[Combined exercise training in men with metabolic syndrome after acute coronary event]

INTRODUCTION

Favourable effect of exercise training on cardiovascular prognosis in patients with metabolic syndrome have been documented in lot of studies. Less information exist about results of cardiovascular rehabilitation in patients with different forms of coronary heart disease and associated diseases and abnormalities within metabolic syndrome.

METHODS

The present article evaluates a benefit of combined, aerobic-resistance training in two groups of patients after percutaneous coronary intervention for acute coronary syndrome: with [group MS(+), n = 42] and without [group MS(-), n = 53] metabolic syndrome. The changes in aerobic capacity (VO2 peak, VO2 peak . kg(-1)), physical performance (W peak, W peak . kg(-1)), blood pressure, BMI and waist circumference after 12 weeks of cardiovascular rehabilitation are evaluated.

RESULTS

Significant improvement in aerobic capacity and physical performance were found out both in group MS(+) and MS(-) (p < 0.01, resp. p < 0.001). Decrease of systolic blood pressure was significant in MS(+), whereas in MS(-) together with decrease of diastolic BP in both groups were not significant. The increase in aerobic capacity and physical performance in patients of MS(+) is comparable with those in MS(-); the decrease in systolic BP was more intensive in MS(+) compared to MS(-). The changes in waist circumference and BMI were not significant in both groups.

CONCLUSION

The results show, that in patients with high number of risk factors associated with metabolic syndrome was demonstrated at least comparable benefit from cardiovascular rehabilitation compared with those without metabolic syndrome.

BLOOD PRESSURE, HEART RATE AND MELATONIN CYCLES SYNCHRONIZATION WITH THE SEASON, EARTH MAGNETISM AND SOLAR FLARES

Three spectral components with periods of about (~) 0.41, ~0.5 and ~1.0 year had been found with serially independent sampling in human circulating melatonin. The time series consisted of around-the-clock samples collected for 24 hours at 4-hour intervals from different patients over several years. Some of these components had been found to be circadian stage-dependent, the daytime measurements following mostly a circannual variation, whereas a half-year characterized the nighttime samples. The latter were incorporated into a circasemiannual map. The relative brevity of the series prevented a check for the coexistence of all three spectral components, even if each component seemed to have a raison d'être. In time series of transdisciplinary data, a 1.00-year synchronized component is interpreted as representing the seasons. The half-year may qualify the circannual waveform, but it is also a signature of geomagnetics. An ~0.41-year (~5-month) component is the signature of solar flares. It has been called a cis-half-year (cis = on this side of a half-year) and may be detected only intermittently. Charles L. Wolff predicted the existence, among others, of ~0.42- and ~0.56-year components as beat periods of rotations at different solar latitudes.The multiple components characterizing circulating melatonin could also be found in a (to our knowledge unique) data set of a clinically healthy scientist (RBS). Herein, we focus on vascular data self-measured by RBS as he aged from ~20 to ~60 years. A multi-component model consisting of cosine curves with periods of 0.41, 0.50 and 1.00 year was fitted to weekly means of systolic (S) and diastolic (D) blood pressure (BP) and heart rate (HR) collected ~5 times a day over 39 years by RBS. All three components can coexist for a while, although all of them are nonstationary in their characteristics and come and go by the criterion of statistical significance.Intermittently, BP and HR are synchronized selectively with one or the other aspect of RBS' physical environment, namely the seasons (at ~1.0 year), earth magnetism (at ~0.5 year) and/or solar flares (at ~0.42 year). Cosmic-biotic transfer of information, albeit hardly of energy (the biospheric amplitudes are very small) may be mediated in this set of frequency windows. As found earlier, RBS' circulation is also frequency-trapped environmentally in multidecadal windows, HR being locked into the transtridecadal Brückner, or rather Brückner-Egeson-Lockyer, BEL sunspot and terrestrial weather cycle, while his BP follows Hale's didecadal cycle in the changing polarity of sunspots.The ~0.41-year HR cycle may be associated with changes in solar flares, the cis-half-year amplitude of HR showing a cross-correlation coefficient of 0.79 with the total solar flare index (from both solar hemispheres) at a lag of ~3.2 years. The superposed time courses of these two variables indicate the presence of a shared Horrebow-Arago-Schwabe sunspot cycle of ~11 years, the cis-half-year in HR being more prominent after the total solar flare index reaches its ~11-year peak. Differences in the time-varying behavior of BP vs. HR are also described.

