Differential effects of nebivolol and atenolol on transmitral diastolic filling parameters in patients with essential hypertension

INTRODUCTION: Impaired left ventricular (LV) diastolic relaxation, detected by pulsed Doppler echocardiography, is predictive of a higher incidence of major cardiovascular events in hypertensive patients. An improvement in LV diastolic function is an important goal of treatment. However, treatment of LV diastolic dysfunction remains empirical. The objective of our study was to compare the short-term effects of nebivolol and atenolol on Doppler diastolic filling parameters in hypertensive patients. METHODS: A total of 32 patients with mild-to-moderate hypertension were enrolled in the study. The patients were randomly assigned to receive treatment with either nebivolol (5 mg/day) or atenolol (50 mg/day) for 1 month. Diastolic filling parameters, with pulsed-wave Doppler transmitral flow velocities, were measured 1 day before and 1 month after treatment. RESULTS: Compared with baseline, both agents significantly decreased heart rate and blood pressure. However, there was no significant difference in pre-and post-treatment values between the nebivolol and atenolol groups. Both drugs significantly improved LV transmitral flow measured by early diastolic flow/atrial contraction signal (E/A) ratio, decreased deceleration time (DT) and isovolumetric contraction time (IVRT), but post-treatment improvement in E/A, DT and IVRT values was more significant with nebivolol compared with atenolol (P=0.05, P=0.05 and P=0.003, respectively). CONCLUSIONS: Although treatment with nebivolol or atenolol results in improved LV transmitral diastolic function filling parameters (E/A ratio, IVRT and DT), nebivolol has a greater effect compared with atenolol in patients with mild-to-moderate hypertension.     

组织多普勒评价室壁肥厚与左室局部及整体舒张功能的关系

目的　应用脉冲组织多普勒( TDI)技术分析左室肥厚( L VH)患者局部室壁厚度、室壁不对称性与左室局部及整体舒张功能间的相关关系。方法　左室肥厚患者4 2例,包括肥厚型心肌病( HCM) 1 6例和高血压性心脏病( HHD)左室肥厚2 6例;正常对照( NC) 2 0例。二维超声测量并计算左室8个节段室壁厚度( r WT)、总厚度( t WT)及室壁不对称指数( CVw) ;TDI测量8个心肌节段的舒张期运动速度比( r E/ A)和等容舒张时间( r IVRT) ;另外分别应用TDI和脉冲波多普勒测量二尖瓣环和二尖瓣口的舒张期参数m E/ A、m IVRT和PVE/ PVE,IVRT作为整体舒张功能指标。结果　( 1 ) L VH者室壁总厚度及其不对称指数、局部等容舒张时间及其舒张不同步性均高于NC组;( 2 )室壁肥厚的程度及其不对称性与左室整体舒张功能相关( r值的绝对值0 .1 8～0 .4 1 ,P<0 .0 5 ) ;( 3 )局部r WT与r E/ A、r IVRT相关( r值- 0 .4 6 ,0 .4 1 ,P<0 .0 5 )。结论　肥厚型心肌病和高血压性心肌肥厚患者的局部室壁肥厚程度与左室局部舒张功能减低及等容舒张期延长有关;左室壁不对称性肥厚通过影响左室局部心肌早期舒张的速度和同步性间接导致左室整体早期充盈异常;TDI技术用于非创伤性评价左室局部及整体舒张功能有一定价值     

Differentiating Systolic from Diastolic Heart Failure Using Impedance Cardiography

