Dobutamin stress-echocardiography has been tried outpatiently in the diagnostic center for feasible use in functional assessment of the myocardium in patients with congestive heart failure class 3-4 by classification of New York Heart Association. Eleven outpatients (a mean age 56 +/- 8 years) with left ventricular dilatation and a reduction in the ejection fraction received an increasing dose of dobutamin (5-40 micrograms) min/kg in intravenous infusion in the course of which central hemodynamics and left ventricular segmental contractility were measured with two-dimensional and Doppler echocardiography. By the hemodynamic response to dobutamin infusion reflecting difference in the myocardial reserve, two groups of patients were identified. The authors suggest dobutamin Doppler echocardiography for use in outpatient setting as a safe and effective procedure for assessing contractile myocardial reserve and prognosis of congestive heart failure.

The paper presents comparative assessment of various loading ECG tests in outpatient diagnosis of coronary heart disease. Of special importance is simultaneous use of transesophageal pacing and echocardiography (stress echocardiography). High sensitivity and specificity of this method are especially useful in coronary heart disease diagnosis in low-risk groups.

Left ventricular blood filling was performed in 72 patients by using pulsed Doppler echocardiography at rest and in postpacing ischemia. In 10 patients, non-invasive examination findings were compared with the values of a left ventricular pressure curve which had been obtained in frequent atrial pacing. No changes in transmitral blood flow were found in patients without coronary heart disease, whereas 2 types of abnormal transmitral blood flow were detected in those with coronary heart disease in the postpacing period. The patients with Type I abnormal transmitral blood flow exhibited prolonged isovolumetric relaxation and slightly elevated left ventricular end-diastolic pressure in the postpacing period when catheterization was conducted. Those with Type I ("pseudonormal") transmitral blood flow displayed more prolonged relaxation and significantly (greater than 20 mm Hg) elevated end-diastolic pressure. The pattern of changes in transmitral blood flow was not pathognomonic to any definite myocardial abnormality, but reflected the hemodynamics.

Experience gained by one of the departments of the interregional diagnostic center (DC) provides evidence in favour of its setting up within the public health system. Owing to the department of functional diagnosis of the center, the outpatients can be examined skillfully, whereas previously only hospitalization was of help. Successful functioning of the department and perfection of its work require at least two conditions. The first one lies in sufficient equipment of the DC with up-to-date facilities and outfits, and the second one in the presence of good specialists, their desire and strivings for constant perfection of the available diagnostic methods and for introduction into medical practice of the new ones.

Coronary arteriography, bicycle ergometry and transesophageal atrial pacing (TAP) in combination with Doppler echocardiography (stress-Doppler echocardiography) were used to evaluate cardialgias in 30 outpatients. Stress-Doppler echocardiography showed a high (94%) sensitivity and a high (86%) specificity to detect coronary heart disease (CHD). There was a high correlation (r = 0.79, p less than 0.001) between the wall motion values obtained by echocardiography during TAP and coronary rating. The left ventricular (LV) diastolic filling (DF) was studied by pulsed wave Doppler echocardiography in the postpacing period. The Doppler-derived parameters of LV DF obtained in that period appeared to be moderately sensitive (75%) and specific (64%) in detecting CHD. In post-pacing ischemia, the "pseudonormalized" LV filling pattern was observed in 5 of 6 patients (sensitivity 80%) having three-vessel disease and major left (or equivalent) coronary stenosis.

Eighteen patients in whom sustained supraventricular tachycardia paroxysms were induced by programmed transesophageal pacing were examined. Doppler echocardiography was used to study left ventricular systolic and diastolic function, as well as cardiac output and pulmonary systolic pressure during sinus rhythm and paroxysms. A profound decrease in the cardiac index during paroxysms was found in 2 patients, one of them had higher pulmonary pressure. The cardiac index increased on an average from 4.4 +/- 0.9 l/min.m-2 during sinus rhythm to 4.8 +/- 1.4 l/min.m-2 during paroxysms. The diastolic function of the left ventricle was ascertained to be one of he factors that determine cardiac index in supraventricular tachycardia paroxysms.

Left ventricular diastolic function was studied by Doppler echocardiography in 18 patients with early signs of hypertensive heart before and after intravenous verapamil, 0.15 mg/kg. Eleven patients without cardiovascular disease comprised a control group. A significant deterioration of left ventricular diastolic function parameters was revealed in patients with hypertensive heart. There was a normalization of left ventricular blood filling following 30 min of verapamil use, which was associated with the direct action of the drug on the myocardium and with its vasodilating effect.

Doppler echocardiography is an excellent tool to study the hemodynamic effects of cardiac drugs. Resting and exercise effects produced by metoprolol and allapinin on Doppler-derived measures of left ventricular (LV) performance were examined in patients with paroxysmal supraventricular tachycardias. Seventeen patients underwent continuous wave Doppler examination from the suprasternal notch at rest and during each stage of a standard exercise protocol. The study was repeated following 3-4 days of treatment with metoprolol given in a daily dose of 200 mg. The hemodynamic effects of allapinin, 100 mg daily, were evaluated in the same manner in 8 patients. With metoprolol, all resting Doppler measurements were altered insignificantly and all Doppler--derived parameters of aortic flow (peak, velocity, mean acceleration, cardiac index and LV ejection force) were much lower at the maximum exercise. Allapinin failed to alter any Doppler measurements of aortic blood flow at rest or during the peak exercise.

Echocardiographic studies of left ventricular function were carried out in 20 patients with chronic unspecific pulmonary diseases (CUPD). These patients showed no true left ventricular myocardial hypertrophy, while electrocardiographic signs of the latter might be related to the recording of potentials from the hypertrophic ventricular septum produced by positional cardiac changes due to pulmonary emphysema. In addition to septal hypertrophy, end diastolic left ventricular size was shown to be diminished. A hypothesis is proposed for the pathogenesis of left ventricular pumping disorders associated with CUPD.