Changes in local left and right ventricular myocardial contractility in patients with recurrent atrial fibrillation

Aim. To evaluate local contractility of left and right ventricular (LV, RV) myocardium, as well as its dynamics in acute drug test (AMT) with nitroglycerin (NG) in patients with recurrent atrial fibrillation (AF), during sinus rhythm maintenance period. Material and methods. The study included 120 patients aged 39-82 years (mean age 61.3±8.9 years): 20 patients with recurrent AF and arterial hypertension (AH) (Group IA); 50 patients with coronary heart disease (CHD) and recurrent AF (Group IB); 50 individuals from control group (Group II). To assess inotropic myocardial function, balanced radionuclide ventriculography was performed in all participants. Local LV and RV contractility was studied in unified 16-segment ventricular model. After registering baseline hemodynamic parameters, local contractility was assessed again in ADT with NG – 30 minutes after sublingual NG administration (0.5-1.0 mg). Results. In Groups IA and IB, local hypo- and akinesis were observed. In ADT with NG, patients from Groups IA and IB demonstrated improved local contractility: akinetic segment number significantly reduced, normokinetic LV and RV zone number substantially increased. In Group II, during ADT with NG, local contractility increased due to hypokinetic segments. Conclusion. Local contractility disturbances in patients with recurrent AF during sinus rhythm maintenance were manifested as hypo- and akinetic zones. In ADT with NG, patients demonstrated significant improvement of local contractility, due to decreased number of akinetic segments. In control group, number of hypokinetic segments significantly decreased

Renal hemodynamics disturbances in early stages of arterial hypertension in young patients

Arterial hypertension (AH) is the most prevalent disease worldwide, with general population prevalence of 15-20%. Despite being typically diagnosed after the age of 50, recently AH becomes more prevalent in adolescents and young adults. Aim. To identify the first clinical signs of renal pathology in young patients (under 35) with initial stages of AH. Material and methods. Forty-two men with Stage I-III AH, aged 15-35 (mean age 21.7±5.6 years), were examined. AH duration varied from 1 to 7 years (3.6±3.0). Mean systolic blood pressure (BP) level was 149.35±9.03 mm Hg, diastolic BP – 93.48±5.32 mm Hg. In all participants, general clinical examination, renal dynamic angioscintigraphy with DTPA-Tc99m, and ophtalmoscopy were performed. Results. Renal dynamic angioscintigraphy with DTPA-Tc99m revealed various renal hemodynamics abnormalities in 98% of the patients (n=41). In most individuals (94%; n=39), renal blood flow was reduced. Ophtalmoscopy revealed initial stages of hypertensive retinopathy in 22 patients (52%). Participants with hypertensive retinopathy experienced decrease in renal blood flow of Stage II-III more often, by 17%: the decline was registered in 77% and 50% of the patients with or without hypertensive retinopathy, respectively. Therefore, retinopathy was associated with more severe abnormalities of renal hemodynamics. Conclusion. In early AH stages, young patients, aged under 35, experience vascular remodeling even with high BP anamnesis as short as 1-7 years. There is a need for early administration of antihypertensive therapy, especially ACE inhibitors

Smoking effects on renal function in young men with early stages of essential arterial hypertension

Aim. To study smoking effects on renal damage progression in young men with early stages of essential arterial hypertension (AH). Material and methods. The study included 118 AH men aged 18–35 years (mean age 22,1±4,54 years). AH duration varied from 1 to 8 years (mean duration 4,14±2,1 years). Self-reported smoking prevalence (>1 cigarette per day) was 52 % (n=61). Smokers and non-smokers were comparable by age, AH duration, body mass index, and other cardiovascular risk factors. All participants underwent dynamic renal angioscintigraphy, with intravenous Tc99m DTPA administration and glomerular filtration rate (GFR) assessment. Results. According to dynamic renal angioscintigraphy data, GFR levels differed significantly in smokers and non-smokers with Stage I AH. In Stage II and III AH, the difference was not statistically significant. Conclusion. Smoking facilitated hyperfiltration progression in Stage I AH young men, comparing to non-smoking patients

