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The authors investigated in 1986-1991 a group of 122 men after myocardial infarction, their mean age was 56 years, the follow up period 35 and at least 24 months. During the ergometric test "symptom limited" 18 days after the attack it was negative in 55% of the men, in 28% positive (depression of ST and/or coronary pain (and in 17% there were elevations of ST above the pathological Q wave. By the end of the follow up period nobody with a negative baseline test died. 6% with a positive test died, 62% patients with elevation of the ST. All patients with ST had elevations an impaired regional ventricular motility with a low ejection fraction (32%) during radionuclide ventriculography. At the time of examination the availability of coronarography and possible revascularization was minimal. Therefore even a retrospective group is valuable. Patients with elevation of ST after exercise have a generally poorer prognosis and are therefore indicated as a priority group for coronarography or possibly revascularization. ST elevation after a load without a pathological Q wave is less frequent and need not be associated with impaired regional motility and may be the manifestation of a coronary spasm or close proximal coronary stenosis, and is also indicated for angiographic examination, and deepening on the result, for revascularization.

Background: Our study was designed to monitor the presence of the "coronary artery disease (CAD) risk factors" after kidney transplantation., Methods: 26 kidneys transplant recipients with well-functioning (creatinine clearance > 0.8 mL/s) renal allografts receiving cyclosporine A (CsA) as the basic component of immunosuppressive therapy and 60 healthy age-matched controls were included into the study. As "CAD risk factors" were determined the levels of fibrinogen, acute phase proteins orosomucoid and C-reactive protein, t-PA Ag, PAI-1 Ag and soluble adhesion molecules E-selectin, P-selectin and ICAM-1 in the peripheral blood serum or plasma., Results: Renal transplant recipients showed higher BMI (p < 0.001) and levels of fibrinogen (p < 0.001), t-PA Ag (p = 0.007) and PAI-1 Ag (p < 0.001), acute phase protein orosomucoid (p < 0.001) and higher level of soluble P-selectin (p = 0.038). The levels of sICAM-1 and sE-selectin did not differ statistically significantly from those in controls., Conclusion: Our study has demonstrated renal graft recipients with good kidney function already show significantly raised levels of "CAD risk factors" fibrinogen, acute phase reactant orosomucoid, t-PA Ag, PAI-1 Ag and sP-selectin.

The authors evaluated retrospectively 206 patients with ischaemic heart disease. These patients were subjected to an ergometric loading test on a bicycle ergometer followed by angiography of the coronary arteries. With regard to the site of the ST depressions during the loading test the patients were divided into 7 groups which were further subdivided according to the coronographic finding. The authors investigated the hypothesis that patients with depressions of the ST segment above the anterior wall suffer from an affection of the ramus interventricularis anterior, patients with depressions of ST above the lateral wall from affection of the ramus circumflexus and patients with depressions above the lower wall have an affection of the right coronary artery. From the work ensues that no site of the ST depression correlates significantly with the coronary finding. The correlation is not statistically significant even when we compare the site of ST depressions with the affection of one artery regardless of the affection of the other coronaries.

Intravascular ultrasound (IVUS) is a clinically useful tool that provides cross-sectional images of the coronary arterial lumen and wall. Diagnostic applications of IVUS include the evaluation of ambiguous lesions on angiography particularly at the bifurcations. IVUS is also useful in the assessment of coronary vasculopathy in cardiac transplant patients or it can help to diagnose abnormalities such as syndrome X or coronary artery spasm. IVUS can optimize the performing of percutaneous coronary interventions, especially stent implantation. It represents as well an optimal tool for assessing regression of atherosclerosis. Three-dimensional reconstruction, elastography and imaging guide wires are some of the recent advances in the field of intravascular ultrasound.

