[Abnormal glucose tolerance and long-term prognosis in patients with acute myocardial infarction].

STUDY AIM: to assess clinical outcomes and cardiovascular events during long-term follow-up after acute myocardial infarction (AMI) in patients (pts) with newly detected abnormal glucose tolerance (AGT). MATERIAL AND METHODS: Consecutive AMI pts (n=391, 24.3% with diabetes mellitus [DM]) were enrolled in the study. Pts with no DM underwent an oral glucose tolerance test (OGTT) at discharge (around 12-th day). All pts were divided into 3 groups: group I - pts with normal glucose tolerance (NGT), group II - pts with AGT, including impaired glucose tolerance (IGT) and newly diagnosed DM (NDM), group III - pts with previously known DM. General and cardiovascular mortality, adverse cardiovascular events during long-term follow-up (26.8+/-6 months) were studied. RESULTS: According to the OGTT 67.9% pts had NGT and 32.1% had AGT (28.7% IGT and 3.4% NDM). Pts with disturbances of glucose metabolism were older, had abdominal obesity, more frequently had Killip class >2 on admission, as well as reduced ejection fraction, left ventricular aneurism and progression of chronic heart failure at discharge. Cardiovascular and general mortality during follow-up were significantly higher in pts with AGT and DM compared to NGT (27.4 vs. 22.1 vs 11.1%, p=0.002, and 23.2 vs. 20.2 vs 10.1%, p<0.05, respectively). The incidence of recurrent nonfatal MI and stroke were similar in the three groups, however the proportion of subjects with heart failure NYHA class >2, revascularization procedures, hospitalization due to cardiovascular events was higher in pts with abnormalities of carbohydrate metabolism. CONCLUSIONS: Abnormal glucose tolerance (IGT and NDM) has high prevalence in AMI patients without known DM, is a major risk factor for future cardiovascular events and is associated with unfavorable long term prognosis after MI.

[Possibilities of the combined use of transesophageal electrostimulation of the heart and physical load in the diagnosis of paroxysmal reciprocal atrioventricular tachycardia]. / Vozmozhnosti sochetannogo primeneniia chrespishchevodnoi élektricheskoi stimuliatsii serdtsa i fizicheskoi nagruzki v diagnostike paroksizmal'nykh retsiproknykh atrioventrikuliarnykh takhikardii.

Possibilities of using transesophageal electrostimulation of the heart in combination with a physical load were studied in 38 patients with paroxysms of reciprocal atrioventricular (AV) tachycardia. The study has shown that the physical load exerts a pronounced influence on the induction, persistence, and electrophysiological parameters of AV tachycardia, significantly increases the functional capacity of the anterograde conduction along the anomalous tract, and reduces the efficacy of vagal techniques in alleviating paroxysms of AV tachycardia.

[Effectiveness and pharmacodynamics of tobanum in patients with paroxysmal reciprocal atrioventricular tachycardia]. / Effektivnost' i farmakodinamika tobanuma u bol'nykh s paroksizmal'noi retsiproknoi atrioventrikuliarnoi takhikardiei.

The antiarrhythmic effects and pharmacodynamics of tobanum were evaluated in 28 patients wist paroxysms of reciprocal atrioventricular tachycardia, by using transesophageal cardiac pacing. The agent given in a single dose of 10 mg produced antiarrhythmic effects in 70% patients with paroxysms of atrioventricular nodal tachycardia and in 40% with atrioventricular tachycardia in the presence of the Wolff--Parkinson-White syndrome. After administration of the drug, its antiarrhythmic effect occurred on an average 1.5 h and retained for 27 h.

[Functional state of atrioventricular conduction and inducibility of atrioventricular reciprocal tachycardia]. / Funktsional'noe sostoianie atrioventrikuliarnogo provedeniia i indutsiruemost' atrioventrikuliarnykh retsiproknykh takhikardii.

Programmed transesophageal electrical stimulation was used to examine 733 rural inhabitants aged 16 to 70 years. Conduction dissociation along the atrioventricular node was revealed in 65 (8.8%) of the examinees, out of them 12 had induced paroxysms of atrioventricular nodal tachycardia. Atrioventricular tachycardia involving the accessory anomalous pathways was provoked in 10 subjects. Among them 2 had apparent, 1, latent, and 7, obscure forms of the Wolff-Parkinson-White syndrome. The induced paroxysms of atrioventricular tachycardias were sustained in 45.5% of the cases. Only 50% of the subjects had clinical signs of tachycardia in their medical histories.

[The potentials for curing atrial flutter by the combined use of transesophageal electrical stimulation and anti-arrhythmia preparations]. / Vozmozhnosti kupirovaniia trepetaniia predserdii pri sochetannom primenenii chrespishchevodnoi élektricheskoi stimuliatsii i antiaritmicheskikh preparatov.

Potentialities of the recovery of the sinus rhythm were studied in 21 patients with atrial flutter (AF) using frequent transesophageal electric cardiac pacing (TEEP) per se and after intravenous injection of ritmilen and novocainamide under outpatient conditions. TEEP made it possible to arrest AF in 24% of patients and to transform flutter into steady atrial fibrillation in 48% of patients. In 28% of cases, the pacing turned out ineffective. Subsequent administration of antiarrhythmic drugs made the rhythm return to normal in 24% of patients, whereas repeated TEEP conducted after drug administration in additionally 33% of patients. The efficacy of frequent TEEP combined with administration of ritmilen and novocainamide amounted to 81%.

[Secondary prevention of arterial hypertension in rural population of Moldavia]. / Vtorichnaia profilaktika arterial'noi gipertonii sredi sel'skogo naseleniia Moldavii.

The results of the third year of nondrug and pharmacological prevention of arterial hypertension according to the steppedcare scheme of WHO are provided. A low rate of response (46%) to annual check-up was noted among rural residents with arterial hypertension detected by screening which hampers the preventive intervention. During the third year of preventive campaign 9.3 percent of people were covered by regular hypertensive treatment, 20.61 percent--by irregular treatment and 24.4 percent with elevated blood pressures detected by screening never received any treatment. Among women the proportion of those receiving hypertensive treatment (both regular and irregular) was larger. An analysis was made of mean levels of systolic and diastolic blood pressure at the beginning and at the end of the third year of observation in groups of patients with different attitude to treatment. At the third year of implementing the programme of secondary prevention the number of hypertonic patients receiving effective treatment increased 8-fold compared with baseline data. Persons with higher levels of arterial blood pressure were more often applying for treatment. The normalization of arterial blood pressure was noted in 39% of persons applying for regular treatment, 31%--for irregular treatment and in 26% of non-treated hypertonic patients.

[Sinoatrial reciprocal paroxysmal tachycardia]. / Sinoatria'lnaia retsiproknaia paroksizma'lnaia takhikardiia.

Detection rates and features of the clinical course of paroxysmal reciprocal sinoatrial tachycardia were examined in 34 patients. The features of the tachycardia should include its short-term and less marked clinical manifestations. In tachycardia, mean heart rate was 118 +/- 13 per minute. Long-term ECG monitoring was found to be the most adequate tool for the diagnosis of paroxysmal sinoatrial tachycardia. The potentials of transesophageal electrostimulation of the heart in the diagnosis and assessment of the clinical significance of that tachycardia were demonstrated to be limited due to instability of induced paroxysms.