[Physical training at ambulatory-polyclinical stage in complex rehabilitation and secondary prevention of patients with ischemic heart disease after acute incidents. Effect on physical working capacity, hemodynamics, blood lipids, clinical course and prognosis (Russian cooperative study)].

AIM: To investigate efficacy of early and long term physical training (PT) of moderate intensity in conditions of practical health care in Russia in patients with ischemic heart disease (IHD) of able to work age - survivors of acute coronary events. MATERIAL AND METHODS: Three hundred ninety two patients were enrolled in this study. They were randomized into intervention group " O" (n=197) and control group " C" (n=195). Inclusion period was 3- 8 weeks from onset of myocardial infarction (MI), unstable angina (UA), or intervention on coronary arteries. Patients were followed up for 1 year and efficacy of intervention was assessed by results of laboratory (levels of lipids), instrumental (ECG, exercise test on veloergometer, echocardiography), and clinical examination. In the group " O" regimen of PT with work loads of moderate intensity (50-60% of power achieved during exercise test) was used. Duration of FT was 45 - 60 min, frequency - 3 times a week. All patients received standard therapy for IHD and a lipid lowering drug when indicated. RESULTS: Proofs of efficacy of PT in the given contingent of patients were obtained. This was manifested by significant increase of physical working capacity: prolongation of exercise time (+31.7%, p<0.001), increases of volume of work performed (+74.3%, p<0.001) and efficiency of cardiac work according to results of exercise tests. All parameters were significantly different from those in the group " C" . Structural functional parameters of the heart also improved in the group " O" : left ventricular (LV) stroke volume increased 4.5% (p<0.005), ejection fraction increased 7.2% (p<0.001), diastolic LV volume decreased 2.5% (p<0.05), systolic LV volume decreased 8.1% (p<0.001). In the group " C" stroke volume and LV ejection fraction rose to a lesser degree - by 5.5% (p<0.01) and 2.9% (p<0.05), respectively. Differences between groups in dynamics of these parameters turned out to be significant (p<0.05). Moreover in group " C" LV diastolic volume increased 2.3% (p<0.05) and systolic volume did not change, while left atrium increased 3.4% (p<0.002). At intergroup comparison differences in dynamics of these parameters were significant (p<0.005). Analysis of lipid profile after 1 year showed no changes in patients of group " C" , while in group " O" it revealed significant (3.6%) lowering of total (T) cholesterol (CH) (p<0.05 compared with baseline and change in group " C" ) and elevation of high density lipoprotein (HDL) CH (+12.3%, p<0.001; compared with group " C" p<0.005). Atherogeneity index TCH/HDLCH decreased 8.5% in the group " O" (p<0.01), and increased 12% (p<0.02) in the group " C" , difference between groups was statistically significant (p<0.001). In the group " O" body mass index decreased 2.8% (p<0.001), and frequency of attacks of angina decreased 50.8% (p<0.001; compared with group " C" p<0.001). Statistically significant differences were registered between the following parameters of composite end point and surrogate points: total number of cardiovascular events - 26 (14.8%) vs 47 (27%), p<0.01; number of cardiovascular catastrophes - 5 (3%) vs 15 (8.7%), p<0.05; number of days out of work because of exacerbation of IHD per 1 person/year - 2.4 vs 4.2, p<0.05 in groups " O" and " C" , respectively. Thus in the group " O" positive effect of PT on the course and outcomes of the disease was registered compared with the group " C" . CONCLUSION: The data obtained are indicative of sufficient efficacy of the used program of PT and feasibility of its application in practice of ambulatory rehabilitation of patients with IHD - survivors of acute coronary events. It also can be looked upon as a method of secondary prevention as results of the study showed its positive impact on risk factors and outcomes of the disease.

[Exercise in outpatient complex rehabilitation and secondary prophylaxis in patients with ischemic heart disease after acute coronary events (a cooperative trial in Russia)].