COSMIC INHERITANCE RULES: IMPLICATIONS FOR HEALTH CARE AND SCIENCE

Countering the trend in specialization, we advocate the trans-disciplinary monitoring of blood pressure and heart rate for signatures of environmental cyclic and other variabilities in space as well as terrestrial weather on the one hand, and for surveillance of personal and societal health on the other hand. New rules (if confirmed novel laws) emerge as we recognize our inheritance from the cosmos of cycles that constitute and characterize life and align them with inheritance from parents. In so doing, we happen to follow the endeavors of Gregor Mendel, who recognized the segregation and independent assortment of what became known as genes. Circadians, rhythms with periods, τ, between 20 and 28 hours, and cycles with frequencies that are higher (ultradian) or lower (infradian) than circadian, are genetically anchored. An accumulating long list of very important but aeolian (nonstationary) infradian cycles, characterizing the incidence patterns of sudden cardiac death, suicide and terrorism, with drastically different τs, constitutes the nonphotic (corpuscular emission from the sun, heliogeomagnetics, ultraviolet flux, gravitation) Cornélissen-series.

[Differentiated approach to prescription of physical activity in patients with left ventricular dysfunction]

Correctly indicated physical exercise performed and controlled on a regular basis is an inseparable part of treatment and rehabilitation of patients with left ventricular dysfunction. In order to guarantee the best effect and safety of physical exercise, it is necessary to adopt a differential approach to its prescription to patients with different degrees of functional damage. In addition, a number of conditions should be fulfilled, among which, in the first place, the determination of functional classification of patients used in practice and described in the relevant literature (NYHA, AMA, Goldman, Weber). Physical exercise cannot be differentiated only with respect to the degree of dysfunction; other conditioning factors should be taken into consideration, too, among which the relative contraindication of physical strain, somatic condition, physical exercise anamnesis and others (i.e. sex, age, motivation, etc.), causing a high degree of patient heterogeneity. Also described are additional conditions for differentiation and correct application of physical training, which involve the selection of suitable types of exercise and their energetic demands, adequate intensity, frequency and duration; it is also important to determine the available effective and safe methods, programmes and means of training. The article contains examples of the above conditions, as well as classification of physical exercise into functional classes NYHA I-IV. In conclusion, the authors point out the necessity of differentiation of physical training and of cooperation of the cardiologist with the physiotherapist in its indication, implementation and monitoring.

CIRCADIAN BLOOD PRESSURE VARIABILITY AND EXERCISE THERAPY

The objective of this study was to find if there was a relationship between the time when cardiovascular rehabilitation was running in the patients after myocardial infarction and an average daily value of systolic and diastolic blood pressure at 7-day ambulatory blood pressure monitoring.Systolic and diastolic pressures significantly increased in patients who underwent cardiovascular rehabilitation in the morning from 9.00 a.m. to 10.15 a.m., and significantly decreased in those who did their physical exercise in the afternoon from 1.30 p.m. to 2.45 p.m., compared to their blood pressure values on days without rehabilitation.

THE INCIDENCE OF SUDDEN CARDIAC DEATH IN AUSTRIA

The aim of the study was to assess the time structure (chronome) of sudden cardiac death (SCD) in Austria. The daily incidence of SCD (ICD-10 I46.1) in Austria was obtained for the 4-year span from Jan 2002 to Dec 2005. Data were available separately for men and women. This data series was analyzed by linear-nonlinear rhythmometry. The major feature is the detection of a cis-half-year that is validated nonlinearly, the estimated period of the cis-half-year is 0.408 year (95% CI: 0.389, 0.426). It is concluded that the chronobiological analysis of sudden cardiac death in Austria showed the variability of total incidence with the period of a cis-half-year.

CHRONOBIOLOGY OF HIGH BLOOD PRESSURE

BIOCOS, the project aimed at studying BIOlogical systems in their COSmos, has obtained a great deal of expertise in the fields of blood pressure (BP) and heart rate (HR) monitoring and of marker rhythmometry for the purposes of screening, diagnosis, treatment, and prognosis. Prolonging the monitoring reduces the uncertainty in the estimation of circadian parameters; the current recommendation of BIOCOS requires monitoring for at least 7 days. The BIOCOS approach consists of a parametric and a non-parametric analysis of the data, in which the results from the individual subject are being compared with gender- and age-specified reference values in health.Chronobiological designs can offer important new information regarding the optimization of treatment by timing its administration as a function of circadian and other rhythms.New technological developments are needed to close the loop between the monitoring of blood pressure and the administration of antihypertensive drugs.

