Nonlinear relationship between erythrocyte sodium-lithium countertransport and blood pressure in man.

A relationship between erythrocyte Na+/Li(+)-countertransport activity and blood pressure was studied in a randomly selected sample (95 subjects) with full range of blood pressure, from a representative group of inhabitants of one of Moscow's districts. The mean rate of erythrocyte Na+/Li(+)- countertransport activity was higher (p < 0.01 or less) in the groups of subjects with both borderline (BH) and moderate essential hypertension (EH) as compared with the group of normotensives (NT). A positive correlation was found between the erythrocyte Na+/Li(+)- countertransport rate and age and body weight in the entire selected group. The total contribution of these confounding parameters is responsible for 20.4% of the interindividual variability of the Na+/Li(+)- countertransport activity. The individual Na+/Li(+)- countertransport values remained unchanged during at least 2 years of follow-up. A nonlinear relationship between erythrocyte Na+/Li(+)- countertransport activity and blood pressure was established in the entire group. No significant association between blood pressure and Na+/Li(+)- countertransport was seen at high and low values of these two parameters. A pronounced change in the erythrocyte Na+/Li(+)- countertransport values occurred within a narrow borderline blood pressure range.

[The risk assessment for a fatal outcome in patients with stable angina based on the data from a long-term prospective observation (a comparison of the 5-year survival prognosis with the data at the 6th to 12th years of the observation)]. / Otsenka riska letal'nogo iskhoda u bol'nykh so stabil'noi stenokardiei po dannym dlitel'nogo prospektivnogo nabliudeniia (sopostavlenie 5-letnego prognoza vyzhivaemosti s dannymi na 6--12-m godu nabliudeniia).

A rule has been developed to predict coronary death in 377 patients with coronary heart disease and stable angina due to coronary stenotic atherosclerosis. Gravimetric values of various clinical signs, resting ECG changes, and bicycle ergometric testing have been obtained by a computer. A decisive rule has been also derived. According to the values of prognostic indices I1 and I2, groups of low, moderate, and high risks for fatal outcomes for 5 years have been identified and the patient's survival during a subsequent follow-up of 6 to 12 years has been assessed. The developed scheme of prognosis permits its use in practice.

Management of essential hypertension in patients with different degrees of left ventricular hypertrophy. Multicenter trial.

Three hundred and four hypertensive patients with different degrees of left ventricular hypertrophy (LVH) were recruited and followed for 4 years. The patients were randomized into two groups: Group I (150 patients) was treated with a combination of hypotensive drugs including beta-blockers, and group II (154 patients) was treated with the same combination of drugs including diuretics instead of beta-blockers. By the end of the fourth year, 60 endpoints were recorded: 17 strokes, 13 myocardial infarctions, and 30 cases of chronic coronary insufficiency. Mortality was statistically higher in group II (7 of 154 or 5% v 1 of 150 or 1%) (P less than .035), but there was no difference between the groups in the incidence of nonfatal endpoints. These data confirm that beta-blockers can reduce mortality associated with the complications presented in hypertensive patients. Increased left ventricular myocardial mass (greater than 200 g, according to Teichholz' formula) was shown to have prognostic value for the development of complications. In patients with LVMM greater than 200 g, the probability of fatal complications was higher (P less than .007), as was the probability of nonfatal myocardial infarction (P less than .01), development of coronary artery disease (P less than .02), and all complications (P less than .0003). Regression of LVH to less than 200 g (according to Teichholz' formula) improved prognosis.

[Reproducibility of functional classification in patients with stable angina pectoris]. / Vosproizvodimost' funktsional'noi klassifikatsii u bol'nykh so stabil'noi stenokardiei.

Diagnostic indices based on various sets of signs were developed to define functional classes of angina pectoris. At the same simultaneous application of clinical parameters (age, conditions for onset of anginal episodes and their arrest, the number of weekly anginal episodes, the level of daily exercise, over 1-mm ST segment depression, resting ECG signs of left ventricular hypertrophy, etc.) and bicycle ergometer testing data (cardiac output, peak exercise heart rate, etc.) augmented the accuracy and reliability of identification of a functional class in patients with stable angina. The diagnostic indices are highly reproducible and may be useful in the assessment of the course of the disease and its prognosis in patients with coronary heart disease.

[Clinico-instrumental criteria of functional classes of patients with ischemic heart disease and stable angina pectoris]. / Kliniko-instrumental'nye kriterii funktsional'nykh klassov bol'nykh ishemicheskoi bolezn'iu serdtsa so stabil'noi stenokardiei.

The study was undertaken to define the clinical and instrumental signs that significantly divide coronary heart disease patients with stable angina into functional classes. Diagnostic criteria constructed on the basis of various clinical and instrumental evidence were developed with regard to the results of the examination of 163 patients with stable angina by using the mathematical statistical methods. The authors provide a procedure for determining and assessing the informative value of the diagnostic index in the long-term prospective survey of patients with coronary heart disease. Concurrent application of clinical parameters and bicycle ergometric findings as part of the index enhances the accuracy and validity of definition of a functional class in patients with stable angina.

[Circulating immune complex cholesterol as a biochemical marker of coronary atherosclerosis]. / Kholesterin tsirkuliruiushchikh immunnykh kompleksov kak biokhimicheskii marker koronarnogo ateroskleroza.

The study was undertaken to examine 134 patients who were divided into 2 groups: 1) those with angiographically documented coronary atherosclerosis and 2) those with unaltered coronary arteries. The levels of immune complex cholesterol and the parameters of serum lipid spectrum were investigated in all the patients. The level of immune complex cholesterol and the apo B/apo AI ratio were the most informative indices in the characterization of coronary atherosclerosis. Immune complex cholesterol may be used as a marker of coronary atherosclerosis, the diagnostic accuracy is 78% with this method.

Lipoprotein immune complexes as markers of atherosclerosis.

Recently we have demonstrated that cholesterol level in LDL-containing circulating immune complexes (CIC cholesterol) correlates with the presence of coronary atherosclerosis. In the present study we attempted to clarify whether CIC cholesterol level correlates with the severity of coronary atherosclerosis. The second task was to reveal the diagnostic value of CIC cholesterol in comparison with other lipid and lipoprotein parameters used as markers of dislipidaemia associated with atherosclerosis. The subjects were 107 patients with angiographically-documented coronary atherosclerosis and 66 patients with documented extracoronary atherosclerosis. Only CIC cholesterol and the apo B/apo A-1 ratio contributed strongly to the discrimination between patients with coronary atherosclerosis and those without stenoses. On the other hand, total cholesterol, triglycerides, HDL cholesterol, apo B, Lp[a] and apo A1 did not correlate with the presence and severity of coronary atherosclerosis. Subjects with stenosis of extracoronary arteries had significantly higher CIC levels than healthy donors. Sensitivity, specificity and accuracy of coronary atherosclerosis diagnosis were assessed for each parameter examined. It was revealed that CIC cholesterol is the most reliable marker of coronary atherosclerosis as compared to other chemical parameters. In addition, the CIC cholesterol level diagnoses extracoronary atherosclerosis with high accuracy.

[Risk factors and survival prognosis in lymphogranulomatosis: a statistical analysis]. / Faktory riska i prognozirovanie vyzhivaemosti pri limfogranulematoze: statisticheskii analiz.

To examine risk factors and to design prognostic models for the total, relapse-free and after-relapse survival, use was made of the Cox model for unifactorial and multidimensional analysis based on the retrospective estimation of the results of the treatment of 235 patients with lymphogranulomatosis, stages II-III. Radiotherapy according to the radical program was carried out in conjunction with polychemotherapy according to the COPP scheme. The number of areas of damage, massiveness of injury to the mediastinum, involvement of the spleen into the process appeared the most informative risk factors for predicting both total and relapse-free survival. The prediction of the after-relapse survival was considerably influenced by the age combined with carrying out of not less than 3 cycles of polychemotherapy given to the patients during initial treatment or with the presence of intoxication symptoms and increased ESR. The tables of the survival probability were calculated.

[Prognosis of the outcome of myocardial infarction by using early dynamic exercise tests]. / Prognozirovanie iskhoda infarkta miokarda s ispol'zovaniem rannikh prob s dinamicheskoi nagruzkoi.

A total of 158 males with a history of myocardial infarction were examined. The examination involved collection of information on their histories, course of the disease and symptoms in the hospital period and early (mean, on day 13) bicycle ergometric exercise tests. A multifactorial analysis made it possible to derive the decision rule to predict the condition of a patient within the first year following the onset of myocardial infarction, which involved prognostically unfavorable history data, such as disability prior to myocardial infarction, alcohol usage, exertional anginal hospital-stage parameters, such as bradycardia, premature contraction, circulatory failure, nodal rhythm, as well as 1 mm or more of ST-segment elevation during the early bicycle ergometric exercise test. The sensitivity of the predictive rule developed was 88.5%, its specificity was 78.5%. The study shows that it is impossible to successfully solve the problem in attempting to predict the outcome from some parameters, including the bicycle ergometric test findings. It is possible to do so only when the complex of data on a patient is taken into account.

[The relation of arterial pressure and the rate of Na-Li countertransport in a representative subsample of the population of Moscow residents]. / Zavisimost' mezhdu arterial'nym davleniem i skorost'iu Na-Li-protivotransporta v reprezentativnoi podvyborke iz populiatsii zhitelei Moskvy.

A study was made of the relationship between Na-Li countertransport and arterial blood pressure in 95 persons selected at random from the representative sample (n = 1716) of the population of one of the districts of Moscow. Of these, 34 persons turned out to be normotensive, 15 had borderline hypertension, 44 stable essential hypertension, and 2 persons presented with secondary hypertension. A positive correlation was found between countertransport and age and weight, determining 20.4% of interindividual variability of countertransport values. The mean value of countertransport in the hypertension group appeared much higher than in the normotensive group, both without and with regard to the correlating parameters. Repeated examinations demonstrated that the countertransport value in each person remained unchanged for two years. A nonlinear correlation was discovered between countertransport and arterial blood pressure. The rate of countertransport is not related to arterial blood pressure (low and high values). A dramatic change in the countertransport values occurred within a narrow borderline range of arterial blood pressure.

[Relation between the energy state of the myocardium and the release of products of anaerobic metabolism]. / [Sviaz' mezhdu énergeticheskim sostoianiem miokarda i vykhodom iz nego produktov anaérobnogo obmena.

The relationships between cellular energy parameters and succinate, alanine and creatine release from isolated guinea pig hearts were studied during a 50 min perfusion (0.2 ml/min) with 5.5 mM glucose or 5 mM sodium acetate. Compared to glucose-perfused hearts, a more rapid ATP depletion accompanied by an increased succinate and creatine release was observed during underperfusion with acetate. The succinate and alanine accumulation in the myocardial effluent was related to a decrease in tissue ATP; the creatine release showed a close inverse correlation with the tissue phosphocreatine/creatine ratio. Hyperbolic and linear relationships were found between these indices for glucose- and acetate-perfused hearts, respectively. The logarithm of tissue ATP had negative linear correlations with the perfusate succinate/creatine ratio for the both substrates. The experimental results suggest that succinate, creatine and alanine assays in the myocardial effluent may be used for the assessment of the energy state of ischemic heart.

[A comparison of the efficacy of quinidine and kordaron as agents to stabilize the recovered sinus rhythm in patients with the permanent form of atrial fibrillation]. / Sravnenie éffektivnosti khinidina i kordarona kak sredstv stabilizatsii vosstanovlennogo sinusovogo ritma u bol'nykh s postoiannoi formoi mertsatel'noi aritmii.

The efficacy of chinidine and cordarone as agents preventing the recurrence of the disturbed sinus rhythm was studied and compared on a material of 459 patients with permanent atrial fibrillation eliminated by electropulse therapy. The sinus rhythm was preserved significantly better in a group of patients given cordarone as a preventive agent, which is confirmed with the aid of a multidimensional statistical analysis as well as an analysis of "competing hypotheses".

[Assessment of the risk of a fatal outcome in patients with stable stenocardia in a 5-year period (II)]. / Otsenka riska letal'nogo iskhoda u bol'nykh stabil'noi stenokardiei na 5-letnii period (soobshchenie II).

Based on the examination of 377 patients with associated coronary heart disease and stable angina pectoris a rule of forecasting coronary death was developed. Computer was used to identify the weight values of different clinical signs, changes in the ECG taken at rest, bicycle ergometry test, coronarography and the deciding rule was deduced. Depending on the magnitude of the prognostic index (I2) groups of low, moderate and high risk of the lethal outcome were identified during the 5-year period. The schedule for coronary death forecasting permits its use at public health institutions.

[Evaluation of the risk of fatal outcome in patients with stable stenocardia over a 5-year period]. / Otsenka riska letal'nogo iskhoda u bol'nykh stabil'noi stenokardiei na 5-letnii period.

The results have been analyzed of the 5-year prospective observation over patients with associated coronary heart disease (CHD) and stable angina pectoris without grave concomitant diseases and heart failure signs. A rule of prediction has been elaborated enabling one to distinguish on the basis of the clinical data a group of patients in whom the disease runs a favourable course. It is unlikely that in the future such a group of patients would require any combined instrumental examination or surgical intervention. The use of the common therapeutic measures (long-acting nitrates, beta-blockers, and calcium antagonists) can be recognized as quite sufficient and effective. The clinical observation can be limited by the patient's attendance of the health center for repeated examination and specification of the further prognosis, which is to be made once a year. The above-said confirms the importance of defining CHD prognosis, since the properly chosen tactics of such patients' management makes it possible to attain the maximal efficacy of the diagnostic and treatment measures and to save costs as well.

[A method of rapid psychological diagnosis of patients with a history of myocardial infarction]. / Metodika psikhologicheskoi ekspress-diagnostiki u bol'nykh, perenesshikh infarkt miokarda.

The aim of the study was to develop a compact questionnaire for analysis of the psychological status of patients who had survived a myocardial infarction (MI) meant for physicians with no special psychology or psychiatry training. For this purpose of 185 questions selected by expert method on the data of 236 cases of MI using the program of stepped discriminant analysis, 37 most informative questions were chosen. These questions allowed determination of the general response to MI (adequate or neurotic) as well as of the degree of overestimation or negation of the disease and the degree of anxious-depressive syndrome. On the basis of the obtained data a method of psychologic express diagnosis (PED) for assessment of the named variables was developed. PED is aimed at wide practical use for psychological screening of patients who had survived a MI.