ABSTRACT
Objective of this study was to assess the impact of pre- and posttransplantation factors on 12-month survival after orthotopic heart transplantation (OHT). Annual survival after OHT was 79.2%. The following factors were significantly negatively associated with annual survival: recipient's serum C-reactive protein (CRP) > or = 11.5 mg/ml prior to donor heart transplant (odds ratio [OR] 5.74, p = 0.011) and infectious complications after OHT (OR = 4.80, p = 0.009). Recipient's high CRP level was associated with mortality due to infectious complications (r(pb) = 0.47, p = 0.006), elevated troponin I concentrations (r(s) = 0.44, p = 0.012), and impaired hemodynamics of both recipient's heart and graft: right ventricular (RV) end diastolic area (EDA) prior to OHT (r(s) = 0.41, p = 0.015), elevated pulmonary artery pressure (PAP) (r(s) = 0.36, p < 0.001), and decreased left ventricular ejection fraction (LVEF) (r(s) = -0.45, p < 0.001) of the transplanted heart. Hearts of those who died after OHT irrespective of cause of death were characterized by more severe right heart dilation as evidenced by statistically significant increase of median RV EDA prior to OHT. After heart transplantation in those who later died decreased RV contractility was accompanied with elevation of PAP and decrease of LVEF. Acute graft rejection events 71.4% of which occurred in patients younger than 30 years had no influence on survival during 12 months after OHT. Other factors not associated with 12 months survival were donor and recipient age, pretransplant pathology, patient's UNOS status, graft ischemia duration, artificial circulatory support and preexistent surgical interventions. Development of diabetes mellitus in posttransplantation period, arterial hypertension and sinus node dysfunction requiring permanent pacing also were not identified as factors affecting 1 year survival after OTH.
Subject(s)
Heart Transplantation/mortality , Adolescent , Adult , C-Reactive Protein/analysis , Diabetes Mellitus/mortality , Female , Graft Rejection/mortality , Heart Transplantation/adverse effects , Humans , Hypertension/mortality , Middle Aged , Postoperative Complications/mortality , Respiratory Tract Infections/mortality , Young AdultABSTRACT
Aim of the study was to determine criteria of phases of stress reaction in humans to psychoemotional loading taking into account regulatory systems of adaptational reserves of organism. We examined representatives of professions potentially exposed to stress and investigated a spectrum of derangements of regulatory systems of the organism (neurovegetative system and cognitive function) under conditions of development of different phases of stress reaction to psychoemotinal loads. The proposed approach will allow to obtain efficiently quantitative assessment of phases of stress reaction in humans at different levels of adaptation to it. This approach can be used in clinical medicine.
Subject(s)
Adaptation, Physiological/physiology , Cardiology/methods , Circadian Rhythm/physiology , Heart Rate/physiology , Stress, Psychological/diagnosis , Adult , Exercise Test/methods , Female , Humans , Male , Stress, Psychological/physiopathologyABSTRACT
AIM: To assess efficacy of reamberin in preoperative preparation and after coronary bypass (CB) in patients with macrofocal myocardial infarction (MI) complicated with postinfarction angina. MATERIAL AND METHODS: A total of 45 patients with Q-positive MI complicated with postinfarction angina pectoris entered the trial. The study group consisted of 20 (44.4%) patients given 200-400 ml injections of 1.5% reamberin solution for 3 days before coronary artery bypass grafting (CABG) and 3-5 days after it. The control group consisted of 25 (55.6%) patients given basic therapy without cardioprotection. ECTG-60, echocardiography, CM-ECG, laboratory tests were made before CABG. CABG was made in conditions of artificial blood circulation in all the patients. RESULTS: Clinical stabilization was observed after direct myocardial revascularization in hospitalized 25 (100%) patients of the study group and 22 (88%) patients of the control group. Early postoperative acute cardiac failure (ACF) developed in 3 (12%) patients from the study group and 9 (36%) from the control group (p = 0.04), arrhythmia occurred in 2(8%) and 8(32%) patients, respectively (p = 0.03). Two (8%) control patients died in early postoperative period from acute cardiac failure. Perioperative MI occurred in 2(8%) control patients. After 12 months of the follow-up, patients of the study group had no recurrent angina pectoris, while among the controls 4(16%) patients had recurrent angina of FC III. After surgical intervention at discharge and 12 months after treatment patients of both groups improved systolic and diastolic functions of the left ventricle. Normalization of the diastolic function was registered in 80% patients of the study group (p < 0.001) and in 44% from the control group (p < 0.001) after 1 year follow-up. CONCLUSION: Reamberin reduces the number of postoperative complications, ischemic damage to the myocardium, significantly improves systolic and diastolic functions of the left ventricle.
