[Aspects of hypertensive heart in arterial hypertension and insulin-resistant syndrome]. / Osobennosti gipertonicheskogo serdtsa pri arterial'noi hipertonii, sochetaiushcheisia s sindromom insulinorezistentnosti.

61 patients with essential hypertension stage II were examined using echocardiography, Holter ECG monitoring, assessment of carbohydrate and lipid metabolism, hormonal profile of arterial hypertension (AH). AH criterium associated with insulin resistance was combination of AH with at least one of the components of the "death four": obesity, hypertriglyceridemia diabetes mellitus or impaired glucose tolerance. Hypertensive heart in AH associated with insulin resistance is severe left ventricular hypertrophy, diastolic myocardial dysfunction. The above disturbances appear prior to elevated blood levels of insulin and aldosteron suggesting the role of the hereditary factors. In hypertensive heart in the syndrome at late stages paroxysmal fibrillation is seen. Episodes of coronary events and ventricular arrhythmia arose irrespective of insulin resistance syndrome.

[Relations between blood insulin concentration, renin-angiotensin-aldosterone system and clinical picture of hypertension]. / Sviaz' kontsentratsii insulina v krovi s sostoianiem renin-angiotenzin-al'dosteronovoi sistemy i klinicheskoi kartiny gipertonocheskoi bolezni.

AIM: To analyse relationships between blood insulin concentration, renin-angiotensin-aldosteron system and clinical picture of hypertension. MATERIALS AND METHODS: Measurements of insulin, renin, aldosteron, angiotensin I, total cholesterol, HDLP cholesterol and triglycerides in the blood were made in 60 males with essential hypertension. The examination also included echo-CG, glucose tolerance test, Ketle's index estimation. RESULTS: Patients suffering from essential hypertension with borderline hyperinsulinemia (insulin within 5.7-12.7 mcU/ml) were characterized by a combination of blood hypertension with a metabolic disorder (obesity or defects in carbohydrate metabolism), activation of renin-angiotensin-aldosteron system and left ventricular diastolic dysfunction. Patients with essential hypertension and marked hyperinsulinemia (insulin exceeded 12.7 mcU/ml) had manifest metabolic syndrome (hypertension, obesity, disturbance of carbohydrate metabolism and hypertriglyceridemia), hyperactivity of renin-angiotensin-aldosterone system, elevated diastolic arterial pressure, remodelling of left ventricular myocardium with development of its concentric hypertrophy and impairment of the diastolic function. CONCLUSION: It is suggested that enhanced activity of renin-angiotensin-aldosterone system may underlie development of insulin-resistance and hyperinsulinemia. The latter plays a significant pathogenetic role in forming clinical picture of essential hypertension in insulin levels > 12.7 mcU/ml.

[The use of frequency-correlation electrocardiography on patients with left ventricular hypertrophy]. / Primenenie chastotnoi korreliatsionnoi élektrokardiografii u bol'nykh s gipertrofiei levogo zheludochka.

The frequency correlation electrocardiogram (FCECG) was recorded in 27 patients with arterial hypertension (AH) and left ventricular hypertrophy (LVH), 8 patients with hypertrophic cardiomyopathy, 22 patients with coronary heart disease (CHD) and in 10 practically healthy volunteers. V4, V5 and V6 ECG leads were used as channel X, whereas lead II was used as channel Y. Application of V6 lead as channel X turned out most informative. The patients with AH and CHD had pathological indices in channel coherence. The patients with LVH manifested deviations in the spectrum of the amplitudes of lead II. The patients with associated LVH and relative coronary insufficiency demonstrated the unchanged FCECG like the practically healthy persons. In the given case, however, the unchanged FCECG in the above patients reflected the impairment of stimulation spreading in the left ventricular myocardium rather than the lack of its hypertrophy.

[The ST-segment-dependent indices of patients with left ventricular hypertrophy and coronary failure]. / Zavisimye ot segmenta ST pokazateli u bol'nykh s gipertrofiei levogo zheludochka i koronarnoi nedostatochnost'iu.

