[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.

[Heart rate and QT-interval dispersion with consideration of left ventricular geometry in a population study of men and women aged 35-59 years].

Interrelationships between heart rate (HR), parameters of QT interval dispersion on resting ECG and four variants of echocardiographically defined left ventricular geometry were elucidated in 723 participants of a population study of inhabitants of Tallinn aged 35-59 years. Examination included anthropometry, blood pressure (BP) measurement, registration of ECG and echocardiography. None of normotensive examinees had concentric left ventricular hypertrophy. Among men with normal BP eccentric left ventricular hypertrophy was very rare (0.88%) and contrary to normal left ventricular geometry was associated with highest values of HR and QTD, QTc, QTDc. Among normotensive women eccentric left ventricular hypertrophy was found in 35.3% of cases and was associated with lowest values of HR while parameters of QT interval dispersion were similar to those observed in other variants of left ventricular geometry. Both men and women with hypertension and left ventricular hypertrophy had significantly lower HR and higher values of QT interval dispersion compared with hypertensives with normal left ventricular geometry. In men HR was positively related to age, systolic and diastolic BP and left ventricular myocardial mass index. In women relationship between HR, BP and age was very weak. Relation of HR to left ventricular myocardial mass index was more noticeable although turned out to be inverse.

[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.

[The importance of ambulatory ECG monitoring for determining the prognosis of patients with stable stenocardia]. / Znachenie ambulatornogo monitorirovaniia EKG dlia opredeleniia prognoza u bol'nykh so stabil'noi stenokardiei.

149 patients with coronary artery disease and stable angina pectoris underwent coronary angiography and had coronary artery stenosis over 50 per cent. All the patients were also subjected to 24-h Holter monitoring at primary examination and 12-18 months after it. Typical ischemic ST changes were defined by transient horizontal or descending ST depressions > 1.0 mV (measured 80 ms after the J point) lasting at least for a minute. 75 (50.3 per cent) patients had episodes of silent myocardial ischemia. The course of the disease was assessed in follow-up period of 12-18 months. Four variants of the course were determined: cardiac events (16 patients), the disease progression (33 patients), a stable course (75 patients), clinical remission (25 patients). A significant correlation between the occurrence, the slope and duration of silent ischemia, the data of selective coronary angiography and clinical course of ischemic heart disease was established. Cardiac events occurred in 87.5% of the patients with silent myocardial ischemia who had total ischemic burden 30 minutes or more and/or ST-segments decrease 3.0 mm and more during heart rate less than 100 beat-min. The stable course was registered in patients with silent ischemia or without it with similar frequency. Clinical remission of angina pectoris in the patients with silent ischemia was observed rarely. The results of this study demonstrate that silent ischemia is an important prognostic factor.

[The outcome and course of IHD in patients with normal and altered coronary arteries under 10-15 years of observation]. / Iskhod i techenie IBS u bol'nykh s normal'nymi i izmenennymi koronarnymi arteriiami pri 10-15-letnem nabliudenii.

The course and prognosis of ischemic heart disease (IHD) were studied in 175 anginal IHD patients regularly examined coronarographically for 10-15 years. The clinical, bicycle ergometry and coronarography findings have given evidence for design of prognostic risk criteria. The first 3 years of the follow-up have shown cases of lethal and transmural myocardial infarction to occur only in high-risk group. Low-risk patients developed transmural myocardial infarction on follow-up year 7, while lethal outcome occurred 14 years after the start of the observation. In patients with normal or insignificantly changed coronary arteries the above events were not observed.

[Silent myocardial ischemia in patients with ischemic heart disease in assessing the severity of the disease]. / Bessimptomnaia ishemiia miokarda u bol'nykh ishemicheskoi bolezn'iu serdtsa v otsenke tiazhesti zabolevaniia.

Ninety patients with angiographically confirmed diagnosis of coronary heart disease were examined. The ECG exercise test and Holter ECG monitoring were carried out. Silent ischemia (SI) was revealed in 40 patients (44.4%). According to the data of examinations, the patients with SI episodes were clinically graver than those without SI. In the SI group, 60% of the patients had prognostic criteria of a clinically high coronarographic risk, namely stenosis of the trunk of the left coronary artery, dangerous localisation of one or more arteries in "incomplete" myocardial infarction, and significant sclerosis of three main coronary arteries. Practically all the patients were at high risk for SI episodes. The probability of a high risk increases if SI is associated with such factors as the total ischemic burden of more than 30 minutes and ST depression magnitude equal to 1.5 mm in the ECG exercise test or 3 mm in Holter ECG monitoring.

