[Effect of treatment with trimethazidine on characteristics of arrhythmia and indicators of heart rhythm in patients with chronic cardiac failure]. / Vliianie lecheniia trimetazidinom na kharakteristiku aritmii i pokazateli variabel'nosti ritma serdtsa u bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu.

AIM: To study the effects of trimethasidine on the specific features of arrhythmias, on the parameters of cardiac rhythm variability (CRV) and ischemic changes in the ST segment in patients with functional classes II-III chronic heart failure (CHF). MATERIAL AND METHODS: Twenty male patients with less than 45% left ventricular ejection fraction were examined. After stabilizing their status and working through basic therapy for a week, the patients were randomly divided in two subgroups equally and followed up in the outpatient setting for 6 months. During two 3-month periods, they alternately received either the standard basic therapy or the standard therapy in combination with trimethasidine in a dose of 20 mg thrice a day. Holter monitoring was performed before and 3 and 6 month after the therapy. RESULTS: In patients with CHF on trimethasidine, there was a significant reduction in the number of paroxysms of ventricular tachycardia and high-grade ventricular extrasystoles, and a significant improvement of cardiac rhythm variability. Concurrently, a significant decrease in the frequency of episodes of ST-segment depression was recorded at ECG. CONCLUSION: Trimethasidine treatment in CHF patients induced a reduction in the incidence of cardiac rhythm disturbances, which may be associated with its antiischemic effect on the myocardium and, possibly, with the positive effect of cytoprotective therapy on autonomic tone.

[Trimetazidine in correction of chronic heart failure in patients with ischemic heart disease]. / Trimetazidin v korrektsii khronicheskoi serdechnoi nedostatochnosti u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Twenty patients with NYHA class II-IV heart failure and ejection fraction below 40% received standard therapy (control period) or standard therapy plus open trimetazidine (20 mg t.i.d.) for 3 months in a cross-over design. Therapy with trimetazidine was associated with attenuation of clinical signs of heart failure (average NYHA class 2.90-/+0.10, 2.27-/+0.20 and 2.88-/+0.13, p<0.05, at baseline, after trimetazidine and control period, respectively), improvement of results of 6-minute walk test (average distance 321-/+19, 375-/+20 m, p<0.02, and 303-/+17 m at baseline, after trimetazidine and control period, respectively), increase of left ventricular ejection fraction (from 34.1-/+2.0 to 38.1-/+1.8%, p<0.05) and improvement of quality of life. Thus in patients with heart failure addition of trimetazidine to standard therapy for 3 months produced positive effect on clinical and hemodynamic status, exercise tolerance and quality of life.

[Neoton and thrombolytic therapy of myocardial infarction]. / Neoton i tromboliticheskaia terapiia pri infarkte miokarda.

AIM: To evaluate neoton therapy effects in acute myocardial infarction (MI) on systolic function of the left ventricle, arrhythmia and clinical symptoms in patients on thrombolytic therapy (TLT). MATERIAL AND METHODS: 106 males with Q-MI entered the study. 47 received treatment without TLT and neoton, 30 patients received TLT with streptokinase preparations, 29 patients were given streptokinase preparations and neoton. Left ventricular systolic function was measured by echocardiography on day 1, 3, 7, 14, 21 and 28; arrhythmia was analysed at Holter monitoring in day 1 and 2 of MI. RESULTS: TLT failed to arrest progression of left ventricular dilation by the end of the hospital stay. Patients given neoton in acute period of MI had no increase in the end systolic and diastolic volumes of the left ventricle in the course of the first months after MI onset. Antiarrhythmic action of neoton manifested on MI day 2. CONCLUSION: Neoton given to MI patients receiving TLT prevents progression of left ventricular systolic dysfunction and establishment of predictors of unfavourable outcome.

[Six-minute walking test for the evaluation of the status of patients with chronic cardiac failure]. / Primenenie proby s 6-minutnoi khod'boi dlia otsenki sostoianiia bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu.

