[The Effect of Bromocriptine on Clinical and Laboratory Parameters in Patients With Peripartum Cardiomyopathy].

Aim      To evaluate the effect of bromocriptine on clinical hemodynamic and functional indexes and to analyze life prognosis for patients with periportal cardiomyopathy divided into two groups: group 1, bromocriptine treatment (n=21) and group 2, standard treatment without bromocriptine (n=22). History was taken, examination and standard clinical evaluation were performed, the Clinical Condition Scale (CCS with V.Yu. Mareev, 2000, modification) was administered, and 6-min walk test (6MWT) was performed. Quality of life was determined with the Minnesota questionnaire. Standard 12-lead electrocardiography, echocardiography, and blood biochemistry with measuring C-reactive protein (CRP) and prolactin, were performed. Follow-up duration was one year.Results Heart rate was significantly decreased in group 1 (22.7%) compared to group 2 (18%); the 6-min distance was increased (61 and 50 %, respectively), the total CCS score was decreased (66 and 55 %, respectively, and the quality of life Minnesota questionnaire score was improved (from 68.4±12.4 to 26.4±12.4 and from 63.4±10.9 to 36.4±15.1, respectively). Also, left ventricular (LV) end-diastolic dimension was reduced from 66.82±7.07 to 60.67±3.79 mm (9.2 %) in group 1 and from 61.92±4.41 to 58.91±4.68 mm (5 %) in group 2, which was associated with increases in LV ejection fraction by 18.3 and 14.5 %, respectively. In both groups, CRP concentration was decreased from 8.3±4.1 to 4.3±1.2 mg/l and from 8.5±3.5 to 6.3±1.5 mg/l, respectively. The bromocriptine treatment was associated with a significant decrease in prolactin level (62 %). The LV function completely recovered in 66.6% of patients in group 1 and in 27% of patients in group 2.Conclusion      The bromocriptine treatment of periportal cardiomyopathy in combination with an optimal drug therapy was associated with an additional beneficial effect on the clinical functional status, intracardiac hemodynamics, blood concentration of CRP, and a potentiality for complete recovery of the LV function.

[Specific features of the clinical picture and course of familial dilated cardiomyopathy].

AIM: To study prevalence, clinical and hemodynamic features, and life prognosis in patients with familial dilated cardiomyopathy (DCM). SUBJECTS AND METHODS: Two hundred and forty-four patients with DCM were examined during the period 2000 to 2010. According to their medical history records and the results of clinical and functional studies, familial cardiomyopathy was diagnosed in 29 (11.8%) of 244 patients. For comparative assessment, the authors formed two groups: 1) 29 patients with the familial form of DCM and 2) 83 patients with its sporadic form. Their examination included ECG, Holter ECG monitoring, 6-minute walk test, X-ray cardiometry, coronarography, and life prognosis assessment. RESULTS: It has been established that the prevalence of the familial form of DCM accounts for 11.9% and is, unlike its non-familial form, associated with younger age; it is maternally inherited in one third of cases and characterized by the development of complete atrioventricular block in some patients. CONCLUSION: Investigating the life prognosis of the patients has shown that the familial form and age less than 30 years are characterized by a rapidly progressing course accompanied by a significant increase in death rates within the first 12 follow-up months.

[Periportal cardiomyopathy. Some peculiarities of clinical picture and course of the disease].

Results of the study of special characteristics of the course of chronic heart failure (CHF) in women with periportal cardiomyopathy (PCMP) are presented. We have found that prevalence of PCMP in the structure of dilated cardiomyopathy is 9.5%. PCMP compared with idiopathic cardiomyopathy is characterized by less pronounced dilation of left cardiac chambers, relative preservation of left ventricular contractile function, more favorable course of CHF with lower frequency of destabilizations of clinical state. PCMP has developed mainly during postportal period and in women with preexisting anemia and chronic viral diseases.

[Effects of atorvastatin and acipimox on the lipid spectrum of blood plasma, endothelial function and a clinical course of unstable angina pectoris].

AIM: Assessment of effects of a 3-month course of atorvastatin and a nicotinic acid derivative acipimox on the lipid spectrum, platelet aggregation, results of brachial artery reactive hyperemia test and clinical outcomes in patients with unstable angina pectoris (UAP). MATERIAL AND METHODS: A total of 109 males with new-onset and progressive UAP entered the trial. They had LDLP cholesterol > or = 115 mg/dl. RESULTS: The addition of atorvastatin to combined therapy of UAP patients resulted in achievement of a target level of LDLP cholesterol level in 64% dose-adjusted patients while in acipimox patients the target level was achieved in 20% patients. In spite of a more potent effect on endothelial function, acipimox had an insignificant effect on the treatment outcomes. CONCLUSION: Hypolipidemic therapy with atorvastatin and acipimox for UAP leads to a significant reduction in LDLP cholesterol. The effect of atorvastatin comes much earlier and more frequently provides a target level of LDLP cholesterol.

[Humoral markers of endothelial dysfunction in essential hypertension]. / Gumoral'nye markery disfunktsii éndoteliia pri éssentsial'noi gipertonii.

