[Prognostic significance of post-infarction "silent" ischemia]. / Prognosticheskoe znachenie "nemoi" ishemii posle infarkta miokarda.

To study the predictive value of silent ischemia, a total of 132 patients with first transmural myocardial infarction were examined, 69 had anterior and 63 had inferior myocardial infarction. On days 8-12 of onset of the disease, all the patients underwent loading two-dimensional echocardiography along with transesophageal pacing, as well as polyposition coronary angiography. According to the echocardiographic findings, 3 groups of patients were identified: 1) 34 (25.8%) with painful ischemia; 2) 37 (28.0%) with silent ischemia; 3) 61 (46.2%) with a negative test. Ischemic alterations were more frequently seen in inferior (73%) than in anterior (36.2%) myocardial infarction. The patients with painful ischemia showed a lower threshold of ischemia occurrence, more severe and prolonged ST segment depression, and greater extent of an asynergic area than did the patients with silent ischemia. A 1-5-year (mean 2.4) follow-up revealed that in terms of the risk for postinfarction angina, recurrent myocardial infarction and fatal outcomes, patients with silent ischemia represent an intermediate group between those with painful ischemia and those who have a negative load test.

[Effect of thrombolytic, anticoagulant and anti-thrombocytic therapy on the development of left-ventricular thrombosis and the incidence of thromboembolic complications in patients with myocardial infarction]. / Vliianie tromboliticheskoi iantitrombotsitarnoi terapii na razvitie tromboza levogo zheludochka i chastoty tromboémbolicheskikh oslozh- nenii u bol'nykh infarktom miokarda.

To reveal the effects produced by thrombolytic and anticoagulative therapies on the formation of left ventricular mural thrombosis (LVT) and the frequency of thromboembolic events, a prospective randomized study was performed in 285 patients with primary transmural myocardial infarction. LVT was diagnosed from the serial two-dimensional echocardiographic findings. No significant effect of the therapy with thrombolytic and anticoagulative agents was found on the incidence and periods of intracavitary LVT development. There was a significant reduction in the incidence of LVT during early (less than 3 hours) reperfusion of the occluded coronary artery. Anticoagulative and antiplatelet therapies performed within the first month of myocardial infarction decrease the risk for systemic thromboembolism in patients with diagnosed LVT.

[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.