[The problem of chronic refractory angina pectoris].

Prognosis in the case of refractory angina pectoris is poor in comparison with stable angina. Patients with refractory angina are more likely to have an acute coronary attack as a result of more diffuse coronary artery lesions and a high prevalence of cardiac risk factors. The quality of life of these patients is also poor. 36 patients 35-70 years of age with chronic stable angina were studied (34-males and 2-females). In all patients the stable angina was diagnoses based on the results of coronary angiography, medical record, ECG, echocardiography, stress-test, blood glucose, coagulation and lipid spectrum tests results. All patients were divided into 2 groups. By coronary angiography in 5 cases severe stenosis (80-95%) and occlusion of left main coronary artery was founded. In 10 cases significant stenosis of main coronary artery was not found and the patients were referred for conventional anti-ischemic therapy. 11 patients were treated by revascularization procedures (4 coronary artery bypass grafting and 7 coronary angioplasty). 15 cases ( 41,6%) were considered as refractory angina pectoris as far as they were suffering from ischemic heart disease and symptoms were present despite optimal medical therapy. They had been considered not suitable for any interventional procedure due to several reasons (distal localization of stenosis, diffuse lesions of arteries, etc.).

[A comparative evaluation of the antianginal efficacy of aldizem and korinfar in patients with stable stenocardia]. / Sravnitel'naia otsenka antianginal'noi éffektivnosti aldizema i korinfara u bol'nykh stabil'noi stenokardiei.

As many as 46 men suffering from coronary heart disease combined with angina pectoris of effort, functional classes II-IV, were examined. The two-week treatment with nifedipine (30-60 mg/day) and aldizem (180-270 mg/day) exerted an antianginal action in 47.8 and 39.1% of the cases, respectively, which was supported by the data of clinical examinations, loading tests, and by the data of ECG monitoring. Nifedipine turned out most effective in patients of functional class II with arterial hypertension.

[HLA-associated predisposition to dilated cardiomyopathy]. / Assotsirovannaia s HLA predraspolozhennost' k dilatatsionnoi kardiomiopatii.

HLA-antigens grade I and II were studied by tissue typing in 60 Russians and 40 Georgians suffering from dilated cardiomyopathy (DCMP), and 40 Georgians with virus myocarditis. 267 test-donors Russians and 579 Georgians served as control. Markers of DCMP predisposition were found different for Russians and Georgians: DR4 (relative risk 2.96) and A11 (RR = 3.07), R12 (RR = 5.5), respectively. Georgians have a marker of resistance to DCMP--B35 (RR = 0.15). Antigen B12 marks a severe DCMP course in Georgians. Markers of virus myocarditis predisposition were distinct from those of DCMP: A1 (RR = 3.78) and B27 (RR = 3.62). This shows different etiology of the two diseases. The conclusion is made on nonidentical genetic markers of predisposition and resistance to the same disease in various populations.

[A new immunogenetic marker of rheumatism]. / Novyi immunogeneticheskii marker revmatizma.

Use of monoclonal D8/17 antiserum was studied for identification of B-cell antigen in 44 rheumatic fever patients. The control group comprised healthy subjects (30) and patients suffering from rheumatoid arthritis (30), ischemic heart disease (IO); chronic tonsillitis (12) and different neoplasma of the brain (10). The preliminary genetic analysis of these patients has shown that monoclonal antiserum D8/17 can identify B-cell marker in 88-100 per cent of rheumatic fever cases.

[Immunological characteristics of viral myocarditis]. / Immunologicheskaia kharakteristika virusnogo miokardita.

A study of cellular and humoral immunity was conducted in patients with viral myocarditis. Quantitative and functional deficiency of T-suppressors and an increase in the number of cytotoxic lymphocytes were revealed in most patients. Disorder in the T-cellular link of immunity correlated with a clinical course of the disease and was found more frequently in patients with a grave course of myocarditis.

[Indices of the interferon system in patients with viral myocarditis and dilated cardiomyopathy]. / Pokazateli sistemy interferona u bol'nykh virusnym miokarditom i dilatatsionnoi kardiomiopatiei.

The authors presented some data on the investigation of the interferon system in patients with dilatation cardiomyopathy (DCM) and viral myocarditis (VM). Diagnosis was verified according to the WHO criteria. Altogether 10 DCM patients and 24 VM patients with a grave course were investigated. Antibodies to Coxsackie B virus and influenza were detected in the VM patients. A decrease in the alpha- and gamma-interferon activity was shown in all DCM patients. The VM patients with a grave course also demonstrated a decrease in the alpha- and especially gamma-interferon (immune) activity. Methods of immune correction in such patients were discussed.