Background: The survival of patients with chronic ischaemic heart disease and malignant ventricular tachyarrhythmia is influenced positively in some instances by revascularization of the heart muscle and implantation of a cardioverter-defibrillator. The objective of the submitted work was to evaluate by perspective follow-up of subjects with chronic ischaemic heart disease and malignant ventricular tachyarrhythmia: a) the effect of revascularization of the heart muscle on the prognosis, making use of programmed stimulation of the ventricles and testing the effectiveness of antiarrhythmic treatment; b) the importance of implantation of a cardioverter-defibrillator in revascularized and non-revascularized subjects for the prevention of sudden "arrhythmic" deaths., Methods and Results: The authors examined 37 patients (32 men and 5 women), age bracket 34 to 78 years (mean age 61 +/- 11) with IHD and spontaneous ventricular tachyarrhythmia after ruling out acute myocardial infarction. The group was divided into sub-groups without revascularization (21 subjects) and with revascularization (16 subjects). In both sub-groups programmed stimulation of the ventricles was implemented. During the diagnostic finding of programmed stimulation they tested antiarrhythmic drugs, most frequently amiodarone administered orally. A cardioverter-defibrillator was implanted to 10 patients. All patients were followed-up to death, the longest period being 24 months. They evaluated the frequency of cardiac deaths (death on cardiac grounds incl. sudden "arrhythmic" death) and sudden "arrhythmic" deaths (death within on hour after onset of symptoms or first recorded malignant ventricular tachyarrhythmia). In the sub-group without revascularization with diagnostic inducibility of the heart muscle in 85.7% of patients the authors described 9 cardiac deaths (42.9%) and 8 sden "arrhythmic" deaths (38.1%). Conversely in the sub-group with revascularization and with diagnostic programmed stimulation of the ventricles in half the subjects 5 clinical deaths were found (31.3%) and 3 sudden "arrhythmic" deaths (18.8%). Analysis of 11 sudden "arrhythmic" deaths revealed that no subjects with an implanted cardioverter-defibrillator (5) died (documented malignant ventricular tachyarrhythmia). Five of the six patients who died (all without a cardioverter-defibrillator) were not revascularized., Conclusions: Revascularization of the heart muscle in patients with ischaemic heart disease (after elimination of acute cardiac infarction) and malignant ventricular tachyarrhythmia reduces the risk of relapse of this arrhythmia. The benefit of implantation of a cardioverter-defibrillator was recorded in all subjects regardless of the revascularization of the heart muscle.

Objective: Evaluate risk factors of ischaemic heart disease (IHD) and the importance of burdening on a bicycle ergometer (BE) in the diagnosis of IHD in diabetic and non-diabetic subjects. CHARACTERISTIC OF GROUP: The authors evaluated in a retrospective study all 308 patients subjected to BE during the period 11/98-1/99 in Konstantinovy Láznĕ. Characteristics of diabetic vs. non-diabetic subjects: number (97 vs. 211), men (70.1 vs. 70.14%) mean age (59.76 vs. 58.01), height (1.71 vs. 1.71 m), body weight (85.91 vs. 81.40 kg), BMI (29.36 vs. 27.68 g/m2), total cholesterol (5.73 vs. 5.51 mmol/l,) triacylglycerols (2.63 vs. 2.08 mmol/l), fasting blood sugar level (7.31 vs. 4.88 mmol/l), hypertension (24.74 vs. 37.44%), hyperuricaemia (40.21 vs. 27.01%), IHD (93.81 vs. 93.84%), ischaemia of the lower extremities (6.19 vs. 13.74%), cerebrovascular episodes (7.22 vs. 5.21%), smokers 10.31 vs. 5.21%), ex-smokers (47.42 vs. 57.82%), non-smokers (42.27 vs. 36.97%). The diabetic patients were treated in 31.96% with PAD, in 5.15% with insulin and in 62.89% by diet only., Evaluation: BE was used to assess and set the load tolerance, i.e. with regard to the current medication. The conclusion of BE is from the aspect of IHD either positive (ECG signs of coronary insufficiency), negative (without signs of coronary insufficiency at the level of 85% aerobic capacity according to Astrand) or impossible to evaluate (without signs of coronary insufficiency, while not attaining this level of load). Positive ergometric examinations were divided into symptomatic ones (i.e. with stenocardias during BE) and asymptomatic (silent ischaemia). In diabetic vs. non-diabetic subjects there were 0% vs. 6.16% symptomatically positive BE, 27.84% vs. 11.37% positive BE with silent ischaemia, 17.53% vs. 20.85% negative BE and 54.64% vs. 61.61% BE which could not be evaluated. The watt training tolerance was 51.55 vs. 57.26 W., Conclusions: In diabetics (31.49% of the group) there was a significantly higher body weight, BMI, TG. As to risk factors of IHD and manifestations of atherosclerosis there were among diabetics more patients with a history of a cerebrovascular episode, more smokers and conversely fewer hypertonic subjects and fewer with ischaemia of the lower extremities than in non-diabetic subjects. During BE in diabetics there were more silent ischaemias than in non-diabetics. None of the diabetics with a positive BE suffered from symptomatic ischaemia. The high percentage of BE which cannot be evaluated in both groups is due to the concurrent administration of drugs, in particular beta-blockers and the protocol of the examination (an increasing loading test after 4 min. á 25 W) which is suitable for setting the training load and not for assessment of coronary insufficiency (for this purpose the protocol after 2 min. á 50 W is more suitable). In the conclusion the authors evaluate the importance and informative value of different diagnostic examinations for detection of IHD or its severity in diabetic and non-diabetic subjects.

