[Early physical rehabilitation after elective percutaneous coronary interventions during incomplete revascularization: exercise regimen calculation by ergospirometry].

AIM: To evaluate the efficiency and safety of outpatient physical exercises (PE), calculated using ergospirometry (ESM) in patients in the early periods after elective percutaneous coronary interventions (PCI) during incomplete coronary bed revascularization. SUBJECTS AND METHODS: Three hundred and eighty-three patients were screened. The trial enrolled the patients after elective PCI in its early periods (3 to 14 days) who had signed an informed consent document to participate in the investigation and who could perform themselves PE at home or visit the medical center. Patients with angioplasty complications (myocardial infarction, severe hematomas, major bleeding, etc.) who had standard contraindications to exercise testing and PE were excluded. The patients included in the trial (n = 50) were divided into 2 groups: (1) 21 patients who had undergone incomplete revascularization; (2) 29 patients who had complete revascularization. The authors estimated exercise endurance by ergospirometry before the investigation, 8 weeks after a course of exercises, and following 6 months and assessed quality of life (QL) using the SF-36 questionnaire. A physical rehabilitation program was elaborated for all the patients according to exercise test results. During the trial, all the patients were allocated to groups of home and clinic exercises using exercise bikes. Medical control of the patients who were exercising at home was made by their telephone conversation, control visits to the medical center at least once monthly, and their concurrently keeping an exercise diary in which each training (duration, intensity), health status, and blood pressure were recorded. The patients could consult their physician at any time if required. RESULTS: In the incomplete and complete revascularization groups, VO2 max increased by 6 and 15%, respectively. Following 6 months, no additional increment in VO2 max was seen in the study groups. According to SF-36 data, QL improved in patients in both groups after 8 weeks and remained at the same level after 6 months. CONCLUSION: An early time course of exercises only in combination with regular medical control has a positive impact on exercise tolerance and QL and preserves its efficiency for at least 6 months regardless of the degree of revascularization.

[Predictive value of cardiopulmonary exercise testing in various categories of patients with chronic heart value].

AIM: To specify the prognostic value of parameters of cardiopulmonary exercise testing (CPET) in patients with chronic heart value (CHF) on optimal medical treatment depending on gender, age, left ventricular ejection fraction (LVEF), cardiac rhythm and achievement of target respiratory exchange ratio (RