[Assessment of myocardial viability and recovery of the left ventricular function in postmyocardial infarction patients]. / Otsenka zhiznesposobnosti mikarda i opredelenie vosstanovleniia funktsii levogo zheludochka u bol'nykh, perenesshikh infarkt miokarda.

AIM: To evaluate prognostic significance of myocardial viability (MV) depending on treatment policy in postmyocardial infarction (PMI) patients. MATERIAL AND METHODS: The study included 196 patients (172 males, 24 females, age 30-75, mean age 53 +/- 8.6 years). Standard stress dobutamine echocardiography was made 14 +/- 6 days (8-21 days) after macrofocal MI. Reperfusion therapy was made in 138 (70%) patients. X-ray contrast coronary angiography was performed in all the patients as the criterion of the immediate effect of reperfusion was achievement of residual stenosis of MI-related coronary artery < 50%. Late after MI (18 +/- 7 months after MI) a comparative analysis of the left ventricular function was made in three groups of patients depending on the clinical response to the treatment. MV criterion was based on a fall in the index of infarction zone wall movement (IZWM) under low-dose dobutamine stress test reflecting contractile reserve of the infarction zone (CR). Left ventricular function recovery was judged by a decrease in initial IZWM index 18 months later vs the initial IZWM 14 days later. Thus contractile reversibility of the infarction zone (CRIZ) was determined. LV function was also assessed by the index of left ventricular end diastolic volume (LVEDV), by the index of left ventricular end systolic volume (LVESV), left ventricular ejection fraction (LVEF). RESULTS: 18 months after MI, CRIZ was higher in group 1 (after effective reperfusion) and group 3 (after myocardial revascularization) compared to group 2 (medication only): 0.33 +/- 0.01, 0.39 +/- 0.02 and 0.23 +/- 0.01, respectively. LVEDV and LVESV in group 1 and 3 diminished while LVEF increased. LVEDV in group 2 remained elevated though EF rose considerably. CONCLUSION: Recovery of LV contractile function depends much on reestablishment of adequate myocardial perfusion by reperfusion therapy or myocardial revascularization. Chronic myocardial hypoperfusion leads to LV remodeling. CRIZ proved a significant prognostic criterion of the IZWM index 18 months after MI only in patients given effective reperfusion therapy.

[Atherogenesis and serum levels of apolipoprotein E]. / Aterogenez i soderzhanie apolipoproteina E v syvorotke krovi.

Serum apolipoprotein (apo) E levels and their relationship with age were examined in different age groups of healthy individuals of both sexes in a Lithuanian population. The serum concentrations of apo E in patients after coronary bypass were measured and patients suffered from diabetes mellitus were also examined. The mean levels of apo E were found to be higher in healthy males than those in healthy females only in young age. Serum apo E levels were inversely associated with age (P < 0.05). Apo E levels were significantly higher in males over 45 years of age who suffered from coronary atherosclerosis and in males under 45 who had diabetes mellitus (types I and II) than those in healthy individuals (P < 0.05). There was an insignificant difference in apo E levels among healthy and diabetic females (P < 0.05). The findings demonstrated the association of increased apo E levels with atherogenesis.

[Atherosclerosis of the coronary arteries and the blood group in the population of Lithuania]. / Ateroskleroz venechnykh arterii i gruppa krovi v populiatsii Litvy.

Data are reported on the relation between atherosclerosis of the coronary arteries and blood group. Examined were 291 patients in whom involvement of the coronary arteries was verified by means of coronarography and aortocoronary shunting. It was established that the group B blood was distinctly more frequent and group O blood was distinctly less frequently observed in male patients under 45 years. In male patients over 45 years of age the blood group apparently influenced advancing of atherosclerotic lesions of the coronary arteries. The obtained data indicate that the A and B blood groups are one of the genetically based factors of risk in the link of atherosclerosis pathogenesis.

[Evaluation of late results of aortocoronary bypass in patients with ischemic heart disease in relation to the bypass function]. / Otsenka otdalennykh rezul'tatov aortokoronarnogo shuntirovaniia u bol'nykh ishemicheskoi bolezn'iu serdtsa v zavisimosti ot funktsional'nogo sostoianiia shuntov.

The authors analyse 82 patients with aggravation of their clinical condition in the late-term periods after aortocoronary shunting. All were subjected to coronaroshuntography 3.6 +/- +/- 0.5 years on the average, after the operation. The main noninvasive criteria of impaired functioning of the shunts were: increase of the degree of angina pectoris (functional class III-IV according to the Canadian classification), diminished tolerance to physical exertion, appearance of "active" myocardial ischemia. Disturbed functioning of the shunts was mainly manifested within the first year, while progression of atherosclerotic changes in the unshunted arteries--in later periods. The main causes of incompetence of the shunts were: small diameter of the shunted arteries, low rate of blood flow in the shunts, and feverish condition of patients lasting for a long time after the operation.

[Dynamics of clinical and functional parameters in patients with ischemic heart disease after aortocoronary bypass surgery]. / Dinamika klinicheskikh i funktsional'nykh pokazatelei u bol'nykh ishemicheskoi bolezn'iu serdtsa, podvergshikhsia aortokoronarnomu shuntirovaniiu.

Complete myocardial revascularization was examined for effects on long-term results of aortocoronary bypass surgery in 219 patients. Myocardial revascularization was proposed to be divided into: (1) truely complete; (2) tentatively complete; and (3) partial. Clinical and functional parameters deteriorated in tentatively complete and partial myocardial revascularization as compared with truely complete revascularization. A positive dynamics in abnormal Q wave signs was found in 9% of the patients after the surgery in the presence of the wave in ECG leads corresponding to the anterior left ventricular wall, in the absence of signs of myocardial asynergy prior to the surgery, and on complete recovery of blood flow in the shunts supplying the diseased myocardial areas.

[Late results of aortocoronary shunting in ischemic heart disease patients in relation to the severity of the coronary lesion and degree of myocardial revascularization]. / Otdalennye rezul'taty aortokoronarnogo shuntirovaniia u bol'nykh ishemicheskoi bolezn'iu serdtsa v zavisimosti ot tiazhesti porazheniia koronarnykh arterii i stepeni revaskuliarizatsii miokarda.

Long-term results of aortocoronary shunting are reviewed in 219 coronary patients with reference to the severity of coronary arterial damage and myocardial revascularization. Functional class of angina pectoris declined 2.5-fold postoperatively and was 1.6 +/- 0.14 at long-term follow-up. The success rate reached 74%. Survival rate was 87.3%, including hospital mortality, and long-term survival was 92.1%. Acute coronary insufficiency was the principal cause of compromised success and survival rates. The operation was particularly effective in patients with first- or second-degree total coronary arterial lesion and true complete myocardial revascularization.