OBJECTIVE: Differentiating systolic from diastolic congestive heart failure (CHF) is often difficult in the ED. Impedance cardiography (IC) allows for the noninvasive evaluation of systolic function and measurement of diastolic time intervals. This study was designed to assess the ability of IC to accurately measure isovolumic relaxation time (IVRT) and determine relative cardiac contractility, thereby differentiating systolic from diastolic mechanisms in acute CHF. METHODS: In an evaluation of the technique, the average differences in the diastolic time intervals measured in normal subjects by both IC tracings and phonocardiography were compared. Likewise, the average Heather index (HI) of patients with known systolic dysfunction (ejection fraction < 30% by echo-cardiography) was compared with the mean HI measured in the normal subjects. In a retrospective analysis, the clinical performance of the method was examined by extracting the values of IVRT and HI from IC tracings of patients presenting with CHF. The determined IVRT and HI values were then correlated to clinical markers for diastolic and systolic dysfunction. RESULTS: Analysis of 280 IC tracings in eight healthy volunteers revealed an average difference of 0.0075 seconds (95% CI = -0.0067 to 0.0217) when IVRT intervals measured by phonocardiography and IC are compared. The HI in this normal group averaged 14.2 (95% CI = 9.4 to 19.0), contrasting to the much lower value of 2.8 (95% CI = 1.98 to 3.62) seen in eight subjects with documented systolic dysfunction. In 26 patients with decompensated CHF, there was a close correlation (r = 0.81) of the measured IVRT to left ventricular hypertrophy by voltage criteria and while a fall in the HI was correlated with intravascular volume expansion. Though there was considerable overlap (46%) in mechanisms of CHF, 35% of the patients were found to have only systolic dysfunction (HI < 5 and IVRT < 0.125), while 19% had a predominantly diastolic etiology (IVRT > 0.125 and HI > 5) for their failure. CONCLUSION: IC measures of contractility and diastolic time intervals are a potentially effective method for differentiating the dominant mechanisms of CHF in the emergent setting and categorizing CHF patients into different subsets.     

组织多普勒显像评价二尖瓣置换术后左心室功能

目的 探讨应用组织多普勒显像(TDI)评价二尖瓣置换(MVR)术后左室功能的临床价值.方法 45例接受MVR术后3个月以上患者为病例组,根据心律分为心房颤动组和窦性心律组,并选取30例正常人为对照组.应用常规超声心动图测量左房室腔大小、机械瓣口流速、射血分数等指标;应用TDI测量心尖四腔观二尖瓣环间隔处和侧壁处运动收缩期峰值速度(Sm)、舒张期峰值速度(Em)、等容舒张时间(IVRT);计算E/Em.结果 ①与对照组相比,MVR组二尖瓣环Sm、Em均明显减低,IVRT延长(P＜0.001),但窦性心律组与心房颤动组之间差异无统计学意义(P＞0.05);②MVR组E/Em较对照组明显增高,二者差异有统计学意义(P＜0.001),且E/Em与IVRT呈正相关;以E/Em＞15.0为最佳截断值,评价左室舒张功能变化的敏感性为91.11%,特异性为90.32%,ROC曲线下面积为0.9548±0.0402.结论 TDI能够准确评价MVR后左室功能,E/Em作为一种评价心肌舒张和左室充盈压的量化指标可以评价MVR术后患者左室舒张功能.     

高血压病患者左室舒张功能的研究

目的 研究高血压病患者左室舒张功能的变化。方法 二维超声检测高血压组72例(左室肥厚35例、非肥厚组37例)、对照组30例的左房大小、室间隔厚度(IVST)、左室后壁厚度，多普勒测定二尖瓣血流频谱及左室等容舒张时间(IVRT)。结果 高血压组与对照组比较：左房明显扩大，室间隔及左室后壁明显增厚，E峰、Ei显著减小，A峰、Ai显著增高，WRT显著延长。高血压组中，左室肥厚组与非肥厚组比较：肥厚组左房扩大，室间隔及左室后壁增厚，E峰、Ei减小，A峰、Ai增高，IVRT延长均较非肥厚组明显。结论 高血压病患者存在左室舒张功能异常，左室肥厚者舒张功能的损害更为严重。     

多普勒超声评价慢性二尖瓣返流左室舒张功能

用脉冲多普勒超声技术对１８例慢性二尖瓣返流（ＣＭＲ）患者和２１例正常人进行二尖瓣舒张期血流频谱定量研究。结果表明，ＣＭＲ出现的假性正常的二尖瓣血流频谱，掩盖了左室舒张功能减退，实际为左室松驰功能障碍及顺应性降低所致。ＣＭＲ组的Ｅ波压差（Ｅ－ＰＧ）、Ａ波压差（Ａ－ＰＧ）、等容舒张时间（ＩＶＲＴ）、Ｅ波减速时间（Ｅ－ＤＴ）及左室充盈时间．（ＬＶＦ）等与正常对照组比较有显著性差异（Ｐ＜０．０１），是ＣＭＲ情况下反映左室舒张功能减退的综合评价指标。     

