[Correlation of lipemia level after fat loading with manifestation of atherosclerosis in coronary arteries]. / Sviaz' urovnia lipemii posle zhirovoi nagruzki s vyrazhennost'iu ateroskleroza koronarnykh arterii.

AIM: To examine relationships between lipemia, atherogenicity of blood lipoproteins spectrum after fat loading (FL) and severity of angiographic manifestations of coronary atherosclerosis. MATERIAL AND METHODS: The study enrolled 72 males free of ischemic heart disease (IHD)--group 1; 60 IHD patients with moderate affection of the coronary arteries (CA), i.e. maximal narrowing of one CA 50%--group 2; 107 IHD patients with severe CA affection, i.e. CA narrowing > 50%--group 3. FL was given by J. R. Patsch technique, blood sampling was made before meal, 3 and 6 hours after FL. RESULTS: It was shown that intake of food fats in IHD and IHD-free patients stimulated development of postprandial lipemia of different severity and duration. It appeared due to increased fraction of lipoproteins rich in triglycerides. In group 2 and 3 there was a definite and up to 6 hours in duration postprandial hypertriglyceridemia associated with proatherogenic deviations in lipid and protein components (LDL and HDL) by FL hour 6: growing of LDL cholesterol, apoB, apoB/apoAI and lowering of HDL cholesterol and apoAI. Patients with severe CA atherosclerosis (> 50% narrowing of three CA) had the most severe atherogenic affections in the postprandial lipoprotein spectrum. CONCLUSION: Postprandial lipemia/hypertriglyceridemia and atherogenic changes in the spectrum of lipoproteins after FL correlate directly with angiographic manifestations of coronary atherosclerosis.

Omega-3 fatty acids in adipose tissue and risk of myocardial infarction: the EURAMIC study.

Omega-3 fatty acids have potential antiatherogenic, antithrombotic, and antiarrhythmic properties, but their role in coronary heart disease remains controversial. To evaluate the association of omega-3 fatty acids in adipose tissue with the risk of myocardial infarction in men, a case-control study was conducted in eight European countries and Israel. Cases (n=639) included patients with a first myocardial infarction admitted to coronary care units within 24 hours from the onset of symptoms. Controls (n=700) were selected to represent the populations originating the cases. Adipose tissue levels of fatty acids were determined by capillary gas chromatography. The mean (+/-SD) proportion of alpha-linolenic acid was 0.77% (+/-0.19) of fatty acids in cases and 0.80% (+/-0.19) of fatty acids in controls (P=0.01). The relative risk for the highest quintile of alpha-linolenic acid compared with the lowest was 0.42 (95% confidence interval [CI] 0.22 to 0.81, P-trend=0.02). After adjusting for classical risk factors, the relative risk for the highest quintile was 0.68 (95% CI 0.31 to 1.49, P-trend=0.38). The mean proportion of docosahexaenoic acid was 0.24% (+/-0.13) of fatty acids in cases and 0.25% (+/-0.13) of fatty acids in controls (P=0. 14), with no evidence of association with risk of myocardial infarction. In this large case-control study we could not detect a protective effect of docosahexaenoic acid on the risk of myocardial infarction. The protective effect of alpha-linolenic acid was attenuated after adjusting for classical risk factors (mainly smoking), but it deserves further research.

[Symptomless myocardial ischemia: feasibility of diagnostic mistakes]. / Bessimptomnaia ishemiia miokarda: vozmozhnost' oshibochnoi diagnostiki.

AIM: To examine feasibility of ST segment depression on ECG in treadmill exercise test and 24-h ECG monitoring in subjects with coronarographically intact coronary arteries. MATERIALS AND METHODS: 9 males aged 41 to 52 years with chest pains unrelated to muscular load. They had neither stenosis of coronary arteries, nor arterial hypertension, valvular defects, disturbance of electrolyte metabolism. All of them have undergone treadmill exercise test and 24-h ECG monitoring. RESULTS: The exercise test provoked chest pain in none of the examinees. ST segment was depressed in one patient. 24-h monitoring registered depression of ST segment in one more patient. The rest 7 patients showed no changes in ST segment either in exercise test or 24-h ECG monitoring. CONCLUSION: It is confirmed that typical ischemic ECG changes (horizontal depression of ST segment) in healthy persons can occur and may be mistaken for silent myocardial ischemia.

