[24-hour heart rate profile in assessment of target organs in women with arterial hypertension].

AIM: To study relationships of 24-hour heart rate (HR) profile with involvement of the heart and kidney in women with arterial hypertension (AH). MATERIAL: We examined women (n=273) aged 40-70 years with essential 2-3 degree AH. METHODS: Blood pressure (BP) measurements (8 times in a week), electrocardiography, echocardiography, ambulatory BP monitoring, complex laboratory diagnostics. RESULTS: Less than 10% HR lowering was registered in 22.7% of patients. Compared with the group with normal HR profile this group was characterized by high levels of clinical systolic and diastolic BP (SBP, DBP), mean 24-hour BP, nocturnal BP, SBP time index, as well as low levels of 24-hour SBP, HR, and HR variability. Same group had also significantly greater left atrial dimensions, and higher values of NT-proBNP and total risk according to SCORE (Systematic Coronary Risk Estimation). Correlation analysis revealed significant reverse association between 24-hour HR index which reflected circadian character of cardiac rhythm, left atrial dimension (r=-0.212) and NT-proBNP (r=-0.346). Flat HR profile was not statistically significant for detection of cardiac pathology (odds ratio 1.19; 95% confidence interval from 0.67 to 2.14). CONCLUSION: Insufficient nocturnal HR lowering in women with AH was not associated with significant changes of the myocardium and kidney and clear cat links with dyslipidemia, obesity, and smoking.

[Dynamics of prevalence of arterial hypertension and other risk factors of development of cardiovascular diseases in female population of Tallin (10 year prospective study)].

Aim of the study was to assess dynamics of prevalence of arterial hypertension (AH) and main cardiovascular risk factors (RF) in a women population of Tallin during 10 years of follow up. In 2008-2009 we repeated measurements of arterial pressure (AP), electrocardiographic, echocardiographic, and complex laboratory examinations in 314 participants of epidemiological study undertaken in 1999-2000. Most prevalent RF was hypercholesterolemia. Rate of its detection substantially rose from 69.1 to 81.2%. Number of subjects who continuously took cholesterol lowering drugs and had target levels of lipid profile was sporadic. Prevalence of hypertriglyceridemia, obesity, and diabetes mellitus insignificantly increased. Only prevalence of smoking had tendency to reduction. AH was found in 28.7 and 44.6% of women in 1999-2000 and 2009, respectively. Obesity and hypercholesterolemia contributed significantly to development of new cases of AH. Among subjects with AH 25% of women received antihypertensive therapy and achieved target AP levels--3 times more than in 2000. Thus prevalence of AH and other main RF in female population of Tallin increased during 10 years follow-up. However control of AP in patients with AH notably improved.

[Arterial hypertension, echocardiographically determined left ventricular hypertrophy and N-terminal pro-B type natriuretic peptide levels in women population aged 56-65 years].

Aim of the study was to investigate relationship between arterial hypertension (AH), left ventricular myocardial mass (LVMM), and levels of N-terminal pro-B type natriuretic peptide (pro-NT BNP) in a population of women inhabitants of Tallinn aged 56-65 years. Of 163 women aged 50-59 years who had participated in epidemiological study in 2000 in 132 measurement of arterial pressure (AP), electrocardiography, echocardiography, complex laboratory diagnostics including determination of pro-NT BNP were repeated in 2007. Most frequent risk factor was AH which was detected in 56.1% of cases. In women with normal AP normal LVMM was noted in 81.1% of cases, while in women with elevated AP normal LVMM was significantly less frequent (28.4%). Only in 5 of 28 women with elevated pro-NT BNP deviations of systolic-diastolic function were observed. Elevated levels of pro-NT BNP were found with almost equal rates among patients with normal and increased LWMM (in 9.1 and 8.3% of cases, respectively). Thus increase of content of pro-NT BNP is of limited significance for diagnosis of left ventricular hypertrophy in women aged 56-65 years without clinical signs of disease.

[Association between QT-interval and its dispersion with factors determining prognosis of cardiovascular morbidity and mortality].

