[Collagen fiber pathology in atherosclerotic plaques of the coronary arteries in ischemic heart disease].

Structure-metabolic changes of collagen fibers (CF) in atherosclerosis plaques of the coronary arteries in the conditions of ischemic heart disease (IHD) have been studied. Segments of the coronary arteries were received from 68 men after a coronary artery bypass grafting. CF was study with using of the Van Gieson's and the Masson's methods. Histologic slices were studied by polarization microscopy. The atherosclerosis plaques with IHD were notable for lipidosis of CF. We've suspected lipidosis of CF is a crucial factor for the development of atherosclerosis plaques instability. Evident lipidosis of CF was attended with destructive changes probably resulted in accumulation of atheromatous mass in atherosclerosis plaques.

[Comparative studies of the evolution of aortic and coronary atherosclerosis in Moscow, Ryazan, and Yakutsk males over 40 years].

Repeated epidemiological morphological investigations of atherosclerosis of the aorta and coronary arteries were performed in apparently healthy men aged 20-59 years in Moscow, Ryazan and Yakutsk at a 40-year interval. More severe atherosclerosis and different rates of its progression were revealed in males of these towns over 40 years.

Monitoring of aortic and coronary atherosclerosis in native and non-native males of Yakutsk over 40 years.

We have analyzed the development of aortic and coronary atherosclerosis over 40 years in native and non-native males of Yakutsk by comparing the data obtained in 1963-1965, 1985-1987 and 2001-2003. The research was carried out in compliance with the WHO program for the atherosclerosis epidemiology studies using autopsy material. Subjects (361 natives and 692 non-natives) included in the research died of external causes at the age of 20-59 years and had no history of chronic diseases, which was confirmed by post-mortem examination. The prevalence and the extent of raised atherosclerotic lesions (fibrous plaques, complicated lesions and calcinosis) in the aorta and coronary arteries were determined by visual planimetry after staining with Sudan IV. An accelerated development of aortic and coronary atherosclerosis was revealed in both populations throughout the entire period of 40 years with more severe manifestations in non-native males. The severity of atherosclerosis increased considerably in native and non-native males aged over 40 years. The rate of the increase in the extent of raised atherosclerotic lesions tended to be greater in native than in non-native males.

[A 40-year study of aortic and coronary artery atherosclerosis in male population of Yakutsk].

The trends in development of aortic and coronary atherosclerosis in healthy male population were studied by WHO methods in three trials: in 1963-1965, 1985-1987, 2001-2003. It was found that atherosclerosis and coronary arteries stenosis were less frequent in the native population of Yakutia than in migrants.

[Evolution of atherosclerosis of the aorta and coronary arteries in practically healthy men in Moscow for a 40-year period].

AIM: To assess 40 years evolution of atherosclerosis of the aorta and coronary arteries among practically healthy Moscow men. METHODS: We compared results of 2 studies of prevalence and extent (area) of atherosclerotic lesions in thoracic and abdominal aorta and 2 main coronary arteries. The studies were conducted in 1963-1965 and 2002-2003 according to WHO program. RESULTS: Prevalence of coronary artery stenoses as well as prevalence and area of raised lesions in these arteries were higher among violent death victims studied in 2002-2003. Raised lesions in both parts of aorta and in left anterior descending coronary artery were more pronounced also in men studied in 2002-2003.

Hyperplasia of coronary intima in young males in relation to development of coronary heart disease in adults.

UNLABELLED: The aim of the investigation was to study structural features of coronary arteries in young males which may influence the development of stenosing coronary atherosclerosis in older age. We studied the coronary arteries from 84 males, 10-39 years old, who died from accidents in Moscow, Malmo and Riga, and 98 males aged 40 and above from Moscow who died from coronary heart disease (71 cases) or other diseases (27 cases). In children and young males from all three cities, musculo-elastic hyperplasia of the coronary intima took place constantly but with different degrees of expression; a strict relationship of the intimal thickness and age was observed. Histometric investigations of the right coronary artery showed that in young males of Riga, in comparison with those of Malmo, the intima was significantly thicker both outside (69.6+/-2.8 and 58. 2+/-2.5 microm) and within the area of cushion like thickening (118. 8+/-4.0 and 101.9+/-3.8 microm), they had more extended cushion-like thickening of intima (42.6+/-3.0 and 30.8+/-3.3% to the length of the artery circumference) and destroyed parts of the internal elastic lamina (28.3+/-1.9 and 19.1+/-1.7% of its length). In males older than 40 years, severe coronary atherosclerosis and stenosis was also significantly more common in Riga than in Malmo. Our data indicate that with age the intimal musculo-elastic hyperplasia in the coronary arteries is transformed to a fibro-elastic layer. The thickness of this layer in the presence of stenosing plaques (>75% of arterial lumen) was much greater than in the presence of plaques with stenoses less than 50% (188.1+/- 7.3 and 69.8+/-4.5 microm, respectively). CONCLUSION: The development of stenosing coronary atherosclerosis is closely related to the degree of musculo-elastic intimal hyperplasia in childhood and young age. The formation of a fibro-elastic layer in the coronary intima decreases the ability of the artery to dilate during the development of atherosclerosis.

