[Right ventricular remodeling after myocardial infarctions of different location].

AIM: To study dynamic dimensional and functional changes of both ventricles after myocardial infarctions (MI) of different locations. MATERIAL AND METHODS: Patients with first acute ST elevation MI (n=180) were distribution to 3 groups: anterior (AMI), inferior (IMI), and posterolateral (PLMI). EchoCG dimensional parameters of LV and RV as well as functional two dimensional EchoCG, flow and tissue doppler parameters were measured on days 7, 90 and after 1 year of follow up to reveal systolic or diastolic dysfunction of both chambers. RESULTS: After 1 year of follow up significant LV remodeling with systolic and diastolic dysfunction was observed in AMI compared with IMI and PLMI. Pronounced RV remodeling was revealed in acute stage of IMI, compared with AMI and PLMI. Dynamic follow up showed reversed RV remodeling in IMI with relative restoration of systolic and diastolic parameters, and progressive RV remodeling in AMI with significant systolic and diastolic dysfunction compared with IMI and PLMI. CONCLUSION: Thus, dynamic structural and functional changes occurr in both ventricles and depend on Ml site, with most ventricular compromise in AMI due to asynergy of the septum, as common ventricular wall plays major role in RV performance.

[Study of morphofunctional characteristics of the myocardium in ischemic heart disease using ultrasonic methods]. / Izuchenie morfofunktsional'nykn kharakteristik miokarda pri ishemicheskoi bolezni serdtsa s pomoshcn'iu ul'trazvukovykh metodov.

Ultrasonic heart tissue characterization was performed in normal subjects and patients with chronic coronary disease and acute myocardial infarction (MI). In normal subjects and anginal patients, no regional differences in myocardial echo density were found, while postinfarction patients showed an increase of echo density in the region of the scar. During MI, initial fall of echo density in the damaged area at the onset of the disease was followed by an increase of echo density later in the course of MI. In some MI patients, there was virtually no increase of echo density in the damaged area throughout hospital stay. These patients also developed severe left-ventricular diastolic dysfunction. The significance and clinical implications of ultrasonic heart tissue characteristics in coronary patients are discussed.

[Correlations between various cardiometric and functional parameters in dilated cardiomyopathy and alcoholic lesion of the heart (data of roentgenological and echocardiographic studies)]. / Sootnoshenie nekotorykh kardiometricheskikh i funktsional'nykh parametrov pri dilatatsionnoi kardiomiopatii i alkogol'nom porazhenii po dannym rentgenologicheskogo i ékhokardiograficheskogo issledovaniia.

Volumetric changes of the heart and its left ventricle, as well as myocardial contractility were assessed in 50 patients with dilatation cardiomyopathy (DCMP) and 16 patients with acute alcoholic heart damage (AHD), on the basis of roentgenologic (cardiac shape and volume, left ventricular and aortic pulsation, respiratory volumetric variations, pulmonary circulation) and echocardiographic (end-diastolic size and volume, systolic increment of posterior wall thickness, ejection fraction and left-ventricular shortening) data. Both DCMP and acute AHD were shown to be associated with total enlargement of the heart, diffuse impairment of myocardial contractility, considerably depressed left ventricular pumping function, early congestion in the systemic circulation network coupled with minor roentgenologic signs of congestion in pulmonary circulation.

[Effect of anti-anginal therapy on the functional state of the myocardium in patients with chronic ischemic heart disease]. / Vliianie antianginal'noi terapii na funktsional'noe sostoianie miokarda u bol'nykh khronicheskoi ishemicheskoi bolezn'iu serdtsa.

Antianginal therapy with long-acting nitrates, beta-blockers, and combinations there of were administered depending on the baseline cardiovascular function, as assessed by spiroergometry, in 300 patients with chronic coronary heart disease. Three degrees of the hypokinetic type corresponding to the degrees of myocardial failure were identified on the basis of adaptability patterns and the disturbance of correlations between the increment in oxygen consumption, heart rate, cardiac output, and the output of work done. It is shown that cardiovascular status should be taken into account in selecting the type of antianginal therapy for chronic coronary patients.

Comparative analysis of circadian rhythms of certain functional indicators of the cardiovascular system in healthy subjects and in patients with ischaemic heart disease.

