[Assessment of the quality of medical assistance for patients with acute ST elevation coronary syndrome for 2009-2010 in regions of the Russian Federation participating in the "vascular program" (by the data of the Russian ACS Register)].

AIM: To assess quality of medical assistance for patients with acute ST elevation coronary syndrome (aSTeCS) for the period from 2009 to 2010 in 23 administrative regions of the Russian Federation (RF) realizing the "vascular program". MATERIAL AND METHODS: We analysed management of aSTeCS patients treated in the regional vascular centers and/or primary vascular departments of 23 administrative regions of the RF for the period from January 1, 2009 to January 1, 2011. Mean age of the patients was 64 (56-75) years, 65.8% were males. For the above period computer medical information was available for 45407 acute coronary syndrome (ACS) patients, of them the diagnosis of aSTeCS was in 17514 patients. RESULTS: We found that most aSTeCS patients seek medical advice late, prehospital aspirin was prescribed only in 50-60% cases. Thrombolytic therapy (TLT) was performed, on the average, in 22 and 27% cases in 2009 u 2010, respectively A definite positive trend in TLT administration in 2009-2010 was seen only in 5 regions. In 2010, frequency of TLT conduction was below the evarage for all the sample in 8 regions of the RE Procedures of urgent percutaneous coronary intervention (UPCI) in 2009 were made, on the average, in aSTeCS patients, in 2010--in 22,6%. A positive trend in application of UPCI in aSTeCS patients was registered in 9 RF regions. The number of UPCI procedures under 100 in 2010 was seen in 5 RF regions. CONCLUSION: CS Register provided data on application of high-tech treatment and pharmacotherapy in 2009 u 2010 in medical institutions of 23 RF regions realizing "vascular program".

[Assessment of dynamics of the autonomic cardiovascular system regulation based on low-frequency rhythm synchronization in patients with ischemic heart diseases complicated by myocardial infarction treated with metoprolol].

AIM: To develop a procedure for assessing the adequacy of metoprolol use in patients with coronary heart disease (CHD) on the basis of synchronization of 0.1-Hz rhythms in cardiac rhythm variability (CRV) and vascular blood filling in the microcirculatory bed (MCB). Materials and methods. 43 patients with CHD (age 63 +/- 8 years), who had sustained myocardial infarction about 6 months before, were examined. Synchronous registration of ECG and a pulsogram were made during an orthostatic test before and after therapy with metoprolol in the maximum tolerable doses during 3 months. The presence of synchronization of 0.1-Hz rhythms identified from a series of R-R intervals and the pulsogram was determined from the difference of phases; the total percent of synchronization (S) was estimated. RESULTS: The authors identified 2 groups of CHD patients: those with positive (n=21) and negative (n=16) orthostatic S, trends during treatment. The groups were matched by major clinical characteristics. There was an inverse relationship between the values of S, in the lying and standing position prior to or following treatment. It is suggested that there is the optimum range of 0.1-Hz rhythm synchronization values in the cardiovascular system during beta-blocker therapy in patients with CHD. CONCLUSION: There is a possibility applying an objective approach to assessing the adequacy of metoprolol treatment in CHD patients on the basis of synchronization of 0.1-Hz fluctuations in variations CR V and vascular blood filling in MCB.

[Assessment of the state of myocardial contractility based on analysis of heart rate variability during exercise tests].

AIM: To elucidate stability of 0.1 Hz component of heart rate variability (HRV) spectrum in patients with different state of myocardial contractile function during bicycle exercise tests under controlled breathing with 10 sec period. MATERIAL: Male patients with class II-III effort angina and either abnormal myocardial contractile function (n=45, age 51.0+/-2.5 years, left ventricular ejection fraction <50%), or without disturbances of myocardial contractility (n=35, age 52+/-6 years, ejection fraction > 60%). METHODS: All patients underwent Doppler echocardiography and submaximal exercise tests with initial loads 25 W. Registration of series of RR-intervals was done during controlled breathing with 10 sec periods (0.1 Hz) for 5 min at rest and exercise (25 W work load). Depth and balance of phases of controlled breathing were similar to those of spontaneous breathing. Analysis of the heart rate variability was made on the basis of auto-regression algorithm. RESULTS: Stability of 0.1 Hz component of the heart rate variability spectrum to low-level exercise correlated with the severity of depression of myocardial contractility.