[Affection of myocardium in diabetes mellitus]. / Porazheniia miokarda pri sakharnom diabete.

Echocardiography was performed in 67 patients with compensated diabetes mellitus (DM) type I and II. No signs of cardiovascular failure were noted. 20 patients have undergone myocardial scintigraphy. The patients were found to have hyperkinetic central hemodynamics resultant in DM type I from tachycardia, high rate of circulatory shortening of myocardial fibers, in DM type II from compensatory myocardial hypertrophy. In both diabetic types the function of myocardial relaxation was deteriorated as indicated by increased end diastolic volume and slow left ventricular relaxation. This evidences for initial cardiac failure. Myocardial scintigraphy registered perfusion defects in all the examinees, more profound in diabetes mellitus type II. The above findings explain the existence of marked coronarogenic and metabolic myocardial defects in DM.

[Detection of risk factors for hemodynamic dysadaptation under physical loading by data of genetic studies (echocardiography data) (Part 2)]. / Vyiavlenie faktorov riska gemodinamicheskoi dezadaptatsii pri fizicheskoi nagruzke po dannym geneticheskikh issledovanii (dannye ékhokardiografii) (soobshchenie 2).

Examination in 28 pairs of twins who were studied by echocardiography just after their performance of exercise (Stage I) and at the peak of effects produced by oral anapriline (Stage II) have shown that at rest such parameters as end-systolic volume, ejection fraction, relative changes in the internal dimension of the left ventricular cavity during a cardiac cycle, show moderate-to-high genetic predisposition. At the same time, a persistent contribution of heredity to myocardial contractility is found only for end-systolic volume when the conditions of the examination were changed. The lesser extent to which contractility parameters had hereditable signs, the more intensively they varied under different conditions. It is assumed that the contraction rate of circulatory myocardial fibers is less resistant to environmental factors. A significant decrease in this parameter during anapriline administration allows one to suppose that cardiac decompensation in patients with coronary heart disease starts with damages to the very myocardial circulatory muscles.

[Detection of risk factors for hemodynamic dysadaptation under physical loading by data of genetic studies (the beta-adrenoreceptor blockade test) (Part 3)]. / Vyiavlenie faktorov riska gemodinamicheskoi disadaptatsii pri fizicheskoi nagruzke po dannym geneticheskikh issledovanii (proba s blokadoi beta-adrenoretseptorov) (soobshchenie 3).

Examinations in 28 pairs of twins who were studied by bicycle ergometry during a "pure" graded exercise and an exercise during oral administration of anapriline have shown that the functional features of the heart make some contribution to cardiovascular implementation of the "pure" graded exercise. When given exercise and anapriline, energy processes play a role in its implementation. It is suggested that exercise + anapriline will cause substantial metabolic changes which can be essential in cardiac decompensation if exercise is not limited in the use of beta-blockers.

[The effect of anaprilin on the reaction of the sympathetic-adrenal system to graded physical loading in healthy subjects and patients with ischemic heart disease]. / Vliianie anaprilina na reaktsiiu simpatiko-adrenalovoi sistemy pri dozirovannoi fizicheskoi nagruzke u zdorovoykh liudei i bol'nykh ishemicheskoi bolezn'iu serdtsa.

The specific features of responses of the sympathoadrenal system during its activation by graded exercise (E), including that along with anaprilin induced blockade of beta-adrenoceptors, were determined from the urinary excretion of norepinephrine, epinephrine, dopamine, and dioxyphenylalanine in 54 healthy males and 22 patients with postinfarction cardiosclerosis concurrent with Functional Class I-II angina pectoris on effort. E caused hyperreactivity of the sympathoadrenal system, as appeared as significantly greater increases in the levels of catecholamines and their precursors in the patients than in the healthy persons. A single anaprilin dose of 40 mg abolished the responsiveness to exercise and improved its tolerance. The revealed features of sympathoadrenal responsiveness to exercise with and without anaprilin suggest that the patients with coronary heart disease have sympathoadrenal dysfunction, which shows one of the possible mechanisms responsible for the cardioprotective effect of beta-adrenoblockers in this disease.

[Physical working capacity and myocardial perfusion in patients with diabetes mellitus]. / Fizicheskaia rabotosposobnost' i perfuziia miokarda u bol'nykh sakharnym diabetom.

A study was made of the interrelationship of myocardial perfusion with physical working capacity in different types of DM (with the duration of disease from 4 to 8 years without clinical signs of circulatory insufficiency). Rated physical exercise testing in 12 patients with insulin dependent diabetes and 27 patients with noninsulin dependent diabetes as well as in 40 healthy subjects has shown a GTT decrease in diabetes mellitus irrespective of patient's age, sex and body mass to be more marked in noninsulin dependent type and to be closely related to disturbed oxygen supply of the heart and a lowered myocardial reserve. Bicycle ergometric testing combined with 201Tl scintigraphy in 20 patients has shown disorder of perfusion in all the patients irrespective of a diabetes type and duration of disease. Insulin dependent diabetes mellitus was characterized by stable perfusion defects resulting from metabolic derangements, and noninsulin dependent diabetes mellitus was characterized by a decrease in the level of a maximum Tl uptake by the myocardium and transient perfusion defects of ischemic type.

