[Endothelial dysfunction in patients with chronic heart failure, and possibilities of its correction with isosorbide-5-mononitrates].

Vascular endothelial dysfunction has been proven to play an important role in the development and progression of chronic heart failure (CHF). The influence of isosorbide-5-mononitrate monocinque on endothelial function in patients with NYHA II class chronic heart failure complicating the course of coronary artery disease (CAD) with II--III class stable exertional stenocardia was studied. Disturbances in endothelium-dependent vasodilation in a form of a lowered endothelial response to an increase in shift tension during reactive hyperthermia test were noted in patients with CHF complicating CAD. After 12 weeks of treatment with monocinque endothelium-dependent vasodilation normalized, which manifested by an increase in the vasodilating response of the brachial artery to stimulation with an increased flow from 8.2 +/- 1.3 to 11.1 +/- 1.0%. Monocinque administered in a day dose of 40 mg possessed antianginal activity in 85.7% of patients: the frequency of anginal attacks lowered by 59.3%, morphofunctional heart parameters improved which manifested by a 8.7% increase in ejection fraction. Side effects of monocinque, typical of nitrates, were noted in 17.9% of patients and did not require discontinuation of the therapy.

[On the use of statins in patients with chronic cardiac insufficiency].

Today, the necessity to use hypolipidemic agents belonging to the group of statins as means of primary and secondary prevention of coronary artery disease (CAD) and its complications is not doubted. The results of numerous large studies conducted in many different countries during the last 10 to 15 years confirm this statement. The appropriateness of statin application to patients with chronic cardiac insufficiency (CCI) is still under discussion, because there are no sufficient data on whether hypolipidemic therapy is able to improve the prognosis in this category of patients. The authors conducted a long-term research into the use of statins in combination with basic combined therapy in patients with CCI complicating the course of CAD. A reverse correlation between the levels of total cholesterol, low-density protein cholesterol, and the degree of CCI severity was demonstrated. Long-term continuous therapy of CCI patients with a combination of medications including statins did not worsen the clinical symptoms. However, hypolipidemic therapy should be administered to CCI patients on a differentiated basis, taking into account the initial state of lipid profile and the severity of the underlying disease.

[Efficacy and Safety of a Domestic Non-selective b-adrenoblocker Possibilities of the Use of Proxodolol in the Treatment of Patients With Chronic Heart Failure.].

Novel (made in Russia) nonselective b-blocker with a1-blocking properties proxodolol was given to 30 patients with ischemic heart disease, NYHA class II-III chronic heart failure (CHF) and left ventricular ejection fraction (LVEF) <40%. Methods of control included clinical examination, registration of hemodynamic and morphofunctional parameters of the heart. Proxodolol caused clinical improvement which appeared as reduction of signs of CHF and betterment of myocardial contractile function with 14% increase of LVEF according to data of echocardiography. Side effects of proxodolol were noted in 26.7% of cases and required withdrawal of the preparation in 6.7% of patients.

[Novel possibilities of antithrombotic therapy in patients with chronic heart failure].

Modern approaches to prevention of venous thromboembolic complications in patients with chronic heart failure are analyzed in this review which contains results of large studies of low molecular weight heparins. In MEDENOX trial the use of enoxaparin in medical patients was associated with 63% reduction of risk of thrombosis. The authors own experience showed that 2 weeks of therapy with enoxaparin in patients with chronic stage IIB-III heart failure caused significant lowering of soluble fibrin-monomer complexes, fibrinogen, and index of turbo-dynamic potential. These changes evidenced for decreased intravascular blood coagulation. Thus enoxaparin can be effectively used for prevention of thrombosis and thromboembolism in patients with chronic heart failure. Novel antithrombotic agents fondaparinux, idraparinux, ximelagatran, recombinant thrombomodulin are perspective medications for prevention of venous thromboses and embolism in medical patients.

[Specific features of cardiovascular diseases in patients with mono- and polygenic types of dyslipoproteinemia]. / Osobennosti serdechno-sosudistykh zabolevanii u bol'nykh s mono- i poligennymi tipami dislipoproteinemii.

