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AIM: To specify effectiveness of different methods for assessment of diastolic function in patients with pre-dialysis chronic renal failure (CRF). MATERIAL AND METHODS: Forty non-diabetic pre-dialysis CRF patients (20 males and 20 females, mean age 51 +/- 11 years) were studied. Serum creatinine was 209.3 +/- 117.4 mcmol/l. 19 patients had chronic heart failure (CHF) of NYHA class I-III. M-mode echocardiography and Doppler echocardiography were performed. Transmitral and pulmonary venous flows were assessed by Doppler echocardiography and the flow propagation velocity (Vp) was estimated by color M-mode Doppler echocardiography. The ratio of peak E-wave velocity of transmitral flow to Vp (E/Vp) was calculated. All the patients had preserved systolic function (ejection fraction > 45%). RESULTS: Interpretation of transmitral flow was difficult in 16 (40.0%) patients. During Valsalva's manoeuvre the E-wave peak velocities, the A-wave velocities and the ratio E/A were decreasing. However, we did not reveal any correlation between E/A and NYHA class of heart failure (r = 0.18; p = 0.32). Interpretation of pulmonary venous flow was possible only in 24 (60.0%) patients. Vp estimation by color M-mode Doppler echocardiography improved evaluation of diastolic function in 15 of 16 patients with problems of transmitral flow assessment. A negative correlation was revealed between NYHA class and Vp (r = -0.39; p = 0.013) and a positive correlation was between NYHA class and E/Vp (r = 0.45; p = 0.004). CONCLUSION: Vp assessed by color M-mode Doppler echocardiography improves the diagnosis of diastolic dysfunction in patients with chronic renal insufficiency. This method has an advantage over pulmonary venous flow investigation. The Valsalva's manoeuvre is low-effective for differential diagnosis of transmitral flow types.

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AIM: To estimate the impact of day-to-day variability of blood pressure (BP) on left ventricular geometry in pre-dialysis patients. MATERIAL AND METHODS: We estimate the impact of day-to-day variability of BP on left ventricular geometry in 42 non-diabetic pre-dialysis patients (22 F, 20 M, mean age 47 +/- 12 years) with arterial hypertension (> 140 and 90 mm Hg). Serum creatinine was 286.2 +/- 176.8 micromol/l. BP was measured in the morning during 12 days and M +/- SD and delta systolic blood pressure (dSBP = SBPmax - SBPmin) was calculated. Echocardiography was performed and left ventricular mass index and relative wall thickness (RWT) was estimated. RESULTS: LVH was detected in 35(83.3%) patients. Multiple stepwise regression analysis revealed that mean SBP is a stronger predictor of LVH than clinical SBP (R2 = 0.59; p = 0.000001 and R2 = 0.35; p = 0.0007, resp.). Standard deviation of mean SBP correlated with RWT (R2 = 0.30; p = 0.006). dSBP > 30 mmHg was associated with an increase of RWT. CONCLUSION: Mean SBP during 12 days is a stronger predictor of LVH than clinical SBP. Day-to-day variability of SBP with dSBP > 30 mm Hg was associated with development of concentric LVH.

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AIM: To examine relationships between left ventricular geometry and general arterial compliance (GAC) in patients with predialysis chronic renal failure (CRF). 102 patients with predialysis CRF unrelated to diabetes mellitus (males 46, females 56, mean age 49.1 +/- 18.3 years). CRF was caused by chronic glomerulonephritis and essential hypertension (77.4%). 92 (90.2%) patients were hypertensive. Serum creatinin was 432.1 +/- 165.3 mcmol/l. GAC was defined as stroke volume/pulse arterial pressure. Echocardiography determined the index of the left ventricular myocardial mass (ILVMM), relative thickness of the left ventricular wall (RTW). Left ventricular hypertrophy (LVH) was diagnosed in 86 (84.3%) patients. In 64 patients it was concentric and in 22 patients--excentric). Multivariance regression analysis showed that systolic arterial pressure and anemia have a direct independent effect on ILVMM (p = 0.004). Independent inverse relationship was between GAC and RTW. Patients with concentric LVH had GAC lower than those with excentric LVH (p = 0.003). Reduction of GAC is an independent factor influencing the development of concentric LVH in patients with predialysis CRF.

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AIM: To investigate remodeling of the heart in patients with predialysis phase of chronic renal failure (CRF). MATERIAL AND METHODS: Patients with predialysis phase of CRF (n = 61; serum creatinine 412.4 +/- 242.69 mumol/l), essential hypertension (EH) (n = 35) and healthy volunteers (n = 20) were assessed with echocardiography. The patients were not significantly different by the level of systolic and diastolic blood pressure, age and gender. RESULTS: Left ventricular mass index (LVMI) was increased in 53(86.9%) patients with CRF. LVMI was not different in patients with CRF and EH (189.9 +/- 71.35 vs. 165.0 +/- 41.83 g/m2; p = 0.3). Relative wall thickness was similar in patients with serum creatinine < 200 mumol/l and patients with more elevated serum creatinine (57.2 +/- 10.33 vs 58.31 +/- 13.33; p = 0.9). The ejection fraction lower than 50% was detected in 14(22.9%) patients with CRF. Multivariate regression analysis showed that LVMI was independently related to systolic blood pressure (p = 0.004) and level of hemoglobin (p = 0.004). Diastolic dysfunction (early and atrial peak filling velocities ratio < 1.0) was detected in 13(50%) from 26 investigated patients with CRF. The independent influence of hemoglobin on isovolumic relaxation time (p = 0.04) and early and atrial peak filling velocities ratio (p = 0.02) are shown. CONCLUSION: In patients with predialysis phase of CRF left ventricular hypertrophy (LVH) is extremely common including patients with mildly elevated serum creatinine. The treatment of patients with renal pathology and normal function must include measures not only to correct renal process but also to prevent development of LVH.

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Examinations of 143 patients with lichen planus of the buccal mucosa and of 45 normal subjects included studies of lipid peroxidation (LPO) activity and of anti-radical defence system, as well as measurements of a number of blood trace elements. Plasma and red cell LPO intensity in the patients was several times higher than in the controls. Plasma glutathione peroxidase activity was found essentially reduced in the patients, whereas in red cells this activity surpassed 5 times the normal values. Glutathione reductase plasma activity was elevated and its red cell activity decreased. These findings indicate significant LPO disorders in the patients with lichen planus; their blood trace element levels were also found changed.

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