AIM: To assess efficacy of early and long-term exercise in patients with ischemic heart disease (IHD) after acute coronary events (acute myocardial infarction--AMI, unstable angina--UA, coronary artery bypass grafting--CABG) in wide outpatient medical practice of Russia. MATERIAL AND METHODS: Three to eight weeks after the acute coronary event (ACE) 373 patients from different clinics of RF regions were randomized into two groups: the study group (n = 188) and a control one (n = 185). Both groups received standard therapy, the study group performed also a special exercise program (moderate exercise for maximum 1 hour 3 times a week for a year). The efficacy of the treatment was assessed by clinical, device and biochemical findings during 6-month follow-up. RESULTS: Physical work capacity, total amount of performed work (PW) in stress test rose in the study group by 26.5% (p < 0.01) and 59.4% (p < 0.01), respectively; HRmax and BPSmax x HRmax increased by 6.4 and 9.8%, respectively, p < 0.01); PW/Hrpeak rose by 48.6% (p < 0.01), PW/DP peak--by 45.9% (p < 0.01). Left ventricular ejection fraction increased by 5.6% (p < 0.05), LV stroke volume--by 3.4% (p < 0.05). In 6 months, controls demonstrated a 4.7% (p < 0.05) rise in HDLP cholesterol, total cholesterol lowered in the study group by 6.4% (p < 0.01), body mass index--by 1.9%, number of anginal attacks--by 0.9%. CONCLUSION: The proposed exercise program is effective and can be applied in outpatients after acute coronary events. The program can be also used as a method of secondary prophylaxis as it lowers total cholesterol, atherogenic index and body mass index.

[The antioxidant ceruloplasmin: its effect on lipid peroxidation, blood rheology and the course of stenocardia]. / Antioksidant tseruloplazmin: vliianie na perekisnoe okislenie lipidov, gemoreologiiu i techenie stenokardii.

Lipid peroxidation, antioxidant system and hemorheology were studied in the course of ceruloplasmin treatment given to 47 patients with ischemic heart disease (IHD). Coupled changes in the above systems seem to be involved in pathogenesis of IHD variants. Ceruloplasmin effectively inhibits lipid peroxidation, corrects hemorheological disorders, improves IHD running.

[Metabolism of several blood prostaglandins in patients with angina pectoris during helium-neon laser therapy]. / Metabolizm nekotorykh prostaglandinov krovi u bol'nykh so stenokardiei na fone gelii-neonovoi lazernoi terapii.

The paper shows the high therapeutical efficiency of combined He-Ne laser therapy in patients with coronary heart disease. Its effect on the thromboxane-prostacyclin system is one of the mechanisms of laser impact. The combined He-Ne laser therapy promotes normalization of the level of thromboxane B2 and its ratio to the metabolite prostacyclin.

[Lipid peroxides and the hemostatic system in myocardial infarct complicated by arrhythmia]. / Perekisi lipidov i sistema gemostaza pri infarkte miokarda, oslozhnennom narusheniiami ritma serdtsa.

A comprehensive study of the levels of lipid peroxidation products and hemostatic parameters was made in 73 patients with various clinical courses of myocardial infarction by using current clinical and laboratory techniques. The patients were demonstrated to have a substantial increase in lipid peroxides and in the activity of glutathione peroxidase, an antioxidative enzyme, which was accompanied by hemostatic disorders. The biochemical changes revealed reflect the severity of the disease and may promote the occurrence and deterioration of cardiac arrhythmias in patients with myocardial infarction.

[The role of lipid peroxides and blood rheological disorders in the pathogenesis and clinical course of ischemic heart disease]. / Rol' perekisei lipidov i gemoreologicheskikh rasstroistv v patogeneze i klinicheskom techenii ishemicheskoi bolezni serdtsa.

Combined assessment of primary and secondary products of lipid peroxidation, functional activity of red cells has been conducted in 130 patients with ischemic heart disease running different courses. Lipid peroxidation was found enhanced both in the whole blood and red blood cells. Blood rheology got abnormal. It is shown that lipid peroxides are involved in damaging erythrocytic membrane structure and function, thus promoting the progression of ischemic heart disease.

[Thrombocytic-vascular hemostasis at rest and under physical loading in patients with ischemic heart disease]. / Trombotsitarno-sosudistyi gemostaz v pokoe i pri fizicheskoi nagruzke u bol'nykh ishemicheskoi bolezn'iu serdtsa.

There was a relationship of the degree of imbalance between thromboxane and prostacyclin, prostaglandins (PG) F2 alpha and E1 in patients with coronary heart disease concurrent with stable angina pectoris. A significant increase in the levels of thromboxane and PGF2 alpha was found with relative prostacyclin and PGE1 deficiency during graded exercise at the moment of transient myocardial ischemia; the imbalance significantly increased as exercise tolerance decreased. Transient myocardial ischemia induced by transesophageal left atrial pacing revealed unidirectional changes in plasma PG, as did exercise.