[Effects of long-term therapy with angiotensin-converting enzyme inhibitor and carvedilol on the heart remodeling process after non-Q-wave myocardial infarction].

This 2-year comparative study of EchoCG data dynamics included 230 CHD patients after primary non-Q-wave myocardial infarction of whom 76 were treated with A CE inhibitor perindopril throughout the study period (group 1) and 72 with perindopril and carvedilol (non-selective alpha-1, beta-1,2 adrenergic receptor blocker) (group 2). The control group was comprised of 82 patients that could not use either medicine for a variety of reasons. These patients developed signs of post-infarction left ventricular remodeling (enhanced MS and LVMM index, left ventricular spherization, cavity enlargement, systolic and diastolic LF dysfunction). Combined therapy arrested the remodeling process within 12 months after onset, reduced systolic MS, and promoted the tendency toward restoration of the LV geometric shape, size, diastolic and systolic function.

[The specific features of left cardiac cavity remodeling in patients with chronic obstructive pulmonary disease and chronic cor pulmonale].

AIM: To study left ventricular structural and functional changes in patients with chronic obstructive pulmonary disease (COPD) and chronic cor pulmonale (CCP) at different stages of a cardiac remodeling process. SUBJECTS AND METHODS: Echocardiography was used to examine 98 patients with COPD complicated by the development of CCP in a number of cases. The significant signs of CCP were absent in 19 patients; the signs of compensated and decompensated CCP in 41 and 38 patients, respectively. RESULTS: In the patients with COPD, the formation of CCP during remodeling of the heart involves its left cavities whose changes lie in the occurrence of left ventricular (LV) diastolic dysfunction, mainly of the restrictive type, in ventricular spherization, higher myocardial systolic tension, in tendencies towards increases in LV mass index, left atrial sizes, and in the indices reflecting LV systolic dysfunction. The LV diastolic dysfunction correlates with the degree of right ventricular hypertrophy and dilatation and the presence of complete right bundle-branch block. CONCLUSION: Progressive worsening of diagnostic filling of the left ventricle and its systolic function is an additional factor aggravating hemodynamic disorders in patients with COPD and CCP, which should be kept in mind on choosing an appropriate therapy for patients with CCP.

[Diagnosis of pulmonary heart in patients with chronic obstructive pulmonary disease].

Informative value of clinical, electrocardiographic, and echocardiographic diagnostic criteria of compensated chronic pulmonary heart (CPH) in patients with chronic obstructive pulmonary disease (COPD) was considered. The study included 229 patients with COPD of which 105 (group 1) showed no signs of CPH, 71 (group 2) had compensated and 53 (group 3) uncompensated CPH. They were examined by the standard echoCG method using an Acuson-128 HR apparatus (USA) and 12-lead ECG during a 2 year-long follow-up period. Direct cardiac clinical and electrocardiographic signs of right ventricular eccentric hypertrophy were found to have high informative value (100%) but very low sensitivity (7-53%). Indirect diagnostic criteria of compensated CHP are such non-specific signs as age of COPD patients above 50 yr, duration of the disease over 8 yr and broncho-obstructive syndrome (episodes of low-productive cough, dyspnea under small physical load and at rest, X-ray signs of lung emphysema, substantial reduction of FEV and FEV/FVC ratio) in 73-94% of the patients were associated with compensated CPH. The most valuable (75.8-90.5%) cardiographic diagnostic criteria for compensated CPH were MPAP > 22 mmHg (at rest), LVEDD > 24 mm, LVEDS > 17 mm, RVWT = > 5 mm, RAEDD > 32 mm. Criterion LVEDD > 24 mm has the optimal ratio of sensitivity (94.4%), specificity (85.7%), and positive predictive value (86.6%). Comprehensive clinical assessment of COPD character and duration, patients' age, manifestation of broncho-obstructive syndrome and direct clinical signs suggesting involvement of the right half of the heart permits to predict CPH in patients with COPD with a probability of 75%. The definitive diagnosis is verified by echoCG or other instrumental methods.