AIM: To elucidate potential markers of endothelial dysfunction and relationships between humoral and vasoregulatory responses of the endothelium in patients with essential hypertension. MATERIAL: Thirty four male patients (mean age 54.4+/-9.2) with I-II degree hypertension and left ventricular hypertrophy. METHODS: Endothelial function was assessed non-invasively by registration of flow-mediated brachial artery dilatation. Serum level of vascular adhesive molecule 1S (VCAM-1S) was measured by enzyme immunoassay, levels of aldosterone and insulin-like growth factor-1 (IGF-1) - by radioimmunoassay. RESULTS: Brachial artery flow mediated dilatation was 2.0+/-7.46%. Patients with hypertension compared with healthy subjects had significantly higher mean levels of VCAM-1S (713.9+/-123.2 and 590.8+/-51.8 pg/ml, respectively, p<0.001), aldosterone (105.41+/-50.17 and 42.7+/-13.16 ng/ml, respectively, p<0.001), and IGF (209.7+/-49.1 and 137+/-21 pg/ml, respectively, p<0.001). Direct significant correlations were found between humoral and functional markers of endothelial dysfunction in the group of patients with essential hypertension. CONCLUSION: These results can be interpreted as indicative of pathogenetic role of IGF-1 and aldosterone in the development of the endothelial dysfunction and myocardial remodeling in essential hypertension

[Thrombocyte aggregation in patients with cardiac arrhythmias and effect of anti-arrhythmia agents]. / Agregatsionnaia aktivnost trombotsitov u bolnykh s narusheniiami ritma serdtsa i vliianie na neë antiaritmicheskikh preparatov.

Platelet aggregability was studied in 81 patients with prior myocardial infarction with various cardiac arrhythmias and its effects of some antiarrhythmic agents (allapinine, ethacizine, obsidan and cordarone). It was 32-39% higher in patients with frequent ventricular extrasystole (VE) and VE of high grades (4a and 4b by the classification of Lown and Wolt) than in control patients (without arrhythmias) and patients with supraventricular and rare VE. Ethacizine and cordarone produced a significant inhibitory effects on platelet functional activity, but the effects of allapinine and obsidan on this parameter were insignificant. There was no correlation between the magnitude of antiarrhythmic effects of the drugs and their antiaggregatory properties. It was shown that the results of examining the effects of antiarrhythmic agents on platelet aggregability in vitro were not in agreement with those obtained in vivo.

[Treatment of ventricular arrhythmias in patients with manifestations of heart failure]. / Lechenie zheludochkovykh aritmii u bol'nykh s proiavleniiami serdechnoi nedostatochnosti.

A comparative study of the efficiency of digoxin and "pure" antiarrhythmic agents was carried out in 56 patients with ventricular arrhythmias and signs of circulatory insufficiency (CI). Digoxin had arrhythmogenic effect in 20% of the patients, which was twice as frequent in the marked CI group. "Pure" anti-arrhythmic agents were effective in 47% (ritmilen) to 71% (cordaron), and etmozin, in 63% of the patients, while adverse myocardial inotropic effect was only produced by ritmilen. Combined use of etmozin, ritmilen or cordaron with digoxin increases their antiarrhythmic efficiency.

[Digoxin in the treatment of patients with ventricular disorders of cardiac rhythm]. / Digoksin v lechenii bol'nykh s zheludochkovymi narusheniiami ritma serdtsa.

A study of digoxin antiarrhythmic effect in 44 patients with recurrent ventricular extrasystole showed the drug to be effective in an average 34% of patients, the effect being more marked in patients with originally impaired ventricular function.

[Deterioration in ventricular arrhythmia caused by anti-arrhythmia preparations]. / Ukhudshenie techeniia zheludochkovykh aritmii, vyzvannoe anti-aritmicheskimi preparatami.

Study of the efficacy of some antiarrhythmic drugs in 92 patients with frequently occurring ventricular premature heart beat including high grades has demonstrated that in an insignificant number of patients these drugs produce an arrhythmogenic action. Such an action is observed after intake of the common therapeutic drug dose and is not accompanied by subjective symptoms pointing to the drug intolerance. The arrhythmogenic action of the drugs results in a dramatic increase in the number of ventricular premature heart beats and in the appearance of high grades of such beats including the development of ventricular flutter.

[Results of prolonged ethmozine treatment in patients with ventricular arrhythmias]. / Rezul'taty dlitel'nogo lecheniia étmozinom bol'nykh s zheludochkovymi narusheniiami ritma serdtsa.

The results of long-term ethmozine treatment given to 44 patients with ventricular disturbances of the heart rhythm showed that the drug (600-800 mg/day) proved to be 100 percent effective in preventing relapses of ventricular extrasystole and its high gradations including paroxysmal ventricular tachycardia. Furthermore, the patients exhibited good tolerance to ethmozine under conditions of its prolonged continuous administration. The drug at the doses studied exerted no adverse action on the liver, kidney or hemopoietic functions.

[Pharmacodynamics and the pharmacokinetic parameters of etmozin in ventricular heart rhythm disorders]. / Farmakodinamika i nekotorye parametry farmakokinetiki étmozina u bol'nykh s zheludochkovymi narusheniiami ritma serdtsa.

A single dose of 300 mg of ethmosine per os has been found to exert an antiarrhythmic action 1-2 h after its administration in 60% of the patients and may be used to terminate episodes of ventricular arrhythmias. 3-4 h after the beginning of its administration, a complete antiarrhythmic effect was observed in giving a "loading" dose of 500-600 mg of ethmosine at the beginning of the treatment followed by maintenance therapy (200 mg given every 8 hours). To treat patients with ventricular rhythm disturbances, ethmosine may be used in a daily dose of 600-900 mg without side effects.

[Comparative effectiveness of ethmozine, mexitil, quinidine and obsidan in the treatment of ventricular rhythm disorders]. / Sravnitel'naia éffektivnost' étmizina, meksitila, khinidina i obzidana u bol'nykh s zheludochkovymi narusheniiami ritma serdtsa.

A comparative assessment of efficacy of the drugs in a group of patients with frequent ventricular extrasystoles has shown that ethmozine and mexitil are effective in most of cases. In certain patients deterioration of the rhythm after all these drugs (ethmozine, mexitil, quinidine, obsidan) has been recorded.