THE RELATIONSHIP BETWEEN CIRCADIAN BLOOD PRESSURE VARIATION AND AGE ANALYSED FROM 7-DAY MONITORING

The relationship between age and circadian blood pressure (BP) variation was the aim of the present study. One hundred and eighty-seven subjects (130 males, 57 females), 20-77 years old, were recruited for seven-day BP monitoring. Colin medical instruments (Komaki, Japan) were used for ambulatory BP monitoring (oscillation method, 30-minute interval between measurements). A sinusoidal curve was fitted (minimum square method) and the mean value and amplitude of the curve (double amplitude corresponds to the night-day difference) were evaluated on every day of monitoring. The average 7-day values of the mean (M) and of double amplitude (2A) for systolic BP (SBP), diastolic BP (DBP), and heart rate (HR) were determined in each subject. The mean values of M (+/-SD) for the whole group were: SBP- 127+/-8, DBP - 79+/-6 mmHg, HR - 70+/-6 bpm; of 2A: SBP - 21+/-7, DBP - 15+/-5 mmHg, HR - 15+/-6 bpm. A linear relationship between M of SBP and age (r=0.341, p< 0.001) and DBP and age (r=0.384, p<0.001) was found (difference between 20 and 77 years: SBP - 16, DBP - 12 mmHg). 2A of SBP and DBP was increasing with age up to 35 years, then the curve remained relatively flat up to 55 years (maximum at 45 years), and then it decreased again (difference between 45 and 77 years: SBP - 13mmHg, DBP - 12 mmHg). Heart rate M and 2A were age-independent. The mean values of SBP and DBP were increasing with age up to 75 years, but the night-day difference of SBP and DBP reached its maximum value at 45 years and then decreased.

CHRONOMICS AND GENETICS

The mapping of time structures, chronomes, constitutes an endeavor spawned by chronobiology: chronomics. This cartography in time shows signatures on the surface of the earth, cycles, also accumulating in life on the earth's surface. We append a glossary of these and other cycles, the names being coined in the light of approximate cycle length. These findings are transdisciplinary, in view of their broad representation and critical importance in the biosphere. Suggestions of mechanisms are derived from an analytical statistical documentation of characteristics with superposed epochs and superposed cycles and other "remove-and-replace" approaches. These approaches use the spontaneously changing presence or absence of an environmental, cyclic or other factor for the study of any corresponding changes in the biosphere. We illustrate the indispensability of the mapping of rhythm characteristics in broader structures, chronomes, along several or all available different time scales. We present results from a cooperative cartography of about 10, about 20, and about 50-year rhythms in the context of a broad endeavor concerned with the Biosphere and the Cosmos, the BIOCOS project. The participants in this project are our co-authors worldwide, beyond Brno and Minneapolis; the studies of human blood pressure and heart rate around the clock and along the week may provide the evidence for those influences that Mendel sought in meteorology and climatology.

ANALYSIS OF BAROREFLEX FUNCTION BY MEANS OF MATHEMATICAL MODEL

Re-evaluation of all functions of baroreflex by means of a simple mathematical model of circulation was the aim of the present study. The following states are modelled: 1. Rest. 2. Immediately after baroreceptor denervation. 3. Several days after denervation. 4. Physical exercise before denervation. 5. Physical exercise several days after denervation. Despite the same cardiac contractility and the same vasodilatation in working muscles as before denervation the cardiac output is by one third lower after baroreceptor denervation. In conclusion, a model simulation revealed the common regulation of blood pressure and blood volume by baroreflex and kidneys as a primary function of baroreflex.

[Medical device Task Force Monitor in diagnostics of syncope by means of head-up tilt table testing]

Head-up tilt table testing is used for diagnostics of vasovagal syncope. Beat-to-beat blood pressure recording and ECG monitoring is not sufficient for clarification of the syncope mechanisms in individual patients, however. That is why a Task Force Monitor was developed in Graz, Austria. In addition this device enables stroke volume recording by impedance method. Other advantages are calculations of cardiac output, beat-to-beat total peripheral resistance, heart rate variability and baroreflex sensitivity as well as activity ofsympathicus and parasympathicus assessment. These methods enable detailed hemodynamic analysis during the whole head-up tilt testing duration, the moment of syncope including.