AIM: To elucidate relation between prolongation of corrected maximal QT intervals and QT dispersion (QTcmax, QTcD) and presence and severity of arterial hypertension, as well as other factors determining high cardiovascular risk in female population of Tallinn aged 56 - 66 years. MATERIAL AND METHODS: A sample of female citizens of Tallinn (n=123, age 56 - 65 years) were subjected to standard examination including blood pressure measurement, electrocardiography, echocardiography, and laboratory tests. RESULTS: Presence of prolonged QTcmax and/or QTcD were associated with elevation of pulse pressure, which reflected strain and elasticity of the aorta, as well as with presence of left ventricular hypertrophy, especially concentric variant of changes of left ventricular geometry. Participants with prolonged QTcmax and/or QTcD had higher total 10 year risk of cardiovascular morbidity and mortality.

[Left ventricular geometry in inhabitants of Tallinn (an echocardiographic population study)]. / Osobennosti geometrii levogo zheludochka po dannym ékhokardiografii v populiatsii Tallina.

Echocardiography was performed in 325 men and 398 women in the framework of a population survey of inhabitants of Tallinn aged 35 to 59 years in 1999-2001. Left ventricular geometry was analyzed according to generally recognized four types. Prevalence of concentric hypertrophy was similar in men and women (7.7% and 9.1%, respectively). In all age groups prevalence of eccentric hypertrophy in women was 4-10-fold higher than in men (33.3 and 4.9%, respectively). Concentric remodeling was also more frequent in women than in men (9.5 and 5.5%; respectively, p<0.05). Regardless of sex and age, concentric hypertrophy was never found in participants with normal blood pressure. In hypertensives there was a tendency for age-related increase of prevalence of concentric hypertrophy: the latter was higher in women than in men (39.1% and 25.5%; respectively, p<0.05). In examinees with body mass index (BMI) <30 this type was rare. In obese persons its frequency increased with age in both sexes reaching 26.5% in men and 21.2% in women (p<0.05). Prevalence of eccentric hypertrophy in men increased with age, especially in the presence of hypertension and obesity. In men the prevalence of concentric remodeling was not related to BMI; it was significantly more often found in older age groups and in hypertensives. In women the prevalence of eccentric hypertrophy and concentric remodeling was not related to age, hypertension and BMI. The frequency of normal geometry decreased with age in both sexes.

[Dynamics of QT-Dispersion During Bicycle Exercise Test in Assessment of Functional State and Prognosis in Patients With Ischemic Heart Disease.]. / Dinamika dispersii intervala Q-T pri provedenii veloérgometrii v otsenke tiazhesti funktsional'nogo sostoianiia i prognoza u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Changes of QT-interval dispersion during bicycle exercise test were registered in 68 patients with ischemic heart disease and stable angina. According to results of 5 year follow-up 3 groups of patients were distinguished - with cardiac events (n=20), with stable clinical course (n=30), and with clinical remission (n=18). Average QT dispersions before exercise were similar in 3 groups. At peak exercise average values of QT dispersion were highest in the group of patients with events. QT dispersion increment

[QT interval dispersion and hypertension in different variants of left ventricular geometry (population study)]. / Dispersiia intervala Q-T i arterial'naia gipertenziia pri raznykh variantakh geometrii levogo zheludochka (populiatsionnoe issledovanie).

AIM: To assess relationship between QT dispersion, hypertension, and different variants of left ventricular geometry (concentric or eccentric hypertrophy, concentric remodeling). MATERIAL AND METHODS: Blood pressure measurement, electro- and echocardiography were used in the study of a random sample of Tallinn population (321 men and 396 women) aged 35-59 years. Corrected QT dispersion (QT(c)D) equal to or exceeding 70 ms was considered increased. RESULTS: Increase of QT(c)D was associated with left ventricular hypertrophy, especially with its concentric variant. QT(c)D prolongation was significantly more frequent in subjects with hypertension.

