic hormone in the dystrophic syndrome of patients with chronic circulatory failure]. / Znachenie somatotropnogo gormona pri distroficheskom sindrome u bol'nykh s khronicheskoi nedostatochnost'iu krovoobrashcheniia.

Concentrations of somatotropic hormone (STH) in the blood were determined in 71 patients with varying degrees of chronic circulatory insufficiency and the dystrophic syndrome and in 12 healthy individuals. The degree of dystrophic changes in the body was evaluated by figures of the dry body weight. In 36 patients with severe circulatory insufficiency albumin metabolism was also studied. The results showed that the basal level of STH of the blood rises when chronic circulatory insufficiency supervenes and develops. No relationship between the degree of STH rise in the blood and dystrophic changes in body was found. A reverse correlation between the STH content in the blood and the size of the dry body weight in patients with enhanced breakdown of albumen suggests that in cardiac insufficiency STH plays a role in the adaptation of metabolism to the dystrophic process in the body, perhaps by stimulating the metabolism of fats.

[99mTc-pyrophosphate scintigraphic indices during the bicycle ergometry test in myocardial infarct in the early phase of healing]. / Pokazateli stsintigrafii s pirofosfatom-99mTc pri veloérgometricheskoi probe u bol'nykh infarktom miokarda v rannei faze ego zazhivleniia.

Scintigraphy with 99mTc-pyrophosphate during bicycle ergometry has been undertaken in 32 patients with myocardial infarction in the early phase of its healing. There were 3 scintigraphic investigations: one during bicycle ergometry and two control ones - before and the day after the test. The determination of changes in the degree of 99mTc-pyrophosphate accumulation under the influence of the exercise in patients with myocardial infarction in the early phase of its healing permitted the authors to detect several variants in the time course of scintigraphic values. Drop or rise of concentration of the labelled pyrophosphate at the height of the bicycle ergometry test compared to the data obtained prior to it are apparently due to changed bloodflow in the focus of lesion during exercise. Changes in the character and intensity of accumulation of the radiodrug after bicycle ergometry can be explained in the majority of cases by increase of metabolic disorders in the myocardium, supervening during the exercise, and in some patients, possibly, to sustained decrease of bloodflow in the affected area of the cardiac muscle.

[99mTc-pyrophosphate scintigraphic indices at different times in acute myocardial infarct]. / Pokazateli stsintigrafii s 99mTc-pirofosfatom v raznye sroki ostrogo infarkta miokarda.

The incorporation rate of 99mTc-pyrophosphate into the myocardium was studied in 123 patients with acute myocardial infarction at different stages of the disease. The capacity of the damaged myocardium to accumulate the labelled pyrophosphate decreased with its healing. The accumulation character of the radiopharmacologic preparation also changed. The revealed phenomena are explained by the features of the 99mTc-pyrophosphate concentration mechanisms of the damaged areas of the myocardium. during the necrosis phase pyrophosphate is accumulated in the irreversibly damaged myocardial cells. The incorporation of 99mTc-pyrophosphate into the myocardium at the late stages of the disease are explained by both the presence of the necrotized cells in the myocardium and possible binding of the radiopharmacologic preparation to collagen.

[Clinical periodization of myocardial infarct]. / Klinicheskaia periodizatsiia infarkta miokarda.

Comparison of the clinical and laboratory tests with the findings of post-mortem examination of 82 hearts of patients who had died in different periods after the onset of the disease allowed the authors to distinguish three periods in the clinical course of myocardial infarction: necrotic, inflammatory and adaptational. Fever, leukocytosis, the time course of MB CPK activity, and the results of polyelectrode ECG are reliable indicators of the duration of the necrotic period. The content of the protein-carbohydrate complexes in the blood adequately reflect the exudative-proliferative phase, while the content of collagen metabolites in blood and urine reflect the collagenization phase of the inflammatory period. These tests allow the physical activity of each patient to be individualized under objective control over the rate of healing of the myocardial infarct. Most patients become fully adapted to life with a reduced mass of contractile myocardium three months after the onset of the disease.