[Cerebral perfusion in patients with arterial hypertension associated with type 2 diabetes].

The aim of the study was to assess cerebral perfusion (CP) in patients with arterial hypertension in combination with type II diabetes. The subjects were 57 patients with stage II AH (mean age 51.6 +/- 5.7 years), among who there were 33 patients without disturbances in carbohydrate exchange and 24 patients with compensated or subcompensated type II diabetes. All the patients underwent single-photon emission computed tomography of the brain with 99m Tchexamethylpropyleneamineoxime. The study showed that patients suffering from AH with or without type II diabetes had signs of cerebral hypoperfusion and lowered cerebrovascular reserve even in the absence of focal neurological symptoms. Disturbances in cerebral perfusion were more prominent in patients suffering from AH with type II diabetes vs. patients without carbohydrate exchange disorder.

[Correlation between the parameters of 24-hour monitoring of arterial pressure and changes in arterial wall structure based on the results of a prospective trial].

AIM: To evaluate prognostic value of 24-h monitoring of blood pressure (BPM-24) for assessment of structural changes in arterial walls in patients with essential hypertension living in West Siberia. MATERIAL AND METHODS: In the course of 5-year prospective study we made two extended clinical and device examinations with use of BPM-24 and ultrasonic measurements of arterial intima-media complex (IMC) in 160 patients (mean age 48.97+/-8.18 years). RESULTS: An independent significant correlation was found between initial drop of the circadian index (CI) of blood pressure, systolic blood pressure (SBP)/diastolic blood pressure (DBP) at night (r = 0.24/0.22, p = 0.012/0.024) and thickness of IMC in 5 years (r = -0.28/-0.30, p = 0.004/ 0.002). The risk of increased thickness of arterial wall in the group with abnormal CI was 1:4. There was no relationships between IMC increase and baseline office blood pressure (r = 0. 18/0.12, p = 0. 057/0.188). In evaluation of office BP effects on progression of arterial atherosclerosis insignificant correlation coefficients for SBP/DBP were obtained (r = 0. 18/0.18, p = 0. 150/0.149) contrary to BPM-24 parameters: mean circadian SBP (r = 0.22, p = 0.046) and heart rate (r = 0.23, p = 0.038), SBP temporal index for 24 hours (r = 0.24, p = 0.035). CONCLUSION: . BPM-24 parameters are more significant predictors of structural changes in arterial wall than standard office blood pressure. This allows calculations of possible risk of such changes.

[Recognition of actual periods of nocturnal rest from 24-hour heart rate profile].

UNLABELLED: Inability to delineate exactly periods of nocturnal sleep and diurnal wakefulness during 24-hour blood pressure (BP) monitoring causes reporting of erroneous BP values for these periods. We suggested a simple mathematical algorithm for detection of periods of nocturnal rest determined as period of low values of cardiac rhythm using data of BP monitoring itself. AIM: To compare novel method of recognition of periods of sleep with 2 standard techniques: use of fixed time interval between 23 and 7 hours (1), or period of sleep according to patient's diaries (2). Reproducibility of nocturnal BP lowering between two 24-hour intervals during 48-hour blood pressure monitoring was used as a measure of precision of determination of diurnal/nocturnal BP. METHODS: Ambulatory 48-hour BP monitoring was carried out in 33 patients with uncomplicated stage II hypertensive disease. Automatic analysis of BP monitoring data was performed with the use of specially designed computer application. Standard deviation (SD) of differences (SDD) between pairs of nocturnal BP lowering during 48 hours was used as a measure of reproducibility. RESULTS: Reproducibility of values obtained with novel algorithm (SDD for systolic/diastolic BP 6.7/8.2 mm Hg) was substantially better than those obtained with standard methods (1) and (2) (SDD 13.0/14.8 and 13.5/18.3 mm Hg, respectively). CONCLUSION: The proposed method of recognition of the period of nocturnal rest substantially improved precision of automatic analysis of 24-hour BP monitoring.

