Vibration analysis of the human left ventricular posterobasal wall at the moment of the first heart sound emission.

We examined whether human left ventricular (LV) wall vibration at the first heart sound emission (LVvibr) could be a potential source of information about the left ventricular physical properties, as has been demonstrated by experimental forced vibration studies. LV posterobasal wall vibration in 51 subjects characterized by functional murmur (n = 13), mitral stenosis (n = 8), hypertrophic cardiomyopathy (HCM, n = 8), ischemic heart disease with old myocardial infarction (n = 12) and without prior infarction (n = 10), was detected with a miniature intraesophageal vibration sensor. Peak frequency, sharpness and peak power of LVvibr in patients with functional murmur and mitral stenosis were linearly related to the Q-vibration interval. HCM patients showed a higher peak frequency and sharper configuration in the power spectrum. However, differing from previous reports, we found no characteristic difference in configuration of power spectrum in patients with ischemic heart disease. These results suggest that human LVvibr possibly includes information demonstrated by experimental forced vibration analysis.     

The improvement of systolic function of depressed left ventricle by external vibration at diastole

The left ventricular (LV) incomplete relaxation (IR) has been reported to play an important role in the pathophysiology of the congestive heart failure such as causing higher diastolic pressure and/or impeding the coronary perfusion during diastole. Therefore, using open chest canine preparations (n = 4), we examined 1) whether the minute external vibration during diastole could release IR and 2) what occurred to LV systolic function in this perturbation. LV failure with IR was induced by propranolol administration and, if necessary, by rapid atrial pacing up to 180 beats/min. When we applied a 50 Hz, sinusoidal vibration of 2.1 mm magnitude during diastole to the epicardium of LV with complete relaxation, there was no significant change in the ventricular function. However, the systolic functional improvement (3.8 +/- 1.1 mmHg elevation in LV systolic pressure) was observed when the vibration was applied to LV with IR. We concluded that external vibration at diastole could release IR and would be useful to improve the systolic function of the depressed heart with IR.     

Effect of left ventricular volume on the magnitude of functional depression by external minute vibration

We examined the effect of the left ventricular (LV) volume on the magnitude of the vibration induced functional depression (VID) using four canine cross-circulated isovolumically beating LV preparations. A sinusoidal, 50 Hz vibration (1.5 mm in amplitude) was applied to the ventricular anterior epicardium at different values of LV volume which was stepwisely increased by 1-2 ml from 0 to 30 ml. VID was estimated as the difference of the peak LV pressure between control and during external vibration. VID increased as an increment in LV volume when the volume was below 7-8 ml and when peak LV pressure was less than 70 mmHg. However, VID remained constant when the volume increased further. We concluded that VID was independent of LV volume at physiological range.     

Adenosine infusion to patients with ischaemic heart disease may provoke left ventricular dysfunction detected by echocardiography

Summary. Infusion of the endogenous vasodilator adenosine to patients with ischaemic heart disease (IHD) frequently provokes myocardial ischaemia, possibly caused by a coronary steal. The aim of this study was to detect the occurrence and incidence of disturbances in left ventricular (LV) wall motion and Doppler indices of altered LV function during infusion of adenosine. Thirty-seven patients (six female) aged 37–74 years with IHD, verified by coronary angiography, were given up to 200 μg kg^-1 min^-1 (mean 155 ± 5) adenosine i.v. for 18 ± 1 min. LV wall motion was monitored by two-dimensional echocardiography (2D-echo). Doppler spectral signal was obtained from the mitral blood flow. All but six of the patients experienced angina pectoris of habitual character in connection with the adenosine infusion. Heart rate increased by 22 ± 1 beats min^-1, systolic blood pressure was unchanged, but diastolic blood pressure decreased slightly. 2D-echo revealed severe regional LV wall motion disturbances already in the basal state in 17 patients. During infusion of adenosine, these abnormalities were aggravated and disturbances also occurred in another 15 patients. Thus, adenosine increased the sensitivity for IHD in this selected material from 49 to 89%. In all, the mean index of wall motion abnormalities increased from 5·1 ± 1·1 to 10·1 ± 1·4 (P< 0·001). The diastolic LV filling characteristics, as evaluated by the Doppler A/E ratios, were of limited value for determination of IHD grade. It is concluded that infusion of adenosine to patients with IHD frequently elicits myocardial ischaemia with disturbances in LV function, and offers an alternative to exercise for stress echocardiography.     

