I/D-polymorphism of ACE gene, morphofunctional heart condition and blood pressure 24-h profile in young men with arterial hypertension

AIM: To study the effects of ACE gene polymorphism on morphofunctional condition of the heart and 24-h blood pressure profile (BPP) in young men with hypertension. MATERIAL AND METHODS: A total of 174 young and middle-aged hypertensive men (mean age 32 +/- 4.6 years and 48 +/- 3.1 years, respectively) were examined (echocardiography, 24-h BP monitoring, tests for I/D-polymorphism of ACE gene). RESULTS: Genotype ID appeared most prevalent both in the young and middle-aged examinees (56 and 49%, respectively). Interventricular septal thickness and left ventricular myocardial mass were the largest in young hypertensive patients carrying genotype DD. Mean 24-h and nocturnal diastolic BP was significantly higher in young hypertensive patients with genotype II vs middle-aged patients with the same genotype. Carriers of genotype II had maximal variability of systolic and pulse blood pressure. CONCLUSION: Genotype DD appeared most unfavourable in relation to left ventricular myocardial hypertrophy. Its carriers had the thickest right ventricular myocardium, the largest mass of the left ventricle. Homozygotes by allele-I had most pronounced changes in a 24-h BP profile.     

Hypertrophic cardiomyopathy: clinical picture and diagnosis in myocardial hypertrophy of various localizations

Sixty-nine patients with hypertrophic cardiomyopathy (HCMP) were subjected to clinical, electrocardiographic and ultrasound cardiographic examinations. Two-dimensional ultrasound cardiography revealed 4 types of most frequently occurring localizations of myocardial hypertrophy. The relationship was found between obstruction of the outlet tract of the left ventricle and localization and thickness of myocardial hypertrophy. The clinical and electrocardiographic signs of the disease were established in patients with HCMP in different localizations of myocardial hypertrophy. Subject to examination were also 15 relatives of the 5 patients. In 7 of them, HCMP was diagnosed for the first time.     

Use of strain imaging in detecting segmental dysfunction in patients with hypertrophic cardiomyopathy.

BACKGROUND: The distribution and magnitude of left ventricular hypertrophy are not uniform in patients with hypertrophic cardiomyopathy (HCM). Previous echocardiographic studies have focused on global left ventricular function. Recently, myocardial Doppler strain (epsilon) imaging, a newly developed technique, has allowed the quantification of regional myocardial motion. The aim of this study was to characterize regional left ventricular systolic function by myocardial Doppler epsilon imaging in patients with HCM. METHODS: Included in this study were 31 patients with asymmetric septal hypertrophy and HCM, and 41 age-matched healthy patients. Regional longitudinal axial systolic epsilon was assessed at the basal, mid, and apical segments of the septal and lateral walls and compared between both groups. RESULTS: Patients with HCM had reduced epsilon at the ventricular septum (-10.3 +/- 5.7%) compared with control patients (-19.4 +/- 3.3%, P <.001). In the HCM group, epsilon in the midseptum (-1.3 +/- 8.2%) was significantly less than at the basal (-12.2 +/- 8.7%, P <.01) and apical septum (-17.3 +/- 10.4%, P <.01), and was also less than at the midlateral wall (-9.4 +/- 5.3%, P <.05). There was a significant correlation between midseptal epsilon and intraventricular septum to posterior wall thickness ratio (r = 0.81, P <.001). CONCLUSION: Midseptal longitudinal epsilon was markedly decreased, even reversed in patients with HCM (paradoxic longitudinal systolic expansion), which was directly related to the degree of septal hypertrophy. Myocardial Doppler epsilon imaging could offer a unique approach to quantify regional systolic dysfunction in these patients.     

Intraventricular blood flow during isovolumetric relaxation and diastole in hypertrophic cardiomyopathy.

