[Auricular vagal stimulation in the treatment of patients with left ventricular dysfunction].

We assessed effect of enhancement of parasympathetic activity by indirect vagal stimulation via sensitive n. vagus-r. auricularis terminals on dynamics of clinical conditions, ejection fraction and global longitudinal left ventricle deformation in patients with chronic cardiac insufficiency (CCI). This comparative placebo-controlled parallel study 3 months in duration included 70 patients with chronic coronary heart disease, signs of IIl-IV FC CCI, and sinus rhythm. Auricular electric vagal stimulation (AEVS) was performed using a device for electric stimulation of sensitive vagus terminals (patent No 2327492 of 27.06.2008). The complex of clinical and instrumental studies included 6 min walk test, echocardiography, and speckle tracking imaging before, immediately and 3 months after AEVS. A course of AEVS improved clinical conditions in 58 (92.06%) of the 63 patients due to one-grade or greater decrease of CCI FC and increase of the walking distance. This effect persisted till month 3. It was absent in 5 (8.33%) patients. Improvement of clinical conditions with the decrease of CCI FC was accompanied by increase of left ventricular ejection fraction due to diminished end-systolic volume. The ejection fraction did not change in 4 patients with HR over 80/min. All patients with lowered HR after AEVS showed improved LV contractility in the longitudinal direction.

[Deformation, rotation, and axial torsion of the left ventricle in coronary heart disease patients with its severe dysfunction].

AIM: To evaluate global left ventricular (LV) systolic longitudinal and circumferential strain rates, rotation, and axial torsion in relation to the type of postinfarction LV remodeling in patients with coronary heart disease (CHD) and severe LV dysfunction. SUBJECTS AND METHODS: Studies were performed in 58 patients with sustained anterior myocardial infarction, an ejection fraction of less than 40%, and NYHA Functional Class IlI-IV heart failure. Three types of postinfarction LV remodeling were identified: 1) with LV apical aneurysm; 2) an intermediate type; 3) with ischemic cardiomyopathy. Global LV systolic longitudinal and circumferential strain rates, end-systolic basal (RotMV/RottMV) and apical (Rot(apex)/RotRapex) rotation, and axial torsion axis were estimated as an indicator of global LV systolic function. RESULTS: No differences were found in the basal global LV longitudinal and circumferential strain rates, basal rotation, and rotation rate between the patients with 3 types of LV remodeling. In the patients with type 1 LV remodeling, the basal rotation was higher than the apical one (RotMV - Rot(apex): -3.085 +/- 2.821 versus 2.293 +/- 1.021; p = 0,002; RotR(MV)--RotRapex: -22.452 +/- 19.823/c(-1) versus 13.641 +/- 10.745/c(-1); p = 0.003). In type 2 postinfarction LV remodeling, the basal and apical rotation values did not differ statistically significantly. Impaired apical rotation (in a clockwise direction) was identified in 5 of the 16 patients with type 3 LV remodeling (Rot(apex): -1.477 +/- 0.392; RotRapex: -30.572 +/- 13.735/c(-1)). There were no differences in the value of LV axial torsion between types 1 and 2 LV postinfarction remodeling (Type 1, 6.714 +/- 3.017; Type 2, 7.463 +/- 5.416). CONCLUSION: It was shown for the first time that there were no differences in global LV longitudinal and circumferential strain rates and end-systolic LV rotation between the patients with types 1 and 2 postinfarction LV remodeling.

[Dynamics of left ventricular longitudinal function in patients with arterial hypertension during therapy with angiotensin converting enzyme inhibitor moexipril].

AIM: To assess left ventricular longitudinal systolic and diastolic function in patients with arterial hypertension in whom regression of left ventricular (LV) hypertrophy (LVH) occurred at the background of long term therapy with angiotensin converting enzyme inhibitor moexipril and hydrochlorothiazide. MATERIAL AND METHODS: Analysis was fulfilled in 44 patients (age 51.76+/-5.58 years) with regression of concentric LVH after 12 months of therapy. Complex examination included tissue Doppler imaging of myocardium and 24-hour blood pressure monitoring. RESULTS: Decrease of myocardial mass (mean 60.26+/-35.92 g) was accompanied with positive dynamics of parameters of 24-hour blood pressure monitoring. We observed decrease of ivrtm from fibrous annulus of mitral valve at the site of interventricular septum, posterior, inferior, and anterior LV walls--in 38 patients (86.4%); increase of motion velocity of mitral valve fibrous annulus during early LV filling at the site of interventricular septum, inferior and lateral LV walls--in 32 patients (72.72%); elevation of systolic velocity of mitral valve fibrous annulus movement at the site of interventricular septum-- in 21 patients (47.73%), and at the site of LV posterior wall--in 28 patients (63.64%). In 35 patients (79.54%) number of segments with e/a <1.0 decreased from 11.41+/-4.42 to 7.92+/-2.81 (p=0.01). In 39 patients (88.64%) number of segments with ivrt >90 ms decreased from 12.73+/-3.67 to 7.33+/-3.54 (p=0.008). In 34 patients (77.27%) regression of LVH was accompanied with elevation of systolic velocity in basal and middle segments of lateral and inferior left ventricular walls.