In 76 patients (66 men and 10 women, age 20-71 years) with stable angina pectoris planar thallium myocardial perfusion scintigraphy, bicycle ergometry and coronary angiography were performed. Thallium scintigraphy was highly sensitive (97%) for detection of ischaemic heart disease, the sensitivity of ergometry was 75%. When comparing patients with affected 1, 2 and 3 coronary arteries perfusion scintigraphy had a sensitivity of 100%, 90% and 100% resp., while bicycle ergometry 62%, 90% and 82% resp. The specificity of perfusion scintigraphy was low (47%), compared with ergometry (60%). The finding of s reversible perfusion defect during scintigraphy indicated significant affection of coronary arteries. The scintigraphic finding of diffuse myocardial ischaemic affection was not significant for assessment of the severity of the coronary artery disease.

The authors assembled and analyzed in the submitted study data on the extension of treatment of acute myocardial infarction by thrombolysis as well as data on the extension of invasive diagnostic methods and non-pharmacological treatment of ischaemic heart disease in a Central Moravian region without a cardiocentre. The conclusions were compared with a similar investigation made in 1989. As compared with the previous investigation, a marked increase in the number of patients with acute myocardial infarction treated by thrombolysis from the total number of patients admitted with this diagnosis was recorded. Thrombolytic treatment is now used by 100% of departments on this territory. The number of patients admitted with the diagnosis of acute myocardial infarction within six hours is more than 50% in the great majority of hospitals. The problem of other invasive diagnostic methods and non-pharmacological therapy of IHD is different: the number of examined patients accounts in relation to the number of patients with acute forms only for a mere 5-10%. While thrombolytic treatment is a routine therapy, the number of patients with IHD treated by invasive methods is rather sporadic. The authors assume that the limitation is the non-existence of a natural cardiocentre catchment area with could meet these demands. The authors consider these as a supporting argument in favour of a system of geographically evenly distributed cardiocentres.