Acute nitroglycerin test for predicting perindopril therapy effectiveness in patients with coronary heart disease and chronic heart failure

Aim. To assess the role of acute nitroglycerin test (ANT) for predicting perindopril therapy effectiveness in patients with coronary heart disease (CHD) and chronic heart failure (CHF). Material and methods. In 127 CHD and CHF patients, assessment of left and right ventricular (LV, RV) contractility was performed, by balanced biventricular radioventriculography and segmental histogram analysis, according to standard protocol. The assessment was performed at baseline ANT and after 6 months of perindopril therapy. By ejection fraction (EF) figures, all participants were divided into two groups: Group I consisted of 89 patients with CHD an Functional Class (FC) II-III CHF, LVEF>40%; Group II included 38 CHD patients with FC III-IV CHF, LVEF<40%. Results. In ANT, Group I demonstrated significant increase in total LVEF, from 62.5±8.4% to 68.0±8.2%, some increase in RVEF, and significant decrease in end-diastolic and systolic volumes (EDV, ESV) - by 21.4 and 40.1%, respectively (р<0.05). In Group II, ANT was associated with increase in total LVEF, from 22.6±10.8% to 30.7±15.3% (р<0.02); RVEF increased from 30.4±13.3% to 37.2±13.8% (р<0.05); EDV and ESV did not change significantly. In both groups, zones of local dyskinesia Р hypo- and akynesia Р were identified. During ANT, the number of normokynetic zones increased, the number of hypokinetic zones decreased, especially in LV anteroseptal area. In patients with EF<40%, the number of LV lateral wall akynetic zones reduced significantly. After 6-month perindorpil treatment, local EF increased in LV lateral wall segments (Group I) and lateral wall (Group II), that correlated with substantial total EF increase. Conclusion. Improvement of local contractility in ANT was due to LV and RV zones with reversible dysfunction. Improved total and local contractility in ACT gives a chance to assess perindopril effectiveness in patients with CHD and FC II-IV CHF

THE INFLUENCE OF LONG-TERM THERAPY WITH PERINDOPRIL ON THE HEART INOTROPIC FUNCTION IN PATIENTS WITH CHRONIC POSTINFARCTION ANEURISM

Aim. To study the influence of long-term therapy with perindopril on the heart inotropic function in patients with chronic postinfarction aneurism. Material and methods. 21 patients suffering ischemic heart disease with postinfarction cardiosclerosis, chronic aneurism of left ventricle and chronic heart failure of functional class III-IV according to NYHA were observed. All patients took perindopril, 2-4 mg daily. Before and after 6 months of therapy myocardial contractile function of left and right ventricles was studied by balanced radioventriculography with segmental and phase analysis of histogram. Results. In patients with chronic postinfarction aneurism significant structural and functional abnormalities were revealed: reduction of left ventricular ejection fraction up to 17,8 ± 3,2 %, the same for right ventricular up to 22,1±4,4 %, their considerable dilation with reduction of filling and expulsion velocity. After 6 months of therapy with  perindopril  improvement of clinic status of patients, tendency towards  increase of both ventricles general ejection fraction, enlargement of maximal filling velocity and filling velocity during 1/3 of diastole as well as tendency to reduction of both ventricles end diastolic and systolic volumes were registered. In left ventricle there were normokinetic zones in 35 (21%) segments, hypokinetic zones in 24 (14%), akinetic zones in 54 (32%) and dyskinetic zones in 17 (10%) segments. In right ventricle there were normokinetic zones in 45 (27%) segments, hypokinetic zones in 62(37%), akinetic zones in 54 (32%) and dyskinetic zones in 7 (4%) segments. After 6 months of therapy with perindopril tendency towards improvement of local myocardial contractility was registered. Conclusion. In patients with chronic postinfarction aneurism deterioration of general and local myocardial contractility were registered. Accurate link between left ventricle local myocardial contractility and localization of aneurism were not revealed. After 6 months of therapy with perindopril tendency towards improvement of general and local myocardial contractility of both ventricles was registered