Atherosclerosis as a key factor of cardiovascular morbidity and mortality is one of the most pressing problem of modern medicine. Most phenotypic deviations of serum cholesterol levels are genetically predetermined and the influence of environmental factors is much less. The vast majority of hereditary dyslipoproteinemia are polygenic. Monogenic disorders are seen in a small proportion of patients with atherosclerosis. However, they only emphasizes the carriage of alleles of the genes that determine various aspects of lipid genesis, transport, and predisposition to atherosclerosis. Virtually all primary dyslipoproteinemias appear as atherogenic types and they represent a special form of atherosclerosis. This fact affects the specific features of cardiovascular diseases in patients with hereditary hyperlipidemias. In these patients coronary heart disease as the most common manifestation of atherosclerosis occurs just in infancy, it is malignant and progressive and unresponsive to treatment. Furthermore, there is a drastic increase in the likelihood of a menacing and fatal complication, such as sudden death. For therapeutical and preventive purposes, these all factors make it necessary to perform a comprehensive early diagnosis of hereditary dyslipoproteinemias by using clinical, genealogical and routine studies, followed by correction of the disorders detected.

[Improving drug therapy in circulatory insufficiency: the role of renal kallikrein-kinin system]. / Optimizatsii farmakoterapii nedostatochnosti krovoobrashcheniia: rol' kallikrein-kininovoi sistemy pochek.

The renal kallikrein system was studied in 62 patients with coronary heart disease complicated by Functional Classes (FC) I-IV circulatory insufficiency and in 18 apparently healthy individuals. The activity of the renal kallikrein-kinin system was found to decrease in parallel to increases in FC: insignificantly in FC I circulatory disorders and significantly in FG II-IV. The use of captopril in the acute drug test in the first days and after fortnight therapy caused increases in renal kallikrein-kinin activity in patients with FC II-IV circulatory insufficiency and its decreases in FC I. The heterogeneous pattern of time courses of changes in the activity of the renal kallikrein-kinin system appeared in the clinical picture of the disease as captopril-induced hemodynamic and morphofunctional changes in the heart of patients with different FC circulatory insufficiencies.

[Effect of peripheral vasodilators on the local contractile function of the myocardium in patients with post-infarction cardiosclerosis]. / Vliianie perifericheskikh vazodilatorov na lokal'nuiu sokratitel'nuiu funktsiiu miokarda u bol'nykh postinfarktnym kardiosklerozom.

Echocardiography was used to explore regional myocardial contractility in 92 patients with postinfarction cardiosclerosis complicated by heart failure developed in the late postinfarction period. All the patients were shown to display regional myocardial contractile dysfunctions as hypo-, a-, and dyskinesia accompanied with hyperfunction of intact myocardial segments. The most severe asynergy was present in anterior postinfarction scars. Peripheral vasodilators were found to improve contractility in the hypokinetic and intact areas of the myocardium.

[Calcium antagonists in the treatment of ischemic heart disease]. / Antagonisty kal'tsiia v lechenii ishemicheskoi bolezni serdtsa.

Using clinical and instrumental findings, the therapeutic effectiveness, hemodynamic effects and tolerance of the three nifedipin derivatives adalate (FRG), corinfar (GDR) and fenigidin (USSR) were studied in 51 patients. The data provided by questioning, examinations and bicycle ergometric tests showed an antianginal effect in 68.5% of the patients treated with corinfar and adalate, and in 61% of those given fenigidin. The best response was observed in patients with angina of effort and those with the angiospastic variant of angina pectoris. The drugs were well tolerated and brought about an insignificant decrease in the arterial pressure and the pulse rate attended by no substantial hemodynamic alterations.

[Clinical, cardio- and hemodynamic effects of long- and short-acting beta-adrenergic blockers in the treatment of patients with stable stenocardia]. / Klinicheskie, kardio- i gemodinamicheskie éffekty neselektivnykh beta-adrenergicheskikh blokatorov prolongirovannogo i korotkogo deistviia pri lechenii bol'nykh stabil'noi stenokardiei.

Sixty-nine coronary heart disease patients with stable angina of effort of Classes II-IV of functional activity were studied for the effect of three nonselective beta-adrenergic blockers on the incidence and intensity of angina attacks, on the tolerance to exercise on the bicycle ergometer, as well as on the heart rate, arterial pressure, cardiac volumes and intracardiac hemodynamics using a complex of clinical and instrumental methods. It was proved that nadolol, pindolol and propranolol hydrochloride possessed similar anti-anginal effects but nadolol exerted the greatest negative chronotropic action while propranolol hydrochloride exerted a negative inotropic action. As regards the degree of the effect on cardiac volumes, corgard (nadolol) occupied an intermediate position between anaprilin (propranolol hydrochloride) and visken (pindolol).

[Pulmonary circulation in patients with different types of "hypertensive heart"]. / Malyi krug krovoobrashcheniia u bol'nykh s razlichnymi tipami "gipertonicheskogo serdtsa".