Thallium-199: a new radiopharmaceutical for myocardial perfusion imaging.

The efficacy of a new radionuclide, thallium-199 for myocardial scintigraphy was compared with conventional thallium-201 imaging. Owing to the short half-life of thallium-199 (7.4 hours), when the injected dose of thallium-199 was increased to 200 MBq, the total dose reaching the critical organs was 3.6-15.5 times lower than with conventional nuclide, thallium-201. Studies were performed in a total of 177 patients. The patients were divided into two groups(a) 17 patients with acute myocardial infarction and (b) 160 patients undergoing coronary angiography: 55 patients with no significant coronary artery disease and 105 patients with coronary disease. The sensitivity of the test was 92% with a specificity of 82% and overall predictive accuracy of 84%. Myocardial images obtained with low and high energy collimators have similar predictive accuracy. Perfusion defects were detected more frequently with increasing severity of angina. Myocardial infarction was characterized by persistent defects and myocardial ischaemia by redistribution of thallium. Thallium-199 myocardial scintigraphy performed at rest can be used for the diagnosis of acute myocardial infarction and for the determination of infarct site and extent. Thallium-199 is a new myocardial imaging agent, with a predictive accuracy for the diagnosis of coronary artery disease similar to thallium-201, but a significantly reduced total body dose permits repeat studies with a reduced radiation dose for the patient.

[Study of myocardial perfusion in patients with hypertension]. / Izuchenie perfuzii miokarda u bol'nykh gipertonicheskoi bolezn'iu.

Exercise 199Tl myocardial scintigraphic data were studied during dipyridamole test in 39 patients with Class II essential hypertension. Transient myocardial perfusion defects were revealed in 60% of patients with negative exercise test. Intraventricular administration of albumin microspheres in 8 females with normal coronary artery allowed the authors to detect areas of their accumulation at the same sites as in exercise 199Tl myocardial scintigraphy. Thus, the changes in the small vessels which are revealed by intraventricular albumin microspheres are one of the causes of impaired myocardial perfusion in patients with essential hypertension.

[Diagnostic usefulness of ECG changes in response to exercise in women with various forms of ischemic heart disease]. / Diagnosticheskaia informativnost' izmenenii nagruzochnoi ekg u zhenshchin c razlichnymi formami ishemicheskoi bolezni serdtsa.

The results of bicycle ergometry and pharmacological tests with isoproterenol and dipyridamol, 24-hour monitoring and blood levels of endogeneous opioids were studied in 99 females with chest pain who had undergone angiography. Coronary microcirculation was examined in 29 patients by introducing albumin microspheres into the left ventricle. The angiography revealed coronary atherosclerosis in 30 patients, whereas its signs were not found in 8 females with documented coronary heart disease (CHD). The predictive value of positive exercise tests in females with angina pectoris was higher for the diagnosis of CHD, including its types without coronary atherosclerosis. In patients with cardialgias, the predictive values of exercise tests were equally low for the diagnosis of coronary atherosclerosis, vasospastic and microvascular CHD types. The patients with cardialgias caused by autonomic dyshormonal myocardiodystrophy showed low blood beta-endorphin and leu-enkephalin levels.

[Thallium-201 myocardial scintigraphy]. / Stsintigrafiia miokarda s talliem-198.

Scintigraphy of the myocardium with 199Tl-chloride was performed in 59 patients. On the basis of the results of clinicoinstrumental investigation the diagnosis of chronic CHD was made in 36, that of acute myocardial infarction--in 7. The control group consisted of 16 persons without signs of coronary pathology. The sensitivity of scintigraphy with 199Tl-chloride in the detection of CHD was 92%, and this radionuclide was shown to be no inferior to 201Tl-chloride. 199Tl-chloride can be recommended for the diagnosis of CHD, cicatrical and necrotic myocardial lesions.