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Arterial hypertension may result from renal artery stenosis. In this type of hypertension renin-angiotensin-aldosterone system is activated and patients often produce signs of hyperaldosteronism. It must be distinguished from primary hyperaldosteronism in order to chose a proper therapy. In this paper we describe a case of a 65-years-old man with severe arterial hypertension, which was difficult to control pharmacologically. The patient revealed symptoms which suggested primary hyperaldosteronism (except normal plasma renin activity). Only imaging techniques allowed diagnose of renal artery stenosis and carry out successful percutaneous angioplasty of renal artery.

Stress echocardiography is valuable, non-invasive method useful for detection of coronary artery disease. In stress echocardiography myocardial ischemia is most commonly induced by exercise or pharmacological agents like dobutamine, dypiridamole, arbutamine or adenosine. The aim of the study was to compare usefulness of dobutamine-atropine stress echocardiography (DATR) with dobutamine-adenosine stress echocardiography (DADE) in detection of coronary artery disease. Studies were carried out in 23 patients, 11 women and 12 men, with suspected coronary artery disease. Both DATR and DADE were performed in all patients. In DATR left ventricular segmental contractility was estimating during intravenous infusion of dobutamine in increasing doses from 5 to 40 microg/kg/min and after intravenous administration of 1 mg of atropine. In DADE regional left ventricular systolic function was analyzed during intravenous infusion of dobutamine in increasing doses from 5 to 40 microg/kg/min and adenosine in dose of 0.14 mg/kg/min. The sensitivity of DATR in detection of coronary artery disease was 87% and specificity was 85%, whereas DADE 87% and 100% respectively. The sensitivity of DATR and DADE in subgroups of patients with one-vessel and multivessel disease was equal: 83% and 90% respectively. There were no significant differences between DADE and DATR in respect of sensitivity and specificity in detection of coronary artery disease. The results of this study suggest that dobutamine-adenosine stress echocardiography is highly sensitive and specific diagnostic test for detection both one-vessel and multivessel coronary artery disease. Moreover, there is no statistically important difference between dobutamine-adenosine stress echocardiography and dobutamine-atropine echocardiography in respect of sensitivity and specificity in detection of coronary artery disease.

Unlabelled: The relation of stress dobutamine echocardiography test results to angiographic features was assessed in 551 patients with chest pain regarded as definite or probable stable angina pectoris. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > 50 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery) and stress dobutamine echocardiography (DSE): Ischemia was defined as new or worsening wall motion abnormalities using a 16-segment model. Sensitivity and specificity of DSE was calculated: 85% and 69% respectively for the entire group, 79% and 71% in women, 87% and 66% in men and compared with diagnostic value of the electrocardiographic exercise test (EE) in the same population. Sensitivity and specificity of the EE was respectively: 93% and 21% for the entire group, 91% and 16% in women, 94% and 27% in men., Conclusions: 1. DSE has comparable sensitivity but significantly higher specificity than EE. 2. Variables determining false positive result of DSE are as follows: mean maximal heart rate, reached % of the target heart rate and wall motion abnormalities present in single segment. 3. Variables determining false negative results are: sex (male) and one vessel disease. 4. Treatment with beta-adrenolytic agents increases incidence of nondiagnostic results of DSE.

Left ventricular hypertrophy, in particular concentric, accompanying hypertension is an independent risk factor of sudden death and other serious cardiovascular complications. It is still not clear how ANP and BNP are related to various types of left ventricular geometry and whether BNP is a better predictor of left ventricular hypertrophy and dysfunction than ANP. The aim of the study was estimation of plasma ANP and BNP levels in patients with hypertension in relation to the changes of left ventricular geometry. Investigations were carried out in 80 patients aged 52.5 +/- 12.6. In every patient plasma levels of ANP and BNP were estimated, blood pressure was measured and echocardiographic study was performed. Based on echocardiographic measurements every patient was classified into one of four left ventricular geometric patterns. It was found that in patients with left ventricular concentric hypertrophy plasma level of ANP and BNP was increased whereas in patients with concentric remodeling and eccentric hypertrophy only plasma level of ANP was elevated. In patients with concentric hypertrophy higher levels of ANP and BNP were found compared to patients with concentric remodeling and eccentric hypertrophy.