[Interval and continuous training in cardiovascular rehabilitation]

The objective of the study was to evaluate the physiological effectiveness and the influence of two modifications of aerobic training (interval and continuous) on the physical performance in the patients with coronary heart disease. 38 males with coronary heart disease (age 60 +/- 10.2 years) passed three months training programme of 60 min 3 times a week (10 min of warm up phase, 25 min of aerobic phase, 15 min of resistance training, 10 min of relaxing phase). Patients with coronarographically verified stenosis > 50% luminal diameter and/or left ventricular ejection fraction lower than 40 % (n = 22) had in terms of aerobic phase interval training prescribed (30 second work phases with work load intensity on the level of anaerobic threshold alternating with 60 second recovery phases with intensity of 5 W); other patients (n = 16) passed aerobic phase of the programme with continual work load of intensity on the level of ventilatory anaerobic threshold. After the determination of three month rehabilitation programme the maximal achieved performance as well as aerobic capacity evaluated by spiroergometric examination statistically significantly increased in the group of patients with interval training and also in the group with continuous training. Despite the group with interval training performed 2.5-3 times less work in each training unit (p < 0.01), the performance and aerobic capacity parameters after the termination of three month programme did not statistically significantly differ from the group with continuous training. The advantage of the continuous training is a possibility to achieve an improvement also in the patients with left ventricular dysfunction and chronic coronary heart disease who could have worse tolerance of the continual work load.

MOVING LEAST SQUARES SPECTRA SCRUTINIZE CHRONOMICS IN AND AROUND US

As an extension of the chronobiological serial section, gliding spectra illustrate the changing time structure (chronome) of physiological, physical and/or other variables in a given frequency range. For this purpose, least squares spectra are computed over a specified interval (much shorter than the observation span) that is progressively displaced by a given increment throughout the entire record. Results can be displayed either as 3D charts or as surface charts, displaying the estimated amplitudes, percentage rhythms or ordering P-values at each trial period for each interval. The procedure is illustrated for the record of Wolf numbers as a gauge of solar activity and for the number of marriages and divorces in Japan during the past century. Major components in these time series show deviations in period length and relative prominence over time. Particularly in the case of non-stationary time series, gliding spectra offer themselves as useful tools to examine changes in time structure beyond a specific spectral component.

CIRCANNUAL VARIATION IN HUMAN DIASTOLIC BLOOD PRESSURE DURING CONSECUTIVE SOLAR CYCLES

Putative circadecadal modulations of a circannual variation in diastolic blood pressure are explored in a still accumulating 35 year record of self-measurements by a clinically healthy man. Analyses of monthly means by gliding spectra, one-way analysis of variance (ANOVA), and cosinor were carried out after removing data collected during travel across time zones or during illness. An about yearly change in diastolic blood pressure may or may not be detected with statistical significance by cosinor or ANOVA, apparently as a function of solar cycle number and/or stage. It appears to be, however, 1 year synchronized in the entire span analysed as a whole. A given variable such as diastolic blood pressure may be characterized by multifrequency rhythms that may intermodulate, so that findings in different stages of cycles with the lowest (e.g., circadecadal) frequency mapped may determine different outcomes in cycles with higher frequencies, such as circannuals.

FURTHER MAPPING OF THE NATALITY CHRONOME IN TODA CITY (JAPAN) MATERNITY HOSPITAL

In order to investigate any circannual and/or circaseptan variations in birth incidence and birth weight in Toda City (Japan), data on 4,411 consecutive births were obtained from the city's Maternity Hospital between 1 Jan 1999 and 31 Dec 2001. Data were analysed by cosinor separately for babies with birth weights in given ranges, and separately for boys and girls born at different gestational ages. A circannual rhythm was detected with statistical significance (P=0.047) for birth incidence of all vaginal deliveries, with an acrophase in the fall. A similar result for caesarean sections was of borderline statistical significance. A circaseptan component with a relatively consistent acrophase around midweek was of borderline statistical significance for birth incidence in some of the groups investigated. About-yearly and about-weekly variations were also found to characterize birth weight in some of the groups investigated.

MAPPING OF CIRCASEPTAN AND CIRCADIAN CHANGES IN MOOD

Circadian changes in mood have been described earlier. A positive affect (PA) has been separated from a negative affect (NA), as independent components in opposite admittedly subjective directions, a circadian rhythm characterizing both aspects. Herein, the time structure (chronome) of human mood is re-examined and extended from the circadian to the circaseptan domain by a meta-analysis of data on 196 clinically healthy students who filled out the positive (PA) and negative (NA) affective scale (PANAS), consisting each of 10-item mood scales. Both PA and NA are found by cosinor to be characterized by a circaseptan, circasemiseptan, and circadian variation. The circaseptan and circasemiseptan amplitudes are found to be larger than the circadian amplitude for NA, whereas the circadian amplitude is largest for PA. Complementing differences in relative circaseptan-to-circadian prominence between PA and NA are differences in the timing of the circadian, circasemiseptan, and circaseptan components of PA and NA. An even broader spectrum of rhythms may include a circadecadal modulation. With this qualification, the information on the time structure of mood provides endpoints to be considered in any attempt to optimize psychological well-being by making sleeping, dietary, and/or other lifestyle adjustments.

UNTREATED TRANSIENT LONGER THAN 7-DAY CHAT, CIRCADIAN HYPER-AMPLITUDE TENSION, IN A 7-YEAR PERSPECTIVE

The case report presented herein aims at promoting the awareness in medical, notably cardiological, practice of the importance of, first, collecting at least a week-long record of around-the-clock measurements of blood pressure (BP) and heart rate (HR) (and a much longer record if the 7 day record so indicates) and, second, of analysing the data chronobiologically in the light of reference values specified as a function of time, gender and age as a minimum. In addition to diagnosing deviations in a chronome (time structure)-adjusted mean value, a chronobiological approach identifies abnormalities in the variability of BP and/or HR, gauged by the circadian characteristics (double amplitude and acrophase, measures of the extent and timing of predictable change within a cycle) and by the standard deviation. A woman in presumably good health was 60 years of age at the start of intermittent monitoring over a 7 year span. The case report illustrates the extent to which a decision based on single BP readings and even on 24 hour averages may be misleading. Treatment based on an initial week-long monitoring may benefit from continued long-term monitoring.

AMBULATORY BLOOD PRESSURE MONITORING: THE NEED OF 7-DAY RECORD

The need for systematic around-the-clock self-measurements of blood pressure (BP) and heart rate (HR), or preferably for automatic monitoring as the need arises and can be met by inexpensive tools, is illustrated in two case reports. Miniaturized unobtrusive, as yet unavailable instrumentation for the automatic measurement of BP and HR should be a high priority for both government and industry. Automatic ambulatorily functioning monitors already represent great progress, enabling us to introduce the concept of eventually continuous or, as yet, intermittent home ABPM. On BP and HR records, gliding spectra aligned with global spectra visualize the changing dynamics involved in health and disease, and can be part of an eventually automated system of therapy adjusted to the ever-present variability of BP. In the interim, with tools already available, chronomics on self- or automatic measurements can be considered, with analyses provided by the Halberg Chronobiology Center, as an alternative to "flying blind", as an editor put it. Chronomics assessing variability has to be considered.

[New techniques in recording cardiac electric potentials]

New technologies of recording and processing of electrical cardiac potentials made significant advances in the course of recent years, contributing to the production of instrumentation the application of which enables a high level of diagnostics, therapy and rehabilitation to be reached in internal medicine. Modern technology of recording potentials by means of vacuum electrodes with surface finish and simultaneous application of new adaptable filters enable a more accurate digital processing of electrical pulses and a higher quality of their recording, indication, transmission, interpretation and archiving. The given requirements are complied with especially by new polyfunctional instruments, made e.g. by the firm SCHILLER AG, and some specialized devices of other producers, serving, among others, for examination of heart rate and its variability. New technical devices, applied sensibly and economically, should be accessible in the near future also to peripheral cardiologic and internal centres.

[Combined training in patients with systolic left ventricular dysfunction]

The objective of the work was to evaluate the effect of eight-week combined training on the performance, aerobic capacity and basic haemodynamic parameters in patients with systolic dysfunction of the left ventricle and to assess its safety. The investigation comprised 26 patients, men mean age (x +/- SD) 61.8 +/- 11.1 years with coronarographically verified chronic ischaemic heart disease and with a left ventricular ejection fraction lower than 40% (EF 35 +/- 4%). Before the beginning and after completion of the rehabilitation programme (eight weeks) a spiroergometric examination was made, up to the symptom-limited maximum. Fitness elements were included after 2 weeks of aerobic training. The lesson lasted 60 mins. and included warming up (10 mins.), aerobic load on an ergometer with an intensity of the load at the level of the anaerobic threshold (20 mins.), the stage of fitness training on a combined training machine (20 mins) and the relaxation stage (10 mins). In the fitness stage the patients started to exercise at the 30% level, after two weeks at the 60% level 1-RM (one repetition maximum) The results showed after eight-week combined training a significant (p < 0.05) increase of the maximum achieved performance (from 104 +/- 27 to 132 +/- 32 W) in patients with systolic left ventricular dysfunction. There was a significant increase in the capacity of the transport system expressed by the value of the maximum oxygen uptake (from 1545 +/- 312 to 1740 +/- 359 ml.min-1) and MET (from 5.3 +/- 1.3 to 6.0 +/- 1.4). There was a significant decrease of the blood pressure at rest, systolic and diastolic, and of the baseline value of the heart rate at rest and of the "product rate, pressure"--RPP. Changes in the EF were not significant.

[The effect of walking exercise on aerobic capacity and serum lipids in type 2 diabetics]

Regular physical activity can have a favourable impact on other risk factors of ischaemic heart disease (IHD) and associated diabetes (DM), such as obesity, hypertension, dyslipidaemia, insulin resistance and others. This important part of treatment of diabetes is frequently difficult to implement because of the lack of willingness ("adherence") of type 2 diabetics to practice regular exercise, and unequivocal data are lacking on the intensity of exercise which will influence effectively these risk factors and be at the same time safe, readily available and psychologically acceptable. The objective of the work was to find out whether walking, i.e. locomotor activity with a low to medium intensity can effectively influence parameters of aerobic capacity and blood lipids. The authors submit the results of two groups of type 2 diabetics. The experimental group B (n = 10, age 57 +/- 7 years, BMI 31 +/- 3, duration of DM 8 +/- 5 years) participated in a 12-week training programme of walking; at the beginning and at the end of this period indicators of aerobic capacity at the level of the anaerobic threshold (VO2ANP) were evaluated as well as at the level of the symptom limited maximum (VO2SL, TepO2SL), and the blood lipid levels. In the control group A (n = 6, age 58 +/- 7 years, BMI 32 +/- 4) indicators of aerobic capacity and blood lipids were assessed after a 12-week period of the usual habitual physical activity. In group B the 12-week walking training led to significant improvement of parameters of aerobic capacity at the level of the anaerobic threshold (ANP), oxygen pulse at the level of the symptom limits maximum (SL) and a significant reduction of total and LDL cholesterol. In the control group no significant changes occurred in aerobic capacity nor blood lipid values. The training programme where walking was selected as physical activity with a low to medium intensity can be considered suitable for everyday life of motivated patients with type 2 diabetics, preferably in the form of a domestic training programme. The prerequisite of success is its regular and frequent evaluation by health professionals.

Microvessels of bulbar conjunctiva in UPTAH goats

Aiming to observe directly the microcirculation after total artificial heart (TAH) implantation, we performed a long-term follow-up in 2 goats using conjunctival angioscopy. A short segment of parallel arteriole and venule was photographed and analyzed on computer picture program (magnification 40x). Three main parameters were measured: arteriole diameter, venule diameter, and arteriovenous ratio (A/V ratio). The intrathoracically implanted TAH was the undulation pump total artificial heart (UPTAH) with cardiac output of 100 ml/kg/min. To stabilize the peripheral hemodynamics a 1/R biofeedback control system was used. Our results provided only elementary data about morphology of bulbar microvessels. The main finding was the tendency to general vasoconstriction, more intensive on the venous side (*P < 0.05 in one goat). We did not observe any pathological shapes (e.g., tortuosities, varicosities, or sludge); this result could be attributed to the high effectivity of 1/R control method. These preliminary results should be considered only as an attempt to apply the widely used clinical method of conjunctival angioscopy to the conditions of TAH.