Exercise echocardiography has in recent years become the best non-invasive method for detection of IHD. The authors made an investigation with the objective to test the feasibility of exercise echocardiography, under our technically imperfect but generally available conditions, for the selection of patients for coronarography. In 44 consecutive patients (30 men, 14 women, mean age 50 years) the authors used before planned coronarography exercise echocardiography and 24-hour monitoring of ECG according to Holter with evaluation of ST segments. The results of all three non-invasive methods were compared with the coronarographic findings. The criterium of positivity of coronarographies was 75% stenosis. Such a stenosis is an unequivocal indication for cardiosurgery or percutaneous angioplasty. On comparison of results of non-invasive examination methods with coronarographic findings the best indicators as regards reliability were obtained with exercise echocardiography. Its sensitivity was 71%, specificity 69%, positive predictive value 77% and negative predictive value 61%. The sensitivity of exercise echocardiography increased, depending on the number of affected arteries (50, 71 and 100%). On isolated evaluation of findings in individual main coronary arteries the sensitivity was highest in the area supplied from the ramus interventricularis anterior (67%), the specificity was 77%. For the ramus circumflexus the sensitivity was 50% and the specificity 96%. For the right coronary artery the sensitivity was 25% and the specificity 96%. The sensitivity of exercise ECG (44%) was even lower than Holter sensitivity (57%). The specificity, on the other hand, was lower in Holter (47%) than in exercise ECG (61%). Electrocardiographic methods were not, contrary to echocardiography, usable for evaluation fo the extent of damage.(ABSTRACT TRUNCATED AT 250 WORDS)

In a group of 24 patients with coronary artery diseases, correlations of left ventricle end-diastolic volume (EDV), end-systolic volume (ESV), systolic volume (SV), and ejection fraction (EF) measurement results were assessed. Compared results were obtained with radiological angiography (RTG), echocardiography (USG), and radionuclide ventriculography (RNVG). In RNVG, the left ventricle volume was calculated using a geometrical method (GEO), a sample method with measurement of left ventricle position depth from a scintigraphic image (VZ1), and a sample method with assessment of left ventricle position depth from body height and body weight (VZ2). Interpersonal variability of RNVG evaluation was assessed simultaneously. Compared with RTG, the best correlation of EDV measurement was attained with GEO (r = 0.83) and VZ2 (r = 0.82). These methods correlate best also in ESV measurement (r = 0.91). The best correlation of EF values was obtained with USG, while r = 0.85 when using GEO and VZ2. A very low correlation was found in SV (r values from 0.39 to 0.50). The studied methods usually overestimate low values and underestimate higher values. To the EF value of 50 per cent corresponds in USG the value 48 per cent, in GEO and VZ2 the value 42 per cent. The values of EDV, ESV, and SV obtained with USG and RNVG correlate well with RTG, while the values of SV are, due to a low correlation, practically useless. Interpersonal variability of RNVG methods evaluation is minimal. (Tab. 6, Ref. 30.)

Coronary artery lesions are evaluated in a group of 43 patients surviving for more than 3 months after heart transplantation. An angiographic finding was obtained from 35 patients, autopsy findings were available in eight cases. Angiography demonstrated coronary artery lesions in 12 out of the 35 patients whereas autopsy findings were positive in five out of the eight post mortem examinations. Overall, lesions were found in 40% of patients at a mean follow-up interval of 3.5 years. While the finding of a coronary artery lesion was not related to the classic risk factors for atherosclerosis, an association to a previous cytomegalovirus or Epstein-Barr virus infection was demonstrated. The data suggest that infection caused by the two above viruses is an important factor in the development of vascular lesions in the heart transplant.

The authors describe the clinical picture and results of some auxiliary examinations in 18 patients with the X syndrome, i.e. with angina pectoris with a normal angiographic finding on the coronary arteries. For the diagnosis of ischemic cardiac changes, which are an integral part of this syndrome, the authors used a complex analysis of the electric cardiac field by means of a Cardiac 128.1 apparatus (manufactured by ZPA-Cakovice). In patients with the X syndrome they observed a significant reduction of some potential and integral values, as compared with an equally sized group of healthy subjects. On maps of the electric manifestation of cardiac activity on the chest surface ischemic changes were revealed on the antrior and lower cardiac wall but also in its lateral and posterior wall. These changes were older and were found in the subendocardial layer or concurrently in another area of the heart with affection of the subepicardial layer. Minor non-transmural fibroses, most frequently on the septum, in some instances spreading to the anterior and lower cardiac wall, were a surprising finding. At present it is not possible to differentiate merely by analysis of the electric cardiac field the X syndrome and ischemic heart disease. This should be made possible by further comparative studies. The present paper is the first description of ischemic and fibrous cardiac changes in X syndrome diagnosed by a complex analysis of the electric cardiac field in the professional literature published in Czechoslovakia and other countries.