Unlabelled: The relation of chest pain characteristics and other features of the history of disease to coronary angiograms was assessed in 551 patients with chest pain regarded as definite or probable stable angina pectoris. A standardised questionnaire was used to record demographic details and chest pain characteristics of interviewed patients. The differentiation between typical, atypical or nonanginal pain was based on classification proposed by Diamond. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > 50 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery)., Conclusion: Chest pain characteristics remains an effective tool for estimating probability of coronary artery disease.

Unlabelled: It has been shown, that successful reperfusion of the infarctrelated artery by thrombolysis can prevent left ventricular (LV) dilatation and dysfunction. To date no study has shown the impact of thrombolytic therapy on LV and RV diastolic filling. The aim of the study was to assess the effects of thrombolysis on LV and RV diastolic inflow and systolic function of LV in patients (pts) after anterior myocardial infarction MI., Methods: Echocardiographic and Doppler-derived measurements of LV systolic function, RV and LV diameters and diastolic function at rest and after treadmill exercise test (TET) were assessed prospectively in 21 patients (pts) after MI treated with streptokinase and 10 pts treated without thrombolysis during one-year follow-up. They were compared with 31 age-matched controls., Results: LV and RV filling indices in both groups of pts after MI were impaired compared to controls but in pts without thrombolysis were more abnormal compared to pts treated with thrombolysis. Among several echocardiographic variables most consistent alteration was shortening of E-deceleration time of mitral as well as RV inflow, more abnormal in pts without thrombolysis. There was strong inverse relation between degree of impairment of diastolic variables and exercise capacity., Conclusions: These data indicates beneficial effect of thrombolysis on RV and LV diastolic function in patients after AMI. E-deceleration was the most sensitive marker of diastolic dysfunction.

Unlabelled: To determine the diagnostic value of the electrocardiographic exercise testing (EET) in 551 patients with chest pain regarded as definite or probable stable angina pectoris (CAD), results of performed EET were compared with coronary angiography. All patients underwent exercise testing according to the Bruce protocol. The criterion for a positive exercise ST-segment response was > or = 1 mm of horizontal or down sloping depression 80 msec after J-point. The indications for cardiac catheterization in each patient were determined at the discretion of the attending physician. Clinically important coronary artery disease was defined as > 50 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery., Results: The sensitivity and specificity of EET for detection of CAD were for the entire group, in women and men respectively: 93%, 91%, 94% and 21%, 16%, 27%., Conclusion: 1. Indications for EET should be based on prior probability of coronary artery disease. 2. Application of higher than conventional ST depression criteria (> or = 2 mm) lowers sensitivity but increases specificity of EET. 3. Variables determining false positive results are as follows: age, sex (female), low probability of CAD, ST-segment depression in leads: II, III, aVF and mitral valve prolapse. 4. Variables determining false negative results are as follows: high probability of CAD, sex (male) and one vessel disease.

Unlabelled: Left ventricular hypertrophy (LVH) is one of the more important risk factors for sudden death. There are multiple factors for development of LVH in patients with hypertension. Sympathetic nervous system may play a key role causing afterload increase and neurohumoral mechanisms activation. The aim of the study was to determine beta-adrenergic receptors density and its relations to left ventricular mass in hypertensive subjects. The study was carried out in 63 patients (23 women and 40 men), mean age 43.3 +/- 11.6 yrs with primary hypertension: stage I--42 pts and stage II--21 pts. The control group consisted of 26 healthy persons matched for age and sex. We evaluated the density of beta-adrenergic receptors using 125I-cyanopindolol radioligand labeling method. Left ventricular dimensions were assessed by echocardiography (Hewlett-Packard 77010 CF) and left ventricular mass index (LVMI) was calculated. Systolic and diastolic blood pressure and LVMI was significantly higher in hypertension group 156.7 +/- 12.5 vs. 119.8 +/- 8.8 mmHg, p < 0.0001, 95.9/5.5 vs. 78.8 +/- 6.5 mmHg, p < 0.0001, 126.5 +/- 41.9 vs. 93.1 +/- 19.9 g/m2, p < 0.001 respectively. Beta-adrenergic receptors density was 40.7 +/- 29.9 fmol/ml in the hypertensive vs. 37.2 +/- 17.8 fmol/ml in control group (p = NS). There was no correlation between beta-adrenergic receptors density and LVMI. There was a statistically significant positive correlation between LVMI and systolic and diastolic blood pressure (r = 0.44, p < 0.05; r = 0.60, p < 0.01 respectively)., Conclusions: 1. Beta-adrenergic receptors density was unchanged in patients with hypertension and did not correlate with LVMI. 2. A high positive correlation between blood pressure values and LVMI, but only in stage II hypertension was revealed.

