[Long-term prognosis in patients with acute non-ST-segment elevation myocardial infarction depending on dynamics of tissue myocardial dopplerography].

AIM: To study long-term prognosis in patients with non-ST elevation acute myocardial infarction (AMI) with reference to changes in myocardial tissue dopplerography (MTD) in the course of treatment. MATERIAL AND METHODS: MTD echocardiography was conducted in 88 non-ST elevation AMI (mean age 58.0-9.8 years) and 34 healthy volunteers (mean age 58.0 +/- 9.8 years). Measurements were made of the velocity of systolic, early and late diastolic peaks at 4 levels of interventricular septum, anterior, lateral and inferior walls of the left ventricle (LV). MTD was repeated before the discharge from hospital. The patients were followed up for 10-18 months after the discharge. RESULTS: By MTD results the patients were divided into 3 subgroups: 1--an asymmetric decrease of MTD values--17(19.3%) patients who had a 20% reduction of the systolic and early diastolic peak velocity compared to healthy controls on one or two adjacent LV walls; subgroup 2--a diffuse decline of MTD values--61 (69.3%) patients. Their velocity of systolic and early diastolic peaks was subnormal on all the walls, all levels of estimation; subgroup 3--10 (11.4%) patients without MTD changes. These proportions changed in the course of treatment: the number of patients with a diffuse decrease of MTD values reduced to 31 (35.3%), the number of patients with an asymmetric MTD decrease rose to 37 (42%), and with unchanged MTD rose to 20 (22.7%) patients. The rate of development of congestive cardiac failure (CCF) and asymptomatic LV dysfunction in the long-term period was significantly higher in the subgroup with retained diffuse decrease of MTD values. CONCLUSION: The treatment of non-ST elevation AMI reduces the number of patients with a diffuse decrease of MTD values and elevates the number of patients with asymmetric decrease of MTD and unchanged MTD. Persistence of MTD diffuse changes is an unfavourable prognostic factor in relation to CCF and LV silent dysfunction.

[Interaction of the neurohumoral and immune mechanisms of progression of myocardial damage].

The review summarizes data on the interference of the neuroendocrine and immune mechanisms of myocardial remodeling. It shows a role of the effectors of the renin-angiotensin-aldosterone (aldosterone and angiotensin II) and sympathoadrenal (noradrenaline) systems in the activation of macrophages, the production of proinflammatory cytokines and inflammatory cell chemoattractants. It is noted that proinflammatory cytokines in turn promote the activation of these neuroendocrine systems. Natriuretic peptides exert an anti-inflammatory effect, but their production can be activated by proinflammatory cytokines.

[Diagnostic value of cardiac troponin T increase in critically ill patients].

There are presently reports on elevated levels of cardiac troponins in patients without acute myocardial infarction (AMI). The objective of this investigation was to study the diagnostic value of increased blood cardiac troponin T levels in patients without its clinical picture and ECG changes characteristic of AMI. The study covered 72 patients (48 males and 24 females) aged 54 to 87 years (mean 69.8 +/- 11.2 years). The inclusion criteria were increased cardiac troponin T; the main exclusion criteria were AMI-typical anginal pain and characteristic ECG changes (ST-segment elevation, the appearance of pathological Q waves). The final diagnosis of AMI was established in only 29 (40.3%) patients; the other 43 patients were diagnosed as having the following diseases: septic state in 21; oncopathology in 10; diabetic nephropathy with chronic renal failure in 6; brain infarct in 4; and B12 deficiency anemia in 2. In dead patients, the level of troponin T was significantly higher than that in discharged patients, respective of the underlying disease. There was a direct correlation between the cardiac troponin T levels and the SAPS II index that reflected the severity of a patient's general condition (r = 0.44; p = 0.0001) and an inverse correlation between the cardiac troponin level and the left ventricular ejection fraction (r = -0.45; p = 0.003). Thus, despite the cardiospecificity of troponin T, its detection in the blood of critically ill patients without other manifestations of AMI is not a specific symptom of AMI, but it is suggestive of the severity of the disease, probably with the involvement of the myocardium into the pathological process.