The circadian rhythm of certain functional indicators of the cardiovascular system was investigated in 141 patients with ischaemic heart disease (IHD), of whom 65 had post-infarction cardiosclerosis and in 26 healthy subjects. The obtained data were processed by an ES-1020 computer according to a special "Cosinor" programme. Specific circadian rhythm was determined of certain haemodynamic indicators, sinus node excitability, impulse conduction, myocardial supply (according to ECG data) and of the blood clotting system. In healthy subjects, the coincidence of the acrophases of circadian rhythms of functional indicators of the cardiovascular system was found; these indicators reached their maximum level during the day and in the evening. In patients with IHD (with prior myocardial infarction as well as without), there were found shifts in the circadian rhythm of bioelectrical processes in the myocardium, with the maximum values shifted to the night and morning hours. These shifts are a consequence of changes in myocardial nutrition and of worsened coronary flow during the day and in the early evening hours, when the patients exhibit also a tendency towards increased activity of the blood clotting system, as well as fibrinolysis depression.

[Development of heart hypertrophy in hypertension]. / Razvitie gipertrofii serdtsa pri gipertonicheskoi bolezni.

A total of 120 patients with essential hypertension, stage I and II, were examined, using radio- and electrocardiography, before and after a hypotensive treatment. Two mechanisms: excessive volume (in patients with hyperkinetic circulation) and excessive pressure (in those with normo- and hypokinetic circulation) were found to form the basis of the formation of left-ventricular muscular hypertrophy. Antihypertensive effect of treatment reducing electrocardiographic signs of left-ventricular muscular hypertrophy was shown to be related to improved arterial pressure control and lesser adrenergic influence on the heart.

[Comparative evaluation of the structural characteristics of the circadian cardiovascular rhythms of healthy persons and in ischemic heart disease]. / Srvanitel'naia otsenka strukturnykh osobennostei sutochnykh ritmov serdechno-sosudistoi sistemy u zdorovykh lits i bol'nykh ishemicheskoi bolezn'iu serdtsa.

Certain indices of haemodynamics and ECG have been recorded in a biorhythmological study in 141 patients with ischaemic heart disease and in 26 practically healthy individuals. It was established that both the healthy individuals and the patients with ischaemic heart disease have diurnal rhythms of pulse rate, systolic and diastolic pressure, minute heart volume, R--R QRST, TQ intervals and R and T waves on ECG. The acrophases of diurnal rhythms of these indices in the healthy people are in mutual concordance with maximum figures during the daily and early evening hours. In the healthy the acrophase of T wave is seen during the day, in patient with ischaemic heart disease at night and early in the morning. This points to disorders of the bioelectric processes in the myocardium due to its nutritional changes over the 24 hours.

Myocardial contractility, haemodynamics, and metabolism in acute myocardial infarction. Experimental and clinical study.

In order to investigate the systemic and central haemodynamics, blood perfusion, and metabolism of the myocardium in acute myocardial infarction (AMI), experiments were carried out in 80 mongrel dogs with experimental AMI, induced by ligation of the descending branch of the left coronary artery, and 183 patients with transmural AMI were clinically followed-up. It was found that after coronary artery ligation the blood flow in the intact myocardial parts increased, whereas in the infarcted zone it decreased. These shifts persisted fairly long after the induction of AMI. Simultaneously the cardiac output markedly tended to decrease in all animals, and this tendency also persisted for the next two days. It was proved that the haemodynamic shifts in question were associated with a decrease in the myocardial biosynthesis of individual fractions of RNA after the coronary artery ligation. The clinical observations confirmed that AMI was accompanied by a decrease in myocardial contractility. The degree of the decrease was directly proportional to the infarct size. The dependence of the changes on the localization of AMI was less marked.

Circadian rhythms of ECG T-wave, arterial pressure and heart rate in patients with ischemic heart disease.

Analysis of the data of 25 healthy subjects and 141 patients with IHD revealed circadian rhythms of heart rate, systolic and diastolic arterial pressure and ECG T-wave voltage both in patients and controls. On the basis of data obtained we conclude that circadian rhythms of heart rate and arterial pressure level in patients with IHD are changed as compared with the data of controls. This change is apparent in the alteration of the acrophase and amplitude in some cases and especially in the mesor alteration of the rhythm in others. Circadian rhythms of T-wave voltage in different leads in controls is characterized by the occurrence of acrophase at midday or in the evening hours. In patients with IHD the acrophase mainly occurs in the early morning hours or at night. These data acquire practical importance in prevention and pharmacological manipulation of IHD.

[Change in the circadian rhythms of the ECG T-wave value in ischemic heart disease]. / Izmenenie sutochnykh ritmov velichiny zubtsa T EKG u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Rhythmological study of the T wave on the ECG was conducted for 24 hours in 25 healthy individuals and 141 patients with ischemic heart disease. A daily rhythm of changes in the blood supply to the myocardium was revealed. Its maximum values were recorded during the day in healthy individuals and during the night and in the morning in sick individuals, i.e. the rhythm in patients was distorted and desynchronized. Consequently, atherosclerosis of the coronary arteries as an organic disease has an effect on the natural daily rhythm of the blood supply to the myocardium.