Regional left ventricular contractility caused by myocardial stunning as a result of transient ischemia and postreperfusion injury is a reversible state it can however persist even for several month. It seems reasonable to shorten this period as much as possible. The aim of the study was to estimate the influence of treatment with metoprolol or enalapril on the recovery of contractile function of left ventricle in patients after acute myocardial infarction treated thrombolytically. Investigations were carried out in 127 patients (mean age 62.3 +/- 11.9 years). Metoprolol was used in 37 patients in dose 0.02-0.05 g b.i.d., enalapril in 48 patients 0.0025-0.01 g b.i.d. 42 patients were not treated with any beta-blocker or ACE inhibitor. In all patients echocardiographic study was performed 3 times: on 2-3rd day following acute myocardial infarction immediately before introducing the treatment with metoprolol or enalapril, after 1 month and after 3 months. Echocardiographic study wall motion index (WMI) was calculated basing on. Significant decrease in WMI was observed after 1 month compared to its value on 2-3rd day acute myocardial infarction and after 3 months compared to 1 month after myocardial infarction in each of 3 subgroups of patients. No statistically significant differences in WMI were found out between studied subgroups. Neither metoprolol nor enalapril started on 2-3rd after thrombolytic treatment of acute myocardial infarction do not affect the recovery of contractile function of stunned myocardium.

The relation of resting electrocardiographic (ECG) patterns to angiographic features was assessed in 566 patients with chest pain regarded as definite or probable stable angina pectoris. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > or = 70 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery) and standard 12 lead electrocardiography which was interpreted by 2 cardiologists independently in coordinating centre. The signs of impaired coronary blood flow were assessed by abnormalities of repolarization (among others S-T segment, the T wave), depolarization and presence of disturbances of cardiac rythm. The resting routine electrocardiogram was assigned to one of three categories: normal, nonspecific abnormalities or typical for coronary insufficiency. The typical pattern for ischemia was present in 104 patients (18%), nonspecific abnormalities were present in 185 patients (33%) and electrocardiogram was normal in 277 patients (49%). Sensitivity and specificity of the typical for coronary insufficiency resting ECG was calculated: 23% and 87% respectively for the entire group, 33% and 81% in women, 20% and 93% in men. In the group with normal resting electrocardiographic pattern 55% of patients have significant stenosis in at least one major coronary artery.

The aim of the study was to estimate the influence of long-term treatment with molsidomine on structure, systolic function and neurohormonal parameters in patients with chronic heart failure (CHF). Investigations were carried out in 30 patients (mean age 63.0 +/- 10.9) in NYHA class III and IV. The cause of CHF was: coronary artery disease in 60% of patients, hypertension in 20% and dilated cardiomyopathy in 20% of patients. Molsidomine was administrated in dose of 2 mg tid for 3 months. During the study the previous treatment with ACEI, diuretics and digitalis was maintained. Using echocardiographic method left atrial dimension (LA), left ventricular end diastolic (LVEDD) and end systolic diameter (LVESD), interventricular septum (IVSDD) and posterior wall end diastolic diameter (LVPWDD), ejection fraction (LVEF) and fraction of shortening (LVFS) were measured. Plasma level of atrial natriuretic peptide, endotelin, neuropeptide Y and aldosterone and plasma renin activity were estimated radioimmunologically. All echocardiographic and neurohormonal measures were performed 4 times: before therapy, after 3 days, 2 weeks and 3 months of treatment with molsidomine. We observed significant increase in LVEF, which at baseline was 33.8% and after 3 months 44.8% (p < 0.05). None of the other echocardiographic parameters nor any of neurohormonal factors changed significantly during the 3-months treatment with molsidomine.

