[Prospects for using non-invasive diagnostic techniques for assessment of cardiac rhythm variability in coronary restenosis].

The aim of the study was to evaluate dynamics of heart rhythm variability (HRV during a1, b1, and b2-adrenoblockade by carvedilol in patients with coronary heart disease (CHD) and recurrent angina pectoris treated by endovascular revascularization. The study included 39 men (mean age 57.5 +/- 0.8 years) who underwent stenting of coronary arteries (CA) 6 month or more before the study. For the purpose of analysis, patients with CA restenosis were allocated to group 1 (n = 17), those without restenosis or complaining of chest discomfort in the absence of restenosis during repeated coronaroventriculography comprised group 2 (n = 22). Patients having no complaints were followed up by coronarography 1 year after stenting. HRV was estimated from the analysis of short (15 min) fragments of the standard ECG obtained in the basal state and during a1, b1, b2-blockade by carvedilol (mean dose 22.88 +/- 2.1 mg/day) for 2 weeks. Carvedilol blockade of a1, b1, b2-adrenoreceptors following coronary stenting significantly improved both temporal and spectral components of HRV. This improvement may serve as an independent marker of revascularization efficiency and an earlier predictor of coronary restenosis or reflect progress of the atherosclerotic process in native arteries.

[Radionuclide renoscintigraphy for the evaluation of nephroprotective action of acetylcysteine].

Radionuclide renoscintigraphy was used to evaluate efficiency of nephroprotection by N- acetylcholine in 36 patients subjected to coronaroangiography (CAG). The patients were randomly allocated to 2 groups, one undergoing CAG without nephroprotection, the other CAG in combination with N-acetylcholine nephroprotector. Dynamic radionuclide renoscintigraphy with 99m Tc-dtpa was performed before and 2-3 days after CAG; the results were used to estimate filtration and evacuation efficiency of the kidneys. Patients of group 1 showed negative dynamics of the renal function following CAG including decreased mean glomerular filtration rate and slowed down blood clearance. Mean half-time of 99mTc elimination from the pelvicalyceal system and parenchyma of the left kidney as well as its cortical retention index in bot kidneys increased. The filtration activity of the kidneys did not significantly change after CAF in patients of group 2; it was slightly impaired only in 5 (28%) of them. More patients suffered deterioration of 99mTc elimination but on the whole changes in the evacuation activity of both parenchyma and pelvicalyceal system were statistically insignificant. It is concluded that acetylcholine has nephroprotective action in patients subjected to radionuclide renoscintigraphy.

[Long-term results of coronary endovascular revascularisation with sirolimus-eluting stents in patients with ischemic heart disease comorbid with type-2 diabetes mellitus: data from 18-month prospective study].

AIM: To study long-term results of 3-42-month (mean 18.1 +/- 1.2 month) of a prospective clinically and angiologically controlled follow-up after coronary endovascular revascularisation with sirolimus-eluting stents (SES) in patients with coronary heart disease (CHD) comorbid with type 2 diabetes mellitus (DM). MATERIAL AND METHODS: A total of 108 CHD patients with angina pectoris resistant to antianginal therapy were divided into 2 groups: 51 CHD patients with mild and moderate type-2 DM (group 1); 57 CHD patients free of diabetes (group 2). All the patients have undergone successful coronary endovascular revascularisation with SES. Anti-ischemic efficacy and safety of stenting were studied in the course of 18-month prospective follow-up. RESULTS: An anti-ischemic effect of stenting in hospital setting was achieved in all the patients. 18 months after stenting frequency and severity of anginal attacks reduced in group 1 by 70.6%, daily need in nitroglycerine--by 71.9%, in group 2--by 87.1 and 93.1%, respectively. As a result, exercise tolerance improved in group 1 by 38.3%, in group 2--by 40.8%. Quality of life improved by 22.7 and 25.1%, respectively. Most of the patients showed no deterioration of carbohydrate and lipid metabolism compensation. Recurrent angina and symptoms of painless myocardial ischemia occurred in 39.3 and 14% patients of group 1 and 2, respectively. More frequent causes of the recurrence were progression of coronary artery atherosclerosis de novo and Cypher stent restenosis (11.8 and 3.5% in group 1 and 2, respectively). CONCLUSION: SES implantation provided good anti-ischemic efficacy in 60.7 and 86% CHD patients with and without DM, respectively. It significantly improved exercise tolerance and quality of life.

