[Impact of shock-wave therapy on the clinical and functional status of patients with coronary heart disease]. / Vliianie udarno-volnovoi terapii na kliniko-funktsional'noe sostoianie patsientov s ishemicheskoi bolezn'iu serdtsa.

AIM: To study of the impact of shock-wave therapy (SWT) on the functional status of patients with coronary heart disease (CHD). SUBJECTS AND METHODS: Thirty-four CHD patients (including 33 men) with left ventricular (LV) asynergic segments, as evidenced by echocardiography (EchoCG), were examined. Their mean age was 60.1±1.76 years. All the patients received a SWT cycle according to the standard scheme. The patient examination protocol involved EchoCG, dobutamine EchoCG, treadmill exercise EchoCG, and tissue Doppler EchoCG, which were performed at baseline, immediately and one month after the end of a SWT cycle. RESULTS: Following a SWT cycle, all the patients were noted to have a significant decrease in mean angina pectoris and heart failure functional classes and in the frequency of daily intake of nitrates. EchoCG showed that at baseline the LV ejection fraction (EF) was 51.1±1.02%; end- diastolic volume index, 71.5±3.6 ml/m2; end-systolic volume index, 34.4±2.2 ml/m2. According to exercise EchoCG, the tolerance threshold was 6.4±0.1 Меts (Bruce protocol); the total exercise time of 5.05±0.23 min was achieved in an average of 75.2±1.32%. Immediately and one month after a SWT cycle, there was an increment in EF from 51.1±1.02 to 55±0.8 and 57±1.7%, respectively; a substantial increase in the tolerance threshold to 8.17±0.24 and 9.45±0.34 Меts, as compared to the baseline values. The exercise time increased up to 6.41±0.17 and 7.7±0.29 min immediately and one month after SWT, respectively. The increment in EF in response to exercise was 8.54±2.12, 14±1.5, and 16±1.2% at baseline, immediately and one month after SWT, respectively. Moreover, myocardial relaxation and diastolic function improved. CONCLUSION: Shock-wave therapy in patients with CHD is accompanied by their improved functional status, which is manifested by increased tolerance threshold and exercise duration, a rise in rest and exercise LV EF, better relaxation of LV, and its diminished stiffness.

[Clinical Case Demonstrating Use of Trimetazidine In the Treatment of Stable Angina].

In a patient with multiple involvement of distal coronary artery bed and recurrence of angina at the background of optimal drug therapy addition of trimetazidine was associated with increase of tolerance to physical exercise and improvement of quality of life.

[Prognostic factors for progression of mitral regurgitation in patients with coronary heart disease after aortocoronary bypass surgery alone and in combination with surgical left ventricular reconstruction].

AIM: To identify risk and prognostic factors for mitral regurgitation (MR) progression after aortocoronary bypass surgery (ACBS) alone and in combination with surgical left ventricular (LV) reconstruction. SUBJECTS AND METHODS: Data on 101 patients with coronary heart disease who had undergone surgical treatment: ACBS alone in 57 (56%) patients and that in combination with surgical LV reconstruction in 44 (44%). RESULTS: In the late periods after ACBS alone, there was reduced or no MR in 18% of the patients; no substantial changes in MR in 52%, the latter being moderate; progression to significant mitral insufficiency (MI) in 30%. In the same periods after ACBS in combination with surgical LV reconstruction, there was a reduction in MR to its minimum or complete absence in 14% of the patients; no substantial change in the degree of MR in 54%, and progression to significant MI in 32%. The prognostic factors of MI progression after ACBs alone and in combination with surgical LV reconstruction were a more than 32-mm fibrous ring of the mitral valve (MV) (chi2 = 11.62; p = 0.0001); a LV sphericity index of more than 0.65 cm (chi2 = 3.38; p = 0.06); a myocardial scar lesion extent of more than 30% of the LV segments (chi2 = 4.7; p = 0.03); a myocardial reserve of less than 25% (chi2 = 3.1; p = 0.07) (when taking low-dose dobutamine). CONCLUSION: Myocardial revascularization should be combined with MV intervention in patients with moderate MR and risk factors for its progression, such as significant LV remodeling (LV sphericity index of more than 0.65 cm), extensive LV scar lesion (more than 30% of the segments), a low myocardial reserve (less than 25%) during dobutamine test, and a MV fibrous ring of more than 32 mm).

[Aspects of risk stratification in acute coronary syndrome: prognostic value of evaluation of left ventricular myocardial viability according to the data of pharmacological stress echocardiography].