[Segmental left ventricular function in patients with syndrome X].

Impulse tissue Doppler study of the left ventricle was carried out in 44 patients with cardiac syndrome X (age 47.15+/-6.27 years) and 46 healthy volunteers aged 35-55 years. Maximal peak velocities "s", "e", "a", "e/a" ratio and segmental isovolumic relaxation time "ivrt" were evaluated for each of 18 selected left ventricular segments. Criteria of disturbed segmental diastolic left ventricular function were e/a ratio <1.0 and ivrt >85 ms. Left ventricular filling was abnormal (E/A (min) <1.0) in 18 (40.9%) patients all of whom had segments with e/a <1.0. According to e/a values 18 of 26 patients (69,23%) with E/A (min) >1.0 had segmental dysfunction while 8 patients (30,77%) had intact segmental diastolic function. Patients with and without segmental diastolic dysfunction had different exercise tolerance, nocturnal blood pressure fall, blood levels of glucose and low density lipoprotein cholesterol. Patients with abnormal (IVRT >90 ms) and normal (IVRT 40-80 ms) left ventricular relaxation had similar numbers of dysfunctional segments. Patients with IVRT 80-40 ms and with (n=21) or without (n=4) disturbances of segmental relaxation had different age, left ventricular myocardial mass index and magnitude of myocardial hypoperfusion.

[ACE and AGTR1 genes polymorphisms in left ventricular hypertrophy pathogenesis in humans]. / Polimorfizm genov ACE i AGTR1 v patogeneze gipertorofii levogo zheludochka serdtsa u cheloveka.

The role of A2350G polymorphism in exon 17 of the ACE gene and A1166C - in 3'-UTR of the AGTR1 in the pathogenesis of left ventricular hypertrophy was studied in patients with essential hypertension (EH) and arterial hypertension combined with diabetes mellitus type 2 (AH + DM2). Patients with EH and AH + DM2 did not differ from the control sample of healthy individuals by allele or genotype frequencies. However, an association of both polymorphisms with LVH was detected in EH patients. The frequency of 1166C allele was higher in patients with LVH (33.6% vs 20.7% without LVH). A1166C polymorphism determined the magnitude of left ventricular mass index (LVMI) in EH patients as well (p = 0.007). 2350G allele frequency of the ACE gene was in 1.5, and GG genotype--in 3.5-fold higher in EH patients with LVH, as compared without LVH. LVMI was significantly higher in patients with GG genotype as compared with heterozygotes and AA homozygotes (p = 0.002). Thus the presence of 1166C allele of AGTR1 and 2350G allele of ACE can be considered as predisposing factors for LVH development in EH. In contrast, association of studied polymorphisms with presence or LVH degree was not detected in patients with arterial hypertension combined with DM2. This may indicate another structure of genetic component of predisposition to LVH in different causes.

[Longitudinal global and regional left ventricular function in patients with hypertensive disease (tissue Doppler echocardiography data)]. / Prodol'naia global'naia i segmentarnaia funktsii levogo zheludochka u bol'nykh gipertonicheskoi bolezn'iu po dannym tkanevoi doppler-ékhokardiografii.

Impulse tissue doppler study was carried out in 154 patients with hypertensive disease (age 35-60 years) and 39 practically healthy volunteers (mean age 43.4+/-5.5 years). According to left ventricular geometry the following groups of patients were distinguished (after A.Ganau): with normal geometry (n=47), with concentric remodeling (n=12), with concentric hypertrophy (n=53), and with eccentric hypertrophy (n=42). Tissue doppler spectrum was registered from mitral annulus and 15 left ventricular segments. The following characteristics were obtained: in each annular spectrum - maximal velocities of peaks s(m), e(m), a(m), ratio e(m)/a(m), isovolumic relaxation time (ivrt) and their average values (from 6 measurements); in each left ventricular segmental spectrum - maximal velocities of waves s, e, a, ratio e/a and segmental ivrt. Compared with healthy persons patients with hypertension had lowered longitudinal global systolic function of the left ventricle. Patients with concentric left ventricular hypertrophy had least values of e(m), e(m)/a(m), ivrt(m) and greatest number of dysfunctional (e/a<1.0 and ivrt>90 ms) segments. Some hypertensive patients with normal values of transmitral blood flow had signs of segmental diastolic dysfunction. Among patients with normal left ventricular geometry isolated segmental diastolic dysfunction was revealed according to e/a in 12 of 20 (60%), according to ivrt in 11 of 22 (50%). All patients with concentric and eccentric left ventricular hypertrophy had segmental diastolic dysfunction. Thus impulse tissue doppler study is indicated to patients with hypertension and normal parameters of transmitral flow for assessment of longitudinal segmental diastolic left ventricular function.

[The relationship between the 24 hour arterial pressure profile with heart changes in patients with essential hypertension]. / Vzaimosviaz' sutochnogo profilia arterial'nogo davleniia s izmeneniiami serdtsa u bol'nykh s éssentsial'noi gipertenziei.