As many as 40 men suffering from essential hypertension (EH) and left ventricular hypertrophy (LVH) or hypertrophic cardiomyopathy (HCMP) were examined. All the patients exercised on a treadmill according to the Cornell protocol taking into consideration the ST/HR slope and the ST/HR index, underwent echocardiography with measurements of the left ventricular mass (LVM), and coronary ventriculography. Coronary insufficiency was revealed in all the patients. Of these, 11 patients suffered from it due to associated EH and coronary heart disease (CHD), 31 had relative coronary insufficiency in the presence of associated EH and LVH phenomena with no stenosis of coronary vessels, and 7 patients showed up relative coronary insufficiency in the presence of HCMP. The ST/HR slope and the ST/HR index correlated well with the LVM and the asymmetry index of the left ventricle but in patients with associated relative coronary insufficiency and EH. In patients with associated EH and CHD, the ST-dependent parameters correlated well neither with the degree of atherosclerosis spreading nor with the LVM. This may indicate that both factors influence the gravity of coronary insufficiency at a time. In case a patient suffering from associated EH and coronary insufficiency phenomena has the ST/HR slope greater than or equal to greater than or equal to 4.5 microV/stroke/min and/or the ST/HR index greater than or equal to greater than or equal to 2.5 microV/stroke/min, it is more likely that myocardial ischemia is provoked by concomitant atherosclerosis of coronary arteries (sensitivity 28%, specificity 71%).

[Features of oxygen supply in exercise load in patients with atherosclerosis obliterans of the peripheral arteries]. / Osobennosti kislorodnogo obespecheniia fizicheskoi nagruzka u bol'nykh obliteriruiushchim aterosklerozom perifericheskikh arterii.

The organism's oxygen balance was studied in 27 patients with atherosclerosis of the peripheral arteries during the test on a bicycle ergometer. The decrease in the patient's physical capacity was found to be in high correlation with the severity of oxygen disbalance.

[A comparative evaluation of loading tests for the diagnosis of ischemic heart disease at the prehospital stage]. / Sravnitel'naia tsennost' prob s nagruzkoi dlia diagnostiki ishemicheskoi bolezni serdtsa na dogospital'nom étape.

Bicycle ergometry, the treadmill test, transesophageal pacing of the left atrium and 24-h monitoring of the ECG were performed on an outpatient basis in 82 persons (all men) with angina pectoris of effort and stenosing atherosclerosis of the coronary arteries verified with the aid of selective coronarography and in 17 men with intact coronary arteries. Transesophageal pacing and the treadmill test exhibited the highest sensitivity (94 and 89%, respectively) in the diagnosis of the latent forms of coronary failure. The sensitivity of bicycle ergometry (77%) was significantly lower which was caused by a considerable number (21%) of tests completed before the appearance of diagnostic criteria. Meanwhile the results of 24-h monitoring of the ECG (65% sensitivity) depended on the degree of the patients' physical activity and way of life. All the four methods did not significantly differ in the specificity. Proceeding from the data obtained it is recommended that the treadmill test and transesophageal pacing of the heart may be widely used on an outpatient basis to diagnose coronary disease.

[Diagnostic significance of changes in the diastolic period of the heart cycle in ischemic heart disease patients undergoing head-down tilt loading]. / Diagnosticheskoe znachenie izmenenii diastolicheskogo perioda serdechnogo tsikla u bol'nykh ishemicheskoi bolezn'iu serdtsa v usloviiakh antiortostaticheskoi nagruzki.

In 62 patients with angina pectoris of different functional classes, physical stress tolerance has been compared to changes of apexcardiographic variables in the postural test. It has been demonstrated that anginal patients have abnormal relaxation velocity and left ventricular filling. Passive volume redistribution test allows one to reveal diastolic myocardial dysfunction, severity of which is related to the degree of coronary insufficiency.