[Trends in 25-year evolution of coronary atherosclerosis in males fom some cities of Europe and Asia]. / Osobennosti évolitsii koronarnogo ateroskleroza u muzhchin v gorodakh Evropy i Azii za 25-letnii period.

AIM: Detection of changes in the course of coronary atherosclerosis (CA) which took place for 25 years of observation in male population in different cities. MATERIAL AND METHODS: Epidemiological surveys of coronary AS by autopsy data according to WHO program were conducted in 1963-1966 (trial 1) and 1985-1989 (trial 2) in 9 cities: Ashkhabad (Turkmenistan), Bishkek (Kirghizia), Irkutsk, Yakutsk (Russia), Riga (Latvia), Tallinn, Tartu (Estonia), Kharkov, Yalta (Ukraine), Malme (Sweden), Prague (Czechia). The surveys enrolled males aged 20-59 years: 7470 males entered trial 1 and 9600 entered trial 2. AS was assessed visually-plan-imetrically in the three major coronary arteries (CA). By the data from Ashkhabad, Bishkek, Irkutsk, Kharkov, Yakutsk, AS in healthy males was also characterized. RESULTS: In 9 CIS countries' cities CS for 25 years has undergone noticeable changes: according to trial 2 atherosclerotic process accelerated, especially in males over 40, in healthy males as well. CA AS had the same features in both trials in Prague and was less pronounced in males from Malme. National differences between native population and immigrants in AS were evident in Ashkhabad, Bishkek and Yakutsk in both trials. In trial 2 CA stenoses were encountered more frequently in all the cities under study. Coronary arteries were more calcified. There was a direct relationship between severity of preatherosclerotic CA changes in young males (20-39-year-old) and speed of AS progression in older males. CONCLUSION: For 25 years there was a tendency to more severe course of coronary AS in CIS countries, in Prague males AS has undergone minimal changes, in Malme the situation with AS severity has improved. Severity of AS in males from different cities and CHD male mortality were correlated.

[Features of atherosclerosis in the ascending human aorta and the link between its development and the main risk factors of ischemic heart disease in patients after aortocoronary shunting]. / Osobennosti ateroskleroza v voskhodiashchei aorte cheloveka i sviaz' ego razvitiia s osnovnymi faktorami riska ishemicheskoi bolezni serdtsa u bol'nykh, perenesshikh aortokoronarnoe shuntirovanie.

Atherosclerosis was found in all ascending aorta biopsies of 125 patients aged 42 to 65 years who underwent aortocoronary bypass surgery. Lipid spots only were found in 91.2% of cases, in 11 patients (8.8%) there were lipid plaques. Three main types of lipid spots were recognized: type I--primary extracellular lipoidosis (40.0%); type II--mainly intracellular lipoidosis (24.8%) and type III--cell lipoidosis with a pronounced component of secondary extracellular lipoidosis (26.4%). A specific feature of ascending aorta atherosclerosis is a frequent combination of intima lipoidosis with media lipoidosis: 92% in type I, 100% in type II and 93.9% in type III. This is probably an important way of lipid elimination from the intima and this predetermines a "mild" course of atherosclerosis in this part of the aorta. Types II and III of lipoidosis occurred more frequently in lipid metabolism disturbances and only under these conditions clusters of foam cells were observed. Arterial hypertension and smoking have a leading role in development of intimal hyperplasia. When assessing atherosclerosis activity in the operated patients not only risk factors of ischemic heart disease but also the results of aorta biopsies studies should be taken into consideration.

Development of atherosclerosis over a 25 year period: an epidemiological autopsy study in males of 11 towns.

