[Cardio-Ankle Vascular Index and Subclinical Peripheral Atherosclerosis in Patients With Stable Coronary Artery Disease].

AIM: To study relationship between cardio-ankle vascular index (CAVI) and subclinical manifestations of noncoronary atherosclerosis in patients with stable ischemic heart disease (IHD). MATERIAL AND METHOD: We included into this study 511 patients with IHD examined within framework of a register of patients before aorto-coronary bypass surgery. CAVI was determined using VaSera-1000 device. RESULTS: We distinguished 2 groups of patients: (1) with abnormal (≥ 9.0, n = 128) and (2) normal (< 9.0, n = 383) CAVI. Group 1 compared with group 2 had high mean age (p = 0.02), comprised more women (p = 0.0016), hypertensive patients (p = 0.0061), patients with three vessel coronary disease, and patients with stenoses in carotid arteries. Multiple logistic regression analysis revealed independent association between elevated arterial stiffness and age. Elevated arterial stiffness was found in 25% of group 1 patients. Abnormal CAVI was associated with increased intima-media thickness and stenoses of carotid arteries but not with presence of stenoses in arteries of lower extremities.

[Predisposition to Psychological Distress in Patients After Coronary Bypass Surgery: Relation to One Year Prognosis].

AIM: to assess effect of type D personality (TDP) on one year prognosis after coronary artery bypass grafting (CABG). MATERIAL AND METHODS: Personality type was evaluated using the DS-14 scale in 683 patients before and in 1 year after CABG; 152 patients had TDP, 531 had not. After 1 year of follow-up we assessed functional class of angina and chronic heart failure, and registered cardiovascular complications (CVC): deaths, myocardial infarctions, strokes, amputations, thromboses of arteries of lower extremities, hospitalizations, requirements in repetitive angiographies of coronary grafts. Rate of development of combined end point comprising all these events was also evaluated. RESULTS: During follow-up CVC developed more often in patients with TDP compared with those without TDP (31.8 and 14.6%, respectively, =0.049). According to multifactorial regression analysis TDP was independently associated with 3.21 fold increase in risk of CVC. CONCLUSION: Detection of TDP after CABG is advisable for conducting subsequent interventions directed at improvement of long term results of treatment.

[Gender-specific features of the prevalence and clinical manifestations of multifocal atherosclerosis].

UNLABELLED: Multifocal atherosclerosis (MFA) has negative effect on prognosis in various groups of patients with cardiovascular diseases. However, gender-specific features of MFA are practically unexplored which provided a rationale for the present work. AIM: To study gender-specific features of MFA in patients with atherosclerosis of different localization. MATERIALS AND METHODS: 1018 patients examined and treated prior to planned surgical intervention on coronary arteries, carotid basin, aorta, and arteries of lower extremities. Group 1 included 193 women aged 59 = 69 (mean 63) years, group 2 was comprised of 825 men aged 53-63 (mean 57 years). All the patients underwent coronarography (CG). Analysis of MFA prevalence was made. RESULTS: The women were older than the men, they were more frequently overweight, suffered arterial hypertension and diabetes mellitus (p < 0.001), showed the higher left ventricular ejection fraction (p = 0.011). Smokers more frequently occurred among men (p < 0.001). CG revealed more lesions in a single vessel (p = 0.023) and less t lesions affecting three vessels (p = 0.015) in men. Signs of MFA were recorded in 28.0% of the men and 24.4% of the women (p = 0.306). Combined lesions of the coronary and carotid basins were more frequent in women (p = 0.048). Clinically significant stenosis of the coronary bed, aortoiliac segment or lower limb arteries occurred more frequently in men (p = 0.012). All three basins were more frequently affected in men (p = 0.061). CONCLUSION: MFA before planned cardiovascular surgery was diagnosed in 27.3% of the cases. Combined lesions in coronary and carotid arteries more frequently occurred in women and those in coronary and lower limb arteries in men (p < 0.05). Most risk factors (except smoking) are more frequently inherent in women in association with the enhanced frequency of three-vessel lesions affecting coronary arteries.

