[The clinical and prognostic information value of painless myocardial ischemia in the early postinfarct period]. / Klinicheskaia i prognosticheskaia informativnost' bezbolevoi ishemii miokarda v rannem postinfarktnom periode.

A study was made of painless myocardial ischemia in the early postinfarction period (day 14) in order to define its influence on the clinical course and immediate prognosis. 25 patients aged 32 to 60 years with acute primary myocardial infarction were examined. 17 patients had large-focal and 8 small-focal infarction. The patients received diurnal ECG monitoring and physical exercise test on a treadmill. An overwhelming majority of the patients manifested myocardial ischemia not correlating with the rate of angina pectoris attacks. In the patients with small-focal infarction, angina pectoris occurred more frequently and was longer. It has been discovered that the total diurnal duration of transitory myocardial ischemia in the early postinfarction period is a more informative indicator of the immediate prognosis as compared to physical exercise tolerance.

[Diagnosis of dilated cardiomyopathy using patient blood serum and myocardial tissue culture]. / Diagnostika dilatatsionnoi kardiomiopatii s ispol'zovaniem syvorotki krovi bol'nykh i kul'tury tkani miokarda.

Based on a study of the interaction of the sera from healthy persons (20), patients with coronary disease (20), rheumatic heart disease (20), myocarditis (20), congestive dilated cardiomyopathy (48) it was established that the sera from dilated cardiomyopathy patients exert an inhibitory effect on the contraction of chick embryo myocardial explants in experiments in vitro. Three grades of the inhibitory effect were detected, depending on the patient's status gravity. The sera from healthy persons and patients with the enumerated cardiovascular diseases failed to produce such an effect.

[Clinical significance of reciprocal changes in the ECG in acute myocardial infarction]. / Klinicheskoe znachenie retsirpoknykh izmenenii EKG pri ostrom infarkte miokarda.

A total of 206 patients with acute myocardial infarction marked by infarction localization in the anterior and inferior walls were examined. It is revealed that reciprocal changes, namely the depression of the ST segment are of prognostic significance in the assessment of the clinical course of the disease, with the ST depression being recorded for over one day. The patients demonstrated a reduction in left ventricle (LV) function, namely a decrease in the ejection fraction of the LV. Moreover, in this group of patients, a greater number of cases with multiple lesions of the coronary vessels were recorded. The reciprocal changes correlated well with the size of myocardial injury.

Left ventricular contractility related to the state of the coronary bed.

The authors studied total and segmental contractility of the left ventricular (LV) myocardium in patients with acute myocardial infarction with single and multiple coronary artery (CA) disease. The group included 75 patients with acute transmural myocardial infarction; coronary arteriography was performed in 56 of them. All patients underwent echocardiography (sector scanning), on the basis of which total (ejection fraction) and segmental parameters (segmental ejection fraction, fraction of segmental wall shortening, velocity of change of segmental area, velocity of change in segmental wall thickness) of LV contractility were calculated. Patients with single CA affection display only a moderate decrease in total ejection fraction, and an insignificant number of complications of myocardial infarction. Segmental contractility data showed severe hyperkinesis of the intact segments of the left ventricle. Multiple CA disease is associated with a marked decrease in both total and segmental contractility of the LV myocardium, and there is no hyperkinesis of the intact segments of the heart.

[Changes in intracardiac blood flow in the acute period of myocardial infarction (according to the results of 2-dimensional impulse Doppler echocardiography]. / Izmeneniia vnutriserdechnogo krovotoka v ostrom periode infarkta miokarda (po dannym dvukhmernoi impul'snoi doppler-ékhokardiografii).

Quantitative parameters of intracardiac blood flow were examined by impulse dopplerography in normal subjects and patients with acute transmural myocardial infarction with reference to the severity of disturbance of left-ventricular segmental contractility. The flow rate through the apical region and left-ventricular efferent tract was basically similar in normal subjects and coronary patients without myocardial infarction. Where myocardial segmental contractility was disturbed, changes in flow rate are different at different left-ventricular levels and depend on the site of infarction, the extent of left-ventricular involvement and the condition of intact myocardium. Reduced flow rate in left ventricular cavity and the efferent tract is indicative of a profound depression of both total and segmental left-ventricular myocardial contractility.

[Determination of pulmonary capillary wedge pressure by the sectoral scanning method]. / Opredelenie davleniia zaklinivaniia legochnykh kapilliarov metodom sektoral'nogo skanirovaniia.