Forty patients with hypertrophic cardiomyopathy were investigated by Doppler echocardiography for intraventricular blood flow abnormalities. None had a bundle branch block. The patients were recruited on the basis of the presence of at least one of four different types of abnormal left ventricular blood flow movements during systole, isovolumetric relaxation, and diastole (time after mitral valve opening). The abnormal blood flow patterns were composed of the following: (1) systolic left ventricular outflow and midventricular obstruction in 20 of 40 and in 6 of 40 patients, respectively; (2) retrograde isovolumetric relaxation flow (IVRFretro; mean velocity, 0.7 +/- 0.3 m/sec), that is, flow toward the apex of the left ventricle, in 28 of 40 patients; (3) antegrade isovolumetric relaxation flow (IVRFante; mean velocity, 1.6 +/- 1.0 m/sec), that is, flow toward the left ventricular outflow tract, in 3 of 40 patients; and (4) diastolic antegrade flow (DFante; mean velocity, 0.9 +/- 0.3 m/sec), that is, flow opposite to mitral inflow, in 10 of 40 patients. There were significantly fewer patients with asymmetric septal hypertrophy (group 1) than with apical hypertrophic cardiomyopathy (group 2) showing DFante (1/29 versus 9/11, p less than 0.01). IVRFretro and DFante revealed higher velocities in patients with marked left ventricular asymmetric hypertrophy than in those with mild hypertrophy. Thus, in hypertrophic cardiomyopathy and especially in patients with marked asymmetric hypertrophy, there are different types of abnormal intraventricular blood flow movements during isovolumetric relaxation and disatole. This phenomenon is probably caused by asynchronous relaxation of the asymmetrically distributed, hypertrophied myocardium. DFante is more often observed in the apical cardiomyopathy than other forms of hypertrophic cardiomyopathy probably attributable to apically localized left ventricular cavity obliteration.     

Myocardial perfusion imaging with thallium-201 to assess left ventricular hypertrophy and regional ischaemia in hypertensive patients

The increase in mortality from cardiovascular disease in the presence of electrocardiographic signs of left ventricular hypertrophy (LVH) has been ascribed to ischaemic changes in the hypertrophied left ventricle even in the absence of overt coronary artery disease. To test this hypothesis and to investigate the usefulness in the detection of LVH myocardial perfusion scintigraphy with thallium-201 and echocardiography was performed in thirty-three hypertensive patients. Sixteen had had electrocardiographic signs of left ventricular hypertrophy. Twelve patients had symptoms of cardiovascular disease. In twenty-six subjects the scintigraphic procedure consisted of a combined rest--exercise study, in the other seven only resting images were obtained. Measurement of septal wall thickness on the scintiscans correlated fairly well with echographic dimensions and allowed separation of a group of patients with LVH from a group without. In individual patients, however, the perfusion scan was not a reliable tool to affirm the presence of LVH. A total of eight patients, six with LVH on the echocardiogram, had an abnormal rest--exercise perfusion scan, either with a new perfusion defect after exercise and/or with a resting defect alone. In nine other patients with echocardiographic LVH, on the other hand, no abnormal perfusion was found. Thus, perfusion abnormalities did not correlate with the presence of LVH. The presence of such abnormalities in relation to increasing age and symptomatic cardiovascular disease could well be the expression of anatomic coronary artery disease and cannot be differentiated from the possible ischaemia of the hypertrophied left ventricle.     