[Suppressive effect of recombinant immunomodulator ronkoleukin on the blood level of antiinflammatory cytokines, anticardiolipin autoantibodies and heart failure].

AIM: To elucidate clinical efficacy and immunocorrecting properties of recombinant immunomodulator ronkoleukin in patients with postinfarction cardiac dysfunction with NYHA FC II-III CHF. MATERIAL AND METHODS: In a 6-months prospective comparative clinically controlled study we observed 33 survivors of myocardial infarction divided into 2 groups according to FC of chronic heart failure (CHF): group I (n=17) with FC II CHF with LVEF > 45% (mean age 52 +/- 2.9 years) and group II (n=16) with FC III CHF and lowered ( 40%) LVEF (mean age 53.7 +/- 3.3 years). Comparison group comprised practically healthy subjects. Clinico-laboratory and functional assessment of state of patients was carried out before initiation of therapy with ronkoleukin and in 2 - 3 days after completion of 2 courses of therapy with 3 months interval. Immunological study included determination of subpopulation content of peripheral blood lymphocytes, blood plasma immunoglobulins, antiinflammatory cytokines Il-1a, Il-1b, Il-2, Il-6, Il-8, TNFa and AB to Cl. RESULTS: It was found that ronkoleukin is an effective immunocorrector producing no adverse effects in patients with FC II-III CHF. Most pronounced effect ronkoleukin manifested in relation to humoral immunity lowering dysimmunoglobulinemia, blood levels of IgA, IgG, CIC and antibodies to cardiolipin, inhibiting excessive cytokine activation in dependence on degree of severity of CHF. CONCLUSION: Administration of ronkoleukin to patients with postinfarction dysfunction of the heart with FC II-III CHF for correction of secondary immunodeficient state in addition to basic therapy provides positive changes of hematological, immunological parameters, intracardiac hemodynamics, facilitates regression of symptoms of CHF and improves quality of life.

[The role of cytokines in restenosing coronary stents and the efficiency of its secondary prophylaxis with statins].

This study was designed to assess the diagnostic value of dynamic patterns of anti-inflammatory cytokines (IL-1b, IL-6, TNF-alpha) in patients with ischemic heart disease (IHD) and restenosis of coronary stents 14 months after their implantation for long-term prophylaxis of dyslipoproteinemia. A total of 40 patients with IHD of advanced functional classes (FC) were examined. Blood cytokine levels were measured before, 1 day, and 12-18 months after coronary stenting. Two groups of 23 and 17 patients included cases with recurrent angina and without it respectively. The main parameters measured in the study were in-stent restenosis rate, incidence of' acute myocardial infarction (AMI), mortality rate, frequency of hospitalization for unstable angina, and the levels of proinflammatory cytokines. Considerable activation of cytokines in patients with post-infarction cardiac dysfunction who rarely resorted to therapy with statins (16.7%) was associated with the high rate of recurrent coronary insufficiency related to in-stent occlusion (8.7%), progressive atherosclerosis (65.2%), impaired myocardial perfusion, and restenosis of coronary stents (26.1%). Patients lacking apparent expression of serum cytokines after revascularization while receiving efficacious secondary prophylaxis of dyslipidemia (13.8 and 17% decrease of triglycerides (TG) and low density lipoproteins (LDL) cholesterol respectively, p = 0.04) had left ventricular ejection fraction (LVEF) improved by 12.5% (p = 0.03%), left ventricular end diastolic pressure (LVEDP) decreased by 15.8% (p = 0.03), and frequency of ischemic perfusion defect (PD) reduced by 45.3% (p = 0.01). Moreover, they showed low incidence of progressive coronary atherosclerosis (17.6%) in the absence of in-stent restenosis. It is concluded that the frequency of restenosis of coronary stents after endovascular myocardial revascularization depends on the preprocedural rise in IL-1b content (R = 0.62, p = 0.0023). It is concluded that long-term secondary prophylaxis of dyslipoproteinemia in patients with ischemic dysfunction at risk of coronary restenosis effectively (more than thrice) decreases the occurrence of coronary stent restenosis after endovascular revasularization.

[The role of cytokines in improvement of coronary restenosis risk stratification after endovascular stenting in patients with ischemic heart disease].