乳腺癌化疗前后左室舒张功能的变化

目的 对乳腺癌病人化疗前后检测反映左室舒张功能的指标,探讨化疗药物对左室舒张功能的影响。方法 27例乳腺癌病人化疗前后做超声心动图检查,常规测定反映左室舒张功能的指标二尖瓣口下的血流流速曲线,测定EA峰值,E/A比值,DT,IVRT。结果化疗前后比较EA峰值,E/A比值,IVRT有显著差异(p<0.05)。结论 化疗药物可导致左室舒张功能的下降,超声心动图的监测可为安全化疗提供参考。     

常规超声心动图技术评价抗病毒治疗对艾滋病患者左心室功能的影响

目的应用常规超声心动图技术评价高效抗逆转录病毒治疗（HAART）对艾滋病患者左心室功能的影响。方法选取198例艾滋病患者,按病程进展分为无症状的人类免疫缺陷病毒（HIV）携带者100例（I组）和发生多种并发症的获得性免疫缺陷综合征（AIDS）患者98例（Ⅱ组）;并按是否接受HAART分为Ia、Ib组和Ⅱa、Ⅱb组;另选取50例心血管无异常发现的健康志愿者作为正常对照组（NC组）。对所有对象行常规超声心动图测量,并对左心室功能相关指标作比较分析。结果（1）与NC组比较,I组、Ⅱ组患者舒张末期左心室内径（LVIDd）、收缩末期左心室内径（LVIDs）、左心室舒张晚期充盈峰（A峰）、等容舒张时间（IVRT）、E峰减速时间（DT）明显增加（P〈0.001）;舒张末期室间隔厚度（IVSTa）、左心室后壁厚度（LVPWTd）和收缩末期室间隔厚度（IVSTs）、左心室后壁厚度（LVPWTs）、左心室射血分数（EF）、左心室短轴缩短率（FS）、室间隔增厚率（△IVST％）、左心室后壁增厚率（△LVPWT％）、左心室舒张早期充盈峰（E峰）、E／A值均明显减小（P〈0.001）;（2）I组患者：Ia组与Ib组相比,IVSTd、LVIDd、LVPWTd、ⅣSTs、LVIDs、LVPWTs、EF、FS、△IVST％、△LVP-WT％、E峰、A峰、E／A值、IVRT及DT差异均无统计学意义;（3）艾滋病患者：Ⅱa组与Ⅱb组相比,IVSTd、LVIDd、LVPWTd、IVSTs、LVIDs、LVPWTs、EF、FS、△IVST％、△LVPWT％、E峰、A峰、E／A值、IVRT及DT差异均无统计学意义。结论与正常人群比较,艾滋病患者心功能相对减低。而在一定时间内,HAART对艾滋病患者左心室功能的常规超声心动图指标无明显影响。     

Low calcium dialysate increases cardiac relaxation in CAPD patients.