The comparison of clinical and instrumental findings of the state of pulmonary hemodynamics with respect to the type of "hypertensive heart" as determined by ultrasonic location of heart chambers, suggested that, in the absence of left-ventricular hypertrophy or in the presence of concentric myocardial hypertrophy combined with hyperfunction of this heart chamber and normal left ventricular size, increased diastolic pressure in pulmonary artery does not reflect left ventricular decompensation; rather, it is a consequence of increased vascular resistance in the pulmonary arterial system irrespective of its pathogenesis.

[Clinical and cardiohemodynamic effects of the new long-acting beta-blocker tobanum]. / Klinicheskie i kardiogemodinamicheskie éffekty novogo prolongirovannogo beta-adrenoblokatora tobanuma.

The effects of long-acting beta-adrenoblocker tobanum on the frequency and severity of anginal attacks, bicycle ergometry, echocardiographic parameters of intracardiac hemodynamics, pulse rate, arterial blood pressure were studied in comparison with the respective effects of the short-acting beta-adrenoblocker anaprilin and the long-acting beta-blocker corgard in 45 coronary patients with stable angina of functional classes I through IV. Tobanum produced antianginal effect in 82.2% of cases, and was well tolerated. The effect of one 5 mg pill set on later, as compared to anaprilin, and lasted longer (averaging 12 hours).

[Prazosin pharmacodynamics and pharmacokinetics in patients with myocardial infarct complicated by heart failure in the subacute period]. / Farmakodinamika i farmakokinetika prazozina u bol'nykh infarktom miokarda, oslozhnennym v podostrom periode serdechnoi nedostatochnost'iu.

Central hemodynamic parameters were monitored by invasive procedures (pulmonary arterial catheterization), and prazosin kinetics following the administration of a single 5 mg dose were determined in 69 patients with subacute myocardial infarction, complicated by heart failure. The response to prazosin was dependent on pretreatment hemodynamic parameters and differed between patients with early and manifest heart failure. There was a correlation between the peaks of hemodynamic change and drug concentration.

[Peculiarities of blood pressure rhythms and blood pressure variability in adolescents with hypertension (in accordance with twenty-four monitoring of blood pressure)]. / Osobennosti sutochnykh ritmov arterial'nogo davleniia i ego variabel'nosti u podrostkov s arterial'noi gipertenziei (po dannym sutochnogo monitorirovaniia AD).

Registration of 24-hour blood pressure in adolescents with and without hypertension revealed active participation of sympathetic nervous system in genesis of juvenile hypertension. Hypertension in adolescents was mainly systolic, blood pressure elevation as a rule was accompanied by accelerated heart rate and increased pulse pressure. Episodes of blood pressure elevations occurred mostly during day time. Desynchronization of 24-hour rhythms due to excessive nocturnal blood pressure lowering was found to be typical for this age group. More than two thirds of adolescents with episodes of blood pressure elevation had also 'white coat hypertension'.

[Dynamics of the echocardiographic indices of myocardial contractile function in chronic ischemic heart disease under treatment with blockaders of the cardiac beta-adrenergic receptors]. / Dinamika ékhokardiograficheskikh pokazatelei sokratitel'noi funktsii miokarda u bol'nykh khronicheskoi ishemicheskoi bolezn'iu serdtsa pri lechenii blokatorami beta-adrenergicheskikh retseptorov serdtsa.

The article discusses the results of dynamic echocardiographic examination of 46 patients with chronic ischemic heart disease before and after 15-day treatment with agents capable of blocking beta-receptors: propranolol (anaprilin), pindolol (visken), talinolol (cordan) which were prescribed in mean therapeutical doses. It is shown that agents blocking beta-adrenergic receptors lead to regular decrease in the indices of myocardial contractility. The character of changes in the volumetric characteristics of the left ventricle depends on the initial levels of arterial pressure and the degree of its dynamics during treatment with beta-adrenergic blocking agents. In patients with chronic ischemic heart disease developing against the background of hypertensive disease the dynamics of changes in the volumetric indices depends on the degree of arterial pressure reduction.

[Blood pressure 24-hour rhythms and variability in adolescents with hypertension]. / Osobennosti sutochnykh ritmov arterial'nogo davleniia i ego variabel'nosti u podrostkov s arterial'noi gipertenziei.

Twenty-four hour blood pressure (BP) monitoring was used for the study of BP 24-hour rhythms and variability in adolescents with hypertension and their normotensive counterparts. The data obtained evidenced for active participation of sympatho-adrenal system in genesis of juvenile hypertension: hypertension was predominantly systolic, BP elevation as a rule was associated with increased heart rate and pulse pressure. Episodes of BP elevation were registered mostly during day time. Desynchronization of 24-hour rhythms due to pronounced BP lowering during sleep characteristic for this age group found its reflection in values of nocturnal BP dipping. More than 1/3 of adolescents with episodes of elevated BP had 'white coat' hypertension.