[Possibilities of diagnosis of non-ST elevation acute coronary syndrome in old subjects].

Diagnosis of non-ST elevation acute coronary syndrome (NSTEACS) in old subjects poses substantial difficulties because in a row of cases clinical picture and changes on electrocardiogram are nonspecific. In this paper we discuss possibilities of diagnosis of NSTEACS with the help of determination of markers of myocardial necrosis (including cardiac troponins and fatty acid transporting protein) and C-reactive protein in the blood. Data on changes of heart rhythm variability are also presented.

[Long-term prognosis in patients with rheumatoid arthritis depending on baseline variability of cardiac rhythm].

AIM: The study of outcomes of rheumatoid arthritis (RA) depending on cardiac rhythm variability (CRV). MATERIAL AND METHODS: A total of 78 patients with RA of I--III degree of activity aged 38-83 years (mean age 60.3 +/- 10.8 years) were examined using 24-h AP and ECG monitoring. Follow-up was 2-4 years. RESULTS: A clear correlation was seen between RA activity and CRV. CONCLUSION: In patients with high activity of RA, CRV decline reflect severity of inflammation. In low RA activity, low CRV may point to the presence of IHD. Low CRV in RA activity of degree I-II may indicate high risk of sudden cardiac death and acute myocardial infarction within 2-4 years.

[What is the reason for low heart rhythm variability during bicycle exercise?].

AIM: To characterize a reduction in heart rhythm variability (HRV) in patients with coronary heart disease (CHD), essential hypertension (EH) and in healthy controls during bicycle exercise test (BET). MATERIAL AND METHODS: BET was made in 21 CHD patients, 23 EH patients and 22 healthy controls (mean age 47.8 years, standard deviation 14 years). HRV was analysed before, during and after BET under continuous ECG monitoring (Cardiotens-01, Meditech, Hungary). Also, this device measured arterial pressure before and after exercise. BET (3 minutes of exercise plus 2 minute rest) was stepwise: the initial stage load was 25 W, at each subsequent stage the load was raised by 25 W RESULTS: In BET, lowering of HRV low-frequency power in CHD patients occurs at lower heart rate (HR) and load than in healthy controls and EH patients, it comes prior to ST wave depression. The individual index of exercise tolerance HRLF < 40/HRsubmax reflecting the ratio of HR at which LF < 40 ms2 is reached to submaximal HR in CHD patients is < 75%, in healthy controls > 80% irrespective of age or gender. CONCLUSION: CHD patients show lowering of HRV at lower HR than EH patients and healthy controls. The index HRLF < 40/HRsubmax under 75% can be used as an additional criterion of positive results of BET.

[Clinical efficacy of xefocam and its effect on arterial pressure and heart rhythm variability in patients with rheumatoid arthritis in combination with arterial hypertension]. / Otsenka klinicheskoi éffektivnosti ksefokama i ego vliianiia na arterial'noe davlenie i variabel'nost' serdechnogo ritma u bol'nykh revmatoidnym artritom v sochetanii s arterial'noi gipertenziei.

AIM: To try clinical response to xefocam, its safety, effects on arterial pressure and heart rhythm variability in rheumatoid arthritis (RA) patients with arterial hypertension (HT). MATERIAL AND METHODS: Xefocam (lornoxicam), a new non-steroid antiinflammatory drug, was given for 12 weeks in a daily dose 12 mg/day to 44 RA patients (mean age 54.5 +/- 7.3 years). 24-h arterial pressure monitoring was made with Cardiotens-01 device. RESULTS: Xefocam in a dose 12 mg/day has shown good tolerance, a high analgetic and antiinflammatory effect as indicated by a positive response of articular syndrome, a significant fall of systolic arterial pressure, decreased heart rate, better heart rhythm variability. CONCLUSION: In hypertensive RA patients xefocam in a dose 12 mg/day proved effective and safe.