Syndrome "X" comprises a heterogeneous group of patients with normal coronarographic findings whose repeatedly occurring chest pain is of ischaemic origin, similarly as angina pectoris in patients with CHD. One of the signs of ischaemic etiology of pain in these patients is significant depression of the ST interval on the ECG during ergometry. We were interested to know whether the depression of the ST interval and angina pectoris which develop during a load are associated also with a transient disorder of left ventricular local kinetics. We examined therefore five patients, using the dipyridamol test combined with an isometric load evaluated by two-dimensional (2D) echocardiography. All examinations revealed a normal coronarographic finding and significant electrocardiographic manifestations of ischaemia during ECG stress test. The investigation showed that none of the patients with "X" syndrome suffered from transient changes in the local kinetics of the heart muscle and we assume therefore that myocardial ischaemia in syndrome "X" does not affect a sufficiently large portion of the cardiac wall in the transmural section to be manifested by impaired kinetics detectable by 2D-echocardiography.

The authors subjected 34 patients (27 men and 7 women) to invasive electrophysiological examination. All patients had early ventricular contractions class 3-5 according to Lown which were recorded during ECG monitoring in bed or by Holter's system. A pathological excitability of the ventricular myocardium was found during programmed stimulation in 29% of the subjects. The excitability of the heart muscle was substantially enhanced by the incidence of ischaemic heart disease and reduced left ventricular function. The decreased frequency and severity of early ventricular contractions during bicycle ergometry, the absence of palpitations and syncopes increases the probability of normal excitability of the ventricular myocardium.

The authors evaluated after 4-year interval the results of coronarographic and spiroergometric examination after a work load on a bicycle ergometer up to the limiting work syndrome in 51 all patients with the aim to reveal "risk factors" of sudden death in CHD patients. The following parameters were recorded: age, duration of treatment number of cigarettes smoked, systolic blood pressure at rest and the daily dose of the most frequently used drugs. After the work load the limiting values of pulse rate, systolic blood pressure, oxygen consumption, blood lactate level and the work ECG were evaluated. In the group of 7 sudden deaths of CHD patients the authors found statistically significant (p less than 0.001) a lower mean limiting value of oxygen consumption/kg and a deeper (p less than 0.0001) mean depression of the S-T segment in the work ECG when compared with 35 CHD patients surviving for 4 years. Both indicators are considered the main "risk factors" for sudden death.

The authors submit a report on a 47-year-old man with the syndrome of angina pectoris and history of myocardial infarction who died after a revascularization operation of the heart from left ventricular insufficiency. On necropsy extensive arteritis of the coronary vessels with aortitis was revealed and with arteritis of the small intramyocardial and lienal arteries and arteries in the renal pelvis. They describe in detail the histological finding on the blood vessels, and consistent with some data in the literature, they assume that this disease forms a separate unit. It must be considered in particular in middle-aged men who have signs of coronary ischaemia and risk factors suggesting atherosclerosis, not occur in the case-history.

In a group of 37 patients with chronic stable angina the authors compared results of bicycle ergometry after a load before and after coronary artery bypass grafting. The group included only patients who had to terminate initial ergometry performed during the last two months before operation on account of stenocardia and signs of myocardial ischaemia on the ECG tracing. On average 20 months after coronary artery bypass grafting ergometry was repeated. Nineteen patients (51%) lacked electrocardiographic signs of myocardial ischaemia, 18 patients (49%) suffered from ischaemia after a load (depression S-T greater than or equal to 2 mm). Of these in 18 patients 8 (44%) no stenocardial attacks were present in another 5 (28%) stenocardia developed only when the depressions were S-T greater than 2 mm. Six patients (33%) had depressions S-T greater than or equal to 3.5 mm at a time when during ergometry they had no complaints and were engaged in similar work loads occasionally also at home. The authors conclude that in the investigated group silent ischaemia after a load was frequent in patients after a coronary artery bypass grafting and frequently it was severe. Patients after coronary artery bypass grafting developed stencardia only after greater S-T depressions than before operation. All patients after coronary artery bypass grafting should be checked by means of loading tests.