Regional Myocardial Perfusion Rates in Patients with Coronary Artery Disease

Regional myocardial perfusion rates were estimated from the myocardial washout of (133)Xenon in 24 patients with heart disease whose coronary arteriograms were abnormal and 17 similar subjects whose coronary arteriograms were judged to be normal. Disappearance rates of (133)Xe from multiple areas of the heart were monitored externally with a multiple-crystal scintillation camera after the isotope had been injected into a coronary artery and local myocardial perfusion rates were calculated by the Kety formula.The mean myocardial perfusion rates in the left ventricle exceeded those in the right ventricle or atrial regions in subjects without demonstrable coronary artery disease. In this group there was a significant lack of homogeneity of local perfusion rates in left ventricular myocardium; the mean coefficient of variation of left ventricular local perfusion rates was 15.8%.In the patients with radiographically demonstrable coronary artery disease, a variety of myocardial perfusion patterns were observed. Local capillary blood flow rates were depressed throughout the myocardium of patients with diffuse coronary disease but were subnormal only in discrete myocardial regions of others with localized occlusive disease. Local myocardial perfusion rates were similar to those found in the group with normal coronary arteriograms in patients with slight degrees of coronary disease and in those areas of myocardium distal to marked coronary constrictions or occlusions which were well supplied by collateral vessels.In subjects with right coronary disease, the mean right ventricular perfusion rates were significantly subnormal; in seven subjects of this group perfusion of the inferior left ventricle by a dominant right coronary artery was absent or depressed. The average mean left ventricular perfusion rate of 12 subjects with significant disease of two or more branches of the left coronary artery was significantly lower than that of the group with normal left coronary arteriograms. In the patients with abnormal left coronary arteriograms, the average coefficient of variation of local left ventricular perfusion rates was significantly increased (24.8%).The studies provide evidence that coronary artery disease is associated with increased heterogeneity of local myocardial perfusion rates. They indicate that radiographically significant vascular pathology of the right or left coronary artery may be associated with significant reductions of myocardial capillary perfusion in the region supplied by the diseased vessel.     

心肌肥厚性疾病患者左心室扭转与心肌纤维化的相关性研究

目的应用三维超声斑点追踪成像技术分析心肌肥厚性疾病患者左心室扭转与心肌纤维化程度的相关性。 方法收集2017年7月至2019年2月在哈尔滨医科大学附属第四医院行心脏超声及心脏磁共振（CMR）检查的心肌肥厚性疾病患者31例,根据CMR钆造影剂延迟强化阳性与否诊断患者是否存在心肌纤维化,并将患者分为心肌纤维化组20例,无心肌纤维化组11例。另选取健康体检者35例作为对照组。应用三维斑点追踪成像技术测量左心室基底段、中间段、心尖段旋转角度峰值,左心室整体扭力及左心室扭转角度峰值。比较心肌肥厚性疾病患者与健康对照组的常规二维超声参数,以及心肌肥厚性疾病心肌纤维化组、无心肌纤维化组与健康对照组的左心室旋转、扭转参数。分析左心室扭转角度峰值与钆造影剂延迟强化阳性心肌/左心室心肌质量比值的相关性。 结果与健康对照组比较,心肌肥厚性疾病无心肌纤维化组及心肌纤维化组的左心室基底段、中间段、心尖段旋转角度峰值及左心室扭转角度峰值均明显升高（无心肌纤维化组：t=4.45、7.51、-5.45、-6.79,心肌纤维化组：t=-5.53、-9.84、-5.82、-9.45;P均<0.01）;心肌肥厚性疾病心肌纤维化组左心室心尖段旋转角度峰值及左心室扭转角度峰值较无心肌纤维化组明显升高（t=-2.71、2.36,P均<0.05）。心肌肥厚性疾病患者左心室扭转角度峰值与钆造影剂延迟强化阳性心肌/左心室心肌质量比值呈正相关（r=0.58,P=0.001）。 结论三维斑点追踪技术可有效评估心肌肥厚性疾病患者左心室扭转及旋转,左心室整体扭转角度峰值与左心室心肌纤维化呈正相关,三维斑点追踪技术可为临床检测心肌肥厚患者心肌纤维化提供新的方法和选择。     

Current approaches to assessment of left ventricular hypertrophy. Aspects of differential diagnosis

Recommendations are proposed how to assess left ventricular hypertrophy (LVH) as well as a complex approach to examination of the heart structure and function in patients with different diseases accompanied with LVH development. LVH differential diagnosis is considered in arterial hypertension (AH), hypertrophic cardiomyopathy (HCMP), accumulation myocardial diseases, non-compact myocardium, valvular and combined cardiac pathology, compensatory LVH in athletes. Novel echocardiological techniques are recommended for use in complicated diagnostic cases. Normal parameters and criteria of LVH severity by thickness of the wall and left ventricular indexed mass according to the latest recommendations of the European and American echocardiology associations are listed.     