Chronic heart failure (CHF) is present in 1-10% of the whole population. From the drugs used in CHF so far only angiotensin converting enzyme inhibitors and nitrate with hydralazine improved the survival which was caused by beneficial influence of these drugs on neurohormonal factors. There is growing interest in beta-blockers which are believed to stop the progress of CHF. Although the first attempts of using beta-blockers in the treatment of CHF took place in 70-ties, only recent years brought better understanding of mechanisms of their action. The beneficial effect of beta-blockers in CHF is related to their protective influence on myocardium and to hampering of apoptosis--programmed cell death--the phenomenon which is exaggerated in CHF. The investigations carried out in last years proved that carvedilol which is beta 1-, beta 2- and alpha 1-blocker and has antioxidant properties improved clinical status and reduced mortality in the cohorts of patients with all-cause CHF. At present great trials estimating various beta-blockers and comparing these drug among themselves are being conducted.

Unlabelled: Diastolic dysfunction of left ventricle appears very often in patients with coronary artery disease (CAD) and hypertension (HT) and is a main cause of heart failure in 30-40% of all cases. Relation between systolic and diastolic function of left ventricle (LV) is commonly known but not documented well enough. Moreover, no quantitative classification of diastolic dysfunction is still available., Aim of the Study: To find out the relations between the parameters of systolic and diastolic function of LV in patients with CAD or HT with impaired relaxation of LV without symptoms of heart failure and to make up the quantitative classification of diastolic dysfunction in the stage of impaired relaxation of LV., Methods: Investigations were carried out in 57 patients (mean age 55.5 +/- 11.5) with angiographically proven CAD and in 91 patients (mean age 56.3 +/- 10.6) with HT and angiographically excluded CAD, all without regional myocardial contractility abnormalities and valvular heart diseases. Control group consisted of 54 healthy subjects (mean age 55.4 +/- 11.4). During 2D echocardiography examination left ventricular end-diastolic (LVEDD) and end-systolic diameters (LVESD) and left atrial dimension (LA) were obtained. Using Doppler method transmitral inflow indices: E velocity (E), A velocity (A), E velocity integral (E-VTI), A velocity integral (A-VTI), total velocity integral (T-VTI), E deceleration time (DT), isovolumic relaxation time (IVRT) and aortic flow velocity integral (Ao-VTI) were measured. Only patients with E/A < or = 1 and--to exclude pseudonormalization of mitral inflow--with DT > or = 140 ms were qualified to the study. We proposed diastolic dysfunction ratio (DDR) calculated from formula: DDR = E/A x E-VTI/T-VTI. Using AFVI, LV outflow diameter, heart rate (HR) and body surface area cardiac index (CI) was calculated., Results: In studied group there were significantly higher values of LA, A, IVRT, DT and lower values of E, E/A, E-VTI and DDR compared to controls. There were no significant differences between these groups in HR, LVEDD, LVESD, T-VTI and CI. No significant differences in any of studied parameters were found between subgroups with CAD and HT. Among healthy subjects in subgroup with abnormal mitral inflow pattern (E/A < or = 1) there were significantly higher values of LA, IVRT, DT and lower values of DDR than in sugroup with normal one. Both subgroups did not differ in LVEDD, LVESD, CI. In the studied group there was positive correlation between DDR and CI (r = 0.69, p < 0.001), DDR and IVRT (r = 0.71, p < 0.001), DDR and DT (r = 0.61, p < 0.001), CI and E (r = 0.34, p < 0.01), CI and IVRT (r = 0.52, p < 0.001), CI and DT (r = 0.42, p < 0.001), CI and E/A (r = 0.54, p < 0.001), CI and E-VTI (r = 0.43, p < 0.001). In the control group significant correlation was found only between DDR and IVRT (r = 0.64, p < 0.02) and between DDR and DT (r = 0.52, p < 0.02) but not between DDR and CI. Using DDR DD was divided into 3 classes: class I with DDR > 0.47, class II with 0.47 > or = 0.30, and class III with DDR < 0.30. Applying of such intervals of values of DDR determined the groups which significantly differed between themselves in CI, IVRT and DT., Conclusions: (1) In patients with CAD or HT with impaired relaxation of LV without symptoms of heart failure there is relation between parameters of systolic and diastolic function of LV: the more advanced diastolic dysfunction, the more impaired systolic function. (2) In healthy subjects there is no relation between parameters of systolic and diastolic function of LV. (3) DDR is a good indicator of quantitative estimation of diastolic dysfunction in the stage of impaired relaxation of LV.