Difficulties in diagnosis of infarction of the right ventricular myocardium

About half of the patients with symptoms of inferior acute myocardial infarction (MI) of the left ventricle (LV) are found to have proximal occlusion of the dominant right coronary artery presented on ECG by ischemia or infarction of the right ventricular wall. Hypotension, high pressure in the jugular veins and, in some cases, shock with clear lung fields--typical clinical picture of right ventricular MI. The diagnosis begins with ECG picture of LV lower wall ischemia (rise of ST wave in leads II, III and aVF) with possible emergence of a pathological wave Q and right ventricular ischemia (rise of ST wave in leads V3R-V6R and its depression in leads V2-V4). Echo-CG and balanced radioventriculography were used for verification of the diagnosis, precise localization of the myocardial lesion. Therapy of patients with right ventricular MI consists in maintenance of adequite preload of the right ventricle, inotropic support and control over atrioventricular conduction.     

The response of normal and failing heart to externally applied vibration in the canine open chest preparation

We examined the left ventricular functional response to externally applied vibration using four canine open chest preparations. A sinusoidal 30 Hz vibration (2.7 mm in amplitude) was applied to the ventricular epicardium at each level of propranolol-induced myocardial depression. External vibration in control conditions induced no significant change either in peak left ventricular pressure (LVP) or in stroke volume (SV). With propranolol, 0.1 and 0.3 mg/kg, peak LVP and SV were depressed by the application of external vibration, even though there was no significant change of these values in the nonvibrating condition compared to control. We conclude that the ventricular response to vibration depends on the underlying myocardial viability.     

Remodeling in cardiac failure of functional class I due to arterial hypertension associated with ischemic heart disease

Hemodynamics and ventricular remodeling were studied echocardiographically in 192 men with heart failure (NYHA functional class I), arterial hypertension (AH) of stage I-III and clinical picture of ischemic heart disease (IHD). The latter presented in the patients with stable angina pectoris of FC I-II (SAP), unstable angina pectoris (UAP) without foci, paroxysmal atrial fibrillation, acute myocardial infarction (MI), postinfarction cardiosclerosis (PC) with SAP or UAP. The control group consisted of 41 healthy men. The patients had AH stage 1. The patients and healthy controls differed significantly by the size of the aorta, left atrium, thickness of the interventricular septum and posterior wall of the left ventricle. There was a significant left-ventucular hypertrophy in the groups with patients with MI, SAP and PC, UAP and PC (p < 0.001). In these groups the type of left ventricular remodeling was characterized as excentric type of left ventricular hypertrophy without its delatation. Normal left ventricular geometry was in healthy men, SAP, UAP, paroxysmal actual fibrillation.     

Viable myocardium: comparative evaluation of surgical and pharmacological treatment of patients with ischemic heart disease, post-infarct cardiosclerosis and chronic cardiac failure