Subject(s)
Angina Pectoris/drug therapy , Cardiotonic Agents/therapeutic use , Coronary Artery Bypass , Meglumine/analogs & derivatives , Myocardial Infarction/complications , Succinates/therapeutic use , Angina Pectoris/etiology , Angina Pectoris/physiopathology , Cardiotonic Agents/administration & dosage , Female , Humans , Male , Meglumine/administration & dosage , Meglumine/therapeutic use , Middle Aged , Myocardial Infarction/physiopathology , Myocardial Infarction/surgery , Postoperative Care , Preoperative Care , Succinates/administration & dosage , Treatment Outcome , Ventricular Function, Left/drug effectsABSTRACT
The stress reactions phases have been studied in humans in psychoemotional strain. The stress reactions phases objective criteria associated with certain cardiac rhythm variability alterations and cognitive function have been revealed. The study was performed using computerized Stroop-test.
Subject(s)
Cognition , Heart Rate , Stress, Psychological/physiopathology , Stroop Test , Adult , Female , Humans , Male , Middle AgedABSTRACT
We studied impact of ethylmethylhydroxypyridine succinate n the course of chronic heart failure during 3 years follow-up after myocardial infarction. Dynamics of objective and subjective parameters was assessed in 100 patients; 48 patients received conventional therapy (control group) and 52 patients received conventional therapy plus ethylmethylhydroxypyridine succinate (main group). Addition of ethylmethylhydroxypyridine succinate resulted in decreases of rates of complications, mortality, and re-hospitalizations. Increases of myocardial contractile function, myocardial adaptation, as well as improvement of range of biochemical parameters were also observed. The latter changes were indicative of antioxidant, anti-inflammatory, anti-stress activities of Ethylmethylhydroxypyridine succinate. Moreover, antidepressant and antineurotic effects of complex therapy including ethylmethylhydroxypyridine succinate was confirmed.
Subject(s)
Heart Failure/drug therapy , Myocardial Contraction/drug effects , Oxidative Stress/drug effects , Pyridines , Ventricular Dysfunction, Left/drug therapy , Antioxidants/administration & dosage , Antioxidants/adverse effects , Cardiotonic Agents/administration & dosage , Cardiotonic Agents/adverse effects , Depression/drug therapy , Depression/etiology , Echocardiography , Female , Health Status Indicators , Heart Failure/etiology , Heart Failure/mortality , Heart Failure/physiopathology , Humans , Male , Middle Aged , Mortality , Myocardial Infarction/complications , Myocardial Infarction/physiopathology , Patient Readmission , Pyridines/administration & dosage , Pyridines/adverse effects , Severity of Illness Index , Treatment Outcome , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/physiopathologySubject(s)
Adaptation, Physiological , Cardiology/methods , Heart Diseases/physiopathology , Humans , SyndromeABSTRACT
The syndrome of preconditioning was described by Murry and patented simultaneously in the USSR (G.I. Sidorenko, 1986). As preconditioning is displayed both in clinic and experiment including isolated endothelial cells it seems appropriate to disclose its nature. The characteristics of living matter are aim, information, and feedback. Preconditioning has been investigated from these positions with autoregulation studied as feedback. Dynamics of further study of preconditioning is proposed.
Subject(s)
Adaptation, Physiological , Coronary Circulation/physiology , Homeostasis/physiology , Ischemic Preconditioning, Myocardial , Biomedical Research/trends , Endothelial Cells/physiology , Exercise Tolerance/physiology , Forecasting , Humans , Ischemic Preconditioning, Myocardial/adverse effects , Ischemic Preconditioning, Myocardial/methodsABSTRACT
The war against smoking requires taking immediate measures because of the growing spread and severe consequences. All minuses and pluses of the Mass Media are underlined in this article. Anti-smoking technical means should to meet the following requirements: (1) each inhalation of cigarette smoke should be carried to the level of conscience; (2) each smoking act should be accompanied by unpleasant perceptions; (3) A conscientious registration number of cigarettes smoked is necessary. These problems have been solved by now. artery stiffness, defined by pulse wave propagation velocity increases after the act of smoking thus imitating aging. The smoker should be aware of this fact.
