Selection of the optimal respiratory muscle training mode in patients with class II-III chronic heart failure.

Aim To study the effect of various types of respiratory muscle training (RMT) in patients with functional class (FC) II-III chronic heart failure (CHF) and more than 70% preserved diaphragm muscle mass.Material and methods 53 patients (28 men and 25 women) aged 50-75 years with NYHA FC II-III ischemic heart disease (IHD) and arterial hypertension with more than 70% preserved diaphragm muscle mass of >70% were randomized to one of four RMT types: static loads, dynamic loads, their combination, and breathing without applied resistance as a control. Peak oxygen consumption (VO2 peak) and maximum inspiratory pressure (MIP) were evaluated at baseline and in 6 months.Results All study groups showed significant improvement of physical endurance indexes compared to baseline values (р<0.05). In pairwise comparison, the groups significantly differed (р<0.01). The greatest improvement was observed for patients of dynamic and combined training groups. Furthermore, in the combined training group, results were significantly higher than in the group of isolated dynamic loads. The most significant (р <0.01), positive changes in the force of inspiratory muscles were observed in groups of dynamic and combined trainings with the best results displayed by patients of the combined training group.Conclusion With preserving more than 70 % of diaphragm muscle tissue (as determined by MIP >60 cm H2O), a combination of static and dynamic RMT is most effective for patients with FC II-III CHF.

[Prognostic role of body composition in patients with pneumonia associated with decompensated CHF].

AIM: To evaluate the effect of body composition on prediction of community-acquired pneumonia caused by Str. pneumoniae in patients with decompensated CHF. MATERIALS AND METHODS: The study included 216 patients. The pneumonia agent was identified by sputum culture. Body composition with determining lean body mass and fat mass was evaluated using a bio-impedance analysis; body mass index (BMI) was calculated. Patients with BMI 18.5-24.9 kg/m2 were included into the study. Statistical analysis of obtained data was performed using the IBM SPSS Statistics 20 software. RESULTS: The in-hospital mortality was 13.4 %; the one-year mortality was 29.6 %. Fat mass strongly, negatively correlated with a fatal outcome within a year, and the degree of lean body mass shortage moderately, positively correlated with the life span of patients. CONCLUSION: Body composition is significantly predictive for patients with decompensated CHF and community-acquired pneumonia caused by Str. pneumoniae.

[Malnutrition: from pathogenesis to current methods for diagnosis and treatment]. / Nedostatochnost' pitaniia: ot patogeneza k sovremennym metodam diagnostiki i lecheniia.

Progressive weight loss is a frequent companion to somatic pathology. The risk of death is known to increase dramatically among those with a body mass index of less than 19 kg/m2. Even mild weight loss in the presence of severe diseases can have a substantial impact on the course of the disease. The paper presents current views on malnutrition, its prevalence in the presence of various somatic diseases, and clinical significance. It describes the basic pathogenetic components of weight loss and the possible ways of correcting nutritional status. Particular emphasis is placed on the methods of nutritional support that is currently regarded as one of the most important components of a comprehensive approach to treating patients with chronic diseases. The authors give recommendations for the assessment of the nutritional status of patients in clinical practice and algorithms for their malnutrition management.

[First Open Study of Syndrome of Acute Decompensation of Heart Failure and Concomitant diseases in Russian Federation: Independent Registry ORAKUL].

Aim of the study was to assess mortality and rate of repetitive hospital admissions on days 30, 90, 180, 360, of observation as well as prevalence of concomitant diseases in patients with congestive heart failure (CHF). The register was formed in 41 centers of 20 cities of Russian Federation. Number of included patients with signs of chronic heart failure (CHF) was 2498. Data on 2404 was available for final analysis. Rehospitalization rate was 31, 11, 11, and 9.5% during 30 days, and during periods 31-90, 91-180, 181-360 days after discharge from hospital, respectively. Hospital mortality was 9%, 30 days and 1 year total mortality was 13 and 43%, respectively. Risk of death was most strongly affected by pneumonia, liver cirrhosis, and chronic kidney disease (mortality 49.5, 45.7, and 47.2%, respectively). Prognostic value of factors was ranked in the following order (descending): age, body mass index < 19 kg/m2, systolic blood pressure < 100 mm Hg, heart rate (HR) > 70 bpm, body temperature < 36.5 C. Each predictor was assigned weight of 1 point. Score 5 meant that risk of death with a high degree of probability approached 100%. Patients included into ORAKUL compared with those included in Euro HF register were more severely ill: in ORAKUL ejection fraction < 40% was observed 1.89 times more often, and more patients had "wet-cold" profile. Patients in ORAKUL had greater HR, smaller ejection fraction, lower glomerular filtration rate, and worse compliance to scientifically based treatment.