The paper presents the results of application of the modified 6-minute walking test for assessment of exercise tolerance in follow-up of patients with ischemic heart disease (IHD) complicated by chronic cardiac failure (CCF). At admission and after 3-4 weeks of treatment 52 IHD patients underwent the walking test and described subjective effects according to modified Borg's questionnaire. The repeated test registered increased walking distance and subjective response. The results of the study confirm validity of using 6-minute walk test in combination with modified Borg questionnaire in routine hospital and outpatient practice as a simple, safe and informative method of control over IHD patients' condition and assessment of their treatment efficacy.

[Effect of mildronate on life quality of patients with chronic heart failure]. / Kachestvo zhizni bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu. Effekt lecheniia mildronatom.

AIM: To study quality of life (QL) of patients with chronic heart failure (CHF) and QL changes resultant from mildronate therapy. MATERIALS AND METHODS: QL was studied in 30 IHD patients with CHF of NYHA class II-IV, ejection fraction > 45%; 40 IHD patients without CHF and 30 healthy subjects. CHF patients were treated for 30 days with oral mildronate (250 mg 4 times a day). QL was assessed according to the method SF-36 Health Status Survey. RESULTS: QL in CHF patients is much lower than that of the controls. Objective severity of the disease and subjective satisfaction with life do not always coincide. Mildronate in a dose 1 g/day per os may be beneficial for LQ of CHF patients. CONCLUSION: It is thought desirable to include QL in analysis of efficiency of managing patients with CHF. SF-36 is a tool able to follow up changes in QL of CHF patients within a short-term treatment period.

[Prophylactic use of Neoton in cardiac failure in patients with myocardial infarction]. / Primenenie Neotona dlia profilaktiki serdechnoí nedostatochnosti u bol'nykh infarktom miokarda.

Echocardiography and integral body rheography were made in 174 patients with macrofocal myocardial infarction (MI) to study hemodynamics at six stages of hospital rehabilitation (MI day 1-28). 97 patients received neoton (4 different scheme) in the acute period of MI. Neoton administration was found to prevent progressive left ventricular dilation and emergence of cardiac insufficiency in subacute period of MI, to reduce the risk of cardiac aneurism, recurrence and postinfarction angina. The response to neoton rises with an increase of its dose on the first day of the disease and lessening of the time span from first symptoms of MI and first neoton injection. An optimal scheme of neoton use is proposed.

[Neoton (exogenic phosphocreatinine) in combined therapy of chronic cardiac failure]. / Primenenie neotona (eksogennogo fosfokreatinina) v kompleksnoi terapii khronicheskoi serdechnoi nedostatochnosti.

To evaluate clinicohemodynamic effect of neoton (exogenic phosphocreatine) given in an intravenous course, the drug was added to standard scheme in 53 patients with chronic cardiac failure (6.0 g/day i.v. drip for 5 days or 3.0 g/day for 10 days). 20 control patients received standard therapy alone. A course neoton produced an increase in the ejection fraction, a reduction in end-diastolic and end-systolic left ventricular volumes. It is recommended to include neoton in the scheme of chronic cardiac failure treatment in the dose 3.0 g/day for 10 days.

[Systemic thrombolytic therapy in acute myocardial infarct: its effect on left ventricular function, body oxygen consumption and disease prognosis]. / Sistemnaia tromboliticheskaia terapiia pri ostrom infarkte miokarda: vliianie na funktsiiu levogo zheludochka, kislorodnoe obespechenie organizma i prognoz zabolevaniia.

Echocardiography, integral rheography of the body, Holter monitoring, assessment of oxygen consumption and blood gases were used in examination of 93 patients with macrofocal myocardial infarction (MI). 48 patients received thrombolytic therapy (TT) within 6 hours of MI which in 27 patients implied standard drugs (streptodecase, celiase, avelysin) and new medicine APSAC (21 patients). 45 patients received no TT. It was found that in acute MI period systemic TT prevented a fall in left ventricular performance, promoted advanced oxygen supply due to intensified oxygen extraction by tissues. This fact is attributed to transient changes in blood rheology. Application of APSAC prevented inhibition of myocardial contractility and development of congestive heart failure in subacute MI period. TT patients demonstrated ventricular arrhythmia on MI day 1 more often though by the number of the main arrhythmia types the groups differed insignificantly. Within 1-year postmyocardial infarction period TT patients had less repeat MI and were less frequently diagnosed to develop congestive heart failure.