[Effect of physical training on the magnitude of left ventricular ischaemic dysfunction in patients with chronic ischaemic heart disease]

Twenty-two patients with chronic ischaemic heart disease (IHD) and reversible myocardial ischaemia after a load as recorded by single photon emission computed tomography (SPECT) participated in an eight-week rehabilitation programme. Before exercise their efficiency was tested by spiroergometric examinatin and the patients were randomized into two groups. Group A (10 patients) took exercise at the level of the anaerobic threshold (high intensity training), group B (12 patients) trained at the level of the 60 % anaerobic threshold (low intensity training). The exercise unit including the warming up and relaxation stage lasted 50 minutes and was repeated three times per week. Before and after the rehabilitation programme in all patients spiroergometry was performed as well as exercise pulsed tissue Doppler echocardiography to evaluate regional systolic and diastolic left ventricular function in the ischaemic area, localized beforehand by the SPECT. The following parameters were evaluated by echocardiograpphy: the peak velocity of motion in the ischaemic area in systole (Si), the peak velocity of motion in the ischaemic area in early diastole (Ei) ad in atrial contraction (Ai), and the ratio Ei/Ai was calculated. With the exception of the decline of the value at rest Ai from 8.4 +/- 1.3 cm/sec to 7.3 +/- 1.3 cm/s (p < 005) in the exercising group A none of the parameters of left ventricular regional function changed significantly after an eight-week rehabilitation programme. The maximal performance achieved in spiroergometry increased however after rehabilitation in group A (from 145 +/- 36 W to 162 +/- 39 W, p < 0.01) as well as in group B (from 112 +/- 36W to 122 +/- 36W, p < 0.05). I It may be concluded that a rehabilitation programme of high and low intensity improved the load tolerance during spiroergometry but did not lead to significant improvement of regional systolic and diastolc left ventricular function in the area of reversible ischaemia.

Baroreflex sensitivity during psychological stress

The aim of this study was to analyse the changes of baroreflex sensitivity (BRS) and their relation to changes of heart rate and blood pressure in medical students during moderate psychological stress brought about by oral examination. The changes of BRS during the stress were compared with the changes during light physical exercise. Thirty three students were examined 30 min before and 30 min after the exam. Thirty-nine students of control group were examined at rest and during light exercise. Blood pressure was noninvasively recorded by Penáz method at rate-controlled breathing (0.33 Hz). The BRS [ms/mm Hg] and BRSf [Hz/mm Hg] were calculated by spectral analysis of spontaneous fluctuations of blood pressure and inter-beat intervals (IBI). BRS before examination (7.12 ms/mm Hg) was significantly lower than after the oral exam (8.77 ms/mm Hg, p<0.05). The difference between BRS in the test group after the oral exam and the control group at rest (10.78 ms/mm Hg) was not significant. BRS during light exercise (7.44 ms/mm Hg) corresponded to the value during psychological stress. The values of BRSf did not change during psychological stress (before: 0.0182 Hz/mm Hg; after: 0.0182 Hz/mm Hg) and exercise (rest: 0.0158 Hz/mm Hg; exercise: 0.0144 Hz/mm Hg). Correlation between BRS or BRSf and blood pressure were not found. A significant negative correlation (r=-0.404, p<0.05) between BRSf and the increase of diastolic blood pressure during stress was observed. It is concluded that BRSf remained constant during psychological stress and exercise, and differed essentially from that in hypertensive subjects.

[24-hour ambulatory monitoring of blood pressure in patients with essential hypertension: the effectiveness of enalapril therapy]

The aim of the present paper was to study 24-h blood pressure profile in twenty patients with essential hypertension (mild to moderate) before and after treatment with ACE inhibitor enalapril in one day dose in the morning (15.6 +/- 6.1 mg). 24-h ambulatory blood pressure monitoring was examined after 14 days of placebo administration and after one month of enalapril therapy. Enalapril treatment decreased systolic blood pressure of 11.3 mmHg during daytime and of 9.4 mmHg at night, diastolic blood pressure of 6.1 mmHg during daytime and 5.8 mmHg at night, all differences were significant in comparison to placebo (p < 0.01). The through-peak ratios were 63.2% for systolic blood pressure and 54.0% for diastolic blood pressure. We can conclude that enalapril treatment in one day morning dose is efficient to decrease blood pressure during 24-h span without altering the diurnal profile.