[Study of the status of energy metabolism in thyrotoxicosis by the insulin test]. / Sostoianie énergeticheskogo obmena pri tireotoksikoze po dannym insulinovoi proby.

The insulin test was carried out in 68 healthy subjects and 20 patients with moderate thyrotoxicosis at the stage of compensation. Blood levels of pyruvate and lactate, plasma and erythrocytic glucose, urinary catecholamines and gas exchange were measured before, 30 and 120 min after intravenous administration of insulin (0.15 U/kg). All the measurements evidenced hypermetabolism: oxygen consumption, carbonic acid production, pulmonary ventilation were enhanced; lactate-pyruvate index and urine catecholamines were lower versus those of healthy subjects. Correlation analysis demonstrated disturbed regulation of hyperventilation by the sympathetic-adrenal system in thyrotoxicosis.

[The hemodynamic support of physical loading in patients with mitral valve prolapse]. / Gemodinamicheskoe obespechenie fizicheskoi nagruzki u bol'nykh s prolabirovaniem mitral'nogo klapana.

Bicycle ergometry and echocardiographic studies were carried out in 29 patients aged 17-29 years with first revealed mitral valve prolapse (MVP) without any signs of mitral regurgitation. According to bicycle ergometry, the patients manifested changes in hemodynamics pointing to dysfunction of the cardiovascular system. Echocardiography discovered a reduction of the mass and a rise of the rate of contraction of the circular fibers of the left ventricle, evidence of the myocardial genesis of the hemodynamic changes. Comparison of the findings of bicycle ergometry and echocardiography allowed a conclusion about the necessity of the follow-up of patients with MVP in spite of the high level of threshold load and the lack of the clinical signs of heart failure.

[Study of metabolic characteristics in patients with ischemic heart disease based on the insulin test]. / Osobennosti metabolizma u bol'nykh ishemicheskoi bolezn'iu serdtsa po dannym insulinovoi proby.

The study was undertaken to examine 68 healthy males and 34 patients with Functional Class I coronary heart disease. The insulin test (fasting intravenous simple insulin, 0.15 U/kg body weight, was given in the morning) was performed. The study was conducted in 3 stages: 1) before, 2) 30 min, and 3) 2 hr after insulin administration. Examination of glycemia and gas exchange revealed changes resulting in impaired energy supply of the body in CHD. In CHD patients, the enhanced glucose uptake after insulin was followed by abnormalities both in aerobic and anaerobic glucose oxidation. The insulin test detected the signs of excessive overtension and diminished reserve potentialities of the sympathetic adrenal system early in CHD.

[Hemodynamics and its control in patients with thyrotoxicosis and in healthy persons according to the data of anapriline and graded exercise tests]. / Gemodinamika i ee reguliatsiia u bol'nykh tireotoksikozom i zdorovykh lits po dannym prob s anaprilinom i dozirovannoi fizicheskoi nagruzkoi.

The study was undertaken to examine effects of anapriline on bicycle ergometric and echocardiographic parameters and catecholamine excretion in 17 patients with thyrotoxicosis and 21 healthy subjects. A single dose of anapriline contributed to transition of hyperkinetic central hemodynamics to eukinetic one and a more saving regimen of heart performance at rest and submaximal exercise levels in the healthy subjects. In contrast, the patients maintained hyperkinetic hemodynamics and had a high energy demand during exercise and showed a reduction in left ventricular systolic and diastolic function and a significant decrease in catecholamine excretion. Disintegration of regulatory mechanisms in thyrotoxicosis was found to be due to the function interrelationship between thyroid hormones and catecholamines.

[The rehabilitation of patients with diabetes mellitus and ischemic heart disease]. / O reabilitatsii bol'nykh sakharnym diabetom i ishemicheskoi bolezn'iu serdtsa.

The results of bicycle ergometry testing were studied in 20 patients with diabetes mellitus of type II without clinical signs of circulatory insufficiency, 21 patients with postinfarction cardiosclerosis with undisturbed carbohydrate tolerance, and in 18 healthy persons. The blood level of glucose in patients with diabetes mellitus was investigated on an empty stomach and 30, 60 and 120 min. after physical exercising. Similar changes of bicycle ergometry results were found in diabetic and CHD patients. In compensation of diabetes in response to graded physical exercise glycemic changes were absent, in decompensation glycemia increased in 30 and 60 min. and returned to the basal level 120 min. after testing. Since the results of bicycle exercises in diabetic (compensated) and CHD patients were the same, the principles of their physical rehabilitation must be identical. In patients with decompensated diabetes mellitus a hyperglycemic reaction to graded physical exercise serves the basis for reduction of motor activity in patients with decompensated diabetes mellitus.