Association between toenail selenium and risk of acute myocardial infarction in European men. The EURAMIC Study. European Antioxidant Myocardial Infarction and Breast Cancer.

The association between selenium status and risk of acute myocardial infarction was examined in a multicenter case-control study in 10 centers from Europe and Israel in 1991-1992. Selenium in toenails was assessed for 683 nonfatal male cases with first acute myocardial infarction and 729 controls less than 70 years of age. Median toenail selenium content was 0.553 microgram/g for cases and 0.590 microgram/g for controls. After adjustment for age, center, and smoking, the odds ratio for myocardial infarction in the highest quintile of selenium as compared with the lowest was 0.63 (95 percent confidence interval 0.37-1.07, p for trend = 0.08). The observed inverse trend was somewhat stronger when the authors adjusted for vitamin E status (p = 0.05). Analysis stratified for smoking habits showed an inverse association in former smokers (odds ratio for the 75th-25th percentile contrast = 0.63 (95 percent confidence interval 0.43-0.94)), but not in current smokers (odds ratio = 0.97 (0.71-1.32)) or in those who had never smoked (odds ratio = 1.55 (0.87-2.76)). Analysis stratified by center showed a significant inverse association between selenium levels and risk of myocardial infarction for Germany (Berlin) only (75th to 25th percentile odds ratio = 0.62 (95 percent confidence interval 0.42-0.91)), which was the center with the lowest selenium levels. It appears that the increased risk of acute myocardial infarction at low levels of selenium intake is largely explained by cigarette smoking; selenium status does not appear to be an important determinant of risk of myocardial infarction at the levels observed in a large part of Europe.

Association between beta-carotene and acute myocardial infarction depends on polyunsaturated fatty acid status. The EURAMIC Study. European Study on Antioxidants, Myocardial Infarction, and Cancer of the Breast.

Because antioxidants may play a role in the prevention of coronary heart disease by inhibiting the peroxidation of polyunsaturated fatty acids (PUFAs), the combined association of diet-derived antioxidants and PUFAs with acute myocardial infarction (MI) was investigated. This multicenter case-control study included 674 patients and 725 control subjects in eight European countries and Israel. Fatty acid composition and alpha-tocopherol and beta-carotene levels were determined in adipose tissue; selenium level was determined in toenails. For alpha-tocopherol no association with MI was observed at any PUFA level. The overall multivariate odds ratio (OR) for low (10th percentile) versus high (90th percentile) beta-carotene was 1.98 (95% confidence interval [CI], 1.39 to 2.82). The strength of this inverse association with MI was dependent on PUFA levels (in tertiles): for low PUFA, the OR for low versus high beta-carotene was 1.79 (95% CI, 0.98 to 3.25), for medium PUFA the OR was 1.76 (95% CI, 1.00 to 3.11), and for high PUFA 3.47 (95% CI, 1.93 to 6.24). For selenium increased risk was observed only at the lowest PUFA tertile (OR, 2.49; 95% CI, 1.22 to 5.09). This interaction between selenium and PUFAs was not significant and may at least partly be explained by a higher proportion of smokers at the low PUFA level. These findings support the hypothesis that beta-carotene plays a role in the protection of PUFAs against oxidation and subsequently in the protection against MI. No evidence was found that alpha-tocopherol or selenium may protect against MI at any level of PUFA intake.

Antioxidants in adipose tissue and risk of myocardial infarction: the EURAMIC Study.

