[Physical training at ambulatory-polyclinical stage in complex rehabilitation and secondary prevention of patients with ischemic heart disease after acute incidents. Effect on physical working capacity, hemodynamics, blood lipids, clinical course and prognosis (Russian cooperative study)].

AIM: To investigate efficacy of early and long term physical training (PT) of moderate intensity in conditions of practical health care in Russia in patients with ischemic heart disease (IHD) of able to work age - survivors of acute coronary events. MATERIAL AND METHODS: Three hundred ninety two patients were enrolled in this study. They were randomized into intervention group " O" (n=197) and control group " C" (n=195). Inclusion period was 3- 8 weeks from onset of myocardial infarction (MI), unstable angina (UA), or intervention on coronary arteries. Patients were followed up for 1 year and efficacy of intervention was assessed by results of laboratory (levels of lipids), instrumental (ECG, exercise test on veloergometer, echocardiography), and clinical examination. In the group " O" regimen of PT with work loads of moderate intensity (50-60% of power achieved during exercise test) was used. Duration of FT was 45 - 60 min, frequency - 3 times a week. All patients received standard therapy for IHD and a lipid lowering drug when indicated. RESULTS: Proofs of efficacy of PT in the given contingent of patients were obtained. This was manifested by significant increase of physical working capacity: prolongation of exercise time (+31.7%, p<0.001), increases of volume of work performed (+74.3%, p<0.001) and efficiency of cardiac work according to results of exercise tests. All parameters were significantly different from those in the group " C" . Structural functional parameters of the heart also improved in the group " O" : left ventricular (LV) stroke volume increased 4.5% (p<0.005), ejection fraction increased 7.2% (p<0.001), diastolic LV volume decreased 2.5% (p<0.05), systolic LV volume decreased 8.1% (p<0.001). In the group " C" stroke volume and LV ejection fraction rose to a lesser degree - by 5.5% (p<0.01) and 2.9% (p<0.05), respectively. Differences between groups in dynamics of these parameters turned out to be significant (p<0.05). Moreover in group " C" LV diastolic volume increased 2.3% (p<0.05) and systolic volume did not change, while left atrium increased 3.4% (p<0.002). At intergroup comparison differences in dynamics of these parameters were significant (p<0.005). Analysis of lipid profile after 1 year showed no changes in patients of group " C" , while in group " O" it revealed significant (3.6%) lowering of total (T) cholesterol (CH) (p<0.05 compared with baseline and change in group " C" ) and elevation of high density lipoprotein (HDL) CH (+12.3%, p<0.001; compared with group " C" p<0.005). Atherogeneity index TCH/HDLCH decreased 8.5% in the group " O" (p<0.01), and increased 12% (p<0.02) in the group " C" , difference between groups was statistically significant (p<0.001). In the group " O" body mass index decreased 2.8% (p<0.001), and frequency of attacks of angina decreased 50.8% (p<0.001; compared with group " C" p<0.001). Statistically significant differences were registered between the following parameters of composite end point and surrogate points: total number of cardiovascular events - 26 (14.8%) vs 47 (27%), p<0.01; number of cardiovascular catastrophes - 5 (3%) vs 15 (8.7%), p<0.05; number of days out of work because of exacerbation of IHD per 1 person/year - 2.4 vs 4.2, p<0.05 in groups " O" and " C" , respectively. Thus in the group " O" positive effect of PT on the course and outcomes of the disease was registered compared with the group " C" . CONCLUSION: The data obtained are indicative of sufficient efficacy of the used program of PT and feasibility of its application in practice of ambulatory rehabilitation of patients with IHD - survivors of acute coronary events. It also can be looked upon as a method of secondary prevention as results of the study showed its positive impact on risk factors and outcomes of the disease.

[Correction of nitrogen metabolic disorders in the myocardium in experimental ischemia]. / Korrektsiia narushenii azotistogo obmena v miokarde pri ego éksperimental'noi ishemii.

Coronary occlusion was carried out in 58 dogs in an acute experiment and the content of ammonia and urea was studied in venous blood draining directly from the zone of ischemia. Early increase in the concentration of free ammonia in the zone of ischemia was revealed. The administration of l-aspartic acid, potassium asparaginate, magnesium asparaginate, and glutamic acid led to intensification of urea-producing processes in the myocardium and reduction in hyperammoniemia and the degree of ischemic damage to the myocardium.

[Effect of nitroglycerine on cerebral blood flow and central hemodynamics in patients with chronic heart failure]. / Vliianie nitroglitserina na mozgovoi krovotok i tsentral'nuiu gemodinamiku u bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu.

The study of the cerebral and central hemodynamics by tetrapolar and chest rheography in 53 patients with various stages of chronic heart failure has shown that the intravenous injection of nitroglycerin exerts a marked vasodilating peripheral effect in patients with pronounced cardiac failure while having no significant influence on cardiac output. The cerebral blood flow increases following nitroglycerin injection which permits recommending the drug for use to improve the cerebral hemodynamics in patients with severe forms of cardiac failure.

[The nondrug treatment of hypertension patients by their adaptation to periodic hypoxia in a barochamber]. / Nemedikamentoznoe lechenie bol'nykh gipertonicheskoi bolezn'iu metodom adaptatsii k periodicheskoi gipoksii v usloviiakh barokamery.

Patients with essential hypertension were exposed to periodic hypoxia in a pressure chamber. It is shown that adaptation to periodic hypoxia results in improvement of general condition of patients who exhibited a decline in blood pressure, minute blood volume, serum sodium concentrations as well as better microcirculation and tissue oxygen tension. Reduced concentrations of total serum cholesterol and atherogenic index were achieved in hypercholesterolemia patients. The changes obtained permitted reduction of hypotensive maintenance treatment. In view of positive results in hypertensive subjects, adaptation to periodic hypoxia in a pressure chamber is recommended for inclusion into combined regimens of hypertension therapy.