[Characteristics of hormonal regulation in patients with ischemic heart disease after the insulin test combined with physical load]. / Osobennosti gormonal'noi reguliatsii u bol'nykh ishemicheskoi bolezn'iu serdtsa pri sochetannom vozdeistvii insulinovoi proby i fizicheskoi nagruzki.

Nine normal subjects and 6 coronary patients (aged 26 to 53 years) who had survived myocardial infarction more than 3 years before and showed no clinical signs of heart failure, obesity, hypertension and diabetes mellitus, while having normal glucose tolerance test values, were exposed to the insulin test in combination with physical stress in the presence of clinically manifest hypoglycemia. Plasma and erythrocyte glucose and immunoreactive insulin, and urinary excretion of catecholamines were measured. Coronary patients showed considerably increased erythrocyte immunoreactive insulin levels, recorded immediately upon discontinuation of exercise, while their sympathoadrenal hormonal activation was less significant, as compared to normal subjects. The combination of the insulin test and exercise in coronary patients with normal glucose tolerance values helps to detect disturbances of regulatory mechanisms at the erythrocyte level and can be used as an adjuvant method for the assessment of latent carbohydrate metabolic disorders.

[The role of changes in central and intracardiac hemodynamics in lowering the physical work capacity of patients with ischemic heart disease and diabetes mellitus]. / Rol' izmenenii tsentral'noi i vnutriserdechnoi gemodinamiki v snizhenii fizicheskoi rabotosposobnosti u bol'nykh ishemicheskoi bolezn'iu serdtsa i sakharnym diabetom.

The data of bicycle ergometry test and echocardiography were studied and compared in patients with postinfarction cardiosclerosis and type II diabetes mellitus without the clinical signs of heart failure. The patients showed the decreased work fitness and the identity of cardiovascular responses to graded exercise, pointing to the common character of the pathogenesis of these diseases. Both groups of the patients manifested the hyperkinetic type of the central hemodynamics as well as the lowering of the rate of diastolic relaxation and the rise of the end diastolic volume of the left ventricle. The intracardiac hemodynamics of coronary heart disease was characterized, in addition, by the reduction of myocardial contractility of the left ventricle due to focal injuries to the myocardial structures, which are more pronounced than in diabetes mellitus.

[Hemodynamic mechanisms of the decrease in physical work capacity in hypothyroidism and thyrotoxicosis]. / Gemodinamicheskie mekhanizmy snizheniia fizicheskoi rabotosposobnosti pri gipotireoze i tireotoksikoze.

A study of 21 patients with hypothyroidism, 22 patients with thyrotoxicosis and 18 normal subjects, using echocardiography and bicycle ergometry, demonstrated different mechanisms of reduced working capacity, associated with those conditions. The decrease in chronotropic and inotropic heart reserve, associated with hypothyroidism, is shown to be rooted in slowed-down relaxation of left ventricular posterior wall in the presence of diastolic arterial hypertension, while limited working capacity, associated with thyrotoxicosis, is rooted in resting myocardial hyperfunction due to hyperkinetic circulation.

[Functional status of the myocardium in thyrotoxicosis]. / Funktsional'noe sostoianie miokarda pri tireotoksikoze.

Twenty-two patients with thyrotoxicosis, showing no clinical signs of heart failure were examined electro- and echocardiographically. Bicycle ergometry was also used in 13 of those. Central and intracardiac hemodynamics were assessed at rest, as was cardiovascular response to exercise. The results were compared to similar parameters in 18 normal subjects. Echocardiography demonstrated hyperkinetic circulation and normal myocardial contractility in the resting patients. Bicycle ergometry showed considerably limited working capacity in those patients. Limited chronotropic and inotropic reserve of the heart in the presence of increased left-ventricular operation at rest may be pathogenetically involved in reduced stress tolerance, seen in patients with thyrotoxicosis.

[Tolerance of the cardiovascular system of hypothyroidism patients for physical loading]. / Tolerantnost' serdechno-sosudistoi sistemy bol'nykh gipotireozom k fizicheskoi nagruzke.

Twenty-one patients with primary hypothyroidism were subjected to electro- and echocardiography, and 10 patients, to bicycle ergometry, to examine their central and intracardiac hemodynamics at rest and cardiovascular response to exercise. The results were compared with the respective parameters of 18 normal subjects. Hypothyroidism was shown to be associated with increased left-ventricular myocardial weight (echocardiographic evidence in the presence of normal myocardial contractility at rest, lowered stress tolerance due to a smaller chronotropic reserve of the heart, and myocardial metabolic disorders.