AIM: To evaluate diagnostic and prognostic significance of the levels of proinflammatory cytokines (IL-1, IL-6, TNF-alpha) in improvement of stratification, i.e. determination of coronary restenosis risk in patients with ischemic heart disease 18 months after coronary artery (CA) stenting. The patients were divided into two groups: group 1 consisted of 30 patients with ischemic heart disease and symptoms of anginal recurrence, 38 patients of group 2 had no recurrent coronary insufficiency. Baseline examination of 68 patients with ischemic heart disease and their examination 6-24 months (18.1 +/- 1.9 months) after CA stenting were performed. RESULTS: High activation of the proinflammatory cytokines in patients with postinfarction cardiac dysfunction and after CA stenting is associated with a high rate of recurrent angina, deterioration of myocardial perfusion, progression of atherosclerosis in CA native bed. Restenosis of CA stents in patients after endovascular myocardial revascularization significantly more frequently correlates with elevated blood levels of IL-6 by 56.8% (p = 0.031). Patients with anginal recurrence caused by stent restenosis, progression of atherosclerosis in native CA developed high expression (10.2-58.1%) of TNF-alpha (p = 0.038) 18 months after endovascular revascularization. Repeated angioplasty is associated with multiple CA affection (k = 0.56, p = 0.004) and predilation before stenting (k = 0.3; p = 0.001). CONCLUSION: Dynamics of proinflammatory cytokines (IL-1, IL-6 and TNF-alpha) is efficient to use in complex diagnosis for better stratification of CA restenosis risk in endovascular stenting of patients with coronary artery disease.

[Revascularization interventions in the left coronary artery system: transesophageal Doppler ultrasound study].

AIM: To elucidate the role of evaluation of coronary reserve in coronary sinus by transesophageal doppler for assessment of efficacy of various revascularization interventions. MATERIAL AND METHODS: Patients with isolated stenoses of either left anterior descending or circumflex coronary artery subjected to stenting (n=14) and with two vessel disease subjected to bypass surgery (n=20). Dipyridamole was used as a stress agent. Coronary reserve was calculated as ratio of peak hyperemic to baseline antegrade coronary sinus blood flow velocity (CR(P)) and as ratio of hyperemic to baseline antegrade coronary sinus volume blood flow (CR(VBF)). RESULTS: In patients with atherosclerotic lesions in the system of left coronary artery normalization of CR(P) after stenting of single vessel stenoses and of CR(VBF) after bypass surgery in two vessel disease were markers of efficacy of revascularization with sensitivity 75 and 71%, respectively.

[An experience of the use of stenting for recurrence of myocardial ischemia after coronary artery bypass grafting].

Coronary artery stenting was carried out in 18 patients with angina recurrence 29.3+/-7.6 after coronary artery bypass grafting. Paired bicycle exercise tests, (199)Tl single photon emission tomography and graft angiography were used in evaluation of patients. Occlusions of 1 or 2 venous grafts were found in 38.9%, stenoses of both previously bypassed and native arteries in 27.8% of patients. Implantation of stents in grafts and/or native coronary arteries was associated with 2.7 fold decrease of angina frequency, 3 fold decrease of nitroglycerine consumption, 72.5% increase of exercise tolerance. The use of statins resulted in obvious lowering of total and low density lipoprotein cholesterol.

[Effects of carvedilol, atenolol and their combination with fosinopril on cardiac rhythm variability, clinicofunctional status and quality of life in patients with postinfarction left ventricular dysfunction]. / Otsenka vliianiia Karvediola, Atenolola i ikh kombinatsii s Fozinoprilom na variabel'nost' ritma sedrtsa, kliniko-funktsional'nyi status i kachestvo zhizni bol'nukh s postinfarktnoi disfunktsiei levogo zheludochka.

AIM: To study effects of carvedilol and atenolol and their combination with fosinopril on heart rhythm variability (HRV, clinicofunctional status and quality of life in postmyocardial infarction patients with moderate chronic cardiac failure (CCF). MATERIAL AND METHODS: An 8-week randomized open study enrolled 50 male patients (mean age 55.7 +/- 1.58 years) with postinfarction CCF. They were divided into two equal groups. Group one received carvedilol (24.4 +/- 2.0 mg/day) followed by addition of fosinopril (2.5-40 mg/day). Group 2 received atenolol (44.1 +/- 5.1 mg/day) followed by fosinopril in the same dose as in group 1. RESULTS: A 4-week therapy with carvedilol and atenolol effectively corrected depression of HRV in both the group. Combined therapy with these beta-adrenoblockers and fosinopril improved impaired global left ventricular contractility, exercise tolerance, quality of life, relieved symptoms of CCF. CONCLUSION: Carvedilol, atenolol and their combination with fosinopril in patients with postinfarction CCF improve clinico-hemodynamic and functional status, raise HRV and quality of life.