Laboratory and epidemiological studies suggest that the antioxidants, vitamin E and beta-carotene, protect against coronary heart disease. In a European multicentre case-control study alpha-tocopherol and beta-carotene concentrations were measured in adipose-tissue samples collected in 1991-92 from 683 people with acute myocardial infarction and 727 controls. Mean adipose-tissue beta-carotene concentration was 0.35 microgram/g in cases and 0.42 in controls, with age-adjusted and centre-adjusted mean difference 0.07 microgram/g (95% confidence interval [CI] 0.04-0.10). Mean alpha-tocopherol concentrations were 193 micrograms/g and 192 micrograms/g for cases and controls, respectively. The age-adjusted and centre-adjusted odds ratio for risk of myocardial infarction in the lowest quintile of beta-carotene as compared with the highest was 2.62 (95% CI 1.79-3.83). Additional control for body-mass index and smoking reduced the odds ratio to 1.78 (95% CI 1.17-2.71); other established risk factors did not substantially alter this ratio. The increased risk was mainly confined to current smokers: the multivariate odds ratio in the lowest beta-carotene quintile in smokers was 2.39 (95% CI 1.35-4.25), whereas it was 1.07 for people who had never smoked. A low alpha-tocopherol concentration was not associated with risk of myocardial infarction. Our results support the hypothesis that high beta-carotene concentrations within the normal range reduce the risk of a first myocardial infarction. The findings for alpha-tocopherol are compatible with previous observations of reduced risk among vitamin E supplement users only. The consumption of beta-carotene-rich foods such as carrots and green-leaf vegetables may reduce the risk of myocardial infarction.

[The effect of maximal and submaximal physical loads on alimentary dyslipidemia]. / Vliianie maksimal'noi i submaksimal'noi fizicheskikh nagruzok na alimentarnuiu dislipidemiiu.

Short-term maximal and long-term submaximal regimens of physical exercise had been assessed for effect on serum lipoproteins in healthy subjects, in preclinical coronary heart disease (CHD) sufferers and in manifest CHD patients having food fat-induced lipemia. Fat loading caused hypertriglyceridemia in all the examinees. In healthy subjects it was associated with a rise in apo AI, while in CHD patients with relevant fall. Maximal exercise in preexisting alimentary hyperlipidemia provoked elevation of total cholesterol, triglycerides, LDL cholesterol, being atherogenic. Apo AI grew with a decrease in apo B/apo AI ratio in healthy subjects, in coronary patients apolipoprotein changes were of atherogenic origin. Prolonged submaximal exercise at the height of food lipemia resulted in lowering of total cholesterol, triglycerides and LDL cholesterol along with elevation of HDL cholesterol and apo AI both in healthy and coronary subjects evidencing anti-atherogenicity. It is noted that the response of lipids and apolipoproteins to fat and physical exercise loads was similar in subclinical and manifest CHD patients.

[The absence of stereoselectivity in propranolol uptake by the lungs]. / Otsutstvie stereoselektivnosti zakhvata propranolola legkimi.

Propranolol (P) is known to be actively captured by the lungs of experimental animal and man. To elucidate the mechanism of the phenomenon, the authors studied the P enantiomeric ratio in the serum from the left ventricle 0-10, 10-20 and 20-30 s after bolus injection of P (0.5 mg) into the pulmonary artery of 8 patients catheterized for coronary angiography. The total P concentrations and enantiomeric ratio were measured by non-stereoselective and stereoselective high performance liquid chromatography. The solid-phase extraction method was used for extracting P from the serum. It showed a small, but significant increase is S(-)/R(+) ratio (to 1.18 +/- 0.12, P < 0.05 vs 1) which was, however, almost the same when measuring this after adding P to serum of the same patients (1.11 +/- 0.05, P > 0.05 vs 1.18). Thus, propranolol uptake by the lung during a single passage is not stereoselective and hardly involves some active process.

[Study of left ventricular blood filling during post-pacing ischemia: comparison of Doppler echocardiography and heart catheterization]. / Izuchenie krovenapolneniia levogo zheludochka vo vremia poststimuliatsionnoi ishemii: sopostavlenie dannykh doppler-ékhokardiografii i kateterizatsii serdtsa.

Left ventricular blood filling was performed in 72 patients by using pulsed Doppler echocardiography at rest and in postpacing ischemia. In 10 patients, non-invasive examination findings were compared with the values of a left ventricular pressure curve which had been obtained in frequent atrial pacing. No changes in transmitral blood flow were found in patients without coronary heart disease, whereas 2 types of abnormal transmitral blood flow were detected in those with coronary heart disease in the postpacing period. The patients with Type I abnormal transmitral blood flow exhibited prolonged isovolumetric relaxation and slightly elevated left ventricular end-diastolic pressure in the postpacing period when catheterization was conducted. Those with Type I ("pseudonormal") transmitral blood flow displayed more prolonged relaxation and significantly (greater than 20 mm Hg) elevated end-diastolic pressure. The pattern of changes in transmitral blood flow was not pathognomonic to any definite myocardial abnormality, but reflected the hemodynamics.

