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In this study, we investigated the relationship between the blood glucose level and the length of the QT-interval as well as the influence of locomotor activity on these characteristics in children and adolescents presenting with type 1 diabetes mellitus during the long-term monitoring of ECG, the level of glycemia, and locomotor activity. The daily dynamics of these parameters was elucidated along with the measurements of the lengths of QT and RR intervals. Specifically, the correlation between the length of the QTc interval and the blood glucose level appears from the fact that the maximum QTc length occurred when glycemia dropped below 4 mmol/l. It also significantly increased at glycemia in excess of 16 mmol/l (and up to 21 mmol/l). Moreover the length of the QTc interval directly depended on the duration of the disease. The locomotor activity was shown to significantly affect the blood glucose level within 3-4 hours after its onset.

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The present study included 71 patients with type 2 diabetes mellitus (41 boys and 30 girls) at the age from 9 to 18 (mean 15.2 (13.6; 16.5)) years, duration of the disease 5.0 (2.5; 9) years, and the HbA1c level of 9.1% (7.0; 10.2). All the patients underwent continuous ECG monitoring with the assessment of the cardiac rhythm variability (CRV) characteristics and the QT interval duration over 24 hours. These studies were supplemented by cardiovascular tests and the PWC170 test with the evaluation of CRV and the heart rate (HR) during testing and the rehabilitation period. Autonomous dysfunction was documented in 22 (30.9%) patients. It was shown that the children and adolescents presenting with the cardiovascular form of autonomous neuropathy (KAH+) had lower CRV values during physical exercises than the patients without KAH+ , and their CRV and HR characteristics failed to be fully normalized after the cessation of loading. This fact may be responsible for the high cardiovascular morbidity and mortality rate among the patients with DM1 in the mature age.

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Резюме Изменения электрокардиограммы, в частности, конфигурация комплекса QRS типа qR в отведении V1, являются фактором риска летального исхода у больных легочной артериальной гипертензией. Цель исследования. Сопоставить конфигурацию комплекса QRS в отведении V1 с выраженностью поражения сердца по данным эхокардиографии (ЭхоКГ) у больных идиопатической легочной гипертензией (ИЛГ) и хронической тромбоэмболической легочной гипертензией (ХТЭЛГ). Материалы и методы. У 40 больных ИЛГ и 40 больных ХТЭЛГ в возрасте 45±12 лет при ЭхоКГ оценивали систолическое давление в легочной артерии (СДЛА), размеры камер сердца, показатели систолической и диастолической функции правого желудочка (ПЖ), систолической функции левого желудочка, сердечно-сосудистое сопряжение ПЖ. Конфигурацию комплекса QRS в отведении V1 определяли на 10-ти секундной цифровой электрокардиограмме. Результаты. Было выявлено 18 вариантов конфигурации QRS в отведении V1. У 30 больных (37,5% случаев) в отведении V1 имелась конфигурация rS ил RS; у 16 пациентов (20% случаев) - различные варианты конфигурации rsR’; у 21 пациентов (26% случаев) - конфигурация qR. У пациентов конфигурацией qR в отведении V1 по сравнению с остальными группами были больше СДЛА и размеры правых камер сердца, отмечалось более выраженное ухудшение систолической функции правого и левого желудочков, а также более тяжелые нарушения межжелудочкового взаимодействия и сердечно-сосудистого сопряжения. Конфигурация qR в отведении V1 позволяла с чувствительностью от 46% до 89% и специфичностью от 89% до 95% выявлять больных с наличием прогностически неблагоприятных изменений ЭхоКГ: наличием перикардиального выпота, площадью правого предсердия больше 26 см2, TAPSE меньше 1,5 см. Заключение. Конфигурация комплекса QRS в отведении V1 у больных ИЛГ и ХТЭЛГ отличается большим полиморфизмом. Наиболее тяжелое поражение сердца наблюдается у пациентов с «qR-типом» комплекса QRSв отведении V1. Summary Changes in the electrocardiogram, in particular, the qR pattern in lead V1, are a risk factor for death in patients with pulmonary arterial hypertension. The aim of the work was to compare the QRS pattern in lead V1 with the severity of heart damage according to echocardiography (EchoCG) in patients with idiopathic pulmonary hypertension (IPH) and chronic thromboembolic pulmonary hypertension (CTEPH). Methods. In 40 patients with IPH and 40 patients with CTEPH aged 45 ± 12 years systolic pulmonary artery pressure (SPAP), sizes of heart chambers, systolic and diastolic function of the right ventricle (RV), systolic function of the left ventricle, RV ventricular-arterial coupling were evaluated with EchoCG. The QRS pattern in lead V1 was determined on a 10second digital electrocardiogram. Results. 18 QRS patterns in lead V1 were identified. In 30 patients (37.5% of cases) in lead V1, there was an rS or RS pattern; 16 patients (20% of cases) had different patterns of rsR ’ type; 21 patients (26% of cases) had a qR pattern. Patients with a qR pattern in lead V1 compared with other groups had greater SPAP and sizes of the right chambers of the heart, a more pronounced worsening of systolic function of the right and left ventricles, as well as more severe disturbances of interventricular interaction and ventricular-arterial coupling. The qR pattern in lead V1 made it possible with sensitivity from 46% to 89% and specificity from 89% to 95% to identify patients with prognostically unfavorable changes in EchoCG: presence of pericardial effusion, area of the right atrium more than 26 cm2, TAPSE less than 1.5 cm. Conclusions. The QRS pattern in lead V1 in patients with IPH and CTEPH is characterized by a large polymorphism. The most severe heart damage is observed in patients with the qR pattern in lead V1.