The aim of the work to assess the frequency of ventricular arrhythmias in patients with isolated mitral valve prolapse isolated spurious cords in heart ventricles as well as in those patients who had both, mitral valve prolapse and spurious cord in heart ventricle. Out of 4156 successive electrocardiographic investigations carried out at the Department and Clinic of Cardiology, Medical Academy in Wroclaw, coexistence of spurious cords in heart ventricle and mitral valve prolapse was diagnosed in 32 patients (0.8% of all subjects), isolated mitral valve prolapse--in 184 patients (4.4%) and presence of isolated spurious cords not accompanied by mitral valve prolapse--in 91 patients (2.2%). In 20 patients with coexistence of spurious cords in heart ventricles and mitral valve prolapse, ventricular arrhythmias occurred in 12 subjects (60.0%) and in 5 of them they were significant. In the group of 29 patients with isolated spurious cords, disturbances of the ventricular rhythm occurred in 13 subjects (44.8%), while significant ventricular arrhythmias were found in 6 patients (20.7%). Out of 60 subjects with isolated mitral valve prolapse disturbances of the ventricular rhythm were found in 20 patients (33.3%) and significant arrhythmias--in 12 subjects (20.0%). The observations did not reveal increased prevalence of significant ventricular disturbances of the heart rhythm in patients with coexisting mitral valve prolapse and spurious cords in the heart ventricles.

7 patients, 4F/3M aged 20-63 years (x = 39.5 yrs) with high grade non-Hodgkin lymphoma (4 pts), Hodgkin's disease (1), acute leukaemia (1) and blastic crisis of CML (1), complicated by massive pericardial effusion with impending cardiac tamponade were presented. Symptoms of neoplastic pericardium infiltration have appeared at the diagnosis of underlying disease in 2 pts, in the remaining 5.5-24.5 months (mean = 12.5 months) since the diagnosis and onset of cytostatic treatment was established. In 6 pts pericadiocentesis or pericardium drainage have been applied, resulting in evacuation of 100-1450 ml (mean = 680 ml) of fluid. In 3 pts pericardial effusion was bloody and in two some neoplastic cells were found. In 4 pts intrapericardially 5-20 mg mitoxantrone, 5-20 mg, was administered 7 times. The survival time since the diagnosis of a massive pericardial effusion ranged 0.5-10 months. One person remains alive 7 months after diagnosis of cardiac effusion and 19 months from the diagnosis of n-HL. The authors conclude that pericardiac involvement in the course of haematologic malignancies is a very unfavorable event.

Unlabelled: The aim of the study was to assess whether the hypotensive activity of amlodipine is associated with regression of left ventricular hypertrophy and improvement of impaired LV or right ventricular (RV) diastolic function or increasing of tolerance of physical activity in hypertensive patients. Assessment of left ventricular structure, systolic and diastolic function as well as RV diastolic dimension and diastolic function were performed in 24 patients with mild-to-moderate hypertension before administration of amlodipine and 3, 6 and 9 months of the treatment. In order to assess the tolerance of physical activity, incremental treadmill exercise testing was performed at baseline and after 6 and 9 months of the therapy with amlodipine., Results: During 9 months of the therapy with amlodipine no significant change in indexes of LV mass or in LVM was observed. Similarly amlodipine did not influence the parameters of LV or RV diastolic function in studied patients. However, amlodipine treatment resulted in significant increase in total exercise time (p < 0.05), total workload (p < 0.01) measured in METs and decrease in diastolic blood pressure during exercise test., Conclusion: The nine months of the therapy with amlodipine resulted in significant improvement in exercise tolerance. Total exercise duration and total workload measured in METs significantly increased. During this time of the therapy no significant changes in LV structure or LV and RV diastolic function were observed. One can make an assumption that amlodipine inhibits progression of structural and functional derangement in hypertensive patients.