Electrocardiogram changes in hypertrophic cardiomyopathy

Eight versions of ECG alterations were identified in 84 patients with hypertrophic cardiomyopathy (HCMP). As for the most prevalent version (60.7 percent of the cases), the pathological Q waves or QS were recorded in the presence of the voltage signs of ventricular hypertrophy or without such signs. The use of ultrasound cardiography and roentgenocardiography made it possible to distinguish 3 groups of patients with different myocardial hypertrophy. The first group included 20 patients with isolated hypertrophy of the interventricular septum (IVS), the second group 40 patients with IVS and left ventricle hypertrophy, and the third group included 24 cases of IVS hypertrophy and combined hypertrophy of the ventricles. The main features of ECG alterations were determined in accordance with the types of hypertrophy under consideration. In the first group, Q waves were mainly recorded (in 71.4 percent of the cases). In the second group, the signs of left ventricle hypertrophy were recorded in 50 percent of the cases while Q/QS in 62.5 percent of the cases. In the third group, the voltage signs of ventricular hypertrophy were observed in 62.5 percent of the cases, whereas the Q and QS were recordable less commonly (in 41.7 percent of the cases).     

多普勒组织成像技术对原发性高血压

目的：应用多普靳组织成像技术的速度模式评价原发性高血压不同左室构型改变的局部室壁运动特点。方法：依据Ｇａｎａｕ分类法将原发性高血压患者的左室构型分为四种类型,并与正常对照组比较分析室壁基底段、中间段、心尖段运动速度（Ｖ）及左室后壁速度阶差（ＶＧ）、跨壁速度阶差（ＭＶＧ）,且与常规超声心功能指标左室短轴缩短率（ＦＳ）、左室射血分数（ＥＦ）进行比较。结果：原发性高血压各组ｓ波、ｅ波运动速度（Ｖｓ、Ｖｅ     

The Acute Administration of Trimetazidine Modified Myocardial Perfusion and Left Ventricular Function in 31 Patients with Ischaemic Ventricular Dysfunction

Trimetazidine (TMZ) increases the mithocondrial oxidative metabolism and improves Tc-99m sestamibi uptake in myocardial single photon emission tomography (SPECT). The aim of this study was to evaluate whether the acute administration of TMZ improved myocardial perfusion and modified left ventricular ejection fraction (LVEF) in ischaemic left ventricular impairment. METHODS: Thirty-one patients (23 males, age 66 years) with prior myocardial infarction (>6 months) and echocardiographic LVEF < or = 45% underwent coronary angiography, rest basal myocardial SPECT (after 3-day placebo administration) and rest TMZ myocardial SPECT [after 3-day TMZ administration (60mg/die)]. The left ventricle was analysed in 16 segments. The summed placebo score (SPS) and the summed TMZ score (STS) were calculated with a 5-point scale (from 0 = normal uptake to 4 = absent uptake) by two blinded operators. The GATED Tc-99m SPECT was always provided. RESULTS: After TMZ administration GATED LVEF improved from 26.5+/-9.7% to 29.1+/-11.3% (p = 0.04) and left ventricular end-systolic volume (LVESV) was reduced from 90.2+/-40.7 to 85.6+/-39.2 ml/mq (p = 0.006). Similarly the addition of TMZ to myocardial SPECT significantly reduced the STS compared to SPS (21.5+/-11 vs. 26.6+/-10.5 p = 0.0001). Eleven patients (35.5%) had an echocardiographic LVEF < or = 30%; in these patients who had severe ventricular dysfunction, GATED LVEF and LVESV did not change after TMZ (20.2+/-5.7% vs. 21+/-6.9% p =0.6; 116.7+/-35.3 ml vs. 112.6+/-32.3 ml p = 0.08, respectively). CONCLUSION: In comparison with placebo, the addition of TMZ to myocardial Tc-99m tetrofosmin SPECT improved myocardial perfusion and LVEF, reducing LVESV. These effects were lost in patients with more severe ventricular dysfunction.     

