[The influence of amlodipine on transcapillary metabolism of oxygen during coronary heart disease with insulin resistance].

This three-week open uncontrolled study included 34 men (mean age 53.14+-1.19 yr) with coronary heart disease (CHD) and insulin resistance (HOMA >2. 77); it was designed to estimate effect of amlodipine on transcapillary oxygen metabolism (TCOM). Multivascular stenosing coronary atherosclerosis was managed by aortocoronary bypass surgery. Traditional methods applied in specialized cardiological clinics were supplemented by TCOM measurement using a PA-2 polarograph (Czech Rep.). Polarography revealed deterioration of TCOM parameters including permeability of hemocapillaries, adaptive reserves of the microcirculatory bed, and oxygen supply to the tissues. Amlodipine therapy demonstrated high antianginal potency of this drug and its ability to improve TCOM

[The long-term results of coronary artery bypass grafting in patients with type II diabetes].

A three-year follow-up of patients with coronary heart disease (CHD) and type II diabetes after coronary artery bypass grafting, shows that the following pathologic conditions are significantly more frequent: arterial hypertension, visceral obesity, marked disturbances of blood lipid spectrum, an increases CHD duration, and an increased rate of myocardial reinfarction and revascularizations. The study shows that the presence of diabetes mellitus in CHD patients undergoing coronary artery bypass grafting, is associated with pronounced disturbances in blood lipid spectrum, and is an important risk factor of coronary event progression.

[Influence of long-term therapy with enalapril on late postinfarction remodeling and functional state of the left ventricle in patients with diastolic heart failure.].

Enalapril (average dose 7,0+/-0.8 mg) was given for 12 weeks to 15 patients with preserved left ventricular (LV) systolic function who had survived large focal myocardial infarction small i, Ukrainian6 months before that. The use of enalapril was associated with 49% lessening of severity of clinical signs of heart failure (p<0.001) and 47% increase of tolerance to physical exercise. It also provided dose dependent 17.8% reduction of LV myocardial mass (p<0.05), normalization of initially "hypertrophic" type of transmitral flow, 21% lowering of LV end diastolic pressure (p<0.05) without effect on LV volume, geometry, global and local systolic function.

[Quality of life of patients with old myocardial infarction on prolonged therapy with atenolol].

The purpose of the study was to evaluate the influence of atenolol, a selective, beta1-adrenoblocker, on the quality of life (QL) of patients with old myocardial infarction (MI). The subjects of this 12-month open uncontrolled study were 40 male patients aged 29 to 59 years (mean age 46.8 +/- 1.19) suffering from functional class II-III stable exertional angina, which occurred 6 months after their first large-focal MI. QL was evaluated before and during the course of therapy (after 1, 3, 6, and 12 months) using EORTC QLQ CORE 30, short version of MMPI test, and Spielberg State-Trait Anxiety inventory. The patients received atenolol in effective doses selected on an individual basis (mean day dose was 67.9 +/- 4.2 mg) within one year; the study revealed increase of QL falling in all the categories of EORTC QLQ CORE 30, decrease of reactive and personal anxiety, as well as positive changes in averaged MMPI profile, which reflected lowering of anxiety and depression level in the actual psyche status.

[Effect of carvedilol on blood levels of cytokines and symptoms of heart failure in patients with postinfarction cardiac dysfunction.]. / Moduliruiushchee vliianie karvedilola na aktivatsiiu tsitokinov i regress serdechnoi nedostatochnosti u bol'nykh s postinfarktnoi disfunktsiei serdtsa.

Effect of 6 months treatment with carvedilol (25 mg/day) on blood levels of cytokines (interleukins 1alpha, 2, 6, 8, tumor necrosis factor alpha) and clinical symptoms of heart failure was studied in patients with cardiac dysfunction after myocardial infarction. Patients with NYHA class II heart failure, ejection fraction 50% and moderately lowered tolerance to physical exercise (n=21) initially had enhanced cytokine expression: blood content of interleukin (IL) 2 was 2.8 times, tumor necrosis factor (TNFalpha) 78%, IL-1alpha 60% above normal level. Therapy with carvedilol in this group was associated with decreases of Il-2 (-23.8%), TNFalpha (-16.7%), IL-1alpha (-12.5%) (p<0.05-0.01). This was accompanied by alleviation of clinical symptoms and improved exercise tolerance. Patients with NYHA class III heart failure (n=16) with low left ventricular ejection fraction (30+/-2.7%) and low exercise tolerance had high levels of all studied cytokines. Levels of IL-2, TNFalpha and IL-1alpha were most elevated (3.1, 2.8 and 2 times higher than normal values, respectively). Therapy with carvedilol was associated with improvement of clinical symptoms and exercise tolerance (+35%, p<0.05)), increase of ejection fraction (+15%, p<0.05), decrease of left ventricular end systolic volume (-17.5%, p<0.05), and lowering of blood levels of TNFalpha (-31%), IL-2 (-17.4%), IL-1alpha (-15.6%). However cytokine levels remained substantially elevated compared with normal values. Carvedilol was well tolerated, and did not cause negative metabolic effects or other complications.