[Value of immunological studies in various forms of cardiomyopathy]. / Znachenie immunologicheskikh issledovanii pri izuchenii razlichnykh form kardiomiopatii.

Immunologic status of 97 patients with dilating cardiomyopathy (DCMP) and 52 patients with hypertrophic cardiomyopathy (HCMP) was studied; total amount of T-lymphocytes as well as the amount of T-active lymphocytes and B-lymphocytes in the test of E- and EAC-rosette formation, subpopulations of T-lymphocytes (T mu, T g in the EA-rosette formation reaction were determined. HLA-typing in the microlymphocytes toxic test was performed. It was determined that the amount of B- and T-lymphocytes as well as the amount of T mu- and Tg-lymphocytes in patients with HCMP does not practically differ from that in normal subjects. Antigens 27, DR1 and DR4 were proved to be HLA-markers of HCMP. Reliable decrease in the amount of T mu and Tg cells as well as NK cells in patients with DCMP compared to that in normal subjects and patients with HCMP was observed. The study of HLA-antigens distribution in patients with DCMP revealed greater prevalence of DR1 and DR4 antigens.

[Left ventricular regional function in patients with dilated cardiomyopathy (computerized echocardiographic data)]. / Issledovanie regionarnoi funktsii levogo zheludochka u bol'nykh s dilatatsionnoi kardiomiopatiei (dannye komp'iuternoi ékhokardiografii).

Computerized echography was used to assess left-ventricular dysfunction in 40 patients with dilatation cardiomyopathy (DCM). The so-called "floating" system was shown to be the most acceptable model for the correction of DCM-associated superposition. An original system was used for segment division by two- and four-chamber projections. Total left-ventricular hypokinesia and a significant reduction of the total ejection fraction (32.5 +/- 1.9%) were demonstrated.

[Immunoregulatory lymphocyte subpopulations in patients with dilated and hypertrophic cardiomyopathies]. / Immunoreguliatornye subpopuliatsii limfotsitov u bol'nykh dilatatsionnoi i gipertroficheskoi kardiomiopatiei.

Forty patients with dilatation cardiomyopathy (DCM) and 30 patients with hypertrophic cardiomyopathy (HCM) were examined immunologically. Immunoregulatory lymphocytes (T1B) and their subpopulations (T helpers, T suppressors, natural killers--NK) were studied quantitatively and functionally. The patients with DCM showed inhibition of the number of T suppressors in part of the cases, attended by a decrease in non-specific (spontaneous) and mitogenin-induced suppressor activity, the lowering of the amount and activity of NK in the overwhelming majority of the cases. Study of the immunological characteristics in the patients with HCM did not reveal any substantial changes as compared to those in health. Immune disorders in the patients with DCM form the basis for conducting goal-oriented immunocorrection.

[Various aspects of drug therapy of chronic forms of ischemic heart disease]. / Nekotorye aspekty medikamentoznogo lecheniia khronicheskikh form ischemicheskoi bolezni serdtsa.

Experience in the treatment of over 500 chronic coronary patients with various anti-anginal drugs or their combinations is summarized. Controlled (double blind) and open studies and acute pharmacologic tests demonstrated comparative efficacy of depot-nitrates, beta-blockers, oxyfedrine, cordaron, lidoflazinum, molsidamine (corvaton). The effects on exercise tolerance (bicycle ergometry) with isolated and combined use of the drugs are described. Indications for surgery are discussed.

[Echocardiographic studies in congestive cardiomyopathies]. / Ekhokardiograficheskie issledovaniia pri zastoinykh kardiomiopatiiah.

Twenty-seven patients with congestive cardiomyopathy and 34 patients with coronary heart disease (postinfarction cardiosclerosis) as well as 30 healthy subjects were studied using one- and two-dimensional echocardiography with a subsequent computerized analysis. Patients with congestive cardiomyopathy showed an increased end-diastolic size, mitral-septal separation, right ventricular and left atrial diameters and left ventricular mass as compared to the other groups. Unlike in coronary heart disease, patients with congestive cardiomyopathy had a decreased mitral ring area, a prolonged isovolumetric relaxation phase, a decreased increment of the anteroposterior diameter during rapid filling.