Coronary artery function and myocardial perfusion in patients with ischemic heart disease isolated and in combination with arterial hypertension

AIM: To characterize coronary arteries and myocardial perfusion in isolated ischemic heart disease (IHD) and IHD combined with blood hypertension (BH). MATERIALS AND METHODS: 20 patients with isolated IHD and 25 patients with combined IHD have undergone coronarography, scintigraphy of the myocardium with Tc-99m, echocardiography. RESULTS: In the combined IHD, overall involvement of the heart arteries appeared less than in isolated IHD (33.40 +/- 7.07% versus 41.40 +/- 8.9%). In the combined IHD and left ventricular hypertrophy (LVH) overall involvement of the heart arteries was less while occurrence of perfusion disorders higher than in the absence of LVH (35.98 +/- 4.73% vs 47.21 +/- 5.91%, and 33.7 vs 25.0%, respectively). Defects in the myocardial perfusion both in right and left coronary artery, isolated and combined IHD were of the same type location. CONCLUSION: Disturbed myocardial perfusion is an essential factor in the onset of coronary insufficiency.     

Quantitative assessment of left ventricular perfusion defects using real-time three-dimensional myocardial contrast echocardiography.

Quantitative assessment of perfusion defects with myocardial contrast echocardiography can be a valuable tool in the evaluation of patients with coronary artery disease. However, the use of 2-dimensional echocardiography for this purpose is limited to a restricted number of imaging planes. Real-time 3-dimensional echocardiography (RT3D) is a novel technique that provides instantaneous volumetric images. The aim of this study was to validate the use of RT3D for the quantitative assessment of myocardial perfusion defects in a model of acute coronary occlusion. To this end, 20 sheep underwent acute ligation of the left anterior descending (n = 14) or the posterior branch of the circumflex (n = 6) artery under general anesthesia. The RT3D images were obtained after left atrial injection of the contrast agent EchoGen (perflenapent emulsion; 0.8-1 mL). Evans blue dye was injected into the occluded coronary artery for subsequent anatomic identification of underperfused myocardium. The mass of the entire left ventricle and of the underperfused myocardial region were measured after death. Blinded off-line calculation of left ventricular (LV) mass and perfusion-defect mass from RT3D images were performed using an interactive aided-manual tracing technique. Total LV mass ranged from 68 to 141 g (mean plus minus SD: 92 +/- 24 g). The mass of the perfusion defect ranged from 0 to 43 g (mean +/- SD: 16 +/- 9 g) or 0 to 36% of total LV mass (mean +/- SD: 18% +/- 9%). The RT3D estimation of total LV mass strongly correlated with the anatomic measurement (r = 0.91; y = -2.54 + 1.04x; standard error of the estimate [SEE] = 11.9 g). The RT3D calculation of the mass of underperfused myocardium also strongly correlated with the anatomic measurement, both in absolute terms (r = 0.96; y = 2.01 + 0.87x; SEE = 2.2 g) and when expressed as percentage of total LV mass (r = 0.96; y = 0.11 + 1.02x; SEE = 2.8%). Hence, RT3D with myocardial contrast opacification accurately predicts the amount of underperfused myocardium in an animal model of acute coronary occlusion. This technique may therefore be useful for the quantitative assessment of myocardial perfusion defects in patients with coronary artery disease.     

二维斑点追踪成像技术评价左心室不同部位心肌梗死患者右心室心肌功能

目的 探讨二维斑点追踪成像技术（STI）评价左心室不同部位心肌梗死对右心室心肌功能的影响。方法 收集诊断为急性心肌梗死（AMI）并接受经皮冠状动脉支架植入术的52例患者（AMI组）,结合心电图、室壁运动评分指数（WMSI）及冠状动脉造影结果,分为下后壁心肌梗死亚组（A组,n=26）和非下后壁心肌梗死亚组（B组,n=26）。另选取26名健康志愿者作为对照组。对3组行超声心动图检查,采用STI技术进行评价,比较左、右心室心肌功能。结果 与对照组比较,B组右心室纵向峰值应变（RV-LS）、右心室面积变化率（RVFAC）、左心室纵向峰值应变（LV-LS）、室间隔纵向峰值应变（Sep-LS）、左心室射血分数（LVEF）减小（P均<0.05）,WMSI增大（P<0.05）;与A组比较,B组RV-LS、RVFAC、LV-LS、Sep-LS减小（P均<0.05）,二尖瓣舒张早期血流速度与二尖瓣瓣环舒张早期运动速度的比值增大（P<0.05）。RV-LS与LV-LS、Sep-LS和LVEF均呈正相关（r=0.48、0.55、0.39,P均<0.05）。结论 非下后壁心肌梗死患者右心室心肌收缩功能减低,且右心室心肌收缩功能主要受室间隔心肌收缩功能的影响。     

