[Value of exercise electrocardiography and other current instrumental studies in the evaluation of percutaneous coronary interventions and in the detection of restenosis].

The current instrumental studies (graded exercise echocardiography (ECG)), exercise tests in combination with myocardial imaging (echocardiography, myocardial perfusion scintigraphy) used to evaluate restenosis after percutaneous coronary interventions (PCI) in patients with coronary heart disease are considered. The sensitivity, specificity, and prognostic value of these studies versus coronarography in the diagnosis of restenosis after PCI are given. The capabilities of other diagnostic techniques (ultrasound study of brachial artery dysfunction, intravascular ultrasound study of coronary arteries, multispiral computed tomography, etc.) are analyzed. It is emphasized that periodic use of exercise ECG tests after PCI has no advantages over their performance only on the basis of the clinical findings of the impact on quality of life, functional status, and clinical signs.

[Assessment of clinical course, prognosis and effectiveness of drug and nondrug treatment of patients with ischemic heart disease and occlusive coronary artery atherosclerosis (data of 5-year prospective follow-up)].

Data of 5-year prospective follow-up were used for assessment of clinical course, prognosis and effectiveness of drug and nondrug treatment of 202 patients with ischemic heart disease, occlusive coronary artery atherosclerosis and preserved left ventricular function. It was found that 5-year cardiovascular mortality and rate of nonfatal myocardial infarction did not differ significantly between groups of patients subjected to drug treatment only, transluminal balloon angioplasty, and coronary artery bypass grafting.

[Differentiated use of nitrates in ischemic heart disease].

Clinical aspects of the use of organic nitrates in the treatment of patients with ischemic heart disease (IHD) are considered. Efficacy of organic nitrates in various forms of IHD as well as in patients with concomitant diseases is discussed. Special stress is made on clinical aspects of application of nitrates in treatment of IHD. Possibilities and safety of contemporary nitrates in patients with various forms of IHD are discussed.

[Effects of isosorbide-5-mononitrate on clinical condition, bicycle ergometry results, endothelium-dependent vasodilation in patients with ischemic heart disease with stable effort angina].

AIM: Assessment of efficacy of treatment of coronary heart disease (CHD) patients suffering from stable effort angina of functional class II-III with the drug isosorbide-5-mononitrate Mono Mac 50 depo (MM 50 D). MATERIAL AND METHODS: Clinical indices, exercise tolerance, endothelial function (the study of brachial artery in reactive hyperemia and sublingual intake of nitroglycerin) were studied in 30 patients with stable angina FC II-III before the treatment, 1 and 3 months after the treatment. RESULTS: MM 50D significantly widens diameter of the brachial artery (by 11.6%), lowers nitroglycerin-dependent vasodilation (from 16% to 10.4% in a month and to 10.2% in 3 months) and blood flow speed in reactive hyperemia. An absolute increment of the brachial artery diameter in reactive hyperemia test remained unchanged. The ratio flow-dependent vasodilation/nitroglycerin-dependent vasodilation increased in the course of therapy from 0.67 to 0.91. The drug produced clinical improvement (anginal attacks rate diminished by 70 and 85%, respectively) and increased exercise tolerance (the threshold performance rose by 28%, total load time--by 30%). CONCLUSION: It is important to use complex assessment of hemodynamic component of endothelial function in the treatment with nitrates.

[Assessment of antianginal and antiischemic effect of trimetazidine and its effects on myocardial perfusion in patients with ischemic heart disease and stable angina.]. / Otsenka antianginal'nogo i antiishemicheskogo éffekta trimetazidina iego vliianiia na perfuziiu miokarda u bol'nykh ishemicheskoi bolezn'iu serdtsa so stabil'noi stenokardiei napriazheniia.