OBJECTIVE: To establish whether changes in serum calcium affect left ventricular (LV) function in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: This study was conducted on 28 clinically stable CAPD patients (11 females, 17 males). Left ventricular relaxation and systolic function were echocardiographically examined in all patients during standard dialysate (containing 1.75 mmol/L calcium) treatment. All patients were then changed to low calcium dialysate (1.25 mmol/L calcium) for 1 month and all patients were re-examined echocardiographically. Decrement in isovolumic relaxation time (IVRT) and deceleration time (DT), and increment in the ratio of peak early to peak late diastolic velocities (E/Amax) were admitted as indexes showing improvement in LV relaxation. 17 age- and sex-matched controls were also echocardiographically examined. RESULTS: Deceleration time, interventricular septal thickness at systole (IVSTS) and diastole (IVSTD), and posterior wall thickness at systole (PWS) and diastole (PWD) were higher in CAPD patients using standard dialysate than in normal controls. With the use of low calcium dialysate, DTs were similar but IVSTS, IVSTD, PWS, and PWD values remained higher. In normal controls, E/Amax values were higher than those in CAPD patients using standard dialysate (p < 0.001) and low calcium dialysate (p = 0.009). Serum intact parathyroid hormone level, weight, clinical volume status, and blood pressure were similar throughout the study period. Serum ionized calcium levels were decreased significantly during low calcium dialysate treatment. The changes in IVRT, DT, and E/Amax suggest improvement in LV relaxation during low calcium dialysate treatment. CONCLUSION: Left ventricular relaxation is increased with the use of low calcium dialysate compared with standard dialysate treatment.The idea of possible beneficial effects of increment in LV relaxation on cardiovascular morbidity and mortality deserves further studies.     

健康人左室质量与舒张功能的关系

目的：探讨健康人左室质量与左室舒张功能的关系。方法：随机选取健康教师320名，行彩色多普勒超声心动图检查，结果：相关分析显示：伴随左室质量的增加E波的峰值速度下降，A波的峰值增加，二者比值下降，等容松驰时间延长，肺静脉收缩波峰值与舒峰值之比增加，但多元回归显示年龄增长、心率加快、体重指数大、血压高和男性是舒张功能减退的独立因素，左室质量指数进入多元回归方程，结论：决定健康人左室舒张功能的因素是年龄、心率、体重指数，血压和性别而不是左室质量。     

Possibilities of Doppler echocardiography application in a patient on program hemodialysis

The aim of the study was to investigate the significance of Doppler echocardiography (echoCG) for assessment of "dry weight" in hemodialysis patients. 43 dialysis patients (20 men and 23 women aged 49 +/- 11 years), receiving 4-hour bicarbonate hemodialysis (HD) 3 times a week, were studied prior to and after HD procedures. M-mode echoCG was performed and left ventricular mass index (LVMI) and ejection fraction (EF) were calculated. Transmitral flow was assessed by Doppler echoCG. Peak velocity of early (E) and late (A) filling, E/A ratio, isovolumic relaxation time (IVRT) and early deceleration time (DT) were detected. Left ventricular hypertrophy (LVH) was detected in 37 (86.0%) patients. EF was lower than 45% in 4 patients. There was significant positive correlation between the amount of ultrafiltration (evaluated in per cents of body mass after HD) and deltaE (r = 0.59; p = 0.001), and there was found no correlation between the amount of ultrafiltration and deltaA. Patients with intradialytic hypotension had substantially higher DT than patients without one (238.7 +/- 64.3 vs. 168.6 +/- 51.2 mc, respectively, p < 0.001). "Dry weight" is associated with increase of early DT over the level normal for the age in hemodialysis patients with left ventricular hypertrophy. Patients with increased early DT are exposed to the high risk of intradialytic hypotension development.     

Effect of cordaron on systolic and diastolic functions of the left ventricle in patients with a mixed form of chronic low cardiac output and cardiac arrhythmias

AIM: To study effects of cordaron on central hemodynamics reflecting systolic and diastolic functions of the left ventricle (LV) in patients with a mixed form of chronic cardiac failure--a systolic dysfunction and LV diastolic dysfunction type I. MATERIAL AND METHODS: 14 patients with a mixed form of chronic heart failure (CHF) and cardiac arrhythmia were followed up for 6 months. All the patients received ACE inhibitors, diuretics, nitrates and, additionally, cordaron in a supporting dose 200-300 mg/day. Control of central hemodynamics was made with echocardiography before, 1, 3 and 6 months of therapy. RESULTS: For 6 months of therapy LV ejection fraction increased by 16%. LV diastolic function improved, primarily, due to a rise of the E max (by 52% for 6 months of therapy). This reflected early diastolic filling of the LV. Improvement of LV diastolic function was associated with heart rate decrease. CONCLUSION: Cordaron used in addition to ACE inhibitors, diuretics, nitrates improves both systolic and diastolic LV function in patients with a mixed form of CHF.     