Left heart lesions in patients with Ebstein anomaly

OBJECTIVE: To identify the incidence of left heart abnormalities in patients with Ebstein anomaly, recognizing that left-sided lesions in this patient group have been overlooked. PATIENTS AND METHODS: According to the echocardiography database at the Mayo Clinic in Rochester, Minn, 106 consecutive patients with Ebstein anomaly underwent echocardiography between July 1, 2001, and February 28, 2003. Clinical data as well as electrocardiographic and echocardiographic reports and images were reviewed. RESULTS: Ebstein anomaly was severe in 76 patients (72%). Previous tricuspid valve surgery was reported in 46 patients (43%), and previous closure of an atrial septal defect or patent foramen ovale was reported in 34 patients (32%). Left ventricular (LV) myocardial changes resembling noncompaction occurred in 19 patients (17.9%), LV systolic dysfunction in 7 patients (7%), LV diastolic dysfunction in 34 (36%) of 95 patients, and LV dilatation in 4 patients (4%). Additional left-sided cardiac lesions included mitral valve prolapse in 16 patients (15%), bicuspid aortic valve in 8 (8%), mitral valve dysplasia in 4 (4%), and ventricular septal defect in 8 (8%). Wolff-Parkinson-White syndrome occurred in 22 patients (21%). The QRS axis tended to be different in LV noncompaction with a mean +/- SD axis of 12 degrees +/- 74 degrees vs 36 degrees +/- 66 degrees overall (P=.08). Otherwise, there were no differences in clinical or surgical data between the groups with normal and abnormal LV myocardium. CONCLUSIONS: In patients with Ebstein anomaly, left heart abnormalities involving the myocardium or valves were observed in 39% of patients. Ebstein anomaly should not be regarded as a disease confined to the right side of the heart.     

Varieties of right ventricular diastolic function in patients with non-obstructive hypertrophic cardiomyopathy

We examined whether differences in the location of myocardial hypertrophy influence the right ventricular diastolic function in patients with non-obstructive hypertrophic cardiomyopathy using cineangiography. Biplane right ventriculography was performed in 34 subjects (normal = 14, asymmetric septal hypertrophy = 9, apical hypertrophy = 11) during cardiac catheterization. In patients with asymmetric septal hypertrophy, compared with apical hypertrophy and normal groups, the indices of the right ventricular diastolic function including right ventricular peak filling rate and filling fraction of rapid filling phase were lower and the time to peak filling rate was prolonged. But in patients with apical hypertrophy, these indices were not significantly different compared with normal. There were no differences in right ventricular ejection fraction and cardiac index among the three groups. These data suggest that the location of the myocardial hypertrophy of the left ventricle is a significant factor affecting the right ventricular diastolic filling in non-obstructive hypertrophic cardiomyopathy.     

Behavior of septum primum mobility in third-trimester fetuses with myocardial hypertrophy.

OBJECTIVES: The mobility of the septum primum (SP) in the fetus is a diastolic phenomenon and could be related to left atrial pressure. We studied the linear displacement of the SP in the left atrium in fetuses of diabetic mothers (FDM) with and without septal hypertrophy (SH) and in normal fetuses of normoglycemic mothers. In this study we set out to test the hypothesis that the linear displacement of the SP flap valve is less marked in fetuses with SH than in those without SH. METHODS: The ratio between the linear displacement of the flap valve and the left atrial diameter (excursion index (EI)) was compared in ten FDM with SH, eight FDM with normal septal thickness and eight normal fetuses of non-diabetic mothers. Atrioventricular flow velocities were also compared in the three groups. RESULTS: Comparison of the three groups showed that in FDM with SH, the mean EI was 0.36 +/- 0.09, in FDM without SH it was 0.51 +/- 0.09 (P = 0.001) and in the control fetuses it was 0.49 +/- 0.12 (P = 0.03). There was a significant negative correlation between septal thickness and EI in FDM with SH. There was no correlation between septal thickness and atrioventricular flow velocities. CONCLUSION: Mobility of the SP in FDM with SH is reduced and there is an inverse correlation between the linear displacement of the SP and septal thickness. These findings may be related to changes in left ventricular diastolic function secondary to myocardial hypertrophy.     