AIM: To compare surgical and drug therapies of viable myocardium in IHD patients with left ventricular dysfunction (LVD), to show how to choose between them basing on the presence or absence of viable myocardium in the dyssenergy zones in such patients. MATERIAL AND METHODS: The study enrolled 55 IHD patients with postinfarction cardiosclerosis, left ventricular ejection fraction under 35%, circulatory disorder class I-III (NYHA classification). Coronary artery bypass operation (CABO) was made in 24 patients, 31 patients received drugs. The examination included dobutamin echo-CG, perfusion myocardial scintigraphy. Viability of the myocardium was assessed before and 6 months after the treatment. RESULTS: The patients were divided by the treatment and number of segments of viable myocardium: group 1--patients with viable myocardium subjected to CABO, group 2--patients with non-viable myocardium subjected to CABO, group 3--patients with viable myocardium treated with drugs, group 4--patients with non-viable myocardium treated with drugs. The greatest rise in LV EF, reduction of the end diastolic volume, end systolic volume of the left ventricle and functional class was observed in group 1. In group 2 these parameters changed less than in group 3. Patients of groups 2 and 4 were similar by parameters of LV global contractility. CONCLUSION: Improvement of central hemodynamics and functional class was the greatest in IHD patients after CABO having viable myocardium. If myocardium is not viable surgical treatment has no advantage over conservative in improvement of the pump cardiac function and is inferior to pharmacological treatment in effect on myocardium function in patients with viable myocardium in dyssynergia zones.     

The role of interventricular septum in kinetics of left and right ventricular contraction in patients with ischemic heart disease and chronic cardiac failure

AIM: To study the role of interventricular septum (IVS) in kinetics of left ventricular (LV) and right ventricular (RV) contraction in IHD patients with chronic cardiac failure (CCF). MATERIAL AND METHODS: Standard equilibrium biventricular radioventriculography was used for the study of an inotropic function of LVand RV myocardium in 117 IHD patients with CCF of NYHA FC I-IV (mean age 58+/-4.1 years). Local myocardial contractility was studied with a unified 16-segment L V and RV model. RESULTS: Segments, local ejection fraction (EF) of which exceeded 50% were considered as normokinetic, 25-50%--hypokinetic, under 25%--akinetic. Total EF of both ventricles in all patients with FCI-II CCF was normal being 63.6+/-4.6% in the left and 53.4+/-5.2% in the right ventricle. Alterations of segmental contractility as zones of hypo- and akinesia of primarily anteroseptal region of the ventricles were revealed. Patients with CCF of FC III had zones of interventricular septum (IVS) akinesia and hypokinesia of its free wall in lowering of LV EF to 43.2+/-6.3%. RV EF also decreased to 38.4+/-4.8%, IVS diskinesia zones appeared due to pulmonary hypertension. Patients with CCF of FC IV had LV EF of 15.1+/-4.1%, RV EF was 25.9 +/-6.8% with more definite disorders of segmentary contractility in the form of increased percentage of dys- and akinetic segments in the septal region and a free wall of both ventricles. CONCLUSION: In IHD patients with initial CCF defects in local contractility occurred in IVS segments. With progression of CCF, lowering of total EF of both ventricles was associated with deterioration of local dysfunction in the form of increased proportion of hypo-, dys- and akinesia zones.     

Experimental myocardial infarction: II. Acute depression and subsequent recovery of left ventricular function: serial measurements in intact conscious dogs

Acute myocardial infarction causes depression of left ventricular function, but the capacity of the ventricle to recover from such an injury remains unknown. This problem was explored by measuring left ventricular function in eight intact conscious dogs before, 1 hr after, and again 6-8 days after myocardial infarction. Acute myocardial infarction was produced using a technique which entails gradual inflation over an average period of 1 hr of a balloon cuff previously implanted around the left anterior descending coronary artery. Occurrence of anterior wall infarction was detected electrocardiographically and later confirmed by postmortem examination. Left ventricular function was evaluated from the relationship between left ventricular developed pressure (left ventricular peak systolic pressure minus left ventricular end-diastolic pressure) and left ventricular end-diastolic pressure during transient aortic occlusion with a balloon catheter. Left ventricular function curves were obtained by plotting left ventricular-developed pressure at increasing left ventricular end-diastolic pressures up to 50 mm Hg. Acute myocardial infarction caused marked depression of left ventricular function measured 1 hr after onset of infarction, but 1 wk later all eight animals showed improvement with return of function toward the control levels. A small but significant descending limb was noted at left ventricular end-diastolic pressures above 35 mm Hg. Quantitatively, the descending limb was similar before, 1 hr after, and 1 wk after myocardial infarction. Hemodynamic data revealed evidence of left ventricular failure in all animals, but variability in individual hemodynamic parameters was noted. The data indicate that the marked depression of left ventricular function observed immediately after experimental acute myocardial infarction undergoes considerable resolution within 1 wk, but that functional recovery remains incomplete.     