[Myocardial revascularization before abdominal aortic surgery in patients with ischemic heart disease].

We retrospectively analyzed 2 cohorts of patients treated in two clinics implementing different strategies of preoperative examination and lowering of perioperative cardiac risk. Patients in clinic 1 (group I, n=86, mean age 59.4+/-7.7 years) were subjected to coronary angiography (CAG) and if indicated - to preventive myocardial revascularization. In patients of clinic 2 (group II, n=95, mean age 54.3+/-6.5 years) only medical therapy was used. In group I CAG was performed in 90%, and myocardial revascularization - in 28% of patients. Total number of complications and hospital mortality were significantly higher in group II compared with group I (20 vs. 8%, p=0.023; 10.5 vs. 2.3%, =0.026). Myocardial infarction was the cause of 6 deaths (6.3%) in group II, while in group I there were no cardiac complications. Thus compared to control group strategy with routine CAG and preventive myocardial revascularization before abdominal aortic surgery was associated with less perioperative complications, myocardial infarctions, and lower mortality.

[Long-term survival after reconstructive surgery on non-coronary arteries in different age groups].

The study was aimed at assessing long-term survival after reconstructive surgery on non-coronary arteries in different age groups as well as the confounding factors. 469 case histories were analyzed retrospectively. The most patients underwent coronary angiography (CA) and preventive myocardial revascularization along with non-coronary artery exam. The mean follow-up period was 57.5 +/- 14.9 months. The groups were similar in terms of aspirin and statin therapy; however, older patients more often received beta-blockers and ACE inhibitors (p < 0.03). The number of patients who undergone CA increased with age (p = 0.002). Older patients had higher long-term mortality (p = 0.008) and poorer long-term survival (p = 0.001) as compared to patients below 60 years of age. The risk of death increased with age (OR 1.11; p = 0.001), in smokers (OR 2.79; p = 0.009) and in case of complications in the postoperative period (OR 4.09; p = 0.001). In turn, lower mortality was associated with CA and further preventive myocardial revascularization, if medical reasons (OR 0.15; p = 0.001). Thus, routine CA and preventive myocardial revascularization were associated with lower long-term mortality. This allows recommending an aggressive preoperative assessment to this category of patients.

[Effect of type 2 diabetes mellitus on extent of multifocal atherosclerosis in patients with ischemic heart disease].

Aim of the study was investigation of influence of diabetes mellitus (DM) on rate of detection of multifocal atherosclerosis (MFA) in patients with ischemic heart disease (IHD) at examination before coronary artery bypass grafting (CABG). We retrospectively analyzed 2411 hospital forms of patients with IHD subjected to CABG. DM was found in 317 patients (group 1). Control group (n=350) comprised patients of comparable sex and age without DM. Clinico-anamnestic data, parameters of coronary angiography, ultrasound and angiographic study of the aorta, brachiocephalic and peripheral arterial beds were compared between these groups. Patients with diabetes compared with patients of the control group more frequently had increased thickness of intima media complex (92 and 77%, respectively; p=0.0001). Simultaneous involvement of 2 or more arterial beds were detected in 46.1% of patients with DM and in 33.1% of control patients. Involvement of only one (coronary) arterial basin was more frequent in patients without DM (p=0.0001). Multifactorial analysis showed that independent effect on detection of MFA produced intima media thickness, presence of DM and history of acute disturbance of brain circulation. Thus among patients with IHD MFA before CABG was found in 46.1% of patients with DM and 33.1% of similar sex and age patients without DM. Patients with DM require focused examination for detection of manifestations of MFA and conduct of necessary curative and preventive interventions.

[Personality types in patients with atherosclerosis of different localization: prevalence and clinical features].

