[Determination of neurometabolism in patients with mild and moderate cognitive impairments].

OBJECTIVE: To estimate the diagnostic value of neuropower mapping (NPM) and positron emission tomography (PET) and their relationships in the evaluation of neurometabolism in patients with predementia cognitive impairments. MATERIAL AND METHODS. The investigation enrolled 125 patients wvith clinical signs of cognitive impairments. The patients were divided into 4 groups: 1) predementia cognitive impairments (PCI) in the presence of cerebrovascular disease (CVD); 2) PCI in the presence of psychoautonomic syndrome (PAS); 3) PCI in the presence of sequels to acute cerebrovascular accident (SCVA); 4) PCI in the presence of toxic, dysmetabolic, hypoxic encephalopathies (TDHEP). All the patients underwent NPM and 55 patients had PET. RESULTS AND DISCUSSION: NPM and PET revealed neurometabolic disturbances in 100 and 46.3% of cases, respectively. The sensitivity of NPM was significantly higher than that of PET. The highest number of diffuse and diffuse-focal hypometabolism cases (n = 19 (63.3%)) were seen in the CVD and SCVA groups. CONCLUSION. 1. NPM and PET assess two aspects of brain neurometabolism. 2. PET hypometabolism characterizes either structural organic abnormalities in the brain in the presence SCVA or initial manifestations of the neurodegenerative process. 3. NPM readings characterize the activity, strength of metabolic responses, that is to say, cerebral reactivity. 4. PET readings are important in determining the prognosis of disease and NPM ones are essential in defining drug treatment policy.

[Noninvasive radiodiagnosis of left ventricular diastolic dysfunction in hypertensive patients].

UNLABELLED: To define the informative value of Doppler studies in the early diagnosis of left ventricular (LV) diastolic dysfunction in patients with hypertensive disease (HD), the authors examined 74 patients with grade 1-2 HD, including 65 men and 9 women aged 43 to 63 years. All the patients underwent echocardiography (echoCG), Doppler echoCG (DechoCG), tissue DechoCG (TDechoCG), and treadmill. According to the echoCG LV mass index (LVMI), all the patients were divided into 2 groups: 1) 33 patients with increased LVMI and 2) 41 with normal LVMI. A control group consisted of 20 apparently healthy patients. Groups 1 and 2 showed a preponderance of patients with concentric LV hypertrophy (CLVH) and those with concentric LV remodeling, respectively. In accordance with DechoCG, the signs of primary LV diastolic dysfunction ((E/A = 0.8+/-0.1; IVRT = 103+/-15) were found only in Group 1 patients. TDechoCG displayed the signs of primary LV diastolic dysfunction in both groups (e' or =10 ratio, suggests elevated LV filling pressure as an early stage of diastolic dysfunction.

[Tissue Doppler imaging during dipyridamole and dobutamine stress echocardiography in the diagnosis of coronary heart disease].

The aim of the study was to determine the sensitivity and specificity of combined high-dose dipyridamole and dobutamine stress echocardiography (stress EchoCG) in the diagnosis of coronary artery stenotic lesions in coronary heart disease in a group of patients who were unable to perform physical exercise, by using different assessment criteria (local contractile impairments and systolic velocity changes during tissue Doppler imaging). The study enrolled 68 men who had undergone dipyridamole and dobutamine stress EchoCG, longitudinal tissue Doppler imaging, and coronary angiography. Stress EchoCG could bring up to diagnostic criteria in all the patients. Coronary angiography revealed no coronary artery lesion in 18 patients, but showed single and multiple vascular lesions in 31 and 19 patients, respectively. The sensitivity and specificity of combined stress EchoCG were significantly higher than those of stress EchoCG examination. The results of combined stress EchoCG allow one to judge to a greater validity (96% sensitivity and 100% specificity) local contractile impairments corresponding to the blood supply area in the atherosclerosis-afflicted coronary artery. Analysis of systolic velocity parameters during tissue Doppler imaging permits the diagnostic value of the technique to be insignificantly improved particularly when the test results are controversial.

[Noninvasive radiodiagnosis of late coronary stent stenoses].