Left and right ventricular diastolic dysfunction in patients with coronary heart disease and initial stages of chronic heart failure

Aim. To study left and right ventricular (LV, RV) diastolic dysfunction in patients with coronary heart disease (CHD) and initial stages of chronic heart failure (CHF). Material and methods. In total, 64 patients with CHD and NYHA Functional Class (FC) I-II CHF (31 men, 33 women; mean age 58,9±2 years) underwent LV and RV myocardial contractility assessment, by balanced radioven-triculography (BRVG), with segmental histogram analysis. Control group included 19 relatively healthy individuals aged 17-48 years. Results. LV and RV ejection fraction was normal in all participants: 63,6+4,6% and 53,4±5,2%, respectively. At the same time, diastolic dysfunction - decreased peak filling velocity - was registered: 259±25%/s and 194±22%/s, as well as decreased 1/3 diastolic filling: 25,9±4,9%/s and 18,3±3,2%/s, respectively. Local dyskinesia was registered for both LVandRV. In LV, 321 segments (62,9%) were normokinetic, 163 (31,8%) - hypokinetic, and 28 (5,4%) - akinetic. Normokinetic zones localized in intraventricular septum (IVS), posterior or lateral LV walls (91%), hypokinetic (85,8%) and akinetic zones (85,7%) - in superior IVS and anterior wall. InRV, prevalence of hypo- or akinetic zones reached 43,5%. Akinetic (70%) and hypokinetic (49%) zones were situated in free RVwall, normokinetic segments (84%) - in anterior-septal RVarea. Conclusion. In CHD patients with initial stages of CHF, LV and RV diastolic dysfunction was observed, manifesting in LV and RV local dysfunction. Maximal segmental contractility abnormalities were registered in LV anterior-septal area and RV free wall

Renal hemodynamics disturbances and microalbuminuria in young patients with arterial hypertension

Aim. To identify the first clinical signs of renal pathology in young patients (under 35) with initial stages of arterial hypertension (AH). Material and methods. Fifty-seven men with Stage I-II AH, aged 15-35, were examined. Exclusion criteria were: secondary AH, chronic renal or urologic pathology, diabetes mellitus in anamnesis. In all participants, renal dynamic angioscintigraphy with DTPA-Tc99m, and ophtalmoscopy, to determine the stage of hypertensive rethinopathy, were performed. In 27 patients, 24-hour microalbuminuria (MAU) was assessed. Results. Renal dynamic angioscintigraphy with DTPA-Tc99m revealed various renal hemodynamics abnormalities in 98% of the patients (n=56). In most individuals (94%; n=53), renal blood flow was reduced bilaterally. Significant bilateral reduction of renal blood flow, of Stage II-III (<420 ml/min, with norm of 690±60 ml/min), was registered in 39 individuals (68%). MAU was revealed in 8 out of 27 examined patients (30%); its mean level was 64.8±15.2 mg/l. Participants with MAU more often experienced Stage II-III decrease in renal blood flow (<420 ml/min, with norm of 690±60 ml/min). Conclusion. At early AH stages, young male patients, aged under 35, experienced renal function remodeling, despite short AH duration. The remodeling manifested in renal blood flow decrease, glomerular filtration rate disturbances, and MAU development

Circadian blood pressure rhythm and renal function in males with essential arterial hypertension