AIM: To define the prognostic value of the indicators of left ventricular myocardial viability according to the data of pharmacological stress echocardiography in patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: The results of examinations were analyzed in a total of 91 patients with ACS; 71 of them were found to have areas of asynergy (these cases formed the key basis for statistical processing). An analysis of the outcomes registered in the established follow-up period (mean 14.3 +/- 0.7 months) took into consideration death from cardiac diseases, a recurrent acute coronary episode (nonfatal myocardial infarction (MI), unstable angina (UA)). RESULTS: Risk stratification for cardiac events in patients with ACS requires both the assessment of a myocardial viability testing result and the detection of stress-induced ischemia. An analysis of the impact of the indicators of myocardial viability on prognosis in the ACS group showed that the most important predictors of cardiac death were impaired segmental contractility index (ISCI), number of asynergic segments, and total ejection fraction (TEF) at rest; TEF, ISCI, number of segments with a negative response to low-dose drug infusion; TEF, deltaTEF (as compared to the baseline data), and a positive or negative peak stress testing result. The most important predictors of major cardiac events (death MI, UA) were ascertained to be ISCI, number of asynergic segments, resting TEF; TEF, ISCI, number of segments with a negative response to low-dose drug infusion; a positive or negative testing result, TEF, deltaTEF (as compared to the baseline data), and ISCI during the peak stress test. CONCLUSION: The low myocardial/coronary reserve increases mortality rates; the high one worsens the prognosis of major cardiac events, particularly when the test is positive, which tacitly transfers these patients to a very high risk group.

[Features of cardiomyocytes structural changes in patients with postinfarction aneurism and reduced myocardial contractility of the left ventricle of the heart].

Cardiomyocytes (CMC) of 18 patients with both ischemic heart disease, aneurism of the front wall and reduced myocardial contractility of the left ventricle (LV) were hypertrophied and in state of chronic hibernation, which was characterized by weakening of tissue-specific signs. Widening of lack myofibrils' zones and in part gap junction of intercalated disk transfer on the side of cells was found The hypertrophy of CMC had positive correlation, but chronic hibernation - negative one with the volume of LV. The worse prognosis of clinical course was degenerative changes of hibernate CMC with accumulation of autophagosomes that correlated with increasing of LV sphericity index.

[Aspects of risk stratification in acute coronary syndrome (Part II): Prognostic value of evaluation of exercise-induced myocardial ischemia according to the data of pharmacological stress echocardiography].

AIM: To define the prognostic value of evaluation exercise-induced myocardial ischemia according to the data of pharmacological (dobutamine or dipyridamole) stress echocardiography (EchoCG) in patients with acute coronary syndrome (ACS). SUBJECTS AND METHODS: The results of examinations were analyzed in a total of 91 patients with ACS. An analysis of events in the established follow-up period (mean 14.3 +/- 0.7 months) took into consideration outcomes, such as death from cardiac diseases, a recurrent acute coronary episode (nonfatal myocardial infarction (MI), unstable angina (UA). RESULTS: Pharmacological stress EchoCG showed a positive result in 40 (44%) patients (Group 1) and a negative one in 51 (56%) patients (Group 2). Thus, the sensitivity and specificity of the pharmacological test in determining the risk for cardiac events were 89.3 and 76.2%, respectively; the prognostic value of positive and negative results was 62.5 and 94.1%, respectively. Analysis of EchoCG parameters used to identify poor prognostic factors in patients with ACS has indicated that the most important predictors of death and major cardiac events (cardiac death, acute MI, UA) are resting impaired segmental contractility index (ISCI), number of asynergic segments, and total ejection fraction (TEF) at baseline; TEF, ISCI, deltaISCI (as compared to the baseline data), and the number of segments with a negative response after low-dose drug infusion; a positive or negative result, TEF, deltaTEF (as compared to the baseline data), and ISCL at the test peak. CONCLUSION: Pharmacological stress EchoCG is a safe noninvasive diagnostic method in a group of patients with ACS. When the latter is diagnosed, it may be performed in the earliest periods (on day 4 after onset of the disease) to estimate its prognosis and to decide whether aggressive treatments should be used.

[Interrelationship between functional state of the right ventricle and severity of heart failure in patients with ischemic heart disease and depressed left ventricular function].

Dobutamine Doppler echocardiography was carried out in 56 patients (n=56) with ischemic heart disease and depressed left ventricular function (left ventricular ejection fraction <40%) and chronic heart failure. Clinical signs of heart failure were moderate (NYHA class I-II) in 34 and severe (NYHA class III-IV) in 22 patients. Patients with moderate and severe clinical heart failure had similar degree of left ventricular myocardium impairment however those with severe symptoms had more pronounced right ventricular (RV) dysfunction (greater suppression of global and local RV contractility, greater percentage of irreversibly dysfunctional RV myocardium, lower RV contractile response to dobutamine infusion, more pronounced disturbances of RV diastolic filling). Dependence of RV pump function on pulmonary artery pressure was more evident in patients with severe clinical heart failure and marked dysfunction of RV myocardium than in patients with moderate symptoms and moderate RV myocardial dysfunction.

