[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.

[Anti-anginal effects of calcium antagonists and intra-cardiac hemodynamics]. / Antianginal'nyi éffekt antagonistov kal'tsiia i vnutriserdechnaia gemodinamika.

The intracardiac hemodynamics was studied in 33 patients with exertional angina pectoris undergoing an acute drug test with verapamil (n-15) and nifedipine (n-18) by using radionuclide ventriculography both at rest and during exercise. All the patients were divided into 2 groups by the increase in exercise duration with the two drugs: 1) those who exhibited a marked antianginal effect and 2) those without it. At rest, the calcium antagonists enhanced ejection fraction in the two groups. Exercise ejection fraction also increased, but in a subgroup of patients who displayed no higher exercise tolerance with verapamil. Verapamil and nifedipine in Group 1 patients resulted in lower left ventricular end diastolic volume. It is suggested that the antianginal effect of calcium antagonists is to a certain degree associated with decreased afterload, as manifested by diminished left ventricular end systolic volume.

[Unstable stenocardia: prognostic significance of painless forms of myocardial ischemia during hospitalization and in the remote period]. / Nestabil'naia stenokardiia: prognosticheskoe znachenie bezbolevykh form ishemii miokarda vo vremia gospitalizatsii i v otdalennom periode.

Variants of unstable angina pectoris were compared upon examination of 366 relevant patients. 24-h ECG monitoring registered painless ST shifts in 75 of them. Treatment at hospital produced results independent of ischemia form (painful or painless). However, the analysis of long-term response for 10 patients demonstrating episodes of ischemia at discharge suggests that in spite of numerous adjustments of treatment in 70% of the patients the risk of unfavorable outcome seems great.

[Comparative effectiveness of psychotropic drugs in patients with chronic ischemic heart disease]. / Sravnitel'naia éffektivnost' psikhotropnykh sredstv u bol'nykh khronicheskoi ishemicheskoi bolezn'iu serdtsa.

As many as 348 courses of psychotropic and antianginal chemotherapy were performed for coronary disease confirmed angiographically. Hypochondriac patients were resistant to the drugs, depressive states and anxiety showed the best response. Tranquilizers and neuroleptic agents proved effective in anxiety, neuroleptics in cardiophobia and hypochondria, antidepressants in depression and asthenia. The addition of psychotropic drugs to antianginal therapy produced a positive effect on cardiac pain with antidepressants benefit ranking first, neuroleptics second and tranquilizers third. Being moderate and transient, treatment-related side effects did not cause the treatment discontinuation.

[Immediate and late prognosis in patients with unstable angina under medical treatment]. / Blizhaishii i otdalennyi prognoz u bol'nykh s nestabil'noi stenokardiei pri medikamentoznom lechenii.

The study was undertaken to examine 221 patients with unstable angina (UA) in the acute period and repeatedly on average of 5.3 years later. Myocardial infarction and sudden coronary death were regarded as unfavorable outcomes of UA. Out of all the patients included into the study, 33 (15%) developed myocardial infarction on days 2-28 of hospital stay, which resulted in death in 7 patients; 6 more patients died suddenly. The hospital mortality rate was 5.8%. Of 175 patients discharged from the unit, 31 developed myocardial infarction in the late period, 1 case ended with a fatal outcome, sudden coronary death was observed in 32 cases. The mortality rates by years were the following: 10.2% within the first year, 17.4% for 3 years, and 28.2% for 5 years. The choice of a complex of initial signs mostly significant for defining the risk for complications with the use of Cox's model of proportional risks indicated that the outcome of UA was affected by the following significant factors: 1) ST segment depression in the leads V4-V6; 2) duration of aggravated condition; 3) duration of coronary heart disease; 4) the number of resting anginal episodes; 5) a patient's fitness on his admission to hospital; 6) a history of arterial hypertension; 7) negative T waves in the leads V4-V5.

[Results of a 10-year prospective study of patients with ischemic heart disease]. / Rezul'taty 10-letnego prospektivnogo nabliudeniia za bol'nymi ishemicheskoi bolezn'iu serdtsa.

The paper analyses the results of a 10-year prospective study of 396 patients with coronary heart disease concurrent with stable angina pectoris of different functional classes without serious concomitant diseases. In all the patients. coronary angiography revealed stenosis of one-to-three great coronary arteries and ventriculography showed no severe abnormalities in left ventricular contractility. A long-term drug therapy promoted not only improvement of the clinical status in most patients, but maintenance of work capacity and increase of their lifespan. The annual mortality rate was 3.0%, the incidence of nonfatal myocardial infarction was 5.9%. Repeated coronary angiography indicated that progression of coronary atherosclerosis was accompanied by a clinical deterioration in the patients' health and a decrease in exercise tolerance.

[Characteristics of the clinical manifestations of stenocardia in patients with ischemic heart disease, without myocardial infarct, in relation to the state of the coronary bed]. / Osobennosti klinicheskikh proiavlenii stenokardii u bol'nykh ishemicheskoi bolezn'iu serdtsa, ne perenesshikh infarkt miokarda, v zavisimosti ot sostoianiia koronarnogo rusla.