[First Open Study of Syndrome of Acute Decompensation of Heart Failure and Concomitant Diseases in Russian Federation: Independent Registry ORAKUL].

Aim of the study was to assess mortality and rate of repetitive hospital admissions on days 30, 90, 180, 360 of observation as well as prevalence of concomitant diseases in patients with congestive heart failure (CHF). The register was formed in 41 centers of 20 cities.

[Effects of aggressive therapy with simvastatin in patients with acute coronary syndrome and initially normal level of LDLP cholesterol on cardiovascular outcomes (LAOKOON). Pilot randomized trial].

AIM: To examine anti-inflammatory effect of statins on outcomes of acute coronary syndrome (ACS). MATERIAL AND METHODS: The trial included 211 ACS patients without ST elevation at ECG. The patients were followed up for 180 days. The anti-inflammatory action was studied for 30 days. The patients were divided into two groups by the treatment: simvastatin 10 mg + aspirin 325 mg (104 patients, group 1) and simvastatin 40 mg + aspirin 325 mg (107 patients, group 2) for 30 days. RESULTS: Simvastatin in maximal dose lowed LDLP cholesterol from 101 +/- 9.8 to 72 +/- 3.3 mg/dl, in a minimal dose--from 104 +/- 11.3 to 81 +/- 2.1 mg/dl (p < 0.05). Only maximal dose simvastatin produced a significant reduction of C-reactive protein (CRP) to the disease day 14. The integral index including all cases of cardiovascular death +acute myocardial infarction+progressive angina+rehospitalization was 70 scores for group 1 and 137 for group 2 (p = 0.047). CONCLUSION: Use of simvastatin in ACS patients, initially normal level of LDLP cholesterol and elevated level of CRP produced a dose-dependent effect, alleviated inflammation and improved the disease course.

[Change in secretion of somatotropic hormone and insulin in myocardial infarct]. / Izmenenie sekretsii somatotropnogo gormona i insulina pri infarkte miokarda

Twenty patients with myocardial infarction and 10 normal individuals were subjected to a carbohydrates tolerance test, and their secretion of insulin and somatotrophic hormone in response to intravenous injections of glucose was studied. The blood serum concentration of insulin and of somatotrophic hormone was determined by way of radio-immuno-assay, while the blood sugar concentration -- by the orthotoluidine technique. It is established that myocardial infarction, like other stress states, is accompanied by disorders in the function of the hypophysis and the adrenal glands, which, in turn, is accompanied by disorders in the secretion of insulin and of somatotrophic hormone.

[A non-invasive method of determining the severity of coronary insufficiency in various forms of ischemic heart disease]. / Neinvazivnyi sposob opredeleniia tiazhesti koronarnoi nedostatochnosti pri nekotorykh formakin ischemicheskoi bolezni serdtsa.

Myocardial pyrophosphate accumulation was examined in various forms of coronary heart disease. The status of the coronary reserve in the myocardial lesion foci where pyrophosphate is accumulated has been shown to determine the severity of coronary failure in various uncomplicated forms of the disease, such as angina without prior myocardial infarction, myocardial infarction in the early phase of its healing, and postinfarction cardiosclerosis. In postinfarction cardiosclerosis, the dimensions of such foci are significant in the development of clinical events of coronary failure.

[Prognosis of the clinical course of post-infarction cardiosclerosis on the basis of pyrophosphate-labeled myocardial scintigraphy]. / Prognozirovanie klinicheskogo techeniia postinfarktnogo kardioskleroza po dannym stsintigrafii miokarda s mechenym pirofosfatom.

Predictive value of myocardial 99mTc-pyrophosphate scintigraphy was assessed in 122 patients with postinfarction cardiosclerosis. In those cases where clinical and scintigraphic complication risk estimates considered, further evidence was shown to be redundant. Prognosis in patients with positive scintigraphic results and asymptomatic postinfarction cardiosclerosis or first-to-second class stable angina should take into account the size of myocardial pyrophosphate accumulation focus and the pattern of stress-induced changes in blood supply of the sites of myocardial damage. Negative scintigraphic results have no predictive value in those postinfarction cardiosclerosis patients who show clinical signs of heart failure and/or severe coronary insufficiency at the time of investigation.

[Clinical importance of 99mTc-pyrophosphate scintigraphy in the bicycle ergometry test]. / Klinicheskoe znachenie stsintigrafii s 99mTc-pirofosfatom pri veloérgometricheskoi probe.