The role of an overall coronary bed affection in heart remodeling in patients with stenocardia and arterial hypertension

AIM: To study a possible role of coronary circulation condition in remodeling heart in ischemic heart disease (IHD) patients with hypertension or without it. MATERIAL AND METHODS: The examination (veloergometry, echo-CG and Doppler echocardiography, selective coronaroangiography and left ventriculography) covered 45 hypertensive men with angina of effort functional class III and 69 normotensive patients. Mean age of the patients was 51.8 +/- 1.2 years, duration of the angina 3 to 10 years. RESULTS: Correlation analysis of the data on hypertensive examinees discovered a direct correlation between proportional overall lesion of the coronary arteries, myocardial mass index and left ventricular (LV) index of systolic sphericity, between the sphericity index and myocardial mass index. An inverse correlation--with LV ejection fraction. CONCLUSION: In anginal patients, coronary circulation is an independent factor influencing LV remodeling. With progression of coronary failure remodeling intensifies. In patients with angina arterial hypertension contributes to the same degree to an increase in the personage of overall affection of the coronary bed, LV systolic sphericity index and index of its myocardial mass, forms an integral, global risk of heart remodelling and, later, heart failure.     

Characterization of Alterations in Diabetic Myocardial Tissue Using High Resolution MRI

Cardiovascular complications, including diabetic cardiomyopathy, are the major cause of fatalities in diabetes. Diabetic cardiomyopathy is expressed in part through fibrosis and left ventricular hypertrophy, increasing myocardial stiffness leading to heart failure. In order to search for curative interventions, precise evaluation of the diabetic heart pathology is extremely important. Magnetic resonance imaging (MRI) is ideally suited for the assessment of heart disorders due to its high resolution, three-dimensional properties and dimensional accuracy. In this study streptozotocin injected Sprague-Dawley rats were used as a model of type 1 diabetes to characterize abnormalities in the diabetic left ventricle (LV). High resolution MRI using a 9.4 T horizontal bore scanner was performed on control and 7 weeks diabetic rats. In the diabetic rats as compared to controls, we found increased LV wall volume to body weight ratio, suggestive of LV hypertrophy; increased LV wall mean pixel intensity, and decreased T2 relaxation time, both suggestive of changes in the diabetic tissue properties, perhaps due to presence of fibrosis which was detected through increase in the collagen fractional area. In addition, changes in the LV cavity area were observed and quantified in post-mortem diabetic hearts indicative of stiffer and less resilient LV myocardial tissue with diabetes. Together the data suggest that LV hypertrophy and fibrosis may be a major factor underlying structural and functional abnormalities in the diabetic heart, and MRI is a valuable tool to non-invasively monitor the pathological changes in diabetic cardiomyopathy.     