Eighty-seven cases of acute myocardial infarction were examined by sectoral scanning to assess the contractility of all heart chambers. The data, particularly the occlusion pressure of pulmonary capillaries, were compared with those obtained at catheterization of the right compartments of the heart. Mathematical formulas were derived to enable the identification of patients with increased occlusion pressure and quantify its magnitude on the basis of noninvasive echocardiographic studies.

[Function of the heart chambers in acute myocardial infarct]. / Funktsiia kamer serdtsa pri ostrom infarkte miokarda.

A study of 87 patients, admitted to hospital within the first day of acute myocardial infarction (AMI) identified 3 groups of patients on the basis of their pulmonary capillary occlusion pressure (OP) values. Sixteen normal subjects made up the control group. Myocardial contractility and volume characteristics obtained by sectoral scanning were reviewed. It was demonstrated that the contractility of the left and right heart chambers had different patterns of change in relation to the magnitude of pressure: left-atrial and right-ventricular ejection fraction (EF) gradually declined, and normal pressure values were associated with right-ventricular hyperfunction. Right-ventricular EF also decreased as the OP grew, yet it did not reach the critical values as observed with the left-ventricular EF. The predominance of the right-ventricular function over the left-ventricular one might be one of the mechanisms underlying the development of insufficiency in the lesser circulation. Contractility unbalance was also shown to exist between the right and left atria. A rise in the end systolic volume in the presence of unchanged end diastolic volume is the earliest manifestation of reduced left-ventricular contractility in acute myocardial infarction.

[Potentials of noninvasive methods in diagnosing multiple coronary artery lesions in ischemic heart disease]. / Vozmozhnost' neinvazivnykh metodov v diagnostike mnozhestvennogo porazheniia koronarnykh arterii pri ishemicheskoi bolezni serdtsa.

A total of 111 patients, aged 35 to 60, were examined. Of those, 97 had survived transmural or large-focal myocardial infarction (MI) 1-2 years before the study. The patients were divided into groups according to MI localization and the number of affected coronary arteries. Coronaro- and ventriculography, echocardiography (sectoral scanning), the computer-assisted treadmill exercise test were performed in all the patients. Exercise tolerance in post-MI patients was shown to be related to coronary circulation and unrelated to left-ventricular myocardial contractility at rest. The analysis of ST variation, particularly ST rise, as the only criterion for the assessment of the results of exercise testing demonstrated its moderate sensitivity in relation to the diagnosis of multiple coronary arterial lesions (MCAL) in post-MI patients. The informative value of the test increases if other parameters, particularly exercise tolerance, are assessed as well. Low tolerance combined with computer evidence of a positive test is in most cases indicative of MCAL, whereas with high tolerance in the absence of electrocardiographic ST changes MCAL would be unlikely.

[Role of certain factors in thrombus formation in patients with myocardial infarct complicated by an acute aneurysm]. / O roli nekotorykh faktorov v obrazovanii tromba u bol'nykh infarktom miokardom, oslozhnennym ostroi anevrizmoi.

A total of 240 patients with acute myocardial infarction (MI) were examined over time with the use of two-dimensional echocardiography. The influence of such factors as the scope of involvement of the left ventricle myocardium, changes of its contractility and hemostasis on thrombus formation in the left ventricle was investigated. It was established that thrombus is formed primarily during anterior myocardial infarction with an extensive injury to the apical segment--formation of a large aneurysm. Thrombus formation is associated with a significantly large scope of the involvement and reduced (both total and segmental) left ventricle myocardial contractility, which may favour the development of hemostasis in the area of the aneurysm. It was discovered that two-dimensional echocardiography coupled with doppler cardiography is a highly sensitive technique, the use of which during MI enables recognizing patients predisposed to thrombus formation.

[Determining the area of myocardial damage by the method of sectorial scanning and its value for prognosis of the outcome of acute myocardial infarction]. / Opredelenie ploshadi porazheniia miokarda metodom sektoral'nogo skanirovaniia, znachenie dlia prognoza iskhoda ostrogo infarkta miokarda.

The authors describe a method for measuring the myocardial injury area, and show the prognostic value of the latter based on examination of 100 patients admitted to the Cardioresuscitation Department with a diagnosis of acute transmural or large-focal myocardial infarction. The lifetime evaluation data of the IM size by means of two-dimensional echocardiography were in a good agreement (r = 0.85) with the morbid anatomy data. Determination of the injury size and ejection was found to be the most informative method for predicting an outcome of acute myocardial infarction. The use of the different combinations of the prognostic signs expands the possibilities of the given method and makes it possible to screen patients with a high risk of a lethal outcome and development of complications on the basis of the primary care at the early disease stage.