[The role of diastolic transthoracic stress echocardiography with incremental workload in the evaluation of heart failure with preserved ejection fraction: indications, methodology, interpretation. Expert consensus developed under the auspices of the National Medical Research Center of Cardiology, Society of Experts in Heart Failure (SEHF), and Russian Association of Experts in Ultrasound Diagnosis in Medicine (REUDM)].

Diagnosis of heart failure with preserved ejection fraction (HFpEF) is associated with certain difficulties since many patients with HFpEF have a slight left ventricular diastolic dysfunction and normal filling pressure at rest. Diagnosis of HFpEF is improved by using diastolic transthoracic stress-echocardiography with dosed exercise (or diastolic stress test), which allows detection of increased filling pressure during the exercise. The present expert consensus explains the requirement for using the diastolic stress test in diagnosing HFpEF from clinical and pathophysiological standpoints; defines indications for the test with a description of its methodological aspects; and addresses issues of using the test in special patient groups.

[Angiotensin converting enzyme activity in the clinical course and forming of cor pulmonale in patients with chronic obstructive pulmonary diseases].

The aim of the study was to evaluate the influence of ACE in various biological media (blood, sputum, and lung tissue) on the clinical manifestations and morphofunctional cardiac variables in 137 patients with chronic obstructive pulmonary disease (COPD), of whom 17% had mild, 70% had medium, and 13% had severe degree of the disease according to Federal program, 1999. Seventy percent of the patients had stage II pulmonary hypertension according to Paleyev, 1986, while the number of patients with stage I and III was 14 and 16%, respectively. Circulatory insufficiency was mild (NYHA I to II) in 124 patients, and medium (NYHA III) in 13 patients only. The results of the study demonstrate that COPD exacerbation is accompanied by an increase in ACE activity, mostly in the lung tissue, induced sputum (IS), and, to a lesser degree, in blood serum; ISA CE activity is almost the same as that in the lung tissue. The study established a direct correlation between IS ACE activity and the level of C-reactive protein, an inflammatory process activity marker, and a reverse correlation between IS ACE activity and respiratory function variables, the latter characterizing bronchial obstruction. The study shows a strong direct correlation between IS ACE activity and the degree of right ventricular (RV) and left ventricular (LV) hypertrophy, as well as diastolic function disturbances according to RV isovolumetric relaxation time and LV early diastolic filling delay time. There is a strong reverse correlation between IS ACE activity and the disbalance of the ratio of blood flow velocities during early and late diastolic ventricular filling. The study found no significant correlations between ACE activity and the variables of ventricular systolic function. The study demonstrates a significant role of ACE activity changes in the progression of obstruction, inflammation, and myocardial remodeling.

[Clinical and hemodynamic efficacy of selective beta-blocker bisoprolol and cytoprotector trimetazidine in the treatment of chronic cardiac failure in patients with ischemic heart disease]. / Kliniko-gemodinamicheskaia éffektivnost' selektivnogo beta-blokatora bisoprolola i tsitoprotektora trimetazidina pri lechenii khronicheskoi serdechnoi nedostatochnosti u bol'nykh ishemicheskoi bolezn'iu serdtsa.

AIM: To assess the effect of a long-term (6 months) treatment with selective beta-blocker bisoprolol, cytoprotector trimetazidine and their combination on the clinical course, left ventricular morphofunctional parameters and quality of life of patients with ischemic heart disease (IHD) with chronic heart failure (CHF) functional class III-IV. MATERIAL AND METHODS: A total of 71 IHD patients with CHF (FC III-IV) entered the study. In group 1 basic therapy was combined with bisoprolol, in group 2--with trimetazidine, in group 3--with bisoprolol + trimetazidine. The initial dose of bisoprolol was 1.25 mg with subsequent dose titration to individually tolerated. Trimetazidine was given in a dose 20 mg 3 times a day. Clinical tests and echocardiography parameters were assessed monthly. RESULTS: CHF functional class decreased in all the groups. End diastolic and systolic volumes of the left ventricle reduced, while ejection fraction increased. The best treatment results were achieved in combination of bisoprolol with trimetazidine (LV EF increased by 42.6%, while Ve/Va decreased by 59%). CONCLUSION: Clinicohemodynamic benefit obtained after long-term administration of bisoprolol, trimetazidine and their combination in IHD patients with CHF (Fc III-IV) justifies inclusion of these drugs as monotherapy and combined treatment of CHF in IHD.

[Potentialities of cytoprotection in the treatment of chronic heart failure in patients with coronary heart disease]. / Vozmozhnosti tsitoprotektsii v lechenii khronicheskoi serdechnoi nedostatochenosti u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The study was undertaken to evaluate the effects of long-term (6-month) therapy with the selective beta-blocker bisoprolol, the cytoprotector trimetazidine and their combination on the clinical course of disease, the morphofunctional parameters of the left ventricle (LV) and life quality in 71 patients with coronary heart disease (CHD) concurrent with functional classes (FC) III-IV chronic heart failure (CHF) (ejection fraction (EF) < 35%, as evidenced by echoCG). In Groups 1, 2, and 3, basic therapy was supplemented by bisoprolol, trimetazidine, and bisoprolol plus trimetazidine, respectively. The initial dose of bisoprolol was 1.25 mg with its subsequent titration to an individually tolerable. Trimetazidine was given in a dose of 20 mg thrice daily. The patients' clinical status and echoCG were monthly assessed. There was a decrease in FC of CHD in all the groups, a reduction in LV end diastolic and systolic volumes, and an increase in shortening faction, LV EF, and an improvement of LV diastolic function. There was evidence that it should be expedient and safe to use the cytoprotector trimetazidine in the treatment of CHF in patients with CHD. In patients with CHD concurrent with CHF, therapy using a combination of bisoprolol and trimerazidine was found to have the most pronounced impact, which yielded the maximum clinical and hemodynamic effect (LV EF increased by 42.6% of the baseline values, the rate of early and late ventricular diastolic filling decreased by 59% of the baseline values). The revealed regularities of the positive effect on the clinical and hemodynamic parameters of long-use of bisoprolol, trimetazidine, and their combination in patients with CHD concurrent with FC III-IV CHF show it expedient to include these drugs and their combination into therapy for CHF that develops in the presence of CHD.