Left Ventricular Function During Physiological Cardiac Pacing: Relation to Rate, Pacing Mode, and Underlying Myocardial Disease

The hemodynamic effects of cardiac pacing at different rates and in different modes were studied in 21 patients who were candidates for permanent pacemaker implantation. Nine of these had primary conduction disturbances (PCD), ten had ischemic heart disease (IHD), seven with additional cardiac failure (CHF), and two had hypertrophic cardiomyopathy (HCM). In patients with PCD, atrial (AOO) and AV sequential (DVI) pacing did not change systolic blood pressure and pulse pressure but ventricular (VVI) pacing caused a progressive fall in these measurements, especially as heart rate increased. Ventricular volume and stroke volume (counts) derived from radionuclide ventriculography (RVG) decreased progressively with higher pacing rates, especially during VVI pacing. Cardiac output was maintained during VVI pacing by the increase in heart rate; during AOO and DVI pacing, cardiac output increased. Similar but more marked differences were observed in patients with IHD and CHF and the changes were even greater in the patients with HCM. Left ventricular (LV) ejection fraction changed little with increasing heart rate in PCD but decreased progressively with the onset of ischemia in IHD and CHF. There was no difference in ejection fraction in the different pacing modes. Graphs related to LV contractility (end-systolic pressure-volume relations) showed that AOO pacing produced the highest and VVI pacing produced the lowest curves of myocardial contractility in all patient groups, except that at higher rates the AOO curve shifted down again in patients with IHD and CHF, presumably with the onset of myocardial ischemia. This study showed that physiological pacing produced the best hemodynamic results in all patient groups. Higher pacing rates should be avoided in patients with ischemic heart disease while VVI pacing should not be used in patients with HCM. Blood pressure and RVG studies during temporary pacing are useful in selecting the optimal pacing system in an individual patient when the clinical choice is not clear.     

超声心动图观察雄激素替代治疗改善慢性心力衰竭雄性大鼠左室收缩功能

目的自身对照研究雄激素替代治疗前后大鼠的心功能状况.方法二维超声结合定量组织速度成像(QT-VI)技术检测四种不同处理(对照组、阿霉素组、睾丸切除 阿霉素组和睾丸切除 阿霉素 雄激素组)大鼠的心脏,测量常用心功能参数,脱机分析后室间隔和左室侧壁二尖瓣环处的速度曲线,记录收缩期峰值速度Vs.结果睾丸切除 阿霉素 雄激素组左室短轴缩短率和二尖瓣环平均峰值速度比睾丸切除 阿霉素组增高,差异有显著性意义.结论雄激素补充治疗能够改善激素水平低下的充血性心力衰竭大鼠的左室收缩功能.定量组织速度成像技术是评价大鼠心血管疾病模型心功能的一个新方法.     

二维应变超声心动图定量评价左心室整体和局部心肌应变的价值

目的探讨二维应变超声心动图（2D-SE）定量评价心肌局部和整体应变的临床应用价值。方法分别采集25例心力衰竭患者与30例正常对照者心尖左室长轴、心尖四腔和心尖左室二腔观的二维灰阶动态图像。应用自动功能成像软件自动测量长轴方向左室18节段收缩应变（εs）和心尖左室长轴观总应变（GLS-LAX）、四腔观总应变（GLS-A4C）、二腔观总应变（GLS-A2C）及左室长轴平均总应变（GLS-Avg）。同时采用二维Simpson法分别测量三个切面观的左室射血分数（2D-EF）。比较心力衰竭组与对照组各参数测值,分析2D-EF与二维应变（2D-GLS）的相关性。结果心力衰竭组18个节段的εS、GLS-LAX、GLS-A4C、GLS-A2C及GLS-Avg均显著低于正常组（P〈0.001）。2D-EF与2D-GLS有良好的相关性（r=0.94）。正常对照组各室壁自基底段向心尖段εS逐渐增加,各壁间差异无统计学意义;扩张型心肌病组各段室壁εS绝对值均明显低于正常对照组（均P〈0.05）,各节段间差异无统计学意义;前壁心肌死梗组中左前降支供血节段的εS绝对值明显低于正常对照组。结论2D-SE可用于定量测量左室整体和局部心肌的应变,为临床提供了一种快速准确、操作简便、可重复性好的无角度依赖的定量左室功能的新方法。     

Difference in the Diastolic Left Ventricular Wall Motion Velocities Between Aortic and Mitral Regurgitation by Pulsed Tissue Doppler Imaging

