[Progression of Chronic Heart Failure: Prognostic Criteria and Non-Drug Prevention].

PURPOSE: to study frequency of progression of chronic heart failure (CHF), to develop multifactorial models for evaluation of risk of progression, and measures of non-drug secondary prevention of CHF. MATERIALS AND METHODS: We included in this study 531 patients with functional class (FC) I-III CHF (FC I - n=254, FC II - n=255, FC III - n=22). Examination included clinical-instrumental, clinical-functional, and laboratory (with determination of NT-proBNP concentration) investigations, use of the AUDIT and Morisky Green questionnaires. RESULTS: Rate of CHF progression for 24 months was 11.7 % (FC I - 16.1, FC II - 7.8, FC III - 4.5 %). Irrespective of FC significant factors of CHF progression were history of myocardial infarction, and low adherence to treatment. Additional prognostic criteria of increase of CHF FC I to FC II were age >74 years, excessive body mass, disturbance of carbohydrate metabolism, arterial hypertension, and frequent intake of alcohol. FC II CHF progression was associated with such factors as type 2 diabetes, 3­degree arterial hypertension, permanent atrial fibrillation, and smoking. Using these prognostic criteria, we developed multifactor models, based on which scales for assessing the risk of FC I and II CHF progression were created. These models demonstrated high accuracy of prognosis and good reproducibility (on independent test samples of patients with CHF FC I and FC II prognostic accuracy was 86.3 и 85.5 %, respectively). We also developed a program of secondary non-drug prevention of CHF progression,  with inclusion of structured dynamic education of patients with organization of control and self-control of knowledge quality. After this therapeutic education progression CHF in high risk patients was 2.2 %. CONCLUSION: Complex application of scores for evaluation of risk of FC I-II CHF progression and the program of secondary non-drug prevention determined lowering of frequency of increases of class of CHF severity from 11.7 to 2.2 %.

[CARDIOPROTRECTIVE EFFECT OF REMOTE POSTCONDITIONING: MECHANISMS AND POSSIBILITIES OF CLINICAL APPLICATION].

Experimental data indicate that postconditioning at a distance is an effective method for cardiac protection against reperfusion injury. Remote postconditioning prevents reperfusion necrosis and apoptosis of cardiomyocytes, decreases a probability of postinfarction remodeling of the heart. Cardioprotective effect of remote postconditioning depends on the release of tissue factor(s) increasing cardiac tolerance to long-term ischemia-reperfusion after transient ischemia. Clinical investigations show that postconditioning at a distance is an effective method for the prevention of reperfusion injury of the heart during coronary artery bypass surgery.

[Neuroprotective and nephroprotective effects of remote postconditioning: Prospects for clinical use]. / Neiroprotektornyi i nefroprotektornyi éffekty distantnogo prekonditsionirovaniia. Perspektivy klinicheskogo primeneniia.

The results of experimental and clinical studies strongly suggest that remote ischemic preconditioning (RIP) has no neuroprotective effect during cardiac surgery performed under extracorporeal circulation. Remote preconditioning (RP) has no neuroprotective effect in hemorrhagic stroke. A randomized multicenter study is needed to evaluate the efficiency RIP in patients with ischemic stroke. RP reduces the severity of ischemia/reperfusion kidney injury during transplantation. RIP has been established to prevent contrast-induced nephropathy. There is a need for a multicenter trial to evaluate the efficiency of RIP in patients with abdominal aortic aneurysm repair. Analysis of the presented data indicates that RIP fails to prevent cardiorenal syndrome in infants and children during cardiac surgery. The data available in the literature on the capacity of RIP to provide nephroprotective effect in patients after coronary artery bypass surgery are discordant and indicative of the advisability of a multicenter study.

[Antioxidant status and glutathione redox potential of erythrocytes in patients with acute coronary syndrome].

Indicators of oxidative stress (OS), systemic inflammation, metabolism and redox status of glutathione (GSH) were investigated and compared in patients with ST-segment elevation myocardial infarction on electrocardiograms (STEMI), and patients with unstable angina (UA). The elevated and decreased myeloperoxidase level, superoxide dismutase activity, and moderate increased plasma levels of interleukin-6, while maintaining the antioxidant potential, were found in Group 1. Disorders in pro-/antioxidant balance and systemic inflammatory response were manifested in UA. Increased GSH concentration (and total GSH) in erythrocytes has been established for STEMI patients and the decreased GSH for UA patients. Thus, a significant shift of erythrocytes redox to oxidization and increase (unlike STEMI patients) of glutathione peroxidase activity were recorded. Mechanisms of the pro- and antioxidant functions of red blood cells in acute coronary syndrome are considered. The role of red blood cell glutathione to provide more oxidized intravascular environment for S-glutathionylation and optimization of redox signaling in target cells is pronounced.