Abnormalities in left ventricular (LV) diastolic function may be the earliest indications of hypertensive heart disease. Because the two ventricles influence each other's performance this study was designed to investigate the impact of chronic LV pressure overload in essential hypertension (HT) on diastolic function of right ventricle (RV). RV and LV diastolic function was evaluated in 74 patients with mild-to-moderate essential HT using pulsed wave Doppler echocardiography. Fifty-five normotensive patients without heart disease acted as control subjects. In studied group, 17 patients (23%) had normal mitral (MV) and tricuspid (TV) flow parameters, 28 (38%) had impaired LV filling parameters [MV early (E) to late (A) peak flow velocity ratio (MV E/A) 0.81 +/- 0.12 vs control 1.19 +/- 0.18, p < 0.001] while 29 patients (39%) had abnormal both mitral [MV E/A) 0.72 +/- 0.15 vs control 1.19 +/- 0.18, p < 0.001] and tricuspid flow parameters (TV E/A) 0.8 +/- 0.19 vs control 1.23 +/- 0.1, p < 0.001). In group with impaired diastolic filling of both ventricles indices of mitral flow were significantly more abnormal compared to group with normal TV flow parameters (MV E/A 0.72 +/- 0.15 vs control 0.81 +/- 0.12, p < 0.05). RV filling parameters correlated with filling parameters. There was good correlation between TV A and MV E (r = -0.56, p < 0.01), the time velocity integral of early mitral inflow (MV E-VTI) (r = -0.64, p < 0.001) and positive correlation with MV A (r = 0.78, p < 0.0001). Also there was good correlation between LV mass and TV E (r = -0.56, p < 0.01) and the time velocity integral of early tricuspid inflow (r = -0.72, p < 0.001). Data indicate that RV diastolic function is abnormal in essential hypertension and these abnormalities are closely related to those of LV diastolic function and LV mass.

Objective: To estimate the influence of electrical cardioversion on the left ventricular systolic function, left atrial size, the plasma activity of creatinine phosphokinase (CPK) and its myocardial fraction (CK-MB) and plasma level of atrial natriuretic peptide (ANP) in patients with paroxysmal atrial fibrillation caused by coronary artery disease, hypertension or mitral valve disease., Patients: The study underwent 36 patients with paroxysmal atrial fibrillation of mean duration 24.5 hours in which sinus rhythm was restored by electrical cardioversion., Methods: Plasma activity of creatinine phosphokinase (CPK) and its myocardial fraction (CK-MB), plasma level of atrial natriuretic peptide (ANP) and echocardiographic examination were obtained before and 24 hour after electrical cardioversion. During echocardiographic examination were measured left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), left atrial size (LA) and early diastolic velocity(E) and velocity with atrial contraction (A) of left ventricular inflow. Electrical cardioversion was initiated with impulse of 100 J. If it failed to convert atrial fibrillation to sinus rhythm next impulse of 200 J and 360 J were consequently applied., Results: In all subgroups of patients formed dependently on a number of electrical shocks, 24 hour after cardioversion significant increase in left ventricular ejection fraction (LVEF) and decrease in plasma level of ANP were noted. In subgroup of patients treated with 1 (100 J) and 2 (100 + 200 J) impulse significant decrease in left atrial size was found out. The increase in plasma activity of creatinine phosphokinase (CPK) and its myocardial fraction (CK-MB) was confined to the subgroup treated with 3 (100 + 200 + 360 J) impulses. No changes in left ventricular end diastolic diameter (LVEDD) and early velocity (E) of left ventricular inflow 24 hours after cardioversion were observed. In all patients electrical cardioversion brought about the appearance of atrial wave of left ventricular inflow. No differences in estimated parameters between patients with coronary artery disease, hypertension and mitral valve disease were observed. Significant positive correlation between plasma level of ANP and left atrial size before (r = 0.69, p < 0.001) and after cardioversion (r = 0.68, p < 0.0001) were found., Conclusions: Restoration of the sinus rhythm in patients with paroxysmal atrial fibrillation leads to the increase in left ventricular ejection fraction (LVEF) and to the decrease in left atrial size (LA) and the plasma level of atrial natriuretic peptide. Left atrial size and plasma level of ANP are related. The cardioversion with impulses of high energy increases the plasma activity of creatinine phosphokinase and its myocardial fraction.