We conducted an analysis of the data from two epidemiological autopsy studies of atherosclerosis in men aged 20-59 years in 1963-66 (the first study, 7470 cases) and in 1985-88 (the second study, 9600 cases). The investigations were performed in accordance with a special program of the World Health Organization in 11 town populations: Ashkhabad (Turkmenistan), Bishkek (Kirgizstan), Irkutsk and Yakutsk (Russia), Malmo (Sweden), Prague (Czech Republic), Riga (Latvia), Tallinn and Tartu (Estonia), and Kharkov and Yalta (Ukraine). Native and non-native populations were studied separately in Ashkhabad, Bishkek, and Yakutsk. Atherosclerosis was studied by the visual morphometrical method in the descending thoracic aorta, abdominal aorta and three main coronary arteries. In each vessel the prevalence and extent (percent of intimal surface) of fatty streaks, fibrous plaques, complicated, calcified and also raised lesions (all lesions except fatty streaks) were determined. Coronary stenosis was estimated in arteries as narrowed by more than 50%. Accelerated development of coronary atherosclerosis, especially in the 40-59 year age group, was noted in the second study in the male populations of most towns except Prague and Malmo. In Prague the extent of raised lesions in coronary arteries was practically the same in both studies, in Malmo it decreased in the second study. Aortic atherosclerosis also accelerated the rate of progression in all towns except Prague, where significant differences were not observed between the studies. Accelerated development of atherosclerosis in male populations from towns of Asia was combined with an increase of fatty streaks in all vessels, while in European populations it was not so obvious. In the native populations of Ashkhabad, Bishkek and Yakutsk, atherosclerosis was much less than in non-natives in both studies. In natives of these towns, accelerated development of atherosclerosis begins only from 40 years, in non-natives from 30. For the second study, there was typically an increase of the prevalence and extent of calcified lesions that were combined with an increased prevalence of coronary stenosis in all towns. The average percentage of stenosis in the coronary left anterior descending artery for men of 40-59 years of age was 12% in the first study and 24.9% in the second; for the coronary right artery, 7.4 and 13.8%, respectively. In accordance with findings of more severe atherosclerosis in males in most towns in the second study, there was an increase in the frequency of death from coronary heart disease in the second study in these towns. The data of this study indicate that the development of atherosclerosis in human populations may change very much in the course of the life of one generation.

[A comparative study of the evolution of atherosclerosis in men over a 25-year period in 11 European and Asiatic cities]. / Sravnitel'noe izuchenie évoliutsii ateroskleroza u muzhchin za 25-letnii period v 11 evropeiskikh i aziatskikh gorodakh.

Repeated epidemiologic study of atherosclerosis in males on the basis of autopsy material with 25-year interval (1963-66 and 1985-89) has been performed in 7 European cities (Malmö, Praha, Riga, Tallinn, Tartu, Kharkov, Yalta) and 4 Asia cities (Ashkhabad, Bishkek, Irkutsk, Yakutsk). Accelerated development of atherosclerosis in the 2nd study has been revealed in males in the majority of cities except Malmö and Praha. No significant differences in atherosclerosis of aorta and coronary arteries were found in these two cities. An increase of the calcinosis surface in the coronary arteries combined with a higher incidence of coronary stenosis was typical for the 2nd study. Atherosclerosis was less pronounced in the indigenous population of Ashkhabad, Bishkek and Yakutsk in both studied than in non-indigenous populations. There was a positive correlation in males between lethality of coronary heart disease and other cardiovascular diseases and the degree of coronary atherosclerosis. Thus, the course of atherosclerosis can change within the life of one generation.

[Atherosclerosis in diabetes mellitus (repeated epidemiologic studies of atherosclerosis with an interval of 25 years)]. / Ateroskleroz pri sakharnom diabete (po materialam povtornykh épidemiologicheskikh issledovanii ateroskleroza, provedennykh s intervalom 25 let).

Repeated epidemiological studies of atherosclerosis were performed in 1985-1989 (as compared to 1965-1968) in 20-59-year-old males of malme, praha, Tallinn, Yalta and in 40-59-year-old females in Malme, Riga and Yalta. 358 cases of diabetes mellitus (DM) were studied. DM occurred more frequently during the second interval as compared to the first one: 6.3 and 4.6% in males, and 7.6 and 4.2% in females, respectively. The severity of atherosclerosis (aorta and coronary arteries were studied morphometrically after staining with Sudan IV) was higher in patients with DM the influence of which was similar to that of the arterial hypertension. The severity of atherosclerosis in DM depended, to a certain degree, on atherosclerosis level in the population. There was a trend to a decrease of atherosclerosis severity within the second interval in Malme and Praha, and its increase in Riga, Tallinn and Yalta. There was no significant difference in atherosclerosis severity that would depend on DM severity and regularity of its treatment.