[Sigmental right ventricular contractile function in patients with ischemic heart disease]. / Segmentarnaia sokratitel'naia funktsiia pravogo zheludochka u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Segmental right ventricular function was assessed by dobutamine stress echocardiography in 101 patients with ischemic heart disease and multiple coronary artery lesions. At rest local wall motion abnormalities were found in 69% of patients. Overall 505 segments of the right ventricle were analyzed (5 per patient). At baseline 34% of segments were asynergic (31% - hypokinetic and 3% akinetic), right ventricular wall motion score index was 1.38+/-0.04. Low dose dobutamine infusion resulted in decrease of portion of asynergic segments (to 6%) and lowering of wall motion score index (to 1.09+/-0.02, p<0.001 vs baseline). The use of stress doses of dobutamine was associated with appearance of ischemic changes of the right ventricle accompanied with typical anginal attacks and ST-segment depressions; increases of portions of asynergic segments (up to 53% including 43% hypokinetic and 10% akinetic), and of patients with abnormalities of local contractility (up to 90%); rise of wall motion score index (up to 1.64+/-0.05, p<0.001 vs low dose dobutamine). Segmental right ventricular wall motion abnormalities reflected mostly reversible myocardial dysfunction (hibernating myocardium was revealed in 28, scar - in 6, and zone at risk of ischemia - in 47% of all segments). Right ventricular myocardial dysfunction developed in patients with predominant involvement of the right coronary artery or anterior interventricular branch.

[Characteristics of coronary artery lesions in patients with painless myocardial ischemia]. / Osobennosti porazheniia koronarnogo rusla u bol'nykh s bezbolevoi ishemiei miokarda.

AIM: To assess extent and localization of coronary artery lesions in patients with painless myocardial ischemia. MATERIAL AND METHODS: Tredmill stress-echocardiograghy, Holter ECG monitoring and coronary angiography were carried out in 59 male patients (age 30-72, mean 54.5 years) with either angina pectoris or painless ischemia. RESULTS: Among patients with painless ischemia 50% had 2-vessel disease, mostly with right coronary artery involvement (87.5%) and there was no case of left main stenosis. Patients with angina were characterized by significantly higher index of obstruction (p<0.005) and often had multivessel coronary artery disease (48.8%). CONCLUSION: Patients with effort angina compared with those with painless ischemia had more extensive and severe coronary artery involvement while the latter more often had right coronary artery stenoses.

[Dynamics of parameters of variability of processes of repolarization after transluminal balloon angioplasty in patients with ischemic heart disease]. / Dinamika pokazatelei variabel'nosti protsessov repoliarizatsii do i posle operatsii transliuminal'noi ballonnoi angioplastiki u bol'nykh ishemicheskoi bolezn'iu serdtsa.

AIM: To study dynamics of processes of repolarization after transluminal balloon angioplasty in patients with ischemic heart disease. MATERIAL AND METHODS: ECG, Holter ECG monitoring, analysis of parameters of variability of processes of repolarization, echocardiography and treadmill stress echocardiography were carried out in 28 ischemic heart disease patients aged 51.3+/-8.1 years prior to percutaneous coronary intervention, before discharge and in 4.1+/-2.1 months after procedure. Coronary angiography was repeated after intervention when restenosis was suspected because of positive stress echo. RESULTS: Number of vessels with significant stenoses was 1.8+/-0.1, number of implanted stents - 2.0+/-0.2. Analysis of parameters of variability of processes of repolarization at rest and after exercise revealed significant increases of maximal value of QT (MQT(c)) and of its dispersion (QT(cd)). In 3-5 days after procedure significant lowering of these parameters occurred. Development of restenosis during follow-up (in 6 patients, 21.4%) was associated with repeated increases of MQT(c) and QT(cd). CONCLUSION: MQT(c) and QT(cd) are sensitive to myocardial ischemia and can be used as supplementary markers of myocardial ischemia during exercise tests in patients with ischemic heart disease.

[Effect of dipyridamole on blood levels of fibroblast growth factor and vascular endothelial growth factor in patients with ischemic heart disease]. / Vliianie dipiridamola na soderzhanie v krovi sosudistogo éndotelial'nogo faktora rosta i faktora rosta fibroblastov u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Addition if dipyridamole to standard therapy in patients with ischemic heart disease was associated with improvement of functional class of angina and elevation of blood levels of fibroblast growth factor and Vascular Endothelial Growth Factor.