Symptoms of Barlow's syndrome were analysed in 60 patients. The diagnosis is described as a plenty of disturbances in the circulatory system. Observed arrhythmias were often one of the important symptoms.

Chronic left ventricular hypertrophy (LVH) is associated with depressed contractile performance, abnormal compliance of the chamber, and ultimately, the development of a left ventricular failure. Thus the presence of LVH carries a particularly ominous prognosis in patients with essential hypertension. Finally, regression of LVH appears to be a worthwhile goal of an antihypertensive therapy along with blood pressure control. Of particular importance, is whether the functional derangements associated with hypertrophy will also be reversed. The present study was undertaken to determine whether antihypertensive therapy reduced ventricular mass, and whether these changes were accompanied by improved diastolic function. 47 patients with mild-to-moderate essential hypertension were divided into two groups. Group I--included 21 patients whose blood pressure responded to nifedipine monotherapy. Group II--included 26 patients whose normalization of blood pressure required combined therapy with nifedipine and metoprolol. 40 healthy volunteers comprised a control group. To assess the effects of antihypertensive therapy on the heart, left ventricular mas (LVM), systolic and diastolic function, by M-mode, 2-D and pulsed wave Doppler echocardiography had been evaluated. Measurements were performed before therapy and every 3rd month during first year, and every 40th month during the second year of observation. RESULTS. At baseline all hypertensive patients had significantly increased LVM compared to the controls. Indexes of systolic function in studied patients were normal, while indexes of LV diastolic filling were significantly abnormal compared to the controls. In the group treated with nifedipine, starting from the 9th month of observation, small but significant decrease in posterior wall thickness was noted but LVM did not change during the whole time of the observation. Similarly, there was no significant change in indexes of left ventricular diastolic filling. Contrary to patients treated with nifedipine, in group of patients treated with combination of nifedipine and metoprolol, significant reduction of LVM and improvement of LV diastolic filling was observed. Of particular interest was the fact, that improvement in diastolic, performance appeared earlier, and preceded regression of LVM. Most striking was the improvement in Ev/Av ratio which increased by 16% after 6 months and by 35% after 24 months of the therapy. CONCLUSION. 1. Combined therapy with nifedipine and metoprolol contrary to monotherapy with nifedipine alone, results in the regression of left ventricular mass and the improvement of left ventricular diastolic function. 2. Improvement of left ventricular diastolic function appears earlier, preceding the regression of left ventricular hypertrophy.

In 4156 echocardiographic examinations, false chordae were observed in 91 persons (2.2%). It was shown that false chordae without evidence of traction caused no increase of the risk of development of ventricular arrhythmia (class II and over according to Lown). In 50% of persons with false chordae and the evidence of traction significant ventricular arrhythmia occurred. It was found that administration of the drugs with negative inotropic action may increase arrhythmia in persons with false chordae in the heart ventricles.

The effect of enalapril and terazosin on serum lipid profile was investigated in 36 patients with primary hypertension and hypercholesterolemia (total cholesterol 5.2 mmol l). 6- and 12-week monotherapy with these drugs did not produce any unfavourable changes in: total cholesterol, LDL- and HDL-cholesterol, triglycerides, apolipoproteins A1 and B as well as in serum lipids. Enalapril and terazosin seem to be very useful as a first step monotherapy especially in patients with hypertension and lipid disturbances.

The effect was studied of 8 weeks of treatment with propranolol and pindolol on the left-ventricular myocardium mass, left-ventricular myocardium mass index, plasma renin activity, and serum aldosterone and total catecholamine concentrations. The studies were carried out in 72 patients with essential arterial hypertension of slight degree. A statistically significant decrease was shown of the left-ventricular myocardium mass, left-ventricular myocardium mass index, plasma renin activity, and aldosterone concentration in all studied patients. A decrease of total catecholamine concentration appeared in patients treated with propranolol. Weaker effect of pindolol on the studied parameters may be connected with its intrinsic sympathicomimetic activity. A correlation was shown between the decrease of the left-ventricular myocardium mass, and the decrease of systolic arterial blood pressure.