We evaluated the difference in the diastolic left ventricular (LV) wall motion velocity between chronic isolated aortic and mitral regurgitation (AR and MR, respectively) by recording subendocardial motion velocity patterns at the middle site of the LV posterior wall in the parasternal (along the short axis) and apical (along the long axis) long-axis views of the left ventricle with pulsed tissue Doppler imaging. We studied 33 patients with AR and 35 with MR, showing moderate to severe regurgitation, and 34 healthy controls (C). The end-diastolic LV dimension along the short axis was greater in the AR and MR groups than in the C group, and that along the long axis was greater in the AR group than in the MR and C groups. There were no significant differences in percent LV fractional shortening along the short axis among the 3 groups, whereas that along the long axis was significantly smaller in the AR group than in the MR and C groups. The peak early diastolic wall motion velocity (Ew) and the time to Ew from the aortic component of the second heart sound (S₂ -Ew) along the long axis were significantly lower and longer, respectively, in patients with AR than in the 2 other groups. The Ew and S₂ -Ew along both the short and long axes were significantly higher and shorter, respectively, in patients with MR than in the 2 other groups. The peak early diastolic velocity of the transmitral flow correlated positively with Ew along the short axis in all patients with AR and correlated positively with Ews along the long and short axes in all patients with MR. In conclusion, early diastolic LV filling was associated with expansion of the LV wall along the short axis but with decreased excursion along the long axis in patients with AR, whereas that in patients with MR was associated with expansion of the LV wall along both the long and short axes. Pulsed tissue Doppler imaging was useful for evaluation of diastolic LV function along the long and short axes in patients with diastolic LV volume overload. (J Am Soc Echocardiogr 1999;12:15-21.)     

多巴酚丁胺负荷试验对诱发心肌缺血患者室壁运动异常的研究

对２９例冠心病患者作多巴酚丁胺负荷试验，应用２－ＤＥ观察在规定剂量时左心室壁运动情况，用１５个切段４级评分法计算室壁运动积分（ＷＭＳ），评估诱发在心绞痛和无心绞痛发作状态下患者左室功能不全的程度和范围。结果表明，在冠状动脉有明显的解剖和功能病变者，多巴酚丁胺负荷试验诱发的左室功能不全，在有或无心绞痛的两组患者中是相似的，但有心绞痛发作患者ＳＴ段下降较多见（５６％对２９％，Ｐ＜０．０５），且休息状态下室壁运动异常范围较广泛。     

无创心肌做功在射血分数保留型主动脉瓣关闭不全患者治疗中的应用

目的 应用无创心肌做功评估左室射血分数保留（LVEF>50%）的慢性主动脉瓣关闭不全患者及其在主动脉瓣置换或修复 (AVR)术后的改变。方法 纳入2019年4月至 2021年5月确诊为中度或重度主动脉瓣关闭不全并通过AVR治疗的保留左室射血分数的患者52例，应用左室压力－应变环（PSL）评价患者左心室整体纵向应变 (GLS)及左室心肌做功指数，包括心肌整体做功指数(GWI)、整体有效功(GCW)、整体无效功(GWW)、整体做功效率(GWE)，并与之前报道的正常参考范围及其他超声心动图指数进行比较分析。 结果 ①与正常参考值相比，保留LVEF的慢性主动脉瓣关闭不全患者左心室整体做功指数（GWI）、整体有效做功（GCW）正常或增加，整体做功效率（GWE）正常。② GWI、GCW与主动脉瓣反流（AR）严重程度指标以及左室收缩功能指数呈正相关。③ AVR术后GWI、GCW、GWE减低 (P <0.001)，但是整体无效做功（GWW）无明显变化(P =.28)。④AVR后LV GLS的损伤比LV GWI损伤更为普遍（72%对28%），28%患者出现术后GWI损伤，与左心室不良逆重构密切相关。 结论 在保留LVEF的CAR患者中，无创左室心肌做功可能比其他超声心动图指数更好地了解心肌力学和能量学改变及术后左室逆重构的过程。     