[Perspective of use of agonists of adenosine and opioid receptors for prevention of reperfusion damages of heart. Analysis of experimental and clinical data].

In Russia inhospital lethality after acute myocardial infarction is 16.5-16.7%. The part of patients perishes even after recanalisation of infarct-related coronary artery as a result of reperfusion cardiac injury. Experimental data indicate that adenosine receptor agonists and opioids can prevent reperfusion damages of heart that is mimic postconditioning phenomena. Data of clinical observation show that adenosine during intravenous infusion or intracoronary administration during thrombolysis or percutaneous coronary intervention exert infarct reducing effect and eliminate manifestation of of "no-reflow" phenomenon. Clinical data indicate that morphine is able to prevent cardiac reperfusion injury in human. Thus, analysis of published data testifies that adenosine and opioid receptor agonists can be prototype for development of drugs for prophylaxis of reperfusion heart injury.

[Cardioprotective effect of remote postconditioning: mechanisms and possibility of clinical application].

Experimental data indicate that postconditioning at distance is an effective method of cardiac protection against reperfusion injury. Remote postconditioning prevents reperfusion necrosis and apoptosis of cardiomyocytes, decreases probability of postinfarction remodeling of the heart. Cardioprotective effect of remote postconditioning is depended on release from tissues after transient ischemia of humoral factor(s) increasing cardiac tolerance to long-term ischemia-reperfusion. Clinical studies show that postconditioning at distance is an effective method of prevention of reperfusion injury of the heart during coronary artery bypass surgery.

[Trigger mechanism of adaptive phenomenon of ischemic heart postconditioning].

Analysis of published data indicates on trigger role of protons, adenosine, opioids, bradykinin, calcitonin gene-related peptide, nitric oxide, epoxyeicosatrienoic acid, reactive oxygen species, hydrogen sulfide in ischemic heart postconditioning. It is shown that B-type natriuretic peptide, transforming growth factor-beta1, cardiotrophin-1, urocortin, acetylcholine, insulin and carbon monoxide can mimic postconditioning phenomenon.

[Changes in hypophyseal-thyroid system function and in the level of atrial natriuretic factor and cyclic nucleotides in the blood of patients with ischemic heart disease exposed to ultrasonic irradiation of the precordial area]. / Izmeneniia sostoianiia gipofizarno-tireoidnoi sistemy, urovnia predserdnogo natriiureticheskogo faktora, tsiklicheskikh nukleotidov v krovi bol'nykh ishemicheskoi bolezn'iu serdtsa pod vozdeistviem ul'trazvukovogo oblucheniia prekordial'noi oblasti.

Radiation of the precordial region with ultrasound at 880 kHz, 0.4 W/cm2 for 12 minutes was examined for its impact on blood levels of thyrotropin, tri-iodothyronine, thyroxine, atrial natriuretic factor, cyclic nucleotides (cAMP and cHMP) in 70 patients with Functional Classes II-III exercise-induced angina. The radiation was found to lead to elevated plasma levels of atrial natriuretic factor, cHMP and inhibited plasma cAMP in patients with coronary heart disease as compared to the control group.

[Changes in the levels of atrial natriuretic factor, aldosterone, cyclic nucleotides and beta 2-microglobulin in patients with myocardial infarction after ultrasonic therapy]. / Izmenenie urovnia predserdnogo natriureticheskogo faktora,al'dosterona tsiklicheskikh nukleotidov i beta 2-mikroglobulina u bol'nykh infarktom miokarda pod vliianiem ul'trazvukovogo vozdeistviia na serdtse.

A total of 43 patients were examined: 21 patients with large myocardial infarction (MI) and 22 donors. In MI patients without signs of left ventricular failure, the level of atrial natriuretic factor was higher than that in the controls, which resulted in inhibition of aldosterone production; whereas in those with the signs, it was slightly lower than that in healthy individuals. All the patients with MI were found to have elevated blood plasma levels of cyclic nucleotides and beta 2-microglobulin. Ultrasound application to the heart was demonstrated to normalize secretion of atrial natriuretic factor, to increase plasma cyclic nucleotide levels and to produce no effects on beta 2-microglobulin quantities.