Valsalva动作鉴别二尖瓣舒张期血流频谱假性正常

目的探讨做Valsalva动作是否可以鉴别假性正常的二尖瓣口舒张期血流频谱。方法在平静时二尖瓣口舒张期血流频谱形态正常的对照组33例,年龄(61.4±9.9)岁和可能为假性正常的心肌缺血组19例(其中8例为经冠状动脉造影证实为一支以上冠状动脉主支近端狭窄＞75%,11例为陈旧性心肌梗塞,年龄(63.1±9.5)岁,比较两组在做Valsalva动作时的二尖瓣口舒张期血流频谱的E、A峰峰值流速,E/A,E峰减速时间(DT)和等容舒张期(IVRT)的变化。结果平静时两组间E、A、E/A和DT均无显著差异。假性正常组的IVRT略大于正常组(93±9)cm/s比(89±12)cm/s,P＜0.05。做Valsalva动作时,两组E、A峰均降低,正常组E峰减低幅度小于假性正常化组(－22±11)cm/s比(－30±9)cm/s,P＜0.01,而其A峰减低幅度大于假性正常化组(－9±14)cm/s比(－2±9)cm/s,P＜0.05,两组E/A出现显著差别,1.3±0.2比0.9±0.2,P＜0.01;两组DT(24±47)ms比(31±52)ms,P＝NS、IVRT(11±11)ms比(13±15)ms,P＝NS,变化幅度相近。结论做Valsalva动作,可以使二尖瓣口舒张期血流频谱正常组和假性正常组E、A、E/A发生不同的变化,可以用于两者鉴别。     

Myocardial contractility evaluation by radionuclide 4D-tomoventriculography in patients with ischemic heart disease

AIM: To estimate the capabilities of the new technique radionuclide 4D-tomoventriculography (4D-RTVG) versus conventional methods, such as radionuclide equilibrium ventriculography (REVG), ECG-synchronized single photon emission computerized tomography (SPECT), and echocardiography (EchoCG), in the evaluation of systolic and diastolic dysfunction in patients with coronary heart disease (CHD). MATERIALS AND METHODS: The study included 29 patients (19 males and 10 females) aged 43 to 66 years who had CHD. The diagnosis of CHD was established on the basis of coronary angiographic findings when the signs of coronary atherosclerosis were found. All the patients underwent 4D-RTVG, REVG, myocardial ECG-synchronized SPECT, and Echo CG. RESULTS: There was a strong correlation of the values obtained by 4D-RTVG versus REVG and EchoCG when ejection fraction and left ventricular (LV) end-diastolic volume and the indices reflecting LV blood filling and ejection velocity were estimated. The correlation between the values provided by 4D-RTVG and myocardial ECG-synchronized SPECT females was slightly weaker. CONCLUSION: The findings suggest that 4D-RTVG is highly reliable in evaluating both LV systolic and diastolic functions. That fact the technique is easy-to-use and mini-invasive shows that it may be clinically applied.     

组织多普勒技术对代谢综合征患者左心室同步性的评价

目的 应用组织多普勒技术评价代谢综合征(metabolic syndrome,MS)患者左心室的同步性.方法 研究对象为22例MS伴左室肥厚患者(MS-LVH组)、69例MS不伴左室肥厚患者(MS-NLVH组)和33例正常人(对照组).测量左心室6个壁12个节段心肌收缩速度和舒张速度达峰时间(Ts,Te),应用12个节段Ts、Te最大值与最小值之差(Ts-diff,Te-diff)及标准差(Ts-SD,Te-SD)来评价左室收缩和舒张同步性.结果 与对照组相比,MS-NLVH组和MS-LVH组Ts-diff、Ts-SD、Te-diff、Te-SD均显著增大,与MS-NLVH组相比,MS-LVH组Te-diff和Te-SD增大更加明显.结论 MS患者存在左室收缩和舒张同步性的异常,左室肥厚对舒张同步性的影响更加显著.     