[Characteristics of immunoregulatory lymphocyte subpopulations in patients with congestive cardiomyopathy and nonrheumatic myocarditis studied by monoclonal antibodies]. / Kharakteristika immunoreguliatornykh subpopuliatsii limfotsitov u bol'nykh s zastoinoi kardiomiopatiei i nerevmaticheskim miokarditom s pomoshch'iu monoklonal'nykh antitel.

Forty patients and 14 donors were examined. Twenty-two patients were diagnosed to have congestive cardiomyopathy (CCM), and 18 to have non-rheumatic myocarditis. The total number of T and B lymphocytes and lymphocyte subpopulations were measured by the method of surface markers (T mu and T gamma) and concurrently with the aid of monoclonal antibodies (OKT 3, OKT 4, OKT 8). The patients with CCM demonstrated a decrease in the number of T suppressors (T gamma and OKT 8). The quantity of T thermostable lymphocytes and T helpers remained unchanged in both the groups. Proceeding from this finding it is concluded that in CCM, the OKT 4/OKT 8 ratio is equal to 1.17, that in myocarditis to 1.15. The pathogenetic role of suppressor cells during myocarditis transformation in CCM requires further study.

[Effect of nonachlazine on ino- and chronotropic function]. / Vliianie nonakhlazina na ino- i khronotropnuiu funktsiiu.

As a result of the stimulation of beta-adrenostructures of the myocardium nonachlazin intensifies ino- and chronotropic functions of the heart. This effect does not manifest after administration of practolol and is less pronounced in animals anesthesized with urethane and alpha-chloralose since the sensitivity of the beta-adrenostructures of the myocardium decreases under the influence of the anesthetics. Apart from the stimulation of ino- and chronotropic function of the heart nonachlazin reduces concurrently the intensity of positive chronotropic effect of isoproterenol. Such a combination of the efects called a "partial" beta-adrenoblockade seems likely to play an important role in the manifestation of the antianginal action of nonachlazin.

[Comparison of the effect of ildamen and nonachlazin on the blood supply and activities of the heart]. / Sopostavlenie vliianiia il'damena i nonakhlazina na krovosnabzhenie i deiatel'nost' serdtsa.

Instravenous infusion of ildamen (0.8-1 mg/kg) into anesthesized cats caused an increase in coronary blood flow and oxygen consumption by the heart to an approximately equal degree; the resistance of the coronary vessels diminished. The values of cardiac activity (cardiac output, contractions, pulse rate) increased simultaneously with increase of the coronary blood flow. In distinction to ildamen, nonachlasin (6 mg/kg) reduced the arterio-venous difference in oxygen and increased the content of oxyhemoglobin in the draining coronary blood. In anesthesized animals cardiac activity altered in two stages. Since beta-adrenergic blocking agents prevented the increase in coronary blood flow and the intensification of cardiac contractions induced by both drugs it is assumed that their effect is caused through stimulation of the beta-adrenergic structures. Besides, ildamen and nonachlasin possess the property of inhibiting cardiac activity. The combination of these two opposite effects evidently plays an important role in the realization of the antianginal effect of the substances studied.

[Mechanism of the antianginal action of oxyfedrine]. / K mekhanizmu antianginal'nogo deistviia oksifedrina.

Oxyphedrine was found to depress the tonicity of coronary vessels, increase the coronary circulation volume, the oxygen uptake by the heart and also to exert a positive inoand chronotropic action in test with urethan and cloralose anesthetized cats. These effects were caused by stimulation of the beta-adrenoreceptors of the heart and vessels. In non-anesthetized cats oxyphedrine did not produce tachycardia. Furthermore, under certain conditions (when superimposed on a preliminary administration of practolol- a beta-blocking agent) oxyphedrine can exert a direct inhibitory action on the myocardium.

[Effect of nonachlazine and oxyfedrine on coronary circulation in dogs]. / Vliianie nonakhlazina i oksifedrina na koronarnyi krovotok u sobak

Coronary circulation was measured in the anesthetized and nonanesthetized dogs by means of ultrasonic Doppler's radiotelemetric apparatus. The ultrasonic pick-up was placed on the upper third of the descending branch of the left coronary artery. Nonachlazine considerably increased the coronary circulation in the anesthetized and nonanesthetized dogs. However, the action of the preparation lasted 2 to 3 minutes only and depended on the changes in the cardiac activity. In difference from nonachlazine, oxphedrine increased the coronary circulation to a lesser degree, but for a much longer time (20min on the average). Taking into consideration a high efficacy of these preparations under clinical conditions a conclusion was drawn that an increase of the coronary circulation was not the principal way of action for reaching the antiangina effect in the patients with ischemic heart disease.