Background. The incidence of arterial hypertension continues to grow. By 2025 the number of patients will increase to 1.5 billion that makes it necessary to develop and implement effective approaches in the diagnosis and treatment of hypertension in practical health care. Aim. Evaluate the effectiveness of two-level diagnostics of left ventricular hypertrophy (LVH). Materials and methods. The distance of the first level of LVH diagnostics in outpatient departments with a territorial is more than 20 km. It was performed by remote electrocardiography, including medical examination of the population. Automatic conclusion of the devices was sent to the personal office of the functional diagnostics doctor. At the second level, the electrocardiograph software was used to convert ECG-12 into a vectorcardiogram (VKG) to clarify LVH. The ECG reports were returned to the device of the doctor/paramedic for further work with the patient. When using scalar ECG criteria for LVH, the most sensitive index was the SokolovLyon index 24.2% of cases, then the Cornell product 19.8% of cases. In the second level of ECG diagnostics, the sensitivity of the method in detecting LVH increased more than 3 times: in terms of the maximum loop vector modulus (M QRS 1.8 mV), 72%, the sensitivity of the total index Rx+Sz (2.7 mV) was 58% of cases, the deviation of the spatial angle QRS-T90 was 42.5%, the spatial area of the loop QRS (S QRSxyz 2.7 mV2), the area of the loop QRS in the horizontal plane (S QRSxz2.2 mV2) 41.5%, the orientation angle of the maximum loop vector t in the horizontal plane (angle Txz70) was detected in 38% of patients. These indicators were found with the same frequency in both groups of examined individuals. Conclusion. The use of remote two-level ECG and ECG diagnostics allowed to increase the detection of LVH in rural and urban populations by 3 times.

Objective: to evaluate the diagnostic significance of the electrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH) in 12 leads in patients with essential arterial hypertension (AH) and in AH in combination with ischemic heart disease (IHD) compared with echocardiography (EchoCG) data. Materials and methods: ECG and EchoCG were carried out in 165 patients with AH (n = 139) and AH with concommitant IHD (n=26). Results: EchoCG signs of LVH ("EchoCG +") were detected in 72 (51,7%) patients with AH and in 12 (46,1 %) patients in AH + IHD. In the EchoCG + group the electrocardiographic signs of LVH (Sokolov-Lyon index, Cornell product, Cornell index) were determined in 37 (30,5 %) hypertensive patients and in no case in the AH + IHD group. In the "EchoCG-" group, electrocardiographic signs of LVH were determined in 8 hypertensive patients and two in the AH + CHD group. The use of additional voltage criteria for LVH in the frontal plane leads (RI > 15 mm, R I + S III > 25 mm, R aVL > 12 mm) increased the detection of LVH from 30,5 % (n=22) to 51,3 % (n=37). The false negative ECG diagnosis of LVH was influenced by: positional features, interventricular conduction defect, metabolic disorders and high index body mass. Conclusion: The Sokolov-Lyon index, the Cornell index, the Cornell product have low sensitivity in the diagnosis of LVH (30,5 %). Adding the frontal plane leads voltage criteria for LVH may contribute to increase in electocardiographic LVH detection (51,3 %). The decrease in the sensitivity of the ECG criteria for LVH is mainly caused by the positional features of the heart, interventricular conduction defect, metabolic disorders and high index body mass.