[Relationship between myocardial viability and ventricular late potentials in patients with history of myocardial infarction]. / Vzaimosviaz' mezhdu zhiznesposobnost'iu miokarda i nalichiem pozdnikh potentsialov zheludochkov u patsientov, perenesshikh infarkt miokarda.

AIM: To study relationship between presence and volume of viable myocardium and registration of late ventricular potentials in patients with history of myocardial infarction. MATERIAL AND METHODS: High resolution ECG, dobutamine stress echocardiography and Holter ECG monitoring were carried out 34 patients (mean age 54.1-/+3.1 years) with history of documented myocardial infarction. RESULTS: According to data of dobutamine stress echo patients were divided into 2 groups: with irreversible myocardial dysfunction (n=16, group 1) and with hibernating myocardium (n=18, group 2). Ventricular late potentials were registered in 3 (18.7%) and 11 (61,1%) patients in groups 1 and 2, respectively. Group 2 patients more often had high-grade ventricular arrhythmias. There was no association between presence of ventricular late potentials and Lown grade of ventricular arrhythmias on Holter ECG. Duration of filtered QRS (QRSt) complex correlated directly with index of regional wall motion abnormality, end-diastolic volume, and negatively - with total ejection fraction. CONCLUSION: Among myocardial infarction survivors patients in whom dobutamine stress echo detects viable myocardium significantly more often have ventricular late potentials and high grade ventricular arrhythmias compared with patients with myocardial scars without viable myocardium.

[Dynamics of parameters of heart rate variability in patients with ischemic heart disease after direct myocardial revascularization]. / Dinamika pokazatelei variabel'nosti ritma serdtsa u bol'nykh ishemicheskoi bolezn'iu serdtsa do i posle operatsii priamoi revaskuliarizatsii miokarda.

AIM: To study dynamics of parameters of heart rate variability (HRV) in patients with ischemic heart disease after direct myocardial revascularization. MATERIAL AND METHODS: Electrocardiography (ECG), 24 hour Holter ECG with spectral and temporal analysis of 24-hour HRV, as well as echocardiography (Echo) and stress-Echo were carried out in 24 patients with ischemic heart disease before, in 2-4 weeks and 2 months after surgery. Healthy persons of the same age (n=20) were used as controls. RESULTS: Prior to operation HRV in all patients was lower than in controls. In 2-4 weeks after coronary artery bypass grafting (CABG) further lowering of HRV parameters occurred. In 2 months after CABG HRV parameters in patients without complications were similar to preoperative values but remained lower than in controls.

[Effect of ritmilen and allapinin on prostanoid and cyclic nucleotide levels in patients with cardiac rhythm disorders]. / Vliianie ritmilena i allapinina na soderzhanie prostanoidov i tsiklicheskikh nukleotidov u bol'nykh s narusheniiami ritma serdtsa.

The effect of antiarrhythmic drugs, ritmilen and allapinin, on endogenic prostanoid and cyclic nucleotide levels was examined in patients with heart rhythm disorders. Intravenous administration of antiarrhythmic agents is shown to be accompanied with increased release of prostacyclin that has antiarrhythmic properties into myocardial outflow. Both ritmilen and allapinin promoted the predominance of prostacyclin over thromboxane, with its intrinsic arrhythmogenic properties. Ritmilen- or allapinin-induced changes in prostaglandins E and F2 alpha consisted in that PGE prevailed, as compared to PGF2 alpha. There were no significant changes in cyclic nucleotide ratios (cAMP/cGMP) in response to treatment.

[Effect of Ritmilen and allapinin on central hemodynamics and myocardial contractility of patients with heart rhythm disorders]. / Vliianie ritmilena i allapinina na tsentral'nuiu gemodinamiku i sokratimost' miokarda u bol'nykh s narusheniiami ritma serdtsa.

The effect of Ritmilen and allapinin, a new Soviet antiarrhythmic drug, on hemodynamics and myocardial contractility were evaluated in 36 patients with various heart rhythm disorders during diagnostic coronary angiography. Ritmilen has been shown to have an essential cardiodepressive effect. An intravenous 150 mg dose of Ritmilen results in a depression of dp/dtmax, Veragut's index, ejection fraction, mean standard circular fibre shortening rate, and increase in left ventricular systolic and end diastolic pressure, total peripheral resistance and mean arterial blood pressure. Allapinin (30 mg) has no marked cardiodepressive effect, as compared to Ritmilen.