[Hemostasiological, lipidemic, and hemodynamic indicators associated with the risk of cardiovascular death in high- and very high-risk patients according to the SCORE scale].

AIM: To identify lipidemic, hemostasiological, and hemodynamic indicators associated with the risk of cardiovascular death in high- and very high-risk patients. SUBJECTS AND METHODS: One hundred and forty-eight patients whose mean age was 50.8 +/- 4.4 years were examined. All the patients were divided into high (1 group) and very high (2 group) cardiovascular death risk groups according to the SCORE scale. Lipid metabolism, hemostatic system parameters (fibrinogen, time of ADP-induced platelet aggregation initiation, D-dimer), endothelial dysfunction markers (von Willebrand factor), and echocardiographic findings were studied. RESULTS: Multivariate regression analysis showed that the odds ratio for a cardiovascular death risk was 1.8 (95% confidence interval (CI), 1.1 to 4.2; p = 0.04) in patients with a D-dimer level of greater than 1 mg/ml, 0.77 (95% CI, 0.6 to 0.97; p = 0.03) in those with an ADP-induced platelet aggregation initiation time of 13.5 sec, 1.04 (95% CI, 1.01 to 1.07; p = 0.02) in those with an end-diastolic volume of more than 123 ml, 1.1 (95% CI, 1.04 to 1.2; p = 0.003) in those with an end-diastolic dimension of more than 51 mm, 1.5 (95% CI, 1.1 to 2.0; p = 0.009) in those with a ventricular septal thickness of more than 11.5 mm, and 2.1 (95% CI, 1.03 to 3.2; p = 0.0032) in those with avon Willebrand factor level of more than 140%. CONCLUSION: The high levels of von Willebrand factor, D-dimer, ADP-induced platelet aggregation, triglycerides, end-diastolic volume, end-diastolic dimension, and ventricular septal thickness are independent predictors of cardiovascular death in very high-risk patients. These indicators bear out a close relationship between lipid metabolic and hemostatic disturbances and between endothelial dysfunction and intracardiac hemodynamic worsening in these patients.

[Peculiarities of the relationship between atherosclerotic lesions of carotid arteries and the severity of cardiac pathology in elderly patients].

The study was aimed at elucidating the relationship between the severity of atherosclerotic lesions in carotid arteries and cardiac pathology in 182 elderly patients subjected to vascular and extravascular surgical treatment. They were divided into 2 groups differing in the degree of atherosclerosis. Group 1 was comprised of 93 patients (mean age 64+/-05 yr) without stenosis of internal carotid artery or with stenosis of less than - 50%, group 2 included 89 patients (mean age 67+/-0.5 yr) with hemodynamically significant stenosis of internal carotid artery. It was shown that carotid stenosis over 50% is frequently associated with the history of myocardial infarction and stable angina of effort. An increase of the degree of stenosis was accompanied by a decrease of stroke and minute volumes.

[Obsidan treatment of neuroendocrine disorders and hyperkinetic syndrome in patients with macrofocal myocardial infarction]. / Korrektsiia obzidanom neiroéndokrinnykh narushenii i giperkineticheskogo sindroma u bol'nykh krupnoochagovym infarktom miokarda.

The trend in blood plasma adrenaline, noradrenaline, renin and parameters of central hemodynamics were studied in randomized sample of 67 patients with uncomplicated macrofocal myocardial infarction with a hyperkinetic syndrome. To 32 patients obsidan was administered intravenously (0.1 mg/kg), then orally for 2-3 days every 3-4 hours to lessen cardiac contraction rate by 20-30 per cent and to obtain moderate hypotension and after than 60-120 mg per 24 hours. The traditional treatment was prescribed to 35 patients of the control group. The acute period of the disease was marked by increased concentrations of catecholamines and renin and a close correlation between them and the central hemodynamic parameters. Use of obsidan led to a more rapid reduction and normalization of the content of biologically active substances, central hemodynamic parameters and to the removal of their correlation. The mechanisms of obsidan action are discussed.