[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.

[Treatment of depression in patients with myocardial infarction with tianeptine].

AIM: To study efficacy and acceptability of tianeptine in treatment of depression in patients with myocardial infarction (MI). MATERIAL AND METHODS: A group of 416 patients (253 men and 163 women) from 35 till 89 years old with MI was studied. Depression was diagnosed in 113 of them (27.2 %) by the use of Zung depression scale and CD-10 criteria. Tianeptine treatment was given to 55 patients (25-37.5 mg/day for 3.3 months), 58 patients were in control group. RESULTS: Tianeptine treatment of depression in patients with MI in 3-7 days led to decrease of feeling of depression and lowering of anxiety. Depression decreased in 9.4% patients of this group in 2 months. After 2 months depression was diagnosed in 55.7 % of patients who did not receive the antidepressant. During 1 year patients, who were treated by tianeptine, had 31% lower number of hospitalizations due to exacerbations of cardiovascular diseases. Patients had a good tolerance of tianeptine treatment independently of age. CONCLUSION: Tianeptine treatment of depression in patients with MI is effective, safe, well tolerated by patients and allows to decrease number of hospitalizations because of complications of cardiovascular diseases during 1 year.