Aim. To assess blood pressure (BP) increase type and circadian BP profile in young hypertensive men aged under 35 years. To describe the association between renal function and 24-hour BP monitoring (BPM) parameters. Material and methods. Twenty-four-hour BPM was performed in 58 patients by «SpaceLabs»device (USA), during 24 hours, with 15-minute intervals in daytime (7 AM - 11 PM), and 30-minute intervals in nighttime (11 PM - 7 AM). Dynamic angionephroscintigraphy with DTPA 99mTc was performed in all participants. Most young patients had Stage I arterial hypertension (AH) (n=51; 43%), or Stage II AH (n=49; 42%). Stage III AH was diagnosed in 18 individuals (15%). Results. Transitory AH was diagnosed by temporal index (TI) in 36 patients (72%). Stable AH with AH TI>50% was observed in 14 participants (28%). Glomerular hyperfiltration was more manifested in stable AH, comparing to transitory AH: 132.0±33.5 ml/min vs 165.57±38.5 ml/min (р=0.04). Significant difference in mean glomerular filtration rates (GFR) was observed in patients with isolated inadequate systolic BP (SBP) decrease, or simultaneous inadequate SBP and diastolic BP (DBP) decrease. In patients with disturbed SBP rhythm, hyperfiltration was observed. Circadian BP profile disturbances were associated with lower mean GFR. Conclusion. In stable AH, hyperfiltration is significantly more pronounced, that is a symptom of kidney pathology as target organ damage. Twenty-four-hour BPM helped to identify a substantial group of patients non-dippers among young males: in 60% of participants, for SBP, in 24% - for SBP and DBP. Circadian BP rhythm disturbances resulted in hyperfiltration development, and inadequate DBP decrease – in reduced GFR

Renal function and morning surge rate of systolic blood pressure in young hypertensive men aged under 35 years

Aim. To investigate the link between renal function and morning surge rate (MSR) of systolic blood pressure (SBP) in young men with arterial hypertension (AH), aged under 35 years.Material and methods. The study included 58 young men with essential AH, aged 18-35 years (mean AH duration 4+1,5 years). Twenty-four-hour BP monitoring (BPM), dynamic angionephroscintigraphy with DTPA 99mTc, and 24-hour microalbuminuria assessment were performed in all participants.Results. In patients with normal SBP MSR, mean total glomerular filtration rate (GFR) was 151,6+38,9, among patients with elevated SBP MSR - 125,4+36,9 (p=0,06). Among those with normal SBP MSR, mean total GFR was 140,4+34,7 in Stage II AH, and 190,5+28,9 in Stage III AH (p=0,07). Among subjects with elevated SBP MSR, mean total GFR was 174+27,2, 117,2+33,1 (p=0,01), and 125,5+37,1 in Stage I, II, and III AH, respectively.Conclusion. AH progression was associated with higher prevalence of elevated SBP MSR. For AH patients with normal SBP MSR, hyperfiltration was more typical, while subjects with elevated SBP MSR were characterized by progressively decreasing total GFR, from hyperfiltration to normofiltratio

Intraventricular septum role in chronic heart failure pathogenesis

Aim. To study intraventricular septum (IVS) role in left and right ventricular (LV, RV) contractility among patients with coronary heart disease (CHD) and chronic heart failure (CHF). Material and methods. In total, 117 CHD patients with NYHA Functional Class (FC) I-IV CHF (mean age 58±4,1 years), underwent IV and RV inotropic function assessment by standard balanced biventricular radioventriculography For local myocardial contractility assessment, a unified 16-segment IV and RV model was used. Results. Local LV and RV segmental contractility was analyzed. Segments with local ejection fraction (EF) >50% were regarded as normokinetic, 25-50% - as hypokinetic, and <25% - as akinetic. Total EF in all patients with FC I-II CHF was normal. At the same time, segmental hypo- and akinesia were registered mostly in anterior-septal area of LV and RV. In FC III CHF, LV EF decrease was associated with local IVS akinesia and LV free wall dyskinesia. RV EF was reduced to 38,4±4,8%, associating with local IVS dyskinesia due to pulmonary hypertension. In FC IV CHF, LV EF reached 15,1±4,1%, and RV EF - 25,9±6,8%, with pronounced segmental dys- and akinesia in septal area and free walls of LV and RV Conclusion. In CHD patients with initial CHF, local contractility disturbances were registered in IVS segments. CHF progression was associated with LV and RV EF decrease, as well as with local hypo-, dys-, and akinesia