[Myocardial mass and geometry in population study of women in Tallinn (echocardiography data)]. / Opredelenie massy miokarda levogo zheludochka i ego geometrii po dannym ékhokardiografii v populiatsionnom issledovanii zhenshchin Tallina.

In a framework of a population study in Tallinn triple blood pressure measurements, electro- and echocardiography were carried out in 398 women (82.6% of all participants) aged 35-59. Left ventricular hypertrophy (left ventricular mass >or=198 g, left ventricular mass/height ratio >or=121 g/m, left ventricular mass/body surface area ratio >or=120 g/m2) was found in 43% of these women. Distribution of variants of left ventricular remodeling was as follows: concentric hypertrophy - 9.1%, eccentric hypertrophy - 33.9%, concentric remodeling - 9.5%, normal myocardial geometry - 47.5%. Only concentric hypertrophy was associated with elevated blood pressure and obesity frequency of both of which increased with age.

[Informative value of programmed electric stimulation of the ventricles, 24-hour ECG monitoring and bicycle ergometry in the diagnosis of electric instability of the myocardium in various clinical variants of stenocardia]. / Informativnost' programmiruemoi élektrostimuliatsii zheludochkov, sutochnogo monitorirovaniia EKG i veloérgometrii v diagnostike élektricheskoi nestabil'nosti miokarda pri variantakh stenokardii.

The informative value of programmed ventricular pacing (PVP), Holter monitoring (HM), and bicycle ergometry (BEM) in the diagnosis of myocardial electric instability was assessed in various clinical types of angina pectoris. An examination was made of 20 patients with first exercise-induced angina (FEIA), 33 with progressive exercise-induced angina (PEIA), 17 with spontaneous angina (SA), 30 with stable exercise-induced angina (SEIA), and postinfarction angina. Myocardial electric instability was estimated from HM and BEM findings in patients with FEIA, SA, as well as in PEIA, SEIA in the presence of preserved myocardial contractility as evidenced by ventriculography. A clear-cut correlation was found between transient myocardial ischemia and the occurrence of high-grade ventricular arrhythmias for the patients from the above-mentioned groups. Lower myocardial contractility despite the nature of angina is an indication for PVP.

[The relation of electric myocardial instability to the intensity of coronary disease--correlation of the data of programmed electrostimulation of the ventricles, selective coronarography and contrast ventriculography]. / Zavisimost' élektricheskoi nestabil'nosti miokarda ot vyrazhennosti ishemicheskoi bolezni serdtsa--sopostavlenie dannykh programmiruemoi élektrostimuliatsii zheludochkov, selektivnoi koronarografii i kontrastnoi ventrikulografii.

Altogether 104 persons with coronary disease were examined in order to determine the correlation between the presence of electric myocardial instability (EMI) identified with the aid of programmed electrostimulation of the ventricles (PESV) and the gravity of injuries to the coronary vessels and to the contractile myocardium of the left ventricle (LV). In accordance with the number of the stimulation-induced recurrent contractions (RC), the patients were distributed into 4 groups. The patients of the second group (4 to 9 RC), of the third group (with unstable tachycardia) and of the fourth group (with stable tachycardia) were considered as having EMI. A marked relationship was discovered between EMI identified with the aid of stimulation and the condition of the contractile myocardium of the LV according to the ventriculography readings (the frequency of recording akinetic and dyskinetic myocardial segments, the magnitude of the end-diastolic pressure). Coronary circulation failure (the degree of stenotic injury to the coronary arteries, the number of impaired vessels) did not determine EMI according to the PESV data.

[ECG in endocardiac electric heart stimulation]. / EKG pri élektricheskoi éndokardial'noi stimuliatsii serdtsa.

An electrocardiographic study was conducted in 126 patients with endocardial electric stimulation from the right-ventricular apex. All electrocardiograms were divided in 6 groups on the basis of the vector direction of the artificial ventricular complex in the frontal aspect and the complex' morphology in right and left standard leads. The clinical value of the proposed classification of artificial ventricular complexes is discussed.