The clinical value of myocardial scintigraphy with 99mTc-pyrophosphate in conjunction with bicycle ergometry was assessed through the correlation of the latter's results with the clinical course of coronary heart disease over 1 year in 21 patients with first myocardial infarction during its early healing stage and 17 anginal patients without a history of myocardial infarction. The disease ran a stable course at the time of the testing in all the patients; later on, 11 of those developed various complications associated with coronary heart disease, or died. Three scintigraphic recordings were made: prior to, at the peak of, and after the exercise. Thirteen scintigraphic patterns were identified. They are interpreted on the basis of presumed variation in the degree of myocardial damage and blood supply to affected areas under the effect of exercise; a relation is also noted with predicted risk of complications. The method has proved reliable in identifying patients at low risk for complications. Providing indirect evidence of the quality of blood supply to damaged myocardial areas during rationed exercise, it furnishes additional criteria for the assessment of the patients' working capacity.

[Means of differential diagnosis between angina pectoris and neurocirculatory dystonia]. / Sposob differentsial'noi diagnostiki stenokardii i neirotsirkuliatornoi distonii.

Plasma somatotropic hormone and cortisol were measured at rest, at the peak of physical stress and 2 hours after the discontinuation of exercise in 15 normal male subjects, 18 male patients with neurocirculatory dystonia and 69 with angina pectoris. The determination of one-dimensional hyperplanes of plasma STH and cortisol during and after exercise allows one to distinguish anginal patients from those with neurocirculatory dystonia and make a diagnosis in patients with nonspecified chest pains.

[Determination of the temporal characteristics of tracer transport in hemodynamics studies]. / Opredelenie vremennykh kharakteristik transporta indikatora pri issledovanii gemodinamiki.

A novel method designed for processing the findings obtained from radionuclide studies of hemodynamics is proposed. This technique is based on the establishment of the mean time needed for the transit of the indicator through the studied physiological structure which is done by determining its transport function. Temporal division of information concerning the right and left departments of the heart suggested by the authors for the preliminary processing of radiocardiographic data has a number of advantages over the current techniques. The application of the proposed method for interpreting radiocardiograms in 74 patients with compromised circulation showed that the determination of the mean time of the indicator transit whose magnitude alters significantly depending on the severity of the disease enables the objective evaluation of the state of the physiological system studied.

[Indicators of scintigraphy using technetium Tc 99m pyrophosphate in angina pectoris in relation to the activity of the pituitary-adrenal system]. / Pokazateli stsintigrafii s 99mTc-pirofosfatom pri stenokardii v zavisimosti ot aktivnosti sistemy gipofiz-kora nadpochechnikov.

The effect of exercise on the parameters of the scintigraphy of the myocardium with labelled pyrophosphate was studied in 35 patients with coronary heart disease and angina of effort and at rest with regard to the activity of the pituitary-adrenal cortex system. The functional status of this system was evaluated on the basis of data on the blood changes in somatotrophic hormone and cortisol. The use of a scoring system made it possible to identify four types of the pattern of the scintigraphic parameters. Type I and II of the pattern of the scintigraphic parameters indicating the normal ratios between the requirements of the cardiac muscle in oxygen and myocardial perfusion were characteristic of the patients with angina pectoris in the presence of an increased activity of the pituitary-adrenal cortex system. When the coronary heart disease patients with angina had a lower activity of this system, the authors more frequently recorded types III and IV of the pattern of scintigraphy which reflected a decreased perfusion and myocardial damage during exercise.

[Phenomenon of pyrophosphate accumulation in the prognosis of different forms of ischemic heart disease]. / Fenomen nakopleniia pirofosfata v prognoze razlichnykh form ishemicheskoi bolezni serdtsa.

The results of pyrophosphate 99mTc scintigraphy of the myocardium during exercise were compared with the parameters of the tolerance and adaptation to the load and the frequency of manifestations of myocardial ischemia during bicycle ergometry in relation to the prognostic value with regard to coronary heart disease (CHD) development. The studies involved 21 patients with myocardial infarction at the early recovery period and 23 CHD patients without a history of myocardial infarction. Manifestations of myocardial ischemia and the pattern of pyrophosphate build-up in the myocardium during exercise are approximately equally informative with regard to the prognosis of a high risk of complications in CHD patients. As regards the capacity to detect patients with a low risk of CHD complications, the finding of pyrophosphate 99mTc scintigraphy of the myocardium are more reliable than the electrocardiographic manifestations of myocardial ischemia or chest pain during bicycle ergometry. The parameters of the tolerance and adaptation to the load were found to be of little use in predicting CHD complications.

[99mTc-pyrophosphate scintigraphic indices during the bicycle ergometry test in myocardial infarct in the early phase of healing]. / Pokazateli stsintigrafii s pirofosfatom-99mTc pri veloérgometricheskoi probe u bol'nykh infarktom miokarda v rannei faze ego zazhivleniia.