[Evolution of aortic atherosclerosis in specific European cities in the the 60's and 80's]. / Evoliutsiia ateroskleroza aorty v otdel'nykh gorodakh Evropy v 60-x i 80-x godakh.

Repeated study of atherosclerosis epidemiology is performed in 5 European cities (Malme, Prague, Riga, Tallinn, Yalta) according to WHO recommendations 20 years after a similar study in the same regions. More frequent and more pronounced development of atherosclerosis in males of 20-39 years of age is found in the present study in 3 big cities (Prague, Riga, Tallinn) as compared to the population of small cities Malme and Yalta. The rejuvenation of atherosclerosis can not be explained by an ecological situation as in females atherosclerosis was most pronounced in Malme. Possible reasons of the evolution of atherosclerosis is discussed.

[Changes in the course of atherosclerosis occurring over a 25-year period in the male population of 9 cities of the CIS and Baltic countries]. / Izmeneniia v techenii ateroskleroza, proizoshedshie za 25-letnii period, u muzhskogo naseleniia 9 gorodov SNG i stran Baltii.

The trends in atherosclerosis presentation were followed up pathomorphologically in a two-stage epidemiological survey performed in 9 cities of CIC and Baltic states at 25-year interval. The investigations were conducted in accordance with WHO program. Stage 1 (1963-1968) covered 6121 cases, stage 2 (1985-1989) included 9201 cases. The material was collected on the condition of aortas and coronary arteries from 20-59-year-old males who were residents of the cities of Irkutsk, Yakutsk, Tallin, Tartu, Riga, Kharkov, Yalta, Ashkhabad, Bishkek. The 2-stage examinations gave evidence for growing severity of atherosclerosis. Risk factor analysis demonstrated an increase in the percentage of males with diabetes mellitus and arterial hypertension, in the percentage of overweight males and of those with atherosclerosis engaged in mental work. It is found that atherosclerosis undergoes changes within the life of one generation (for 20-25 years).

[Morphometric characteristics of coronary atherosclerosis in different ethnic groups of Andizhan population]. / Morfometricheskaia kharakteristika ateroskleroza koronarnykh arterii v razlichnykh étnicheskikh gruppakh naseleniia Andizhana.

A gross morphometric study of coronary atherosclerosis was performed in 554 native males aged 20-59 years and 142 migrant males of the same age from Andizhan according to the WHO Expert Programme (Bull, WHO, 1976, vol. 53, p. 485). The migrants over 40 years displayed a greater extent of atherosclerosis (except lipid streaks) than did the natives; but there were small differences between the comparable groups of young persons under 40 years. A histometric study of the coronary arteries was made in 81 apparently healthy males indicated that fine-dropped (mainly intracellular) lipid deposits were more common in the natives, mixed (fine- and coarse-dropped) and coarse-dropped lipid deposits occurring with cell breakdown were seen in the migrants. The thickness of atherosclerotic lesions in the coronary arteries was greater in the migrants. Varying degrees of coronary intimal hyperplasia were found in individuals from the comparable ethnic groups. The hyperplasia was more profound in the migrants. There was a direct relationship between its degree and the development of atherosclerotic lesions.

[Age-related dynamics of aortic atherosclerosis of various ethnic groups of the male population of Andizhan]. / Osobennosti vozrastnoi dinamiki ateroskleroza aorty u razlichnykh étnicheskikh grupp muzhskogo naseleniia Andizhana.

Quantitative study of the aortic atherosclerosis was performed in 587 males of the indigenous (IP) and in 149 males of non-indigenous population (NIP) at the age of 20 to 59 years in the city of Andizhan according to the WHO program. The course of atherosclerosis was more severe in NIP persons although at the age of up to 40 years the differences in the mean surface of atherosclerotic changes were lacking. The surface of lipid spots was similar in both groups or was somewhat lower in NIP, but these spots in NIP persons were thicker and contained more foam cells and more areas of diffuse lipid deposition. The rate of the surface increase of prominent lesions drastically increased in the 5th decade of life in both groups. The frequency of rhythmical structures in the aorta was the same in both groups; their incidence was higher in cases of pronounced atherosclerosis.