[24-hour monitoring of blood pressure in patients with essential hypertension]

The aim of the study was to determine the efficiency of enalapril therapy during 24-hours blood pressure monitoring. A group of healthy subjects (C, n = 11), a group of patients with essential hypertension without therapy (EH, n = 9) and a group of patients with essential hypertension II (WHO) treated with enalapril (Acepril Lachema) in once a day doses (13.0 +/- 2.1 mg per kg) during at least 10 months (EH A, n = 8). In all groups of patients and healthy subjects 24-hours blood pressure measurement was provided using Accutracker II equipment. The mean values of systolic (SBP) and diastolic blood pressure (DBP) from 24-hours measurement (+/- SD) were in the group of healthy subjects C 121.38 +/- 10.49/74.79 +/- 7.88 mmHg, in the group EH 146.58 +/- 12.20/88.0 +/- 8.97 mmHg, in the group EH A 127.38 +/- 8.36/74.71 +/- 6.08 mmHg. The differences between the maximum and minimum mean blood pressure values during 24 hours (SBP/DBP) were in the group C 33/27 mmHg, EH 37/29 mmHg, EH A 29/21 mmHg. The smaller difference in SBP and DBP in EH A patients was significant in comparison to C and EH (t-test, p < 0.05). Cosinor analysis proved the results. From our results we can conclude that the Acepril therapy decreases blood pressure more during the day-hours then during night and it is preferable in connection to the risk of night hypotension with hypoxia.

[Free oxygen radicals in patients with hyperlipoproteinemia]

The authors investigated the effect of hyperlipoproteinaemia on the formation of free oxygen radicals to which a significant role in the genesis of atherosclerosis is ascribed. They cause among others peroxidation of blood lipids with formation of lipoperoxides with a higher atherogenity. Using the method of luminol-dependent chemiluminiscence, their spontaneous and activated production in phagocytic blood cells was examined in a group of patients investigated on a long-term basis on account of hyperlipoproteinaemia (n = 24). The results were compared with a group of healthy subjects (n = 20); concurrently also blood lipids were examined. The authors revealed a statistically significant reduction of the spontaneous production of free oxygen radicals in the group of patients with hyperlipoproteinaemia. On examination of the activated production the drop of oxygen radical formation was at the borderline of statistical significance.

[Free oxygen radicals in patients with hypertension]

The objective of the investigation was to test the impact of hypertension on the formation of free oxygen radicals which participate in the development of atherosclerosis. Using the method of luminol-dependent chemiluminescence, the authors assessed the spontaneous and stimulated production of free oxygen radicals in phagocytic cells of complete blood in a group of healthy subjects, in not treated essential hypertension (EH), essential hypertension treated with metipranolol (Trimepranol Spofa) and EH treated with diltiazem (Blokalcin Lachema). A statistically significant increase of spontaneous and activated production of free oxygen radicals was found in the group of EH treated with diltiazem. Differences between the group of healthy subjects, untreated EH and hypertension treated with metipranolol were not statistically significant.

[Vascular changes in essential hypertension after treatment with enalapril]

A group of patients with essential hypertension and healthy subjects from the same work place were investigated for a period of four weeks and were subjected, in addition to a basic clinical medical examination, to an ergometric examination ECHO cardiography, occlusion plethysmography, and concurrently serum levels of adrenaline (A), noradrenaline (NA), renin, cyclic adenosine monophosphate (cAMP) beta receptors before and after four weeks treatment with enalapril were assessed. The results are consistent with available data from the literature where administration of inhibitors of the angiotensin converting enzyme (ACE) caused a reduction of the peripheral vascular resistance and increased blood flow assessed by means of occlusion plethysmography. Similar results were recorded after captopril administration for a one year period, as reported by Agabiti-Rose (1). Statistically significant differences were detected between hypertonics given placebo and those given enalapril for four weeks, as regards blood flow at rest and peripheral vascular resistance at rest. There was also a significant difference when hypertonic and normotonic subjects were compared. The results are presented in tables and figures.

[Relation between echocardiographic indicators and beta 2-adrenergic receptors in essential hypertension during treatment with enalapril]

A group of 22 men with essential hypertension stage I and II according to WHO, mean age 29.1 +/- 1.4 years, was divided at random into two sub-groups. Eleven patients were treated for four weeks with enalapril (E), 10 mg/day, 11 patients were given placebo (P), also for a period of four weeks. The patients were subjected to echocardiographic examination before and after four-week therapy with enalapril or placebo. In patients treated with E a significant reduction of the left ventricular wall and the interventricular septum was observed. There was also a highly significant decline of the weight of the left ventricle and the index of left ventricular mass. Enalapril led to a decline of the specific binding capacity and affinity of beta 2-adrenergic lymphocyte receptors. In the group given P no differences were found during the examination repeated after four weeks. By means of multidimensional linear regression estimates a close relationship was revealed between the difference in the weight of the left ventricle, the difference of the index of left ventricular mass and the difference of specific binding capacity and affinity of beta 2-adrenergic lymphocyte receptors.