Structural-functional alterations in the heart affecting dynamics of transmitral blood flow during a hemodialysis session

AIM: To study dynamics of transmitral circulation (TMC) during a hemodialysis (HD) session in patients with chronic renal failure (CRF) regarding structural-functional alterations of the heart and baseline condition of the diastolic function of left ventricular (LV) myocardium. MATERIAL AND METHODS: Sixty one patients (34 females and 27 males, mean age 47 +/- 11 years) on programmed HD free of heart valvular disease, ischemic heart disease, acute myocardial infarction, atrial fibrillation. Before and after HD session the patients underwent echocardiography, including Doppler regime. RESULTS: Normal LV geometry was detected in 3 (4.9%) patients, concentric remodeling - in 9 (14.8%), concentric LV hypertrophy (LVH) - in 37 (60.7%), excentric LVH - in 12 (19.7%) patients. The ejection fraction was under 45% in 5 (8.2%) patients. Diastolic dysfunction of LV myocardium was found in 42 (68.9%) patients, TMC characteristic of slow relaxation was registered most frequently (47.6%). A pseudonormal type of TMC was recorded in 16 (38.1%) patients. HD did not change TMC significantly in patients with normal diastolic function (before HD E peak velocity was 88.7 +/- 19.8 cm/s, after - 80.0 +/- 24.6 cm/s, p > 0.05). In patients with initially disturbed relaxation the velocity of early diastolic flow (Vp) (color M-mode Doppler) increased (before HD, Vp was 67.6 +/- 17.1 cm/s, after - 72.9 +/- 15.7 cm/s, p < 0.05), E/Vp reduced (before HDm E/Vp was 1.2 +/- 0.4, after 1.0 +/- 0.4, p < 0.05). The subgroup with initially pseudonormal TMC showed decreased velocity in the E peak (before HD - 103.4 +/- 13.5 cm/s, after - 76.8 +/- 24.0 cm/s, p < 0.001). In restrictive TMC this velocity also decreased - 129.0 +/- 17.8 cm/s and 108.8 +/- 14.7 cm/s, p < 0.05, respectively). CONCLUSION: TMC alteration during a HD session depends more on initial type of diastolic dysfunction than on LV geometry. A HD session improves intracardiac hemodynamics in patients with pseudonormal TMC.     

肝硬化左心功能彩色多普勒超声显像观察

目的　探讨肝硬化高动力循环对心功能的影响。方法　应用彩色多普勒超声检查 2 8例肝硬化患者和 2 0例正常人左室收缩末内径 ,舒张末内径 ,二尖瓣口E峰、A峰峰值流速、VE/VA比值、E峰减速时间 (DT)和左室等容舒张松弛时间 (IVRT) ,评价左室收缩、泵血功能和左室舒张功能。结果　肝硬化患者左心收缩、泵血功能与正常人无显著差异 (P >0 .0 5 ) ,但左心舒张功能减低 (P <0 .0 5 ) ,肝硬化失代偿合并腹水的患者舒张功能受累尤为严重 (P <0 .0 5 )。结论　在肝硬化高动力循环状态下 ,心室舒张功能减低 ,收缩、泵血功能无明显变化     

Impact of a hemodialysis session on cardiac function in patients with chronic renal failure

AIM: To determine the impact of hemodialysis (HD) session on cardiac function in patients with chronic renal failure. MATERIAL AND METHODS: Thirty patients (17 male, 13 female, mean age 49 +/- 11 years) on bicarbonate HD were studied. M-mode echocardiography was performed and ejection fraction (EF) was estimated. Transmitral flow was assessed by Doppler echocardiography. Peak velocity of early (E) and late (A) filling, E/A ratio, isovolumic relaxation time (IVRT) and early deceleration time (DT) were estimated. All the estimations were made one hour before and immediately after HD by one investigator. Flow propagation velocity of early diastolic flow was assessed by color M-mode Doppler echocardiography. RESULTS: A significant decrease of the ejection fraction (delta EF) was observed only in patients with intradialytic hypotension. Hemodialysis resulted in a decrease of early flow velocity from 99.2 +/- 23.8 to 80.6 + 26.0 cm/s (p = 0.0000) and E/A ratio from 1.23 +/- 0.57 to 0.98 +/- 0.43 (p = 0.006). IVRT and DT showed no significant difference. There was a significant positive correlation between the amount of ultrafiltration and deltaE (r = 0.46; p = 0.01), there was no correlation between the amount of ultrafiltration and delta Vp (r = -0.01; p = 0.9). CONCLUSION: The results show that a hemodialysis session influences cardiac function in patients with chronic renal failure. Early diastolic filling considerably decreased in correlation with ultrafiltration. A significant decrease in an ejection fraction was detected only in patients with intradialytic hypotension. Ultrafiltration had no impact on flow propagation velocity of early diastolic flow of the left ventricle assessed by color M-mode Doppler echocardiography.     