The aim of the work was to study the influence of D-type personality on clinical characteristics and extent of the pathological process in patients with atherosclerosis (AS) of different localization. A total of 943 patients (774 men and 169 women, mean age 58.6+-3 yr) were examined prior to arterial surgery. D-type personality was identified using a DS-14 questionnaire. The patients were divided into those with D-type personality (n=182) and without it (n=761). The following parameters were recorded: risk factors of AS, severity of clinical symptoms, history of myocardial infarction, acute cerebrovascular accidents, transitory ischemic attacks, concomitant pathology, and echocardiographic measuremnents. AS of non-coronary basins was diagnosed by color duplex scanning or angiograpgy. The number of affected vascular basins with stenosis of 30% or more arteries was detected. D-type personality was revealed in 19.3% of the patients with AS of different localization. It did not correlate with the social status, risk factors, and clinical symptoms. However D-type was associated with AS of extracranial arteries and combined lesions in several vascular basins as well as with the enhanced level of anxiety and depression and impaired quality of life.

[Prevalence of multifocal atherosclerosis in different age groups].

Aim of the study was to assess prevalence of lesions in several arterial beds in patients with atherosclerosis of various localization in the clinic of cardiovascular surgery. We examined 1018 patients (825 men and 193 women, aged 31-78 years, mean age 59+/-12 years) in the period of preparation to elective surgical interventions on coronary arteries or other arterial beds. All patients were divided into 4 age groups: group 1 - younger than 60 years (n=542), group 2 - 60-64 years (n=215), group 3 - 65-69 years (n=141), group 4-70 years and older (n=120). All patients were subjected to coronary angiography and Doppler ultrasound investigation (USI) of extracranial arteries. USI of arteries of lower extremities and angiography of peripheral arteries were carried out if indicated. Presence of 50% or greater stenosis was considered a criterion of involvement of an arterial vascular bed. Lesions in 2 or more beds were found in 321 patients (31.5%). Stenoses in 2 and 3 arterial beds were revealed in 24 and 3.5%, respectively, of patients in group 1, and in 31.8 and 10%, respectively, of patients in group 4 (p=0.008). Purposeful diagnostics of multifocal atherosclerosis in patients of the given category apparently should not be limited by older age groups.

[Impact of old age on risk of perioperative complications in non-coronary vascular surgery].

The objective of the study was to assess coronary arteries and the rate of perioperative complications in elderly patients undergoing non-coronary vascular surgery. 412 medical records of patients aged 60.8 +/- 8.5 years undergone non-coronary vascular surgery were analyzed retrospectively. All the patients had a coronary angiography and, if indicated, a preventive myocardial revascularization performed before a surgery. Patients who were over 70 years old had more often significant coronary stenotic lesions (64.5%) than those who were less than 60 years old (59.4%). A myocardial revascularization was significantly more often (p = 0.03) done for patients, who were less than 70 years old (32.7-36.5%), than for those aged over 70 years (14.5%). The groups did not differ in the frequency of beta-blockers, statins and ACE-inhibitors administration (p = 0.42). The groups were also similar in the rate of perioperative complications, including mortality rates. A preventive myocardial revascularization strategy in patients with significant coronary artery disease appears to be an essential stage in the treatment nondependent of the coronary artery disease clinical course. The age per se should not be a reason to refuse those patients in performing non-coronary vascular surgery.

[Role of coronary angiography in decreasing cardiac complications rate during vascular operations].

In order to assess the prevalence of coronary artery lesions in patients running various clinical risks of cardiovascular complications prior to surgical interventions on cardiac vascular basins, we performed a retrospective analysis of 392 case histories (340 men and 52 women, mean age 61.0±8.5 years). All patients in the preoperative period underwent coronary angiography (CAG). For the analytical purposes, the patients were subdivided into four groups. Group One (n=44) comprised patients without clinical risk factors, Group Two (n=184) was composed of those diagnosed as having one clinical risk factor. Group Three (n=122) comprised those with two clinical risk factors, and finally Group Four (n=42) was composed of those presenting with three and more clinical risk factors. CAG revealed that 91% of patients had coronary artery lesions. Haemodynamically significant lesions of three coronary arteries and/or stenosis of the left coronary artery trunk were observed in 15.6% of patients with no clinical risk factors of cardiac complications, in 19.0% of patients with one such factor, in 28.5% of those with two risk factors, and in 42.2% of patients with three and more risk factors. Preventive myocardial revascularization was performed in 22.7% of cases, more often in Group Three and Group Four patients. The number of postoperative complications in the groups did not differ significantly. The total hospital mortality rate was low (0.8%), with all 3 lethal outcomes observed amongst the patients with one clinical risk factor (1.6%). Hence, clinical preoperative stratification of the risk by means of the Lee index prior to vascular operations fails to reveal a considerable part of patients with prognostically unfavourable lesions of coronary arteries, and thus it should seemingly be used in this patient cohort with caution.