[Cardiac function in transient coronary insufficiency after electrophoretic and injection methods of obsidan administration]. / Funktsiia serdtsa pri tranzitornoi koronarnoi nedostatochnosti v usloviiakh elektroforeticheskogo i in'ektsionnogo metodov vvedeniia obzidana.

The peculiarities of the preventive use of obsidan administered by injection and electrophoresis were studied in experiments on rats with a model of transitory coronary insufficiency. A high efficacy of obsidan was demonstrated irrespective of the route of its administration into the body. This was manifested by a decrease in the rate of cardiac contractions in intact animals and depression of hyperkinetic cardiac reaction in the initial period of myocardial ischemia. The unfavourable inotropic and the antiarrhythmic effects of the agent were less in electrophoretic administration than in injection.

[Hemodynamic changes in patients with myocardial infarct complicated by acute left ventricular failure during combined nitroglycerin and dobutamine therapy]. / Izmeneniia gemodinamiki u bol'nykh infarktom miokarda, oslozhnennym ostroi levozheludochkovoi nedostatochnost'iu, pri kombinirovannoi terapii nitroglitserinom i dobutaminom.

A total of 18 patients with acute myocardial infarction complicated by acute left ventricular failure were examined for their central hemodynamics. Intravenous nitroglycerin was shown to cause positive changes in central hemodynamic parameters, but it failed to normalize the hemodynamics in patients with baseline low blood pressure, as nitroglycerin induced a further reduction in blood pressure. A combined administration of nitroglycerin and dobutamine solutions contributes to hemodynamic normalization and is indicated for patients with acute myocardial infarction complicated by acute left ventricular failure at a baseline low blood pressure.

[Echocardiographic indices of cardiac function and systemic hemodynamics in patients with cardiac fibrillation paroxysms and their dynamics as affected by disopyramide phosphate]. / Ekhokardiograficheskie pokazateli funktsii serdtsa i sistemnaia gemodinamika u bol'nykh s paroksizmami mertsatel'noi aritmii i ikh dinamika pri vozdeistvii dizopiramida fosfata.

Clinical and echocardiographic studies in 25 chronic coronary patients with atrial fibrillation paroxysms following intravenous administration of 0.61-3.8 mg/kg Rhythmilen or its single oral dose (1.25-2.5 mg/kg), as well as during prolonged treatment with 400-600 mg Rhythmilen daily, demonstrated that their myocardial contractility parameters were reduced in the absence of an attack. Contractility parameters were not basically affected where the drug had no effect. Rhythmilen is an effective anti-arrhythmic agent: it arrests atrial fibrillation paroxysms in 73% and maintains the sinus rhythm when used preventively in 82% of cases.

[Modern aspects of nitro preparation use]. / Sovremennye aspekty primen eniia nitropreparatov.

On the basis of clinical examination and the results of bicycle ergometry and echocardiography in 58 patients with chronic ischemic heart disease the authors determined the contingent of patients in whom long-acting nitrates were most effective. The high clinical effectiveness of the agents in patients with symptoms of the initial stage of cardiac insufficiency is proved and the absence of any essential differences between long-acting nitrates in the character of their effect on hemodynamics is shown. It is established that nitroglycerin and long-acting nitrates cause a qualitatively similar effect on myocardial contractile function and intracardiac hemodynamics in patients with ischemic heart disease.

[Effect of blockaders of cardiac beta-adrenergic structures on the central hemodynamics and contractile function of the myocardium in acute experimental coronary insufficiency]. / Vliianie nekotorykh blokatorov beta-adrenergicheskikh struktur serdtsa na tsentral'nuiu gemodinamiku i sokratitel'nuiu funktsiiu miokarda pri ostroi koronarnoi nedostatochnosti v éksperimente.

The indices of central hemodynamics and myocardial contractile function were studied in 35 dogs before and in different periods after the administration of drugs which block beta-receptors: propranolol, pindolol, and talinolol. The drugs blocking the beta-adrenergic receptors were administered against the background of an intact myocardium to 15 dogs and against the background of acute coronary insufficiency to another 15; acute ischemia was induced in 5 dogs to which the drugs were not given. It was established that beta-adrenergic blocking agents have a beneficial effect in the acute stage of myocardial ischemia; they exert a marked influence on the consumption of oxygen by the myocardium, intramyocardial tension, and the contractile capacity and rhythm of the heart. Talinolol produced the most favourable effect.