[The effect of one-year treatment with captopril on exercise tolerance and myocardial ischemia in patients with myocardial infarction ]. / Wplyw jednorocznego leczenia kaptoprylem na wydolnosc wysilkowa i niedokrwienie miesnia sercowego u chorych z zawalem serca.

The aim of the study was to assess the effect of 1-year captopril therapy initiated 1-4 days (mean: 21-24 h) after beginning of AMI on exercise performance and myocardial ischemia during cycle ergometer test. 93 pts with first documented Q-wave AMI, aged L 70 years were qualified for the study. 50 of the pts were randomly included to the captopril group, 43 to the control group. In both groups pts with inferior AMI (accordingly 66% and 72%) and normal LV function (EF > or = 40% in ECHO) were prevailed in the study. Captopril therapy was initiated with the dose of 3.125 mg, then every 8 hours the dose of 6.25 mg was administered in Ist and IInd day, 12.5 mg--in III day and 25 mg from IV day on. Exercise cycle ergometer tests (ExT) were performed in every pt at 14 day, and 1, 3, 6 and 12 months after AMI. The ExT began at 25 W of power and was increased at 2-minute intervals by 25 W until fatigue or other typical cause of termination of the test. In the captopril group duration of ExT lengthened significantly in comparison with initial test (on 14 day) after 3 (6.4 +/- 1.47 vs 5.3 +/- 1.54 min; p < 0.01), 6 (6.7 +/- 1.59 vs 5.3 +/- 1.54 min; p < 0.001) and 12 months (7.0 +/- 1.22 vs 5.3 +/- 1.54 min; p < 0.001). In the control group exercise time was longer after 6 and 12 months compared to initial examination (accordingly 6.4 +/- 1.43 and 6.5 +/- 1.26 vs 4.8 +/- 1.47 min; p < 0.001). However, the differences regarding this time between the captopril and control group were not significant on consecutive control stages. The final result of the test (positive, negative, doubtful) did not differ significantly in both groups on consecutive examination stages. Captopril administered during 1-year period after AMI slightly improved physical working capacity (accelerated the improvement) and had no effect on ischemia during estimated cycle ergometer test. These results may depend on inclusion to the study predominantly pts with normal LV function and interior MI.

[Echocardiographic analysis of segmental and global myocardial contractility after administration of dipyridamole in patients with ischemic heart disease]. / Echokardiograficzna analiza kurczliwosci odcinkowej i ogólnej miesnia sercowego po podaniu dipirydamolu u pacjentów z choroba niedokrwienna serca.

Aims of the study were to assess the usefulness of global and segmental myocardial contractility parameters detected during dipyridamole echocardiography test in diagnosis of ischaemic heart disease. Dipyridamole time (the time from the onset of dipyridamole infusion to development of asynergy) was also evaluated. The study included 97 patients with suspected or known ischaemic heart disease (32 patients after acute myocardial infarction), mean age 48.5 years. All patients underwent dipyridamole stress echocardiography and afterwards coronary angiography. Significant stenosis (< or = 70% lumen reduction in at least one major coronary vessel) was present in 52 (54%) patients-group I. Normal coronary arteries or no significant stenosis were found in 45 (46%) patients-group II. Significant increase of wall motion score index was observed in group I. No significant change with two and there vessels disease have shorter dipyridamole time than patients with one vessel disease. Significant decrease in ejection fraction during dipyridamole echocardiography test was found in group I, whereas not significant increase in ejection fraction was observed in group II. Dipyridamole echocardiography test is a sensitive, specific and well tolerated test in the diagnosis of ischaemic heart disease.

[Comparative assessment of digoxin and captopril in the treatment of chronic congestive circulatory failure, NYHA grade II]. / Ocena porównawcza digoksyny i kaptoprylu w leczeniu przewleklej zastoinowej niewydolnosci krazenia II stopnia wg NYHA.

In 42 patients aged 33 to 79 years (mean age 55 years) with NYHA grade II chronic congestive circulatory failure, a comparative assessment was carried out of the effectiveness of treatment with captopril (29 patients, daily dose 18.75-150 mg, mean 82.5 mg) adn digoxin (13 patients, daily dose 0.125-0.5 mg, mean 0.275 mg). The patients were administered the drugs, depending on the improvement obtained, for 3-5 weeks. In the assessment of the effectiveness of the treatment, the following was taken into account: medical examination, laboratory investigations, chest X-ray, exercise tests and haemodynamic parameters measured during 2D and M echocardiographic examination. In the group of patients treated with digoxin the following was observed: a significant, in comparison to the patients receiving captopril, reduction of the heart rate by 11 beats per minute, decrease of the heart volume index by 50 ml/m2 and increase of the stroke volume by 14 ml. Higher effectiveness of captopril was observed as increase of the maximal workload during exercise test by 21 W and prolongation of its duration by three minutes. It seems that captopril may find use also in the treatment of early stages of circulatory failure.