Restenosis after percutaneous transluminal coronary angioplasty is a critical factor limiting the usefulness of this procedure. It has been reported to occur in 25% to 50% of patients averaging 33%. In the majority of patients it appears within 6 months after procedure. Some clinical, angiographic and procedural factors can predict higher incidence of restenosis--they are discussed in the article. Main mechanisms which result in restenosis are intimal hyperplasia and smooth muscle cellular proliferation. Exercise thallium-201 scintigraphy and coronary angiography are the best methods in diagnosis of restenosis. The prevention and the therapy of restenosis appear as a difficult problems. Successful pharmacological approach doesn't exist until now. In about 50% of patients with restenosis coronary angioplasty is repeated with the same success and restenosis rate as in the first angioplasty.

Using thallium scintigraphy after a load (LTS), the authors tested suspected silent myocardial ischaemia (SIM) in subjects without angina pectoris. They examined 21 active pilots suspected of SIM after a previous ECG loading test (LET) and 33 patients with diabetes type I and II. In six pilots (28.6%) they found on LTS accumulation defects suggesting ischaemic disorders of the large coronary arteries. All except one had during submaximal load during LTS obvious depression of the ST segment on the ECG. Except one, in another five pilots small depressions of the ST segment were associated with normal LTS. Twelve diabetic patients (36.4%) had obvious minor accumulation defects on LTS. Only two had on the ECG a ST depression under 2 mm during LTS. Based on data in the literature suggesting a higher sensitivity and specificity of LTS, as compared with LET and the possibility of a false positive diagnosis of SIM from LET alone, the authors recommend when SIM is suspected to use also LTS. A more detailed diagnosis of SIM is essential not only with regard to the assessment of work capacity but also for the long-term follow-up of patients with SIM for assessment of its incidence, impact and prognosis in our population.

The concentration of C peptide which is an indicator of the secretory capacity of the beta-cells of the pancreas was assessed in 109 patients with type II diabetes, hospitalized on account of prolonged difficulties as regards compensation. The values on fasting, the maximal values after stimulation following an experimental meal and increments were greater than in age- and weight-matched controls. In diabetic patients some highly significant relationships were revealed between the C peptide concentration on fasting and indicators of the risk of ischaemic heart disease [IHD]. They included HDL cholesterol, the body mass index and uric acid. The relationship between the maximal C peptide concentration and serum sodium may be associated with a greater disposition for hypertension. Thirty-one patients with symptoms of an ischaemic myocardial lesion had a significantly elevated C peptide concentration on fasting. The increments of C peptide concentration after an alimentary stimulus correlated indirectly with indicators of the actual and long-term compensation of diabetes. In relation to the reduced increments also the need of insulin therapy was reflected. Data obtained by examination of the C peptide concentration in the blood of type II diabetics can contribute to the objectivization of needs of insulin treatment and to the detection of the link between cardiovascular risk and hyperinulinaemia.