The use of mildronate in combined therapy of postinfarction chronic heart failure in patients with type 2 diabetes mellitus

The aim of this open randomized study was to compare the clinical efficacy of mildronate in complex therapy of chronic heart failure (CHF) and basic therapy in patients with CHF and type 2 diabetes mellitus (DM2) during the postinfarction period. The subjects were 60 II to III NYHA CHF patients aged 43 to 70 yo also suffering from DM2; the patients were observed during the early postinfarction period (weeks 3 to 4 from the onset of myocardial infarction). The patients were randomized into two groups: the 30 patients of the main group received basic therapy plus mildronate in a dose of 1 g a day, while the 30 patients of the control group received basic therapy only. The observation lasted 16 weeks. The following parameters were measured dynamically: NYHA functional class (FC), 6-min walking test results, left ventricular ejection fraction (LVEF), LV isovolumic relaxation time, microalbuminuria, glomerular filtration speed (GFS), functional renal reserve (FRR), carbohydrate and lipid exchange, cardiac rhythm variability parameters, and the quality of life. The use of mildronate in addition to basic therapy was associated with a more evident decrease in CHF FC, (by 19% vs. 14%), increase in 6-min walking test distance (25.5% vs. 18%), as well as a tendency to normalization of diastolic heart function and an increase in LVEF (by 12% vs. 7%). By comparison with basic therapy, the patients in the mildronate group displayed a statistically significant improvement in renal functioning: GFS increased by 20% vs. 2% (p < 0.05), the proportion of patients with an exhausted FRR decreased (p < 0.05), the average level of MAU decreased significantly (24% vs. 9%, p < 0.05). In the main group, a significant decrease in blood triglyceride level (by 33%, p < 0.05) and total cholesterol level (by 28%, p < 0.1) was noted. A hypoglycemizing ability of mildronate was noted. The use of mildronate in the basic therapy favors the normalization of vegetative homeostasis and improves the quality of life.     

The role of apically directed intraventricular isovolumic relaxation flow in speeding early diastolic left ventricular filling

Left ventricular (LV) systolic performance has been acknowledged to have a close relation to LV early diastolic filling and LV relaxation. However, the mechanism showing how good LV systolic function enhances the LV early diastolic filling has not been fully elucidated from the viewpoint of intraventricular flow dynamics. Thus, we investigated this issue in 82 patients with suggested coronary artery disease who underwent cardiac catheterization. Apically directed intraventricular isovolumic relaxation flow (IRF) and the propagation velocity of early diastolic filling flow were measured using pulsed and color Doppler echocardiography. LV ejection fraction and LV relaxation time constant tau were obtained in cardiac catheterization. As we were not able to measure the IRF velocity less than 14 cm/s that was limited by a Doppler low-cut filter, we analyzed the data collected from 78 patients with measurable IRF velocity. The IRF velocity significantly correlated with LV ejection fraction (r = 0.74, P <.001) and with LV relaxation time constant tau (r = -0.31, P <.01). The propagation velocity of early diastolic filling flow significantly correlated with the IRF velocity (r = 0.73, P <.001) and also significantly correlated with LV ejection fraction (r = 0.70, P <.001). Good LV systolic performance augments LV early diastolic filling directly, mediated by IRF. A faster IRF velocity may play a role in delivering good LV systolic performance to LV early diastolic filling.