Mono- and multifactorial discriminant analyses aided by computer were used in 106 patients with coronary disease to compare the clinical and angiographic findings common to different manifestations of angina pectoris. The relationship was discovered between the clinical form of angina pectoris and the gravity of lesions of the coronary artery. Intracardiac hemodynamics and left ventricular contractility at rest did not differ whatever the patients' group. According to the bicycle ergometry test, the physical exercise tolerance was lower in patients with progressive angina pectoris and depended on the gravity of coronary artery lesions. The outcome of the clinical manifestations of angina pectoris during observation at hospital was mainly influenced by the natural course of coronary disease, primarily stipulated by obstruction in the coronary arteries. Using the multifactorial discriminant analysis aided by computer, the classifying signs were outlined, making it possible to differentiate between the groups of angina pectoris patients depending on the duration of angina pectoris attacks (in minutes), irradiation of pain to the shoulder or to both arms, T wave inversion on the ECG, and the gravity of coronary artery obstruction. The given signs enable one to recognize patients with destabilization of the clinical course of angina pectoris.

[Calcium antagonists and the regional contractility of the left ventricle in stenocardia patients]. / Antagonisty kal'tsiia i regional'naia sokratimost' levogo zheludochka u bol'nykh stenokardiei.

The overall and regional left ventricular ejection fraction (EF) was assessed by rest-exercise equilibrium radionuclide ventriculography in 33 patients (mean age 52.3 +/- 10.3 years) given a single dose of calcium-channel blockers (CCB). Of these, 18 patients were administered 20 mg of nifedipine and 15 patients received 80 mg of verapamil. According to the antianginal effects (AE) of nifedipine and verapamil at exercise all the patients were divided into 4 groups: 9 were on nifedipine, 10 on verapamil with AE (groups I and 3), 9 were on nifedipine, 5 on verapamil without AE (groups 2 and 4). After administration of a single dose of nifedipine and verapamil the overall rest EF increased in group I from 55.5 +/- 6.1 to 65.0 +/- 7.7%, in group 3, from 59.8 +/- 4.8 to 67.4 +/- 5.4%, in group 2, from 55.5 +/- 9.8 to 60.9 +/- 9.9%, and in group 4, from 54.8 +/- 5.4 to 59.6 +/- 4.5%. The exercise EF increased only in patients with AE of CCB (from 51.5 +/- 4.2 to 64.6 +/- 7.9%, group 1) and from 54.8 +/- 6.2 to 61.1 +/- 5.7%, group 4). In patients with AE of CCB (groups 1 and 3), the baseline values of the regional EF before drug administration decreased from rest to exercise in ischemic segments and that decrease ranged from 9 to 17%, while in patients of groups 2 and 4, from 1 to 8%. After administration of CCB insignificant improvement of the regional rest-exercise EF was recorded in groups 1 and 3 in the formerly ischemic segments.

[The efficacy of the hypnosuggestive psychotherapy of myocardial infarct patients]. / Effektivnost' gipnosuggestivnoi psikhoterapii bol'nykh infarktom miokarda.

The efficacy of the short-term psychotherapy was studied in 90 patients with myocardial infarction using the rating scale and the psychological Mini-Mult test. The hypnosuggestive therapy improved the mental status of the patients by reducing affective disorders. It promoted the formation of adequate psychological reaction to the illness and successful psychological adaptation, exerted a favourable effect on angina pectoris, cardialgia and moderate arterial hypertension.

[The characteristics of cardiosclerosis in dilated cardiomyopathy]. / Kharakteristika kardioskleroza pri dilatatsionnoi kardiomiopatii.

In 52 patients who had died of dilated cardiomyopathy (DCMP) severity of cardiosclerosis (CS) was studied in relation to the patients' age, possible etiological factors, disease duration, and heart weight. In DCMP, diffuse and diffuse small focal CS were common in all segments of the heart, including myocardial portions without macroscopically visible changes. Various types of CS in DCMP were seen in the left ventricular (92.3% cases), ventricular septum (86.5%) and right ventricle (68.2%). There are highly significant variations in the degree of CS in various patients with DC, however, different parts of the heart showed similar changes within the observation. No direct relationship was found between the cardiac weight and severity of CS. Diffuse CS prevailed in cases of DCMP with infective onset of disease. There was a direct relationship between the CS severity and disease duration in DCMP patients.

[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.

[Effect of stepwise rehabilitation of patients with various types of myocardial infarct on their work capacity and disability and means of increasing the social efficacy of rehabilitation measures (cooperative study)]. / Vliianie poétapnoi reabilitatsii bol'nykh, perenesshikh razlichii po kharakteru infarkt miokarda, na ikh trudosposobnost' i invalidizatsiiu i puti povysheniia sotsial'noi éffektivnosti kompleksa reabilitatsionnykh meropriiatii (kooperativnoe issledovanie).

The results of stepwise rehabilitation as part of current state-wide rehabilitation system, on working capacity and invalidism of the survivors of transmural, large-focal and small-focal myocardial infarction and 2 years' follow-up of 2193 patients of giving age are reported. Combined stepwise rehabilitation improves working capacity and invalidism rates both within the first and second year after myocardial infarction. Great potentials of improving social efficacy of stepwise rehabilitation involve better assessment of patients' condition, using specific criteria (clinical ones in particular) with due regard to acceptable and unacceptable occupations, careful choice of adequate jobs and correct estimation of the duration of temporary postinfarction disability.