Four- to seven-year follow-up of pharmacological postconditioning with mangafodipir as an adjunct to primary PCI in ST-segment elevation myocardial infarction

Introduction

Adverse left ventricular remodelling (AR) develops over time in approximately 30% of patients with a history of coronary artery disease. AR manifests as a structural change in the left ventricle (LV) in terms of increased volumes and reduced left ventricular ejection fraction (LVEF). Manganese dipyridoxyl diphosphate (mangafodipir) has demonstrated interesting cardioprotective features in acute myocardial ischaemia. Pharmacological postconditioning (PP) with mangafodipir as an adjunct to primary percutaneous coronary intervention may possibly reduce the development of AR over time in ST-elevation myocardial infarction (STEMI). The aim of this 4–7-year follow-up study is to investigate the potential benefits of PP with mangafodipir in STEMI patients.

Method

Thirteen out of the initial 20 patients that were included in the primary study of Karlsson et al. were followed up between April and June 2017. The study group underwent review of the hospital records, a clinical examination with ECG and blood sample analysis before cardiac magnetic resonance examination of the patient. LVEF, left ventricular diastolic volume, left ventricular end systolic volume, LV mass and myocardial strain in all directions were computed.

Results

The PP group showed a decrease in LV volume, mass and higher LVEF at follow-up (p < 0.05) while the individual response of the placebo group showed features that are seen in AR. Although there was no difference in myocardial strain, measurement for the PP-group was higher in absolute terms.

Conclusion

Pharmacological postconditioning with mangafodipir in STEMI demonstrated cardioprotective features compared to the placebo group at follow-up. This article is protected by copyright. All rights reserved.     

Evaluation of myocardial perfusion in patients with hypertrophic cardiomyopathy in comparison with clinical and echocardiographic data

AIM: To study peculiarities of myocardial perfusion in patients with hypertrophic cardiomyopathy (HCMP) in correlation with clinical and echocardiographic data. MATERIAL AND METHODS: 62 patients with HCMP (23 females and 39 males, mean age 44.4 +/- 11.2 years, the disease duration 13.0 +/- 10.4 years) have undergone ECG, 24-h ECG monitoring, echocardiography, perfusion scintigraphy of the myocardium with 99m-TcMIBI at rest and in combination with bicycle ergometry. The patients were divided into two groups: 35 patients of group 1 had moderate left ventricular hypertrophy (the septal thickness in diastole under 20 mm; 27 patients of group 2 had severe hypertrophy (the thickness was over 20 mm). RESULTS: Dyspnea and syncopal states occurred more frequently in patients from group 2. They also had a higher functional class of heart failure (2.0 +/- 0.8 and 1.2 +/- 0.7 for group 1 and 2, respectively, p < 0.05). Cardiac performance was significantly higher in patients of group 1. The size of the left atrium, left ventricular myocardium mass, the septal thickness and thickness of posterior wall of the left ventricle, gradient of pressure in the outflow tract of the left ventricle proved higher in patients of group 2. Deep stable defects of myocardial perfusion were detected in 5 (15%) patients of group 1 and 10 (37%) patients of group 2. Transient defects of myocardial perfusion were found in 9 (26%) patients of group 1 and 12 (44%) patients of group 2. The index of myocardial ischemia in group 1 patients was significantly lower than in patients of group 2 (3.5 +/- 2.2 and 8.3 +/- 2.5, respectively, p < 0.05). CONCLUSION: Patients with severe hypertrophy of the left ventricle had severe clinical picture, low exercise tolerance, marked hemodynamic changes, more frequent defects of left ventricular perfusion defects compared to patients with moderate hypertrophy of the left ventricular myocardium.