A 24-h profile of arterial pressure (AP), structural-geometrical changes of the left ventricle (LV) and severity of hypertensive heart were compared in 47 patients with essential hypertension. Absolute AP and LV geometric models were not related. In patients with concentric LV hypertrophy, the time index (TI) of night systolic hypertension was significantly higher than TI in excentric LV hypertrophy. A relationship was found between mean day systolic pressure, a morning rise in AP and form of LV hypertrophy. The severity of hypertensive heart correlated with TI of 24-h systolic arterial pressure (SAP), TI of 24-h diastolic arterial pressure (DAP), mean 24-h SAP, mean daytime SAP, mean night SAP, mean 24-h DAP, mean daytime DAP, a morning rise in DAP. Thus, a 24-h AP profile, a morning rise in DAP, 24-h hypertension time correlate with LV structural-geometric changes and severity of hypertensive heart.

[Polymorphism of angiotensin-converting enzyme and endothelial nitric oxide synthase genes in people with arterial hypertension, left ventricular hypertrophy, and hypertrophic cardiomyopathy]. / Polimorfizm genov angiotenzin-prevrashchaiushchego fermenta i éndotelial'noi sintazy okisi azota u lits s arterial'noi gipertenziei, gipertrofiei levogo zheludochka i gipertroficheskoi kardiomiopatiei.

Data on polymorphism of the angiotensin-converting enzyme (ACE) and endothelial cell nitric oxide synthase (NOS3) genes in patients having arterial hypertension (AH) with or without left ventricular hypertrophy (LVH) and those with hypertrophic cardiomyopathy (HCM) are presented. An association between polymorphism for the ACE and NOS3 loci and the LVH index among AH patients with LVH and HCM was shown. In AH patients, an association between the NOS3 locus polymorphism and some parameters of blood pressure was revealed. Possible relationships between the ACE and NOS3 polymorphisms and the clinical manifestation of the LVH and AH are discussed.

[The antianginal action of calcium antagonists: the results of instrumental examination and their clinical assessment]. / Antianginal'noe deistvie antagonistov kal'tsiia: rezul'taty instrumental'nogo obsledovaniia i ikh klinicheskaia otsenka.

In 88 patients with coronary heart disease and stable exercise-induced angina pectoris, the efficiency of calcium antagonists was examined by using myocardial Tl-199 scintigraphy and comparing its data with the parameters of angiography and their intracoronary injection. Three types of therapy-induced changes in myocardial perfusion were identified, which were as follows: 1) significant decreases in hypoperfusion area dimensions; 2) no changes in scintigraphic parameters, and 3) clinically asymptomatic increases in the number of hypoperfused sectors. There was a relationship between the therapy-induced changes and the number of sclerotic arteries though the ability of large coronary vessels to dilate was substantially decreased, as shown by angiopharmacological studies.

[The effect of cilazapril on left ventricular function and myocardial perfusion in patients with essential hypertension (hypertensive disease) stage II]. / Vliianie tsilazaprila na funktsiiu levogo zheludochka i perfuziiu miokarda u bol'nykh s éssentsial'noi gipertoniei (gipertonicheskoi bolezn'iu) II stadii.

22 patients (mean age 45.08 +/- 1.38 years) with essential hypertension stage II were entered in a placebo-controlled blind trial of cilazapril, angiotensin-converting enzyme. A complex of clinical-instrumental tests comprised dipidamol test, bicycle ergometry, 199Tl myocardial scintigraphy, echo-CG. A 3-month course of cilazapril reduced myocardial hypoperfusion in 15 patients, improved left ventricular relaxation: Anti-ischemia effect of the drug was also evident.

[Study of myocardial perfusion in patients with hypertension]. / Izuchenie perfuzii miokarda u bol'nykh gipertonicheskoi bolezn'iu.

Exercise 199Tl myocardial scintigraphic data were studied during dipyridamole test in 39 patients with Class II essential hypertension. Transient myocardial perfusion defects were revealed in 60% of patients with negative exercise test. Intraventricular administration of albumin microspheres in 8 females with normal coronary artery allowed the authors to detect areas of their accumulation at the same sites as in exercise 199Tl myocardial scintigraphy. Thus, the changes in the small vessels which are revealed by intraventricular albumin microspheres are one of the causes of impaired myocardial perfusion in patients with essential hypertension.

[Bicycle ergometry in the diagnosis of cardiac lesions in chronic tonsillitis]. / Veloérgometriia v diagnostike porazheniia serdtsa pri khronicheskom tonzillite.

Bicycle exercise test, load myocardial 99mTc pyrophosphate (99mTc-PYP) scintigraphy and echocardiography were performed in 42 women with chronic tonsillitis between the ages of 18 and 35 years. Of the 21 patients with chronic decompensated tonsillitis combined with ventricular extrasystole and horizontal ST segment depression during the exercise test 18 exhibited diffuse myocardial 99mTc-PYP uptake. Patients with positive scintigraphic findings had reduced index of left-atrium emptying compared with controls and patients with a negative 99mTc-PYP test finding.