[Disturbance of endothelium-dependent vasodilation and morphological changes of the radial artery in patients with coronary heart disease].

AIM: To elucidate whether endothelium-dependent vasodilation (EDVD) is a method of early diagnosis of endothelial dysfunction or is a sign of established morphological changes in the vascular wall. MATERIAL AND METHODS: Endothelialfunction was studied in 44 males with essential hypertension (EH) (mean age 46.9 +/- 0.9 years), in 52 patients with coronary heart disease (CHD) (mean age 50.0 +/- 0.9 years) after mammary-coronary and aortocoronary bypass operation with use of radial artery (RA), and in 28 healthy males (mean age 44.2 +/- 1.2 years). Intraoperative RA biopsy results for patients with ischemic heart disease after coronary artery bypass grafting with RA as an arterial graft were analysed. RESULTS: Patients with CHD showed thicker complex intima-media (TIM) of the common carotid arteries compared to control and hypertensive patients free of CHD clinical symptoms. This is associated with lowering of EDVD in RA and, therefore, suggests systemic occurrence of endothelial dysfunction. The histological study of RA has found hyperplasia of the internal vascular intima of 1.1 +/- 0.2 degree in 97% of CHD patients. Combination of CHD with hypertension showed thicker intima, higher index of intima thickness and RA narrowing percentage vs such parameters in CHD free of hypertension. CONCLUSION: Impaired EDVD in the test with reactive hyperemia is due to morphological changes in the radial artery, its intima. The degree of changes in endothelial vascular reactions in RA is closely related to severity of systemic atherosclerosis. In CHD, RA has a marked intimal hyperplasia which leads to vasospasticity and may result in development of stenosis in its use as a graft for myocardial revascularization. One of the basic factors influencing the degree of intimal hyperplasia of the radial artery is severity of arterial hypertension.

[Heat shock proteins 70 kD as a new marker of lesions to target organs in hypertension]. / Belki teplovogo shoka 70 kD--novyi marker povrezhdeniia organov-mishenei pri gipertonicheskoi bolezni.

The presence and concentration of the inducible form of heat shock proteins (Hsp70) were determined in blood serum of patients with hypertension (HT), stage II, including 28 males with stage II HT, who did not receive any antihypertensive therapy, and 10 healthy subjects. A higher Hsp70 content was found in blood serum of in patients with stage II HT. Such Hsp70 concentration was related with ECG signs of left ventricular hypertrophy and with the rennin content in blood. The findings of endothelium-dependent vasodilation (EDVD) of the radial artery did not differ within the examined groups. Still EDVD was reliable lower in patients with atherosclerotic plagues in the common carotid arteries. A reduced EDVD in the radial artery was attributed to a higher EDVD content in blood serum, which did not depend on a prescription or on an arterial hypertension severity. The results are indicative of that a higher inducible Hsp70 concentration in blood serum could potentially be a marker of lesions to target organs in HT; equally it could be of a certain significance in the atherosclerotic pathogenesis.

[Rheological properties of blood and endothelial function in patients with hypertensive disease]. / Reologicheskie svoistva krovi i funktsiia éndoteliia u bol'nykh gipertonicheskoi bolezn'iu.

Patients with hypertension are characterized by elevated platelet and erythrocytes aggregation and presence of relationship between rigidity of red blood cells and myocardial mass index. They also have increased number of leukocytes in peripheral blood, enhanced adhesive ability of neutrophils, increased representation of integrin receptors on lymphocytes and monocytes, and expression of Fas-receptors. These features evidence for augmented functional activity of leukocytes in hypertensive disease. Changes of rheological parameters of blood occur before impairment of vasomotor endothelial function. Augmentation of viscous properties of blood and functional activity of leukocytes aggravates hemodynamic disturbances in hypertension and can facilitate myocardial and vascular remodeling.

[Trimetazidine in correction of chronic heart failure in patients with ischemic heart disease]. / Trimetazidin v korrektsii khronicheskoi serdechnoi nedostatochnosti u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Twenty patients with NYHA class II-IV heart failure and ejection fraction below 40% received standard therapy (control period) or standard therapy plus open trimetazidine (20 mg t.i.d.) for 3 months in a cross-over design. Therapy with trimetazidine was associated with attenuation of clinical signs of heart failure (average NYHA class 2.90-/+0.10, 2.27-/+0.20 and 2.88-/+0.13, p<0.05, at baseline, after trimetazidine and control period, respectively), improvement of results of 6-minute walk test (average distance 321-/+19, 375-/+20 m, p<0.02, and 303-/+17 m at baseline, after trimetazidine and control period, respectively), increase of left ventricular ejection fraction (from 34.1-/+2.0 to 38.1-/+1.8%, p<0.05) and improvement of quality of life. Thus in patients with heart failure addition of trimetazidine to standard therapy for 3 months produced positive effect on clinical and hemodynamic status, exercise tolerance and quality of life.