[Evaluation of captopril levels in chronic congestive heart failure, stages NYHA III and IV]. / Ocena wartosci stosowania kaptoprylu w przewleklej zastoinowej niewydolnosci krazenia w III i IV okresie wg NYHA.

Thirty eight patients, aged between 25 and 81 years (mean age 56.9 years) with diagnosed chronic congestive heart failure of NYHA III and IV stages have been examined. The following phases of therapy have been distinguished depending on the used drugs: phase 0--digoxin in a daily dose of 0.25 mg and furosemide in a daily dose of 40-150 mg (mean value 72.4 mg) for 14 days; phase A1A2--nifedipine has been added in a daily dose of 40-80 mg (mean value 64.0 mg), lasting also for 14 days; phase B1B2--captopril (Lopirin--Squibb) has been added to the previous drugs in a daily dose of 25-150 mg (mean value 67.4 mg) in three divided portions for 28 days; phase C1C2--captopril has been withdrawn and drugs as in phase A1A2 have been administered for 14 days. Routine laboratory tests, ECG, a 24-hour ECG-records with Holter's technique, exercise ECG, chest X-ray, and 2D and M echocardiography were performed prior to and after 7 days as well as after each phase of the studies. A significant improvement in the left ventricle functioning assessed with Cubet's echo 2D has been observed in phase B1B2 in comparison with phase A1A2. These parameters have been the following: EF 42.61% vs 31.52%; CO 3.2 vs 2.9 L/min; SV 57.15 vs 44.24 mL (p < .001). Moreover, a decrease in heart volume (X-ray) from 1,145.25 mL to 1,088.25 mL, an increase in exercise tolerance (exercise ECG) in 52.6% of the patients, decrease in Lown's class in 11 out of 24 patients have been noted.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of biological availability and anti-arrhythmic effect of a new drug Phenytoinum "Polfa"]. / Ocena dostepnosci biologicznej i dzialania przeciwarytmicznego nowego preparatu Phenytoinum "Polfa".

Studies were performed in 15 patients with ventricular arrhythmia. During the first day, the patients received 1000 mg of a new micronised form of Phenytoinum "Polfa" or adequate dose of a foreign drug in 3 doses every 3 hours and subsequently during 10 days alternatively native or foreign drug in a daily dose 300 mg. Twenty-four EKG Holter monitoring and determination of serum drug level were carried out after a 10-day treatment; area under the curve (AUC) in one 8 h dose interval was determined. Studies have shown usefulness of a new form of Phenytoinum (Polfa). Blood serum drug levels near to the therapeutic ones were observed. Steady-state Phenytoinum concentration was 11.1 +/- 5.9 micrograms/ml and after foreign drug it was 11.7 +/- 6.1 micrograms/ml, AUC0-8 was 90.4 and 105.3 micrograms/ml/h respectively. In 9/15 patients (60%) Phenytoinum (Polfa) produced substantial improvement in the cardiac arrhythmia.

Pharmacokinetic studies of procainamide (PA) and N-acetylprocainamide (NAPA) in healthy subjects.

Pharmacokinetic studies after a single oral dose of 750 mg of PA in 10 normal subjects were performed. In 6 of them, pharmacokinetics of NAPA were also determined after a single oral dose of 900 mg of NAPA. Substantial differences in pharmacokinetic parameters of PA depending on acetylation phenotype were found. In fast acetylators (sulphadimidine phenotyping), half-life was shorter (2.4 +/- 0.7 hr) and 24 hr urine NAPA excretion was larger (22.5 +/- 5.8% of dose) than in slow acetylators (3.6 +/- 1.0 hr and 8.8 +/- 5.4% respectively). NAPA was characterized by different pharmacokinetic parameters (t 1/2 7.0 +/- 1.0 hr, 24 hr urine elimination - 58.5% of dose). Clinical implications of these findings are discussed.

Methodological aspects of clinical evaluation of antianginal drugs.

The principles of patient selection and designing and management of the clinical evaluation of antianginal agents are discussed. The study should involve patients with stable angina pectoris, history of anginal attacks of at least three months duration with five or more attacks per week, ST-segment depression at least one mm and anginal attack during the exercise test. Subjective criteria based on detailed dilaries kept by the patients and objective criteria based on exercise tests with cycloergometer, treadmill and atrial pacing are described; and difficulties related to final evaluation of the antianginal agent are discussed.