AIM: To assess antianginal and antiischemic effects of trimetazidine and its action on myocardial perfusion in patients with ischemic heart disease and stable angina. MATERIAL: Open trimetazidine was given for 3 months to 53 nitroglycerine and beta-blocker treated men aged 47-69 (mean age 60.2+/-0.85) years with ischemic heart disease and stable angina. Stenoses of 1-3 main coronary arteries were found at angiography in 37 of these patients. METHODS: Registration of frequency of anginal attacks and nitroglycerine consumption, treadmill exercise tests and 24-hour ECG monitoring, assessment of severity of myocardial perfusion defects by scintigraphy with (99m)Tc MIBI were used for elucidation of treatment efficacy. RESULTS: After 3 months number of anginal attacks per week decreased from 9.3+/-0.6 to 4.8+/-05% (-48%, p<0.001), weekly nitroglycerine consumption fell from 9.9+/-0.8 to 4.6+/-0.6 pills (-53%, p<0.001), time to ST-segment depression during exercise on treadmill increased from 6.4+/-0.4 to 7.7+/-0.5 min (+16.9%, p<0.001) and total work performed increased from 7.8+/-0.4 to 9.2+/-0.5 METS (+15.2%, p<0.001). According to 24-hour ECG monitoring numbers of episodes of painful and painless ischemia decreased from 4.1+/-0.9 to 1.9+/-0.7 (-56.3%, p<0.002) and their overall duration shortened from 24.3+/-7.0 to 10.6+/-3.9 min (+56.3%, p<0.02). Analysis of heart rate variability revealed significant augmentation of SDNN in 77.8% of patients (from 130.0+/-6.9 to 145+/-8.1, p<0.05). Severity and extent of myocardial perfusion defects decreased in 87.5% of patients by 24,2% (from 476.1+/-78.5, p<0.01) and 20.3% (from 19.7+/-2.4 to 15.7+/-2.0, p<0.01), respectively. CONCLUSION: The use of trimetazidine as complimentary therapy to nitrates and beta-blockers in patients was associated with additional antianginal and antiischemic effects and improvement of myocardial perfusion.

[Various forms of mononitrates in treating patients with stress angina]. / Razlichnye formy mononitratov pri lechenii bol'nykh stenokardiei napriazheniia.

AIM: Clinical and device evaluation of efficacy of new dosage forms of isosorbide-5-mononitrate (ISMN) in patients with angina of effort of functional class (FC) II-III in 1-3 month treatment. MATERIAL AND METHODS: 54 patients with ischemic heart disease (IHD) and stable angina pectoris (42 males, 12 females aged 48-70, mean age 59.4 +/- 3.6 years) were examined. 16 of them had angina of effort FC II, 35--of FC III and 3--of FC IV. IHD was verified at stress tests and 24-h Holter ECG monitoring. In 85.2% of IHD patients the diagnosis of stenotic coronary atherosclerosis of 1-3 great arteries was confirmed by coronarography findings. The treatment effect was assessed by bicycle exercise tests, Holter ECG monitoring, patients' records of anginal attacks before and after treatment. RESULTS: Long-term forms of ISMN--Mono Mac Depo (100 mg) and Mono Mac 50D (50 mg)--and non-retard form Mono Mac (40 mg) produced a stable antianginal effect in 85, 80 and 75% patients, respectively. ISMN preparations given for 1 and 3 months reduced frequency of anginal attacks, improved functional condition of the patients, exercise tolerance, variability of heart rhythm. Mono Mac Depo and Mono Mac 50 D were well tolerated, induced no serious side effects. CONCLUSION: ISMN preparations can be recommended as monotherapy in patients of FC II-III angina or in combination with beta adrenoblockers for treatment of patients with angina FC III-IV.

[Clinical course of disease and prognosis in patients with ischemic heart disease with stable angina pectoris, caused by stenosing coronary atherosclerosis (data from a a 20-year study]. / Klinicheskoe techenie zabolevaniia i prognoz u bol'nykh ishemicheskoi bolezn'iu serdtsa so stabil'noi stenokardiei, obuslovlennoi stenoziruiushchiem koronarnym ateroskloerozom (dannye 20-letnego nabliudeniia).

AIM: To study a course and prognosis of ischemic heart disease (IHD) with stable angina pectoris (SAP) caused by stenotic coronary atherosclerosis (SCA) by 20-year follow-up data. MATERIAL AND DATA: Prognosis of survival was made in 318 patients with SAP due to SCA. RESULTS: The results of a 20-year study show that prognosis in IHD patients depends on SAP severity (by the functional class), exercise tolerance (by the exercise test), severity of coronary bed affection and of left ventricular contractility affection as assessed by coronary- and ventriculography. If lethality of the test subjects was not higher than in the population, the patient had good prognosis associated with one-vessel lesion, normal myocardial contractile function, high exercise tolerance, absence of the leading risk factors. CONCLUSION: The multivariance analysis with stepwise selection enabled the design of the model of the integral prognostic index (IPI) for the studied patients. The IPI index under 1.86 suggests a favourable prognosis, 1.87-2.33--an intermediate prognosis and in IPI higher than 2.34--unfavourable prognosis. Early surgery is recommended for patients with high IPI.

