Vol 84, No 4 (2012)

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.

Aim. Detection and analysis of factors of pulmonary artery thromboembolism (PATE) overdiagnosis in a prehospital setting. Material and methods. A total of 102 patients with prehospital diagnosis of PATE entered the study. Prehospital clinical and ECG picture was compared in groups of verified PATE (n=61) and rejected PATE (n=41). Clinical probability of PATE was assessed retrospectively according to Revised Geneva Score (RGS) scale. In 47 cases the analysis was made in dynamics (in 92±42.1 min, on the average). Results. In the group of patients with false-positive PATE diagnosis we significantly more frequently observed angina-like chest pain and satisfactory condition at examination, ECG evidence for right heart overloading (the most significant marker S I—Q III; p=0.009) occurred less often, mean heart rate was significantly lower than in patients with verified PATE (85 ± 23,8 and 100±23,0 b/min, respectively; р = 0,007). Low probability of PATE by the RGS scale was stated in 37% patients from the group with false-positive diagnosis and only in 8% patients with a verified diagnosis of PATE (р = 0.0005). Conclusion. Prehospital PATE overdiagnosis can be explained by non-specificity of clinical and ECG picture of the disease in acute period. Application of the RGS scale is effective for objective assessment of the condition and accurate diagnosis.

Aim. To show distribution of the investigated patients into diagnostic groups, find out the diagnostic value of the levels of hemoglobin and packed cell volume as possible markers of absolute erythrocytosis in the group of patients with polycythaemia. Material and methods. We evaluated 61 patients, mean age was 46 years (18-82), 9 females and 52 males before treatment. Mean levels of hemoglobin in females — 171g\l (143-190), packed cell volume 52% (49-61). Mean levels of hemoglobin and packed cell volume for males were 187 g/l(168-196) and 57,8% (49-65), respectively. All blood samples were taken in the morning. Full blood picture of venous blood was determined by Coulter principle on Gen S ("Beckman-Coulter", USA) blood analyzer with preserving agent (ethylene diamine tetraacetate, EDTA). Red cell mass and plasma volume were measured by the radionuclide method (Cr-51). Results were performed with an allowance for patient’s surface area and were interpreted according to International Council for Standardization in Haematology guidelines (ICSH) (Pearson et al. 1995). Results. Polycythaemia vera was detected only in 19(31%) among 61 patients, 15 patients refused from further investigation. Among others 46 patients 14 subjects had secondary erythrocytosis, among them 9 were diagnosed with absolute erythrocytosis (hypoxic) and 5 with idiopathic erythrocytosis. Relative ("apparent") erythrocytosis was detected in 13 cases. Measurement of red cell mass allowed us to divide patients into groups with absolute and relative erythrocytosis. Such laboratory parameters as hemoglobin, number of red blood cells and packed cell volume do not always completely show the level of red cell mass due to possible variations of the plasma volume and can not be the reason for diagnosis of haematological disorder. It is shown that hemoglobin level over 185 g/l confirms the presence of absolute erythrocytosis only in 50% of males with polycythaemia, 15% of males with secondary erythrocytosis might have incorrect diagnosis as though increased red cell mass. Statistically defined highly significant (p=0,001) difference of the level of red cell mass in males with polycythaemia and patients with "apparent" polycythaemia turned out to 166% and 111%, respectively. The levels of red cell mass in patients with polycythaemia confirm absolute erythrocytosis over superior normal limit (more then 25%) in comparison with secondary erythrocytosis where red cell mass rate remained normal. Average plasma volume measurements in the same groups of patients were at normal range — 95% и 81%, respectively. Difference between these mean values was authentically significant. Conclusion. Red cell mass and plasma volume measurement is easy and necessary procedure for estimation absolute and "apparent" polycythaemia. Rather common occurrence of different forms of erythrocytosis and in particular "apparent" erythrocytosis must determine certain diagnostic approach according to specific clinical case.

Aim. To compare effects of original trimetazidine versus its generics addition to antianginal treatment efficacy and quality of life in patients with stable angina (SA). Material and methods. Twenty patients aged 37-74 years with SA of functional class (FC) II-III received standard SA treatment with addition of trimetazidine generics which were later changed for original trimetazidine. Original trimetazidine effects were examined by frequency of anginal attacks and use of short-acting nitrates, changes in anginal FC and chronic cardiac failure, in quality of the patients’ life. Results. SA treatment with hemodynamic drugs in combination with trimetazidine generics was insufficiently effective. Change of the generics for an original drug (preductal MB) raised antianginal treatment efficacy as shown by less frequent anginal attacks (reduction from 9.0±6.9 to 0.3±0.6 per a week) and by reduced need in short-acting nitrates (from 9.1±6.9 to 0.4±0.6 per week) and significant improvement of the patients’ quality of life. Conclusion. In combined treatment of SA patients it is more effective to use preductal MB which is an original trimetazidine drug than trimetazidine generics.

The article presents a new classification of postural hypotension (pH) and PH detailed characteristics by parameters of arterial pressure, central and peripheral hemodynamics including cerebral circulation; describes methods of detection of different PH variants; gives original data on modified diagnostic criteria and diagnosis of one of the least studied variants of PH initial PH.

Pulmonary hypertension is a rather frequent pathophysiological and hemodynamic condition detectable in many clinical situations including pulmonary and cardiac diseases. Pulmonary arterial hypertension (pAH) is a specific clinical group of severe and rare diseases with similar morphological, hemodynamic and therapeutic characteristics. PAH diagnosis is confirmed by catheterization of the right heart. Special pharmacotherapy has been developed of late for PAH-oriented treatment. PAH is a progressive disease and therefore demands continuous monitoring and escalation of pharmacotherapy if therapeutic targets fail to be achieved with monotherapy. Combined treatment of PAH seems to be optimal now.

Cardiovascular diseases is one of the key causes of lethality in developed countries. Coronary heart disease and arterial hypertension make significant contribution to this lethality. The above two diseases are often accompanied with compensatory acceleration of the heart rate (HR). At the same time long-term tachycardia is an independent risk factor of complications resultant from high consumption of oxygen, disturbed energy metabolism in cardiomyocytes, regress of heart contractility, development of cardiac failure. Heart contraction rhythm depends on electric activity of the sinus node cells which spontaneously generate action potentials (AP) present in all heart compartments and triggering contractile activity of cardiomyocytes. The study of the pacemaker cells (pC) discovered not only mechanisms responsible for AP rise and HR physiological regulation but revealed new ionic channels —f-channels involved in acceleration and lowering of the heart rate. Reduction of current along the f-channels (If-current) lowers AP generation in PC and, therefore, HR. Three groups of medicines are now used for HR lowering : beta-adrenoblockers, non-dihydropyridine calcium antagonists and recently introduced into clinical practice innovative drug ivabradin (coraxan) selectively suppressing activity of f-channels of sinus node cells and thus lowering HR. The review analyses differences in mechanisms of a negative chronotropic effect of these drugs.