[Depression of diurnal dispersion of sinus rhythm in patients after myocardial infarct]. / Depressiia sutochnoi dispersii sinusovogo ritma u bol'nykh, perenesshikh infarkt miokarda.

AIM: To study a relationship between reduced heart rate variability and ventricular ectopic activity in patients with coronary artery disease and also efficiency of atenolol in suppression of ventricular arrhythmias and increase of heart rate variability. MATERIAL AND METHODS: 32 men with stable angina of effort (functional class II-III) after the first myocardial infarction (mean age 52.9 years). 24-h ECG monitoring was carried out in 25 patients before and 3 weeks after treatment with atenolol in the dose 50-100 mg/day for 3 weeks. RESULTS: The mean standard deviation of the R-R intervals in 24 hours was much lower in patients with ventricular arrhythmias. In the majority of the patients with frequent ventricular premature beats (> 10 VPB/hour), the changes in vegetative homeostasis manifested mainly by activation of sympathetic nervous system. Atenolol given for 3 weeks to these patients proved effective. CONCLUSION: Low heart rate variability correlated with increased frequency of ventricular premature beats. Atenolol can be recommended for the treatment of such patients.

[State of lipid peroxidation, blood antioxidant defense in patients with myocardial infarction aggravated by circulatory insufficiency]. / Sostoianie perekisnogo okisleniia lipidov, antioksidantnoi zashchity krovi u bol'nykh infarktom miokarda, otiagoshchennym nedostatochnost'iu krovoobrashcheniia.

AIM: To study free radical processes in patients with myocardial infarction (MI) aggravated by heart failure. MATERIAL AND METHODS: Forty seven patients taken to the clinic within the first 5 hours of MI were examined. The patients were divided into 2 groups: 1) those with left ventricular failure-complicated IM (n = 25); 2) those with uncomplicated MI (n = 22). A control group included 17 apparently healthy males. The activity of lipid peroxidation (LPO) and blood antioxidative defense was determined in the patients' red blood cells prewashed off the plasma with saline solution at a temperature of 4 degrees C. RESULTS: The tension of free radical lipid oxidation mechanisms in patients with MI aggravated by circulatory insufficiency is followed by an increased antiradical activity. In patients with uncomplicated higher LPO activity is attended the less marked activation of antioxidative enzymes. The examinees were found to show a correlation of the global systolic function of the left ventricle with the concentration of LPO products and with the activity of antioxidative enzymes. CONCLUSION: More significant LP activation coupled with left ventricular systolic dysfunction was noted in patients with MI aggravated by acute heart failure.

[Antihypertensive and antiischemic effectiveness and safety of the AT1-receptor blocker irbesartranin arterial hypertension in patients with prior myocardial infarction]. / Antigipertenzivnaia i antiishemicheskaia effektivnost', bezopasnost' blokatora ATI-retseptora irbesartana pri arterial'noi gipertonii u perenesshikh infarkt bol'nykh.

Thirty males with prior myocardial infarction concurrent with arterial hypertension (AH) were examined to study the antihypertensive and antiischemic effects of the AT1-receptor blocker irbesartran. Group 1 comprised 12 (40%) patients with mild AH; Group 2 included 18 (60%) with moderate AH. In Group 2, the standard therapy with irbesartan in a single dose of 150 mg in the morning was supplemented by the beta1-adrenoblocker atenolol in the average daily dose of 31.25 mg. In Group 1 patients there were decreases in systolic blood pressure (SBP) by 28% and diastolic blood pressure (DBA) by 19% while in Group 2 receiving combined therapy with atenolol, SBP lowered on the average of 38.3 mm Hg of the baseline values and DBA became normal in 66.7% of the patients (p < 0.00). Thus, irbesartan provides good antihypertensive and antiischemic effects in patients with grade 1 AH; the combined therapy enhances the efficiency of treatment by 92% in patients with moderate AH.

[Anti-ischemic effects of trimetazidine in patients with post-infarction heart failure]. / Anti-ishemicheskaia éffektivnost' trimetazidina u bol'nykh s postinfarktnoi serdechnoi nedostatochnost'iu.

The antiishemic efficiency of course monotherapy with trimethazidine and its impact on myocardial perfusion were studied in patients with postinfarct dysfunction of the left ventricle (LV), which was associated with moderate heart failure (HF). This prospective controlled clinical study included 47 patients who had experienced myocardial infarction. The patients had also angina pectoris on exertion and NYHA Functional Classes (FC) II-III HF. The patients were randomized into 2 groups: Group 1 comprised patients with more than 50-W exercise tolerance (ET), FC II angina, and FC II HF; Group 2 consisted of those with 50-W or less ET, FC II-III angina, and FC II-III HF. Four-week course therapy with trimethazidine in a dose of 60 mg/day was found to exert a pronounced antiischemic effect in patients with reversible LV ischemia associated with HF. The tolerance of the drug during its 4-week course therapy was good and the drug caused no adverse reactions.