[Double bonds of fatty acids, alcohols glycerol, cholesterol and nonpolar serum lipids. Diagnostic value of hypercholesterolemia]. / Dvoinye sviazi zhirnykh kislot, spirty glitserin, kholesterin i nepoliarnye lipidy syvorotki krovi. Diagnosticheskoe znachenie giperkholesterinemii.

A method for evaluation of double bonds (DB) by ozone titration in a pool of serum lipids during extraction after Folch is developed. A method for measuring the weight of nonpolar lipids in apoB-100-lipoproteins (LP) with a hydrophobic fluorescent probe K-37 was used. Cholesterol and glycerol alcohols were measured in the serum using Cholesterol and Triglycerides kits (Hoffmann la Roche). Twenty-four patients with myocardial infarction, 29 coronary patients, and 37 healthy children were examined. The level of cholesterol alcohol reflects the number of double bonds in fatty acids (FA) and hence, the content of essential polythenic FA in the serum. The higher the level of cholesterol alcohols the greater the pool of essential poly-FA, circulating in the blood as nonpolar cholesterol polyesters within low density lipoproteins (LDL). Presumably, the higher the level of cholesterol LDL, the more pronounced is the deficit of essential poly-FA and the greater is the compensatory activation of the synthesis of endogenous poly-FA. A positive correlation between the content of cholesterol alcohol in the serum and weight of nonpolar lipids in apoB-100-LP was noted.

[Six-month xenical (orlistat) therapy of patients with stable angina pectoris concomitant with obesity and hyperlipidemia]. / Opyt 6-mesiachnogo primeneniia ksenikala (orlistata) u bol'nykh stabil'noi stenokardiei s ozhireniem i giperlipidemiei.

AIM: To evaluate the efficiency of 6-month therapy with xenical (gastrointestinal lipase inhibitor) in combination with diet in patients with stable angina pectoris associated with obesity and hyperlipemia. MATERIAL AND METHODS: An open comparative randomized study of the efficiency of xenical in combination with diet was carried out in patients with stable angina pectoris concomitant with obesity and hyperlipemia. Thirty coronary patients aged 45-65 years with stable angina of effort (functional class I-II) with body weight index 28.1-45.6 kg/m2 (mean 33.5 kg/m2) were examined. All patients presented with dyslipemia (low density lipoprotein (LDL) cholesterol more than 4.14 mmol/liter, triglycerides (TG) more than 2.2 mmol/liter). Controls (n = 15) were treated with diets alone for 6 months. In the main group diets were supplemented by xenical in a dose of 360 mg/day. RESULTS: Body weight index decreased in both groups (by 9.9% in the main group and by 4.2% in the control). Body weight stabilization during 6 months of treatment and the fact that it was slow and gradual were essential. In patients treated with xenical total cholesterol level decreased by 10.9% and of LDL cholesterol by 12.2% after 6 months (p < 0.05). Changes in the levels of high density lipoprotein cholesterol and TG were insignificant. The drug did not affect the incidence of angina attacks and improved exercise tolerance after 6-month therapy. Blood biochemistry (transaminases, alkaline phosphatase, glucose, and creatinine) changed negligibly. No side effects were observed; all patients received a complete 6-month course. CONCLUSION: The results confirm that xenical (orlistat) can be used for long therapy of patients with stable angina of effort concomitant with obesity and hyperlipemia.

[Proportion of alcohols of cholesterol, glycerol and double bonds of fatty acids in blood serum and lipoproteins. Diagnostic significance of hypercholesterolemia]. / Vzaimootnosheniia spirtov kholesterina, glitserina i dvoinykh sviazei zhirnykh kislot v syvorotke krovi i lipoproteinakh. Diagnosticheskoe znachenie giperkholesterinemii.

A new method in quantitative determination of double bonds (DB) in the pool of fatty acids (FA) has been worked out by ozone titration after extraction of lipids according to Folch. A correlation was observed among DB content, the level of cholesterol alcohol (CS, r = +0.612; p < 0.001) and the level of glycerol (GL) alcohol (r = +0.392; p < 0.01). The grown-ups with ischemic heart disease and children have a constant ratio (5.05 +/- 0.18) DB:CS ratio.

[Comparison of dinitrate isosorbide retard forms in ischemic heart disease patients with stable effort angina]. / Sravnenie retardnykh form izosorbida dinitrata u bol'nykh IBS so stabil'noi stenokardiei napriazheniia.