OBJECTIVE: To study the diagnostic value of stress echocardiography (stress echoCG) in the early diagnosis of coronary stent stenoses in the late postoperative period. SUBJECTS AND METHODS: The study enrolled 39 men aged 37 to 58 years with symptoms of cardialgia, who had previously (3 to 8 years earlier) undergone balloon angioplasty and coronary artery stenting to treat coronary heart disease. To exclude coronary stent stenoses, all the patients had dobutamine stress echoCG, transesophageal atrial electrostimulation, and further coronary angiographies (CAG). RESULTS: Stress echoCG showed a lesion of the stented coronary artery in 34 patients and that of previously angiographically intact coronary arteries in 5 patients. According to CAG data, there was stenosis of > 70% in the coronary stent lumen in 16 patients and that of 40 to 70% in 12 patients. Six patients were found to have de novo stenoses in the previously stented coronary artery. Stress echoCG showed that the diagnostic accuracy and sensitivity of both stenoses of intracoronary stents and de novo ones in the stented artery and previously intact coronary arteries was 100%. CONCLUSION: Stress echoCG is a highly informative method for the early topical diagnosis of both stenoses of coronary stents and a stenotic lesion of previously intact portions of coronary arteries. The early diagnosis of coronary stent stenoses permits mini-invasive endovascular treatment to be performed.

[Complications of stress-echocardiography used for diagnosis of ischemic heart disease].

Prevalence of minor and major complications, side effects of stress echocardiography (stress-echoCG) was studied in a group of 1359 patients with suspected ischemic heart disease (IHD). Dipyridamole/atropine test was carried out in 184, dobutamine/atropine test - in 231, transesophageal atrial pacing (TEAP) - in 154, veloergometry (VEM) in half sitting position - in 122, and combination stress-echoCG - in 668 patients (dipyridamole/TEAP, n=151; dipyridamole/dobutamine, n=162; dipyridamole/paired TAP, n=112). We classified ventricular and supraventricular extrasystoles, head ache, nausea, muscular tremor as side effects, short paroxysms (less than 2 min) of hemodynamically insignificant supraventricular and ventricular tachycardia - as minor complications, and development of acute coronary syndrome, ventricular fibrillation - as major complications. Most frequent side effects during stress-echoCG were rare ventricular extrasystoles (26.0% during dobutamine, 18.9% during VEM test), and head ache (16,7% in dipyridamole tests). Major complications occurred in 2 cases (0,147%). One patient during standard dipyridamole test developed acute coronary syndrome requiring urgent coronary angiography and angioplasty of the right coronary artery. Another patient after administration of 0.25 ml of 0.1% atropine solution at the background of dobutamine infusion (40 mcg/kg/min) had ventricular fibrillation requiring resuscitative measures. Although stress-echoCG in general is a safe and highly informative method of diagnosis of IHD it can be accompanied with side effects during action of stress-agents, minor and major complications during conduction of tests. This dictates necessity of obtainment of compulsory informed consent from patients.

[Value of various criteria of assessment of a test in stress echocardiography in diagnosis of ischemic heart disease].

Aim of investigation was to study significance of electrocardiographical and echocardiographical criteria of development of angina attack, and their combination in assessment of results of stress echocardiographical tests (stress-echo) with various stress-agents. Stress echocardiography, coronary angiography and left ventriculography were carried out in 928 patients (805 men and 123 women) aged 31 - 72 years with suspected ischemic heart disease (IHD). Attack of angina (AA) was registered in 324 cases, 1.5 mm ST-segment depression (Scapital TE, Cyrillic) -- in 448 tests, disturbances of local myocardial contractility (DLC) at piece exercise -- in 625 patients. Coronaro-ventriculography did not reveal hemodynamically significant coronary artery lesions in 235 patients. Accuracy, sensitivity, and specificity of assessment of stress-echo result were for criterion "ST" 62.1, 56.9, 77.4%, respectively, for criterion "AA" - 50.0, 40.7, 87.0%, respectively, for criterion DLC - 90.7%, 88.9%, 96.2%, respectively, for combinations of criteria "ST+DLC" - 46.1, 30.6, 91.9%, "ST+AA" -- 66.7, 56.1, 97.8, respectively, for "DLC+AA" -- 54.9, 40.5, 97.4%, respectively. Echocardiographic criterion DLC appears to be determinant in assessment of results of stress-echo tests.