[A role of activation of proinflammatory cytokines and production of autoimmune complexes in the pathogenesis of chronic heart failure in patients with postinfarct cardiac dysfunction]. / Rol' aktivatsii provospalitel'nykh tsitokinov i produktsii autoimmunnykh kompleksov v patogeneze serdechnoi nedostatochnosti u bol'nykh s postinfarktnoi disfunktsiei serdtsa.

A comparative randomized clinical study was conducted to evaluate the diagnostic and prognostic value of the activation of proinflammatory cytokines [tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1alpha, IL-2, IL-6, IL-8)] and the increased production of autoimmune complexes in the pathogenesis of chronic heart failure (CHF) in patients with coronary heart disease (CHD). The study included 47 patients with CHD who had a more than 6-month history of Q-forming myocardial infarction. The patients were randomized into 3 groups: 1) 21 patients with NYHA Functional Class (FC) II heart failure (HF); 2) 16 patients with FC III HF; and 3) 10 with FC IV HF. Basic therapy involved angiotensin-converting enzyme (ACE) inhibitors, nitrates, diuretics, beta-adrenoblockers; 27.6% received digoxin, disaggregatory agents. A study protocol involved the estimation of the parameters of EchCG, paired bicycle ergometric tests, 6-min walking test, ECG daily monitoring, the levels of proinflammatory cytokines in the serum and IgG autoantibodies to cardiolipin. The findings suggest that with the higher expression of autoimmune complexes, the activation of cytokines (primarily TNF-alpha, IL-1alpha, IL-2) plays an important role in the pathogenesis of CHF in patients with postinfarct cardiac dysfunction: the high activation of cytokines and the elevated level of autoimmune complexes are associated with moderate or severe NYHA FC II-IV HF, depressed left ventricular contractility (ejection fraction, 23-38%), low exercise tolerance, and cardiac remodeling.

[Assessment of antiischemic efficacy of balloon angioplasty, coronary bypass surgery and conservative therapy after myocardial infarction in patients with single coronary artery disease. Three year prospective study]. / Otsenka antiishemicheskoi éffektivnosti ballonnoi angioplastiki, koronarnogo shuntirovaniia i konservativnoi terapii u postinfarktnykh bol'nykh s odnososudistym stenozirovaniem koronarnogo rusla pri 3-letnem prospektivnom nabliudenii.

Efficacy of balloon angioplasty, coronary bypass surgery and conservative therapy in postmyocardial infarction patients with single coronary artery disease was assessed in 3 year prospective study. Positive clinical effect persisted after coronary artery bypass grafting (CABG) in 78 and 73% of patients and after balloon angioplasty in 60 and 40% of patients in 1 and 3 years, respectively. Significant decreases of number of anginal attacks (by 94.1 and 74.1%, respectively), nitroglycerin consumption (by 93.6 and 74.8%, respectively) and dimensions of ischemic perfusion defects (by 68.8 and 33.7%, respectively) were observed 1 year after both CABG and angioplasty. Lowering of exercise tolerance (by 11.1%), increase of nitroglycerin consumption (by 15.8%) and worsening of myocardial perfusion (by 9%) were observed after 3 years in conservatively treated patients.

[Correction of coronary insufficiency by dihydropiridine antagonists of calcium in patients with coronary artery bypass]. / Vozmozhnosti korrektsii koronarnoi nedostatochnosti digidropiridinovymi antagonistami kal'tsiia u bol'nykh, perenesshikh aortokoronarnoe shuntirovanie.

AIM: To study antiischemic and antianginal efficiency of adalat and its prolonged form adalat SL, dihydropiridin antagonists of calcium, in patients 1-3 years after surgical correction of stenosing coronary atherosclerosis. MATERIAL AND METHODS: The drugs were tried in 40 patients with angina of effort (functional class II-III) with a satisfactory inotropic function of the left ventricle 1 to 3 years after coronary artery bypass surgery (CABS). Myocardial circulation was measured with one-photon emission computed tomography using 99m-Tc-MIBI (CT). RESULTS: A 3-week therapy with adalat reduced the number of anginal attacks, nitroglycerin requirement, enhanced exercise tolerance. CT showed that myocardial blood flow significantly improved. CONCLUSION: Adalat proved to be effective in patients after CABS. Its prolonged form adalat SL is preferable.