[Stress-Doppler echocardiography in the diagnosis of ischemic heart disease in an ambulatory setting]. / Primenenie stress-Doppler-ekhokardiografii dlia diagnostiki ishemicheskoi bolezni serdtsa v ambulatornykh usloviiakh.

Coronary arteriography, bicycle ergometry and transesophageal atrial pacing (TAP) in combination with Doppler echocardiography (stress-Doppler echocardiography) were used to evaluate cardialgias in 30 outpatients. Stress-Doppler echocardiography showed a high (94%) sensitivity and a high (86%) specificity to detect coronary heart disease (CHD). There was a high correlation (r = 0.79, p less than 0.001) between the wall motion values obtained by echocardiography during TAP and coronary rating. The left ventricular (LV) diastolic filling (DF) was studied by pulsed wave Doppler echocardiography in the postpacing period. The Doppler-derived parameters of LV DF obtained in that period appeared to be moderately sensitive (75%) and specific (64%) in detecting CHD. In post-pacing ischemia, the "pseudonormalized" LV filling pattern was observed in 5 of 6 patients (sensitivity 80%) having three-vessel disease and major left (or equivalent) coronary stenosis.

[Complications and side effects of spinal anesthesia]. / Oslozhneniia i pobochnye éffekty spinal'noi anestezii.

Complication and side effects of spinal anesthesia have been studied in 2603 patients. The following complications of spinal anesthesia have been observed: transient and prolonged arterial hypotension; marked respiratory and circulatory depression; neurological consequences and early and late respiratory depression associated with intrathecal administration of narcotic analgesics. Side effects comprised vomiting, nausea, transitory urination disturbances, and itching. The dependence of the number of complications and side effects on the level of puncture, the patient's age and concentration of the anesthetic introduced into subarachnoidal space has been established.

[Possibilities of the questionnaire method for detection of the symptoms of preclinical stages of coronary arteriosclerosis and ischemic heart disease]. / Vozmozhnosti metoda oprosa v vyiavlenii simptomatologii doklinicheskoi stadii koronarnogo ateroskleroza i ishemicheskoi bolezni serdtsa.

A comprehensive study was made of 140 males aged 26-55 years who were divided into 3 groups: (1) 47 healthy individuals; (2) 67 subjects with early signs of coronary heart disease; and (3) 29 patients with coronary heart disease (Functional Class II). The pattern of chest pain was thoroughly analyzed by a specially developed questionnaire. The results were compared with the data obtained from an interview by Rose's questionnaire. The analysis demonstrated that neither Rose's questionnaire nor the detailed one specially developed by the authors identified subjects with preclinical coronary heart disease.

[Evaluation of subarachnoid anesthesia using local anesthetics in combination with morphine]. / Otsenka subarakhnoidal'noi anestezii mestnymi anestetikami v sochetanii s morfinom.

The efficacy of subarachnoidal anesthesia with lidocaine (trimecaine) in combination with small morphine doses was compared to anesthesia with lidocaine (trimecaine) alone. The analysis of the results obtained has demonstrated that the combination of local anesthetics (lidocaine, trimecaine) with minimum doses of narcotic analgesics (morphine) improves considerably the quality of anesthesia, enhancing the blockade of nociceptive impulsation from the operative area and ensures prolonged postoperative analgesia.

[Evaluation of the effectiveness of spinal anesthesia using lidocaine combined with morphine]. / Otsenka éffektivnosti spinal'noi anestezii lidokainom v sochetanii s morphinom.

Spinal anesthesia with 2% solution of lidocaine++ in combination with 1-1.5 mg of morphine is more effective as compared with an analogous method of anesthesia without a narcotic analgetic: it considerably increased the quality of the above mentioned analgesia at the expense of an increased blockade of nociceptive reactions and longer duration of the surgical stage of anesthesia and also results in continuous postoperative analgesia.