[The clinical pharmacology of antianginal agents]. / Klinicheskaia farmakologiia antianginal'nykh sredstv.

This paper provides the basic advances made in studying the clinical pharmacology of antianginal agents (AAs), demonstrates the contribution of current tools for evaluating their antianginal effects, namely pharmacodynamic studies using pair bicycle ergometry and repeated treadmill exercises, 24-hour ECG monitoring, pharmacokinetic studies. It shows that AAs can be chosen on an individual basis. The authors present pharmacodynamic characteristics of a number of new AAs from nitrates (trinitrolong, dinitrosorbilong, etc.), calcium antagonists, beta-adrenoblockers (proxodolol, etc.). They have developed a method for assessing the biological equivalence of AAs. The paper discusses the tolerance that can be developed to nitrates and how it can be prevented. It first demonstrates that nifedipine tolerance can develop and that the withdrawal syndrome can occur if nitrates and calcium antagonists are discontinued. There are screening data on various combinations of AAs. A two-stage scheme for choosing an AA therapy is given.

[An assessment of the efficacy of a course of using different forms of prolonged-action nitrates in patients with stable stenocardia with the help of repeated daily ECG monitoring]. / Otsenka éffektivnosti kursovogo primeneniia razlichnykh form nitratov prolongirovannogo deistviia u bol'nykh stabil'noi stenokardiei s pomoshch'iu povtornykh sutochnykh monitorirovanii EKG.

A study was made of the antianginal and anti-ischemic effects of sustac (ST) and trinitrolong (TNL) during their cross continuous use in patients with stable angina pectoris, functional class II-III (according to the classification of the Canadian Association of Cardiologists). In accordance with the daily ECG monitoring data, the three-month treatment with the effective doses of ST and TNL produced a significant lowering of the frequency and the total intensity of the episodes of ST segment depressions of the ischemic type as compared to the continuous administration of placebo. The use of criteria for evaluating the efficacy of the antianginal drugs (the decrease of the total number of ST segment depression episodes during one day by 3 and over and/or reduction of the total intensity of ST segment depression by 50% and over) made it possible to reveal varying effects of the nitrates on painful episodes (PE) and painless episodes of ST segment depression. Both the dosage forms of nitroglycerin administered in the effective amounts (in short- and long-term continuous treatment) significantly lowered the rate and total intensity of myocardial ischemia episodes at the expense of a significant decrease of the frequency and total intensity of PE. They produced no material effect on the number of painless episodes. Provided ST and TNK turned out ineffective, there was a significant rise of the frequency and total intensity of painless episodes in short-term continuous treatment while ST produced the above effect in long-term treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of the efficacy of a course of verapamil and nifedipine in patients with stable stenocardia by daily monitoring of the electrocardiogram]. / Otsenka éffektivnosti kursovogo primeneniia verapamila i nifedipina u bol'nykh stabil'noi stenokardiei s pomoshch'iu sutochnogo monitorirovaniia élektrokardiogrammy.

The daily ECG monitoring was used in 20 patients with stable functional class II-III angina pectoris to study the antianginal and anti-ischemic effects of verapamil and nifedipine during the cross use of the drugs. Verapamil and nifedipine applied in the effective doses provoked a significant decrease of the number and total depth of painful depressions of the ST segment. The effect of verapamil on painful episodes of ST segment depressions was significantly more pronounced than that of nifedipine. At the same time nifedipine significantly reduced the number and total depth of painless episodes of myocardial ischemia whereas verapamil did not cause any significant lowering of these indicators. In cases where the drugs appeared ineffective, verapamil provoked a significant increase of the number of painless episodes of myocardial ischemia. This indicates that the painful threshold of sensitivity may change with the occurrence of myocardial ischemia in patients suffering from angina pectoris. In turn, nifedipine produced no significant effect on the number and intensity of painless episodes of myocardial ischemia.

[Methodological approaches to the evaluation of the effectiveness of anti-anginal preparations in patients with stenocardia by 24-hour ECG monitoring]. / Metodicheskie podkhody k otsenke éffektivnosti antianginal'nykh preparatov u bol'nykh so stenokardiei s pomoshch'iu sutochnogo monitorirovaniia EKG.

Scientific rationale are given for methodological approaches promoting improved reproducibility of 24-hour ECG monitoring data, for the method to be used repeatedly in assessing patient's condition. Repeated 24-hour-ECG monitoring in identical motor conditions (a standard mobility regimen) has been shown to improve considerably the reproducibility of its results. Criteria for the efficiency of antianginal therapy in patients with angina of the 2nd and 3d functional classes, as evidenced by 24-hour ECG monitoring, have been developed and substantiated. They are a drop in the number of ST depression episodes (by 3 and more) and in the total depth of depression (by 50% and more). The sensitivity of the assessment of each of the two indicators of myocardial ischemia or their combination was 70%, and the specificity was 77.8% and 88.9%, respectively.

[Diagnostic value of changes in Q wave amplitude in left thoracic leads during physical loading]. / Diagnosticheskaia tsennost' izmenenii amplitudy zubtsa Q v levykh grudnykh otvedenii pri fizicheskoi nagruzke.

The informative value of stress-induced changes in Q wave amplitude and ST segment for the diagnosis of coronary heart disease was compared in records from left chest leads. Bicycle ergometry was conducted in 74 patients with coronary angiographically documented stenosis (more than 70% of the lumen) of one or more coronary arteries, and 28 subjects showing no apparent coronary arterial changes. The lack of increment in Q wave amplitude was shown to be a fairly sensitive sign of myocardial ischemia. Yet, its specificity is relatively low, much inferior to that of ST changes. The predictive value of changes in ST segment is significantly higher, as compared to that of changes in Q wave amplitude during exercise. Simultaneous assessment of ST and Q wave changes in response to stress failed to improve the predictive accuracy, as compared to the interpretation of ST changes alone.