[Sarcopenia: prevalence, detection, clinical significance].

Population aging is a most important demographic process in the recent decades. The elderly subjects constitute an increasingly greater fraction of the patients staying at multifield hospitals. They are characterized not only by having multiple pathologies but also by age-related changes in peripheral tissues. These physiological changes may considerably aggravate the clinical conditions of the patients. One of the processes accompanying aging is sarcopenia or the loss of muscular mass leading to deterioration of the quality of life and physical independence, disablement and a poor life prognosis. Sarcopenia has been extensively studied in recent decades with reference to it social and economic consequences. At the same time the efficacy of measures designed to control sarcopenia is impaired by concomitant diseases and age-related changes in the muscular tissue. The problem of sarcopenia is insufficiently dealt with in the Russian-language literature despite its clinical significance. This review is intended for a wide circle of clinicians dealing with aged patients in their practical work.

[The PATRIARCH study: effect of passive training on long term treatment results with myocardial infarction].

In order to study long term results of passive training sessions in myocardial infarction in older patients with the use of electromyostimulation (EMS) of skeletal muscles (the PATRIARCH Study) we examined 94 patients with acute myocardial infarction (IM) older than 60 years. Among patients subjected to EMS training we distinguished groups with age 60-69 years (n=19) and older than 70 years (n=32). Control groups also contained patients aged 60-69 years (n=19), and older than 70 years (n=25). For training we used "Myorhythm-040" apparatus. During 2 hours of a training session we stimulated rectus muscle of abdomen, back extensors, buttocks, quadriceps muscle of thigh, muscles of calf. In hospital course of EMS led to improvement of strength and endurance of skeletal muscles in patients older than 70 years. Strength and endurance of skeletal muscles at discharge from hospital was among factors influencing 5 year survival of patients with MI in older age groups (together with Killip heart failure class and left ventricular ejection fraction). EMS facilitated improvement of results of treatment of patients of main group during 5 years of follow up. Effect on prognosis requires elaboration in studies with greater number of patients.

[Prevalence of distress and coronary behaviour in patients with atherosclerosis of various localization].

Prevalence of distressor personality traits and coronary behavioral type was studied in 943 patients (774 men and 169 women) with clinical forms of atherosclerosis of various localization. Intermediate behavioral type AB prevailed (69.9%), while types A (25.3%) and B (4.8%) were less frequent. Patients with type B more frequently had involvement of several vascular beds. They also had greater intima-media thickness, and lower left ventricular ejection fraction. Patients with type B behavior were characterized by higher level of distressor personality traits (<0.00001). Rate of type D personality in patients with type B behavior (44.4%) was higher than in patients with behavior types AB (21.7%) and A (8.3%). Reverse correlations were noted between pronouncedness of "coronary" behavior and number of involved vascular beds and the presence of distressor personality traits (personality type D, levels of depression and anxiety).

[The iodination degree of the thyroid gland colloid as the index of work performance]. / Stepen' iodirovaniia kolloida shchitovidnoi zhelezy kak pokazatel' urovnia rabotosposobnosti.

The iodination degree of the thyroid gland colloid of male dogs that underwent the regimen of multiple physical loads (PL) was estimated by authors by visualization of SH and SS groups by dioxydinaphtildisulphyde (DDD). The quantitative analysis of the iodination degree in the different groups of animals and the analysis of the spatial organization of the section (the central and peripheral zones) does not indicate reliable differences between them. TLPs, influencing the whole organism leads to the increase of the concentration of iodine in TG of animals, the function of the heart and respiratory system, the effective consummation of the peak of efficiency. The average optic density is a marker allowing to forecast the changes of TG in response to multiple PL.