[The PATRIARCH study: effect of passive training on long term treatment results with myocardial infarction].

In order to study long term results of passive training sessions in myocardial infarction in older patients with the use of electromyostimulation (EMS) of skeletal muscles (the PATRIARCH Study) we examined 94 patients with acute myocardial infarction (IM) older than 60 years. Among patients subjected to EMS training we distinguished groups with age 60-69 years (n=19) and older than 70 years (n=32). Control groups also contained patients aged 60-69 years (n=19), and older than 70 years (n=25). For training we used "Myorhythm-040" apparatus. During 2 hours of a training session we stimulated rectus muscle of abdomen, back extensors, buttocks, quadriceps muscle of thigh, muscles of calf. In hospital course of EMS led to improvement of strength and endurance of skeletal muscles in patients older than 70 years. Strength and endurance of skeletal muscles at discharge from hospital was among factors influencing 5 year survival of patients with MI in older age groups (together with Killip heart failure class and left ventricular ejection fraction). EMS facilitated improvement of results of treatment of patients of main group during 5 years of follow up. Effect on prognosis requires elaboration in studies with greater number of patients.

[Effect of stress-limiting factors on characteristics of intracardial hemodynamics in patients with early cardiac insufficiency].

Effects of stress-limiting factors on intracardiac hemodynamics at early stages of heart failure were evaluated in 71 patients aged 50.7 +/- 1.4 years with coronary heart disease (CHD) of NYHA functional class I-II. Based on the results of echocardiography, the patients were divided into 3 groups, viz. SDF group (n = 23) with left ventricular (LV) systolic dysfunction (ejection fraction (EF) < 45%), DDF group (n = 22) with LV diastolic dysfunction (E/A < 1.0 at EF > 45%), and control group (n = 26) (EF > 45%, E/A > 1.0). Parameters of intracardiac hemodynamics were assessed at muscular relaxation and in the image visualization test intended to improve the heart pump function. Either test revealed a 11.9% and 14.3% increase of LV EF respectively in patients of the SDF group compared with its initial value (p < 0.05). LV filling parameters in these tests remained unaltered. The E/A ratio in the DDF group increased from 0.91 +/- 0.05 to 0.97 +/- 0.05 at muscular relaxation and to 0.99 +/- 0.05 in the image visualization test (p < 0.05 in both cases). These changes were unaccompanied by variation of intraventricular filling and might be due to decreased afterload. Parameters of LV systolic function in this group did not appreciably change in either test. It is concluded that stress-limiting factors examined in this study improved intracardiac hemodynamic characteristics in patients at early stages of chronic heart failure. This suggests that they may be of value for combined therapy of these patients.

[Effects of diazepam on intracardiac hemodynamics in patients with chronic cardiac failure]. / Vliianie diazepama na pokazateli vnutriserdechnoi gemodinamiki u bol'nykh khronicheskoi serdechnoi nedostatochnost'iu.

Diazepam effects on intracardiac hemodynamics were studied in 45 patients with ischemic heart disease. The patients were divided into 3 groups: a control group (n = 13), a group with a systolic dysfunction (EF < 45%, n = 16) and a group with a diastolic dysfunction (E/A < 1.0, n = 16). Echocardiography was made before and after intravenous injection of 10 mg diazepam (relanium, "Polfa). The above diazepam injection improved heart rate and diastolic blood pressure in patients with left ventricular systolic dysfunction, cardiac pump function improved in patients with initial diastolic or systolic dysfunction. In the controls these parameters worsened. Diastolic function was not influenced much in all the three groups. Thus, combination of a sedative effect, a moderate positive action on cardiac pump function and no negative impact on diastolic filling characterizes diazepam as a stress-limiting medicine in patients with chronic cardiac failure.

[Psychotherapy impact on effectiveness of in-hospital physical rehabilitation in patients with acute coronary syndrome]. / Vliianie psikhoterapii na éffektivnost' statsionarnoi fizicheskoi reabilitatsii bol'nykh s ostrym koronarnym sindromom.

Of 103 patients with acute coronary syndrome (mean age 51.6 +/- 0.9 years) 47 patients participated in 5 group psychotherapeutic sessions added to conversional rehabilitation program. Psychotherapy included progressive muscular relaxation, neurolinguistic programming, eriksonian hypnosis, therapeutic metaphora. Psychotherapy decreased the hear rate, number of ventricular extrasystoles, stimulated tonicity of the parasympathetic nervous system. Compared to the controls, the test patients developed higher exercise tolerance and lower reactivity of the central hemodynamics in all the exercise tests.