AIM: To compare antianginal and anti-ischemic efficiency and tolerance of two forms of isosorbide dinitrate--cardiket-retard 120 mg and cardiket-retard 40 mg in IHD patients with stable effort angina. MATERIAL AND METHODS: The study included 18 IHD patients with stable angina of functional class II (5 patients) and III (13 patients). The trial was open cross-over. The treatment with both the forms lasted 1 month. Frequency of anginal attacks and exercise tolerance by veloergometry data were assessed. RESULTS: A significant decrease in the number of anginal attacks and greater exercise tolerance was recorded in cardiket 120 mg intake once a day. Both forms were well tolerated, serious side effects were absent. CONCLUSION: Comparison of the two isosorbide dinitrate dosage forms--cardiket 120 mg once a day and cardiket 40 mg 3 times a day--showed that the former is superior by clinical efficiency.

[Effect of probucol on cardiac electrophysiology in anginal patients with hyperlipidemia and diabetes mellitus type II]. / Vliianie probukola na élektrofiziologicheskie parametry serdtsa u bol'nykh stenokardiei, sochetaiushcheisia s giperlipidemiei i sakharnym diabetom tipa 2.

AIM: To investigate effects of a hypolipidemic drug with antioxidant action probucol on electrophysiological parameters of the heart in patients with ischemic heart disease (IHD), stable angina (SA), hyperlipoproteinemia (HLP) and diabetes mellitus (DM) type II. MATERIAL AND METHODS: The trial entered 48 IHD patients (11 males and 37 females) aged 47-73 years with SA functional class II and III (39.4 and 60.6%, respectively), secondary HLP (mean group total cholesterol 6.5 +/- 0.17 mmol/l), DM type II (mean fast glucose 7.7 +/- 1.8 mmol/l) and obesity (mean body mass index 29.7 +/- 2.2 kg/m2). Transesophageal pacing of the left ventricle was conducted in all the patients before probucol treatment and 18 hours, 1 month and 3 months after it. RESULTS: Probucol (a single dose 500 mg) significantly reduced the time of recovery of sinus node function. Three months of probucol administration in a dose 1000 mg/day enhanced pacemaker activity of the sinus node. CONCLUSION: In addition to a beneficial effect on lipid metabolism (a decrease of total cholesterol by 13.4%, LDLP cholesterol by 15.2%, triglycerides by 15.8%), probucol enhanced pacemaker activity of the sinus node. This makes it perspective in patients with sinus node dysfunction. Caution is necessary in prescribing probucol to patients with supraventricular tachycardia caused by re-entry mechanism.

[Comparative study of isosorbide dinitrates and mononitrates in patients with ischemic heart disease and stable angina pectoris caused by stenosing coronary atherosclerosis]. / Sravnitel'noe izuchenie izosorbida di- i mononitratov u bol'nykh ishemicheskoi bolezn'iu serdtsa so stabil'noi stenokardiei, obuslovlennoi stenoziruiushim koronarnym aterosklerozom.

In an open clinical trial 19 patients with angina pectoris (functional class II-III) received in turn either non-retard tablets of isosorbide dinitrate (nitrosorbid, cardiket) in a mean dose 80 mg/day or isosorbide 5-mononitrate (mono mac) in a mean dose 51.5 mg/day. Each drug was given for a month. The effect was assessed by changes in frequency of anginal attacks and exercise tolerance. Non-retard isosorbide dinitrate and isosorbide 5-mononitrate demonstrate a good antiischemic effect, are safe and well tolerated. Isosorbide dinitrate and mononitrates do not differ significantly in reduction of the anginal attacks and by an increase in exercise tolerance but the effective dose of mono mac was 1.5-2 times less than that of nitrosorbide or cardiket, thus it is more cost-effective.

[Comparative study of retard and non-retard forms of isosorbide-5-mononitrate in coronary patients with stable angina pectoris]. / Sravnitel'noe izuchenie retardnoi i neretardnoi form izosorbid-5-mononitrata u bol'nykh ishemicheskoi bolezn'iu serdtsa so stabil'noi stenokardiei.

An open cross-over trial compared retard and non-retard forms of isosorbide-5-mononitrate (monomac 50D and isomonat, respectively) in 15 patients with stable angina of effort (functional class II-III). Both drugs were found rather effective, they significantly increase exercise tolerance. A single daily dose of monomac 50D reduced the number of anginal attacks. It was well tolerated, caused no serious side effects and had advantages over isomonat taken 2 or 3 times a day.