Myocardial ischemia in severe aortic regurgitation despite angiographically normal coronary arteries

Patients with severe aortic regurgitation frequently present with angina pectoris. The exact pathophysiology for angina in aortic regurgitation is not clear. Left ventricular hypertrophy and myocardial blood supply-demand mismatch have been the suggested mechanisms to explain ischemia. However, no conclusive clinical study exists to define the incidence of ischemia in patients with severe aortic regurgitation and normal coronary arteries. We, therefore, investigated the frequency of myocardial ischemia in relation to left ventricular hypertrophy or dilatation in patients with severe aortic regurgitation and normal coronary arteries. We reviewed the medical records of all patients (n = 311) with aortic valve replacement due to aortic regurgitation between 2007 and 2010. We selected subjects with normal coronary arteries (n =182) for the study purpose, and we identified 35 patients who underwent myocardial perfusion scintigraphy prior to the coronary angiography (19 female and 16 male subjects; age 45.0 ± 8.9 years). Left ventricular hypertrophy and dilatation were detected in 9 (26%) and 5 (14%) patients, respectively. Myocardial perfusion scintigraphy showed evidence of ischemia in 10 (29%) patients with normal coronary arteries. The presence of ischemia did not relate to the presence of left ventricular hypertrophy and/or dilatation. As a potential mechanism, aortic regurgitation causes backflow of blood from the aorta into the left ventricle, hence disturbs coronary flow dynamics. In conclusion, myocardial ischemia is common (nearly one-third) among patients with severe aortic regurgitation even in the absence of coronary obstruction, left ventricular hypertrophy and/or dilatation.     

HLA antigens in hypertension patients with myocardial hypertrophy of the left ventricle

As many as 34 patients with essential hypertension (EH) and 66 with hypertrophic cardiomyopathy (HCMP) were examined. Concentric hypertrophy of the myocardium was identified in 14 patients with EH and 35 patients with HCMP. Asymmetric hypertrophy of the myocardium was diagnosed in 20 EH patients and 31 HCMP patients. Distribution of class I and II HLA antigens was examined in all the patients. The high rate of DR1 antigen demonstration was established in patients with associated EH and asymmetric hypertrophy of the myocardium. The patients with associated HCMP and hypertrophy of the myocardium showed the high rate of B40 and DR4 antigen demonstration, those with associated HCMP and asymmetric hypertrophy of the myocardium the high rate of DR1 and DR4 antigen demonstration. The data obtained may be of importance for the formation of the groups at risk for the development of the diseases in question and for their differential diagnosis in doubtful cases.     

Magnetic resonance tomography of the heart in hypertrophic cardiomyopathy

The authors provide the results of the use of magnetic resonance tomography (MRT) in examining 20 patients suffering from hypertrophic cardiomyopathy (HCMP). MRT was made using an apparatus with a field force of 0.23 synchronized with the ECG. The MR-sections were performed both in transverse and inclined planes oriented along the long axis of the left ventricle. MRT made it possible to identify and to assess with a high accuracy asymmetric hypertrophy of the left ventricle myocardium including the cases with apical localization of hypertrophy. Analysis of the data showed a certain decrease of the left ventricle cavity in the systole, dilatation of the left atrium and pronounced hypertrophy of the myocardium (mainly of the interventricular septum). The asymmetry coefficient amounted to 2.1. Correlation of the MRT data and two-dimensional ultrasound cardiography readings demonstrated good comparability of the results obtained with the use of both methods. MRT can be applied in the diagnosis of HCMP in cases where it is difficult to carry out ultrasound cardiography as well as for diagnosis verification provided the results derived with the use of other research methods are inconclusive.