[Clinical and functional characteristics of patients with ischemic heart disease in long-term remission of angina pectoris]. / Kliniko-funktsional'naia kharakteristika bol'nykh ishemicheskoi bolezn'iu serdtsa s dlitel'noi remissiei stenokardii.

Long-term (5-15-year) prospective surveys of 171 angina patients have yielded clinical, coronarographic, and bicycle ergometric criteria for predicting the favourable course of the disease. A prolonged (at least 3 years) clinical anginal remission was observed in 43 (25.1%) patients. The patients had typical features: a short (less than 6-9 months) history of classical angina, the age at the onset of CHD under 50 years; high performance during bicycle ergometric test, lack of angina after sustained so-called "accomplished" myocardial infarction. The coronarograms of patients with a long-term anginal remission most frequently displayed severe stenosis or occlusion of "unsafe" site of a large coronary artery. The duration of remission was less than 10 years if atherosclerosis also affected the remaining coronary arteries. That of remission was more than 10-15 years, if the remaining coronary arteries proved completely intact.

The use of lipid indicators and indexes for assessment of ischaemic heart disease.

The informative value of various lipid indicators and indexes in healthy subjects and in patients with ischaemic heart disease (IHD) is compared. In 10 investigated biochemical indicators significant differences were found between healthy people and subjects with epidemiological or clinical signs of IHD. The first places in the order according to Anderson-Bahadur intervals were held by the cholesterol atherogenity index, total cholesterol (CS) and the percent of high-density lipoproteins cholesterol (HDL-CS) in total CS. The cholesterol atherogenity index and HDL-CS percent in total CS were closely correlated with the severity of angiographically proved changes in the coronary arteries.

[Data on repeated studies on the blood lipid levels in evaluating the severity of chronic ischemic heart disease]. / Dannye povtornykh issledovanii sederzhaniia lipidov v krovi v otsenke tiazhesti khronicheskoi ishemicheskoi bolezni serdtsa.

During 3 years cholesterol, triglyceride and lipoprotein levels were repeatedly determined in the blood of 125 patients with coronary disease, and the severity of the disease was assessed with bicycle ergometry and coronarography. A relationship has been established between the severity of the disease and its course and the degree of disorders in the lipid metabolism. Group with stable normolipidemia (28%) showed less manifest symptoms of the disease and absence of rapid progression with new coronary accidents. Groups with hyperlipoproteinemia both stable (52.8%) and transient (19.2%) had predominantly severe forms of the disease running unfavourable course. The more frequent with severe and extended, according to angiography atherosclerosis of the coronaries and unfavourable course of disease were associated with hyperlipoproteinemia type II.

[Metabolic mechanisms of different types of disuse muscular atrophy]. / Metabolicheskie mekhanizmy atrofii myshts raznogo tipa pri ikh bezdeistvii.

Radiotracer studies in vivo on protein biosynthesis have been made in red (m. soleus) and white (m. extensor digitorum longus) rat shin muscles during their disuse atrophy caused by foot exarticulation. The rate of protein biosynthesis (as calculated per mass unit of total RNA) was increased in the white muscle on the 4th and 14th days, being unaltered on the 7th day after the surgery, but this rate was decreased in the red muscle at all these stages. The data obtained suggest that all these stages. The data obtained suggest that the atrophy, more pronounced in the red muscle than in the white one, can be mainly attributed in the former to decreased protein biosynthesis but in the latter to the increased protein degradation.

[Rifampicin in the therapy of gonorrheal urethritis in men]. / Rifampitsin v terapii gonoreinykh uretritov u muzhchin

The therapeutic efficiency of benemycin (rifampicin of Polish production), a semisynthetic antibiotic was studied in 96 male cases with gonorrhea urethritis. The antibiotic was used in a dose of 300 mg every 6 hours (2.1--3gm for the treatment course depending on the desease severity). Observation of the patients for 1--2 months showed etiological recovery in 91 (94.8 per cent) out of 96 patients. Postgonorrhea inflammatory processes were observed in 8.7 per cent of the cases. For studying late results of the treatmant 62 patients were observed for 3 to 12 months. Gonococci were isolated from none of the patients. No side reactions were found in the patients treated with rifampicin.