Scintigraphy with 99mTc-pyrophosphate during bicycle ergometry has been undertaken in 32 patients with myocardial infarction in the early phase of its healing. There were 3 scintigraphic investigations: one during bicycle ergometry and two control ones - before and the day after the test. The determination of changes in the degree of 99mTc-pyrophosphate accumulation under the influence of the exercise in patients with myocardial infarction in the early phase of its healing permitted the authors to detect several variants in the time course of scintigraphic values. Drop or rise of concentration of the labelled pyrophosphate at the height of the bicycle ergometry test compared to the data obtained prior to it are apparently due to changed bloodflow in the focus of lesion during exercise. Changes in the character and intensity of accumulation of the radiodrug after bicycle ergometry can be explained in the majority of cases by increase of metabolic disorders in the myocardium, supervening during the exercise, and in some patients, possibly, to sustained decrease of bloodflow in the affected area of the cardiac muscle.

[Importance of pyrophosphate-99mTc scintigraphy in the diagnosis of acute myocardial infarct]. / Znachenie stsintigrafii s pirofosfatom-99mTc v diagnostike ostrogo infarkta miokarda.

Scintigraphy with pyrophosphate 99mTc was performed in 230 patients with various forms of ischemic heart disease and in 15 persons with pain in the region of the heart caused by osteochondrosis of the cervical and thoracic spinal segments or vegetovascular dystonia (control group). It was found that labelled purophosphate accumulated in the myocardium in necrosis of the heart muscle or when coronary insufficiency takes a course in which necrosis of the myocardial cells is quite possible. Positive results of scintigraphy with pyrophosphate 99mTc are not a strict criterion of acute myocardial infarction because they are also encountered in a chronic course of ischemic heart disease and are evidence in this case that "a state of risk" has occurred during the disease.

[Pyrophosphate-99mTc scintigraphy in stenocardia patients]. / Stsintigrafiia s pirofosfatom-99mTc u bol'nykh so stenokardiei.

The authors examined 166 patients with ischemic heart disease and attacks of angina pectoris and 21 healthy individuals. Scintigraphy, electrocardiography and tests for the activity of creatine phosphokinase and its MB fraction were carried out at rest, during physical exercise and 1--3 days after it. It was found that pyrophosphate-99mTc may accumulate in the myocardium both during the attack of angina pectoris and after its cessation. Angina pectoris may occur both with diffuse and with focal pyrophosphate-99mTc accumulation in the myocardium. Positive results of scintigraphy were encountered considerably more often in patients examined during physical exercise than in those examined at rest. Scintigraphic signs of angina pectoris which occurs under the effect of physical exertion develop less frequently, but persisted for a longer time than its electrocardiographic signs.

[Size of myocardial necrosis and left ventricular insufficiency in acute myocardial infarct]. / Velichina nekroza serdechnoi myshtsy i levozheludochkovaia nedostatochnost' u bol'nykh ostrym infarktom miokarda.

The dependence between the severity of cardiac insufficiency and the size of the necrotic lesion of the heart muscle, measured according to the area of 99m Tc-pyrophosphate cumulation and the rate of liberation of the isoenzyme MV creatine phosphokinase into the blood, was studied in 77 patients with myocardial infarction in the acute period of the disease. It was demonstrated that the severity of left ventricular insufficiency is directly dependent on the size of necrosis of the heart muscle. Not only the size of the necrotic focus but also the state of the contractility of the other parts of the myocardium is an important factor determining the origin and severity of cardiac insufficiency.

[Role of somatotropic hormone in the dystrophic syndrome of patients with chronic circulatory failure]. / Znachenie somatotropnogo gormona pri distroficheskom sindrome u bol'nykh s khronicheskoi nedostatochnost'iu krovoobrashcheniia.

Concentrations of somatotropic hormone (STH) in the blood were determined in 71 patients with varying degrees of chronic circulatory insufficiency and the dystrophic syndrome and in 12 healthy individuals. The degree of dystrophic changes in the body was evaluated by figures of the dry body weight. In 36 patients with severe circulatory insufficiency albumin metabolism was also studied. The results showed that the basal level of STH of the blood rises when chronic circulatory insufficiency supervenes and develops. No relationship between the degree of STH rise in the blood and dystrophic changes in body was found. A reverse correlation between the STH content in the blood and the size of the dry body weight in patients with enhanced breakdown of albumen suggests that in cardiac insufficiency STH plays a role in the adaptation of metabolism to the dystrophic process in the body, perhaps by stimulating the metabolism of fats.