[Exogenous phosphocreatine in the prevention and treatment of cardiac insufficiency in patients with myocardial infarction]. / Profilaktika i lechenie serdechnoi nedostatochnosti u bolnykh infarktom miokarda s pomoshchíu ékzogennogo fosfokreatina.

Central, intracardiac hemodynamics and myocardial contractility were assessed in 97 inpatients with macrofocal myocardial infarction. Of them, 71 received conventional chemotherapy versus 26 patients given additionally intravenous phosphocreatine (neoton). The total dose of neoton 30 g was injected during the course of 6 days following the disease onset. With minimal changes in central hemodynamics, phosphocreatine was found to prevent left-ventricular dilatation and development of congestive heart failure by decreasing preload, to maintain myocardial contractility without reduction.

[Effect of systemic thrombolytic therapy on clinico-hemodynamic indicators in patients with acute myocardial infarction]. / Vliianie sistemnoi tromboliticheskoi terapii na kliniko- gemodinamicheskie pokazateli u bol'nykh ostrym infarktom miokarda.

Left ventricular contractility, central hemodynamics and a clinical course of acute myocardial infarction were investigated in inpatients on systemic thrombolytic therapy and controls. This treatment is shown to diminish the risk of acute left ventricular failure, ventricular fibrillation and atrioventricular block. Furthermore, it prevents inhibition of left ventricular contractility in acute period of the infarction. Subsequently, noticeable differences between the test group and controls disappeared.

[Phosphocreatine in the treatment of patients with myocardial infarct: effects on hemodynamics and oxygen supply]. / Fosfokreatin v lechenii bol'nykh infarktom miokarda: vliianie na gemodinamiku i kislorodnoe obespechenie organizma.

Changes in the major parameters of central and intracardiac hemodynamics and body's oxygen supply were examined in 93 patients with massive myocardial infarction in the in-hospital period of the disease. Traditional therapy was given to 71 patients; in addition, phosphocreatine infusions (a course dose being 30 g) were used in 22 patients in acute myocardial infarction. Phosphocreatine therapy failed to substantially affect cardiac pump function, but prevented left ventricular dilation and development of congestive heart failure. The patients receiving phosphocreatine showed an increase in body's oxygen consumption due to its elevated tissue extraction. No adverse effects of phosphocreatine were found.

[Oxygen supply of the body in myocardial infarction]. / Kislorodnoe obespechenie organizma pri infarkte miokarda.

Oxygen transport and demand were examined in 71 patients with myocardial infarction within the first 5 weeks of the disease. The volume of blood-transported oxygen was shown to be determined mainly by the blood circulatory minute volume. Lower arterial blood oxygen is an additional factor of diminished oxygen transport in hypodynamic central hemodynamics. Within the first 5-10 days of myocardial infarction, there was a progressive reduction in oxygen transport, but by days of 28-35, there was its gradual increase. These changes are the most prominent in patients with a hyperdynamic type and negligible in those with a hypodynamic type within the first 24 hours of myocardial infarction. The important of oxygen transport decrease compensation is its increased tissue extraction from arterial blood, thereby providing the stable oxygen demand in the wide range of its supply fluctuations.

[Changes in stroke volume in ventricular asystole]. / Izmeneniia udarnogo ob"ema krovi pri zheludochkovoi ékstrasistolii.

Change in the stroke volume in ventricular extrasystoles was studied in 27 patients. In patients with cardiac insufficiency a decrease in the extrasystolic stroke volume was more noticeable than in patients without cardiac insufficiency. "Hemodynamic debts" for extrasystolic and postextrasystolic contractions in patients with the presence and absence of cardiac insufficiency were undistinguished. In interpolated extrasystoles "hemodynamic debts" were less than in non-interpolated.