[A comparison of the hypolipidemic action of probucol at doses of 500 and 1000 mg/day in moderate hyperlipoproteinemia]. / Sopostavlenie gipolipidemicheskogo deistviia probukola v doze 500 i 1000 mg/sut pri umerennoi giperlipoproteidemii.

AIM: Evaluation of effectiveness of hypolipidemic action of probucol in doses 500 and 1000 mg/day and comparison of probucol blood concentrations on the treatment month 3 and 6. MATERIALS AND METHODS: Probucol (Akrikhin, Russia) was given to 41 patients with primary hypercholesterolemia in a dose 500 mg/day. 3 months later the patients were divided into two groups. Group 1 patients exhibited a > 10% decrease in cholesterol levels and continued to take probucol in the dose 500 mg/day. Group 2 patients were crossed over to higher cholesterol dose--up to 1000 mg/day. Lipids levels were measured by enzyme tests, apoproteins--by immunoturbidimetry and immunodiffusion, probucol concentrations--by high-performance liquid chromatography. RESULTS: After 3 months of treatment, cholesterol lowered by 14.3 and 9.2% in groups 1 and 2, respectively. After 6 months, by 19.7 and 12.9%, respectively. Probucol concentrations in blood were higher after 6 months of treatment than after 3 months in both groups. No significant differences existed between the groups by probucol concentrations in 3 and 6 months. CONCLUSION: Hypolipidemic effect of probucol depended on the individual features of lipoproteins metabolic disorders rather than the drug blood concentration. Larger probucol doses fail to reduce cholesterol further.

[Diagnostic significance of glycolipid sialic acids in hyperlipoproteinemias]. / Diagnosticheskoe znachenie sialovykh kislot glikolipidov pri giperlipoproteidemiiakh.

Total and lipid-bound sialic acids in the blood were measured and lipoprotein metabolism assessed in 219 men and women with primary (n = 129, coronary patients) and secondary (n = 66, patients with type II diabetes) hyperlipoproteinemias and normolipidemia (n = 24, normal subjects). The level of total sialic acids in coronary patients reliably differed from that in normal subjects or diabetics. The level of lipid-bound sialic acids was the same in coronary patients and normal subjects and reliably higher in diabetics. The results do not confirm the hypothesis about the probable diagnostic value of total and lipid-bound sialic acids as markers of coronary disease and coronary atherosclerosis. Measurement of total sialic acids may be one of the tests verifying the disorders of lipoprotein metabolism.

[Total and lipid-bound sialic acids in the blood in primary and secondary hyperlipoproteinemias]. / Obshchie i sviazannye s lipidami sialovye kisloty krovi pri pervichnykh i vtorichnykh giperlipoproteidemiiakh.

Total and lipid-bound sialic acids (TSA and LBSA) were measured in the blood of 219 patients with primary or secondary hyperlipoproteinemia (129 patients with ischemic heart disease and 66 patients with diabetes mellitus type II) versus 24 normolipidemic healthy subjects. TSA levels in IHD patients differed significantly from those in IHD-free and diabetic patients. LBSA quantities were the same in IHD and IHD-free patients, being significantly higher in diabetes mellitus than in IHD. These findings give no proves to diagnostic value of TSA and LBSA as markers of IHD and coronary atherosclerosis. TSA levels may be used in the test for disturbed lipoprotein metabolism.

[The antioxidant probucol as a regulator of the intensity of free-radical lipid peroxidation processes in the blood of patients with coronary atherosclerosis]. / Antioksidant probukol kak reguliator intensivnosti protsessov svobodnoradikal'nogo perekisnogo okisleniia lipidov v krovi bol'nykh koronarnym aterosklerozom.

Two series of studies were made to assess probucol medicines (lipomal, "Alkaloid"; fenbutol "Akrikhin") effect on clinical symptoms, lipid metabolism, primary and secondary products of lipid peroxidation, activity of antioxidant enzymes (superoxide dismutase, glutathione peroxidase) in atherosclerotic patients with hyperlipidemia type IIA and IIB. In both series probucol reduced frequency of anginal attacks, content of total cholesterol and LDL cholesterol. HDL cholesterol remained unchanged or reduced insignificantly. Lipoperoxides and malonic dialdehyde levels in plasma progressively lowered against activation of antioxidant enzymes. These biochemical parameters returned to initial values within 3 months since the drug discontinuation. It is evident that antiatherogenic effect of probucol is due to indirect activation of natural defense systems responsible for enzymic detoxication of active oxygen forms and lipoperoxides rather than to direct interaction of this synthetic antioxidant with lipid radicals.