Subject(s)
Blood Flow Velocity/drug effects , Legislation, Medical/organization & administration , Nicotine/pharmacology , Smoking Cessation , Smoking , Behavior Control , Forecasting , Health Promotion/trends , Humans , Smoking/epidemiology , Smoking Cessation/legislation & jurisprudence , Smoking Cessation/methods , Smoking Prevention , Tobacco Smoke Pollution/adverse effects , Tobacco Smoke Pollution/prevention & control , Tobacco Use Disorder/physiopathology , Tobacco Use Disorder/prevention & control , Tobacco Use Disorder/psychologySubject(s)
Antihypertensive Agents/therapeutic use , Hypertension/complications , Hypertrophy, Left Ventricular/etiology , Blood Pressure , Disease Progression , Humans , Hypertension/drug therapy , Hypertension/physiopathology , Hypertrophy, Left Ventricular/physiopathology , Hypertrophy, Left Ventricular/prevention & controlSubject(s)
Coronary Circulation/physiology , Exercise Test/methods , Myocardial Contraction/physiology , Myocardial Ischemia/physiopathology , Coronary Angiography , Electrocardiography, Ambulatory , Female , Humans , Male , Middle Aged , Myocardial Ischemia/diagnosis , Prognosis , Severity of Illness Index , Stroke Volume/physiologyABSTRACT
Optimization is understood as choice of the best version out of the competitive decisions. The strategy and tactics of prevention is presented from this point of view. Optimization of diagnostic investigations is viewed from the positions of continuum with quantitative assessment of results. Characteristics of loads and heart activity, as recommendations suggest, should be in agreement in stress tests. Optimization of dynamic investigations of biochemical markers is described on the model of acute coronary syndrome. Optimization of therapy is based on the determination of criteria of optimum. This statement is illustrated by the example of antihypertensive therapy. Optimization of pharmacotherapy must envisage the preservation of favorable effect of protective natural mechanisms in the form of autoregulation and adaptation to intermittent ischemia (preconditioning).
Subject(s)
Cardiology , Myocardial Ischemia , Humans , IschemiaABSTRACT
Social and economic transformations of the society enable to suggest an ever increasing role of psychoemotional factors in the development of cardiovascular pathology. The paper contains a review of psychoemotional functional stress tests (arithmetic, speech, information, computer games). Stroop-testing method, which over the recent half of a century has been acknowledged as <
Subject(s)
Cardiology , Exercise Test , Blood Pressure , Echocardiography , Heart Rate , Humans , Stress, PsychologicalABSTRACT
AIM: To assess advantages of a stochastic functional stress test during which workloads change according to law of random numbers. METHOD: Results of stochastic tests and standard stress tests with stepwise increments of workloads were compared in 45 healthy subjects and 90 patients with ischemic heart disease (45 with angina pectoris, 45 after myocardial infarction). RESULTS: Compared with standard tests stochastic test was characterized by shorter times of achievement of ischemic threshold and higher double product. Sensitivity and specificity of stochastic test were significantly better than those of standard stress test. The difference between results of two tests can be explained by increased information content of the stochastic test.
Subject(s)
Exercise Test/trends , Myocardial Ischemia/diagnosis , Myocardial Ischemia/physiopathology , Chronic Disease , Female , Forecasting , Humans , Male , Middle Aged , Severity of Illness Index , Stochastic ProcessesABSTRACT
Difficulties of diagnostics of neurocirculatory dystonia are discussed. Definition based on Myasnikov's ideas about hyperreactivity, that is inadequate cardiovascular responses to psychoemotional stress, is proposed. Peculiarities of classification and therapy of neurocirculatory dystonia are presented.
Subject(s)
Neurocirculatory Asthenia , Stress, Psychological , Thiophenes , Acrylates/administration & dosage , Acrylates/therapeutic use , Adolescent , Adult , Antihypertensive Agents/administration & dosage , Antihypertensive Agents/therapeutic use , Child , Clinical Trials as Topic , Diagnosis, Differential , Female , Humans , Imidazoles/administration & dosage , Imidazoles/therapeutic use , Male , Neurocirculatory Asthenia/diagnosis , Neurocirculatory Asthenia/drug therapy , Neurocirculatory Asthenia/psychology , Neurocirculatory Asthenia/therapy , PsychotherapyABSTRACT
The paper deals with blood pressure level assessment and selection of individual optimal blood pressure by means of determination of critical frequency of fusion of flashes. The problem of "white coat" and office hypertension as well as encoding of these states in the context of WHO International Classification of Diseases is also discussed.
Subject(s)
Blood Pressure/physiology , Hypertension/classification , Hypertension/physiopathology , Blood Pressure Determination/methods , Humans , Hypertension/diagnosisABSTRACT
Definite dissociation exists between severity of clinical symptoms of heart failure and degree of cardiac dysfunction. Comparative analysis of existing heart failure classifications reveals low degree of congruence in evaluation of patient's state by different experts. This disagreement is mainly caused by limited number of gradations in NYHA classification and descriptive character of information. That is why supplementation of current classification with quantitative assessment of functional state by means of introduction of precise and easily obtainable statements is required. A modification of 6 min walk test is suggested for this purpose. The paper contains methodology of the test and calculations necessary for assessment of working capacity (in joules) and intensity of work (in watts). Possibility of evaluation of results of cardiovascular surgery is especially stressed.