[Structure of aortic lipid spots in two ethnic groups of the Yakutsk population]. / Osobennosti struktury lipidnykh piaten aorty v dvukh étnicheskikh gruppakh naseleniia iakutska.

Histometric study of aortic lipid spots (LS) in males of both ethnic groups who died of incidental causes at the age of 20-39 showed a decrease of the lipid-containing smooth muscle cells number (SMC), an increase of the foam cell (FC) number and extracellular lipids, retraction of the non-lipid zone surface in LS in proportion with their thickening. LS on the aorta with fibrous plaques in both Yakuts and Russians are characterized by the accumulation of FC, extracellular lipids and by their trend to the thickening as compared to LS in the aorta without fibrous plaques. Thick aortic LS in Russians with a predominant accumulation of FC in the superficial and intermediate layers are the most probable precursors of the atherosclerotic plaque.

[The determination of ventricular myocardial mass by magnetic resonance tomography]. / Opredelenie massy miokarda zheludochkov metodom magnitnoi rezonansnoi tomografii.

MR-tomography (MRT) was used to investigate 10 isolated hearts from patients who died of various cardiovascular diseases. The purpose was to study the accuracy of MRT for determination of the myocardial mass (MM) of the left and right ventricles. MM was calculated using Simpson's method and the "area-length" formula. The first method demonstrated a high correlation of MRT results with autopsy findings with relation to the left, right ventricles and the interventricular septum (r = 0.98, 0.88, 0.85, respectively). The accuracy of the second method was also very high (r = 0.96 with relation to the left ventricle), however great scattering of MM values with relation to true values was noted. MRT can serve as a highly informative method in the evaluation of the ventricular MM and the time course of its changes.

[Modern methods for the instrumental diagnosis of intracavitary thrombosis of the left ventricle in myocardial infarct]. / Sovremennye metody instrumental'noi diagnostiki vnutripolostnogo tromboza levogo zheludochka pri infarkte miokarda.

To study the sensitivity and specificity of two-dimensional echocardiography in the diagnosis of left ventricle thrombosis which often attends myocardial infarction and to define diagnostic potentialities of the new research methods (digital subtraction ventriculography and MR tomography), 449 patients with acute transmural myocardial infarction were examined. Based on the comparison of the echocardiographic readings and morbid anatomy data it has been shown that the sensitivity of two-dimensional echocardiography in revealing left ventricle thrombosis amounts to 89%, specificity to 88%. Digital subtraction ventriculography has a lower (77%) sensitivity, with the specificity being satisfactory enough (88%). Meanwhile MR tomography enables a highly precise diagnosis of left ventricle thrombosis and can be used as a supplementary diagnostic method in questionable cases and in thrombi small in size or in unsatisfactory ultrasonic visualization of the heart structures.

[Age-related dynamics of aortic atherosclerosis in males of Riga]. / Vozrastnaia dinamika ateroskleroza aorty u muzhchin Rigi.

The epidemiological autopsy study of 1338 men in Riga aged 20-59 was repeated 20-25 years after the first similar investigation. Aortas were stained with Sudan IV and atherosclerotic lesions were graded by visual-planimetric method. It was the significant growth, with age, of all kinds of lesions except lipoid streaks, having the most prominent increase in men aged 40-49. In the abdominal aorta the extent of lesions was significantly higher than in the thoracic aorta beginning from the fourth decade of life. Significant increase of various lesions in aorta was observed in the same male population 20-25 years after the first examination. The tendency to the earlier transition of fibrous plaques into more severe forms of atherosclerosis (complicated lesions and calcinosis) is noted.

[Myocarditis and dilated cardiomyopathy (an analysis of questions of etiology, pathogenesis and differential diagnosis in a clinical example)]. / Miokardit i dilatatsionnaia kardiomiopatiia (analiz voprosov étiologii, patogeneza i differentsial'nogo diagnoza na klinichekom primere).

Development and clinical course of dilated cardiomyopathy is analysed in detail on one clinical case. Myocardial biopsy findings, immunologic data and autopsy findings are compared. The data obtained indicate that myocardial lymphocyte infiltration correlates with the rise in titres of antibodies to cytomegalovirus and the virus of herpes simplex as well as increase in serum alpha-interferon, neopterin and beta-2-microglobulin concentrations. Rise in the level of antibodies to cardiolipins is combined with thromboembolic syndrome. The roles of immunological control disturbances and immunity system activation in the pathogenesis of dilated cardiomyopathy as well as possible evolution of myocarditis into dilated cardiomyopathy are discussed.