The importance of noninvasive methods in cardiology has continuously been increasing; beside electrocardiography, phonocardiology, bicycle ergometry, echocardiography, radioisotopic examination and nuclear magnetic resonance, mechanocardiography preserves its significance, too. There are several reasons for it: modern apparatus technique has brought a pronounced increase in examination accuracy, comparison with invasive methods showed a number of mechanocardiographic data to be of value for left ventricular function evaluation, mechanocardiography is especially useful in repeated and long-term functional observation of the left ventricle, evaluation of treatment effects, revealing the onset of left ventricular dysfunction, the method is relatively economical and applicable even in peripheral workplaces. The literature survey of the study sums up the present knowledge of mechanocardiographic techniques, the genesis of curves and the manner of their evaluation, the physiological and other influences on the mechanocardiographic data and their clinical utilization. An analysis of experience gathered in a number of laboratories all over the world demonstrates the need of further improvement and development of the method. The present dissertation is aimed at this goal. I has set itself a task to contribute to the solution of some methodological problems of mechanocardiography and to evaluate critically its importance for the clinical practice. Polygraphy and apexcardiography (including 1st derivatives of curves) performed both at rest and during isometric handgrip exercise were used. From the obtained curves a wide spectrum of parameters was determined and several indices were calculated, some of them being introduced originally. The mechanocardiographic data were correlated in some studies with the results of echocardiography and bicycle ergometry and with invasive examination (heart catheterization, coronarography). The following results were obtained in the research into mechanocardiographic methodology problems: the suitability of a LPA 100 transducer of Czechoslovak production (Tesla VUST) was demonstrated; some physiological influences on the obtained values were determined (effects of age, respiration, body weight). The author's own method of cardiac cycle intervals correction to comparable values at unified cycle duration was elaborated; the effects of isometric handgrip exercise were studied in detail. The work was focused on verifying the importance of mechanocardiography for clinical cardiology. Therefore the method was used in a number of diseases and pathological conditions to get more complex experience. On the basis of the results obtained the value of mechanocardiography application in coronary artery disease has been demonstrated. The method provides a certain possibility in CAD diagnosis by means of combined evaluation of three sensitive parameters (pulse transmission time and two parameters of alpha wave amplitude). This type of valuation has been proposed by our laboratory.(ABSTRACT TRUNCATED AT 400 WORDS)

The authors give an account of the mechanism of action of dipyridamole. Via adenosine it produces selective and maximal vasodilatation of resisting coronary vessels in the non-ischaemic area. Thus redistribution of the blood flow from the ischaemic to the non-ischaemic portion of the heart muscle occurs along with clinical and electrocardiographic manifestations of cardiac angina which can be used for its diagnosis. The pharmacological dipyridamole test makes detection of myocardial ischaemia possible in a fundamentally different way as compared with other loading tests. The authors mention pharmacodynamic, metabolic, haemodynamic and associated phenomena of the action of dipyridamole and the mechanism of the opposite effect of aminophylline and nitroglycerin.

The authors compared the sensitivity of the simple dipyridamole test (DP test) and the dipyridamole test combined with an isometric load (DP + HG test). Evaluation by means of two-dimensional echocardiography was used. The sensitivity and specificity of the DP test, in case of a 50% or greater stenosis of one or several coronary arteries, as a criterion of classification of the group was 45% and 100%, as compared with 72% and 100% in the combined DP + HG test. The correct diagnosis was confirmed by a selective reference coronarographic findings in all patients. The electrocardiographic changes alone in both tests were positive for IHD only in 9 and 17% resp. Ergometry was more sensitive (44%) than electrocardiographically evaluated changes, using the mentioned intervention tests, but it did not attain the sensitivity of the echocardiographic evaluation. The work indicates that temporary changes of the regional kinetics evaluated by two-dimensional echocardiography are a highly specific manifestation of myocardial ischaemia which developed during a load, and these changes are detected sooner and more frequently than associated electrocardiographic changes.

The authors compared the value of two non-invasive methods in the diagnosis of myocardial ischaemia, i.e. precordial working maps of the ST segment and working scintigraphy of the myocardium with 201T1 after a load. On comparison with the finding on the coronary arteries, the authors found a high sensitivity of mapping, 89.3%, and of 201T1 scan, 92.9%, while the specificity of both methods was lower, 57.1%. Both methods are equally valuable for diagnosis of myocardial ischaemia; for assessment of the site of affection thallium scintigraphy of the myocardium is preferable.