To assess the feasibility, safety and usefulness of dipyridamole stress echocardiography for the detection of coronary artery disease we evaluated 194 patients (124 men, 70 women) with effort chest pain. All patients underwent electrocardiographic submaximal bicycle exercise testing and 2-dimensional echocardiography after dipyridamole injection. Echocardiographic test was considered positive when new wall motion abnormalities were observed after dipyridamole i.v. injection (0.56 mg/kg b.m.). Sensitivity and specificity of electrocardiographic exercise test and dipyridamole stress echocardiography were assessed in 37 persons who underwent selective coronary angiography. The sensitivity and specificity of dipyridamole stress echocardiography, were respectively 85.0% and 91.7% and were higher than those of exercise electrocardiography. 2-dimensional echocardiography after dipyridamole injection is a well tolerated, feasible and effective test in the diagnosis of coronary artery disease.

In 20 patients with acromegaly, morphology of the heart and its systolic and diastolic function were studied by echocardiography, and growth hormone concentration was examined in the serum. Increased muscle mass of the left ventricle was found and that increase depended on disease duration and the growth hormone serum concentration. An increase was also shown of the left ventricular end-diastolic dimension, and the dimensions of left ventricle posterior wall and intraventricular septum, as well as an increase of end-systolic left ventricular dimension and of the size of the left atrium. Out of systolic function parameters, an increase was shown of stroke volume, cardiac output and cardiac index. In 40% of the studied patients an impairment was shown of left ventricular diastolic function but in a half of them no diseases other than acromegaly were found which could have been its cause.

To assess the feasibility, safety and usefulness of dobutamine stress echocardiography for the detection of coronary artery disease we evaluated 63 patients (45 men, 18 women) with effort chest pain. All patients underwent electrocardiographic submaximal bicycle exercise testing and 2-dimensional echocardiography during dobutamine infusion. Echocardiographic dobutamine test response was considered positive when new wall motion abnormalities were observed during dobutamine infusion. Sensitivity and specificity of electrocardiographic exercise test and dobutamine stress echocardiography were assessed in 25 patients who underwent selective coronary angiography. The sensitivity and specificity of dobutamine stress echocardiography, respectively 93.3% and 83.3%, were higher than those of exercise electrocardiography. 2-dimensional echocardiography during dobutamine infusion is a well tolerated, feasible and effective test for detecting coronary artery disease.

In asthmatic patients treated on a long term basis with steroids echocardiographic examination of the heart disclosed morphological and functional changes in the heart muscle. Such changes were not found in asthmatic treated occasionally with steroids. Differences between both groups depended on decreased contractibility of the heart muscle and concentric hypertrophy of the left ventricle present in asthmatic treated on a long term basis with systemic steroids.

A limited number of experiments have shown that treatment of rheumatoid arthritis by means of cooling the entire body in cryogenic chamber reduces the pain in joints affected by inflammatory process and increases their mobility. The aim of the present thesis was to try explain the mechanisms responsible for the observed improvement of the patients' condition, and an investigation of the treatment's effect on selected hemodynamic indices. Tests were carried out on 63 patients with rheumatoid arthritis mainly in the 3rd and 4th stage of illness, all of whom had been treated for 14 days, once daily, by cooling the body for two-minute periods in cryogenic chamber with temperatures ranging from -110 degrees C to -160 degrees C, followed by kinesitherapy. It was demonstrated that after a single session in the cryogenic chamber, after 7 and 14 days the level of ACTH, cortisol and beta-endorphins in blood serum rises. The level of TSH, T4, T3, GH and 6-keto-PGF1 alpha+, however, remains unchanged. The cryogenic chamber treatment does not affect the heart rate, arterial blood pressure nor the value of the left ventricle fractional shortening index and its ejection, neither does it cause of arrhythmias and ischemic changes of the heart.