[Lung Hyperinflation in Chronic Obstructive Pulmonary Disease and Long-Term Outcomes of Percutaneous Coronary Intervention].

OBJECTIVE: to assess the effect of lung hyperinflation (LHI) in patients with chronic obstructive pulmonary disease (COPD) on longterm outcomes of percutaneous coronary intervention (PCI). MATERIALS AND METHODS: Patients with COPD who suffered stable ischemic heart disease and underwent PCI (n=135) were included in a prospective cohort study. LHI was found in 60 patients, while 75 patients had no LHI. Evaluation included comparing the frequency of major adverse cardiac events (MACE) (cardiac death, myocardial infarcпункtion [MI], stroke, repeat revascularization) and Kaplan-Mayer curves between groups of patients with and without LHI. Associations of parameters of pulmonary function and plasma levels of high sensitivity C-reactive protein (hsCRP) with occurrence of MACE were also elucidated. Duration of follow-up was up to 3 years (median 20 months). RESULTS: Study groups did not differ significantly by main factors of cardiovascular risk, except plasma level of hsCRP. MACE occurred in 41.7 and 26.7 % of patients in groups with and without LHI, respectively (p=0.097). However, divergence of the Kaplan-Meier curves was statistically significant (p=0.04). The main contribution was made by cardiac death, MI and stroke (21.7 and 8.0 % among patients with and without LHI; p=0.027). No difference was found regarding repeat revascularization. The correlation between functional residual lung capacity and plasma level of hsCRP was closer than the correlation between forced expiratory volume in 1 second and hsCRP level (r=0.36 and r=0.19; p.

[Ability to Overcome the Thrombocyte Resistance to Acetylsalicylic Acid in Patients With Coronary Artery Disease After Myocardial Revascularization With Coronary Stenting].

Resistance to acetylsalicylic acid (ASA) in patients with coronary artery disease is a poor predictor for the development of atherothrombotic complications. In 277 patients with coronary artery disease suffered uncomplicated coronary angioplasty with stent implantation, we was estimated arachidon-induced platelet aggregation during treatment with acetylsalicylic acid by bedside VerifyNow Assay test at 28-90 days after the intervention. It was found that 18.9% of the 144 patients receiving a combination of ASA 75 mg with 15.2 mg of magnesium hydroxide had true (laboratory) resistance to ASA. At the same time on the original enteric coated ASA 100 mg, we can found only 0.8% resistance to ASA among 129 patients. We made switch from combination of ASA 75 mg with 15.2 mg of magnesium hydroxide to original enteric coated ASA 100 mg and repeat VerifyNow Assay test at 2-4 days and found lost of resistance in 92% of 28 patients. Thus, resistance to the ASA is not constant, it depends on the form and the applied dose of ASA, and eliminating more than 92% when ASA changes from ineffective to effective form.

[Efficacy and safety of enoxaparin use during drug-eluting stents implantation].

We assessed possibility of the use of low molecular heparin enoxaparin during percutaneous coronary interventions (PCI) with implantation of drug eluting stents. Enoxaparin was administered to 225 (0.3 mg/kg intraarterially via catheter) and 215 (0.5 mg/kg intravenously) patients. In comparison group (n=207) we used unfractionated heparin (UFG) intravenously according to standard scheme under control of activated clotting time. Stents implanted (n=797) were Cypher, Taxus, and Endeavor. Immediate angiographic success was 100%. During 48 hours after PCI pronounced bleeding (4.3%) and blood transfusions predominated in UFG treated patients. Number of bleedings was minimal after the intra-arterial use of enoxaparin (0.3 mg/kg). However total rate of all adverse events after PCI turned out to be minimal (7.0%) in the group of patients receiving enoxaparin intravenously (0.5 mg/kg). Thus the use of low molecular heparin enoxaparin is justified during implantation of drug eluting stents. Its optimal dose according to data obtained is 0.5 mg/kg intravenously.

[Evaluation of the effect of intravenous administration of streptodecase on the extent of the damage in myocardial infarction]. / Otsenka vliianiia vnutrivennogo vvedeniia streptodekazy na razmer porazheniia pri infarkte miokarda.

Precordial mapping was employed to examine 29 patients with acute anterior transmural myocardial infarction (MI). Seventeen of them received intravenous streptokinase, eleven underwent symptomatic therapy. The size of the lesion was assessed in the course of the disease. It is shown that streptokinase administration within the initial 6 hours of MI promotes arrest of the ischemic lesion augmentation and eventually diminishes the area of MI.

[Evaluation of the potentialities of ultrasonic sectorial scanning for calculating left ventricular volumes by the disc method]. / Otsenka vozmozhnostei ul'trazvukovogo sektoral'nogo skanirovaniia pri raschete ob"menov levogo zheludochka do diskovomu metodu.

Possibilities of estimating left-ventricular volumes on the basis of the disc method were examined, the primary data being provided by ultrasonic sectorial scanning. A simplified ventricular model for the estimation of volumetric parameters of unchanged and asymmetrically deformed hearts is described. The results of comparisons between the estimates and actual pathomorphologic measurements are presented. Methodological aspects of the investigation are discussed. A close correlation is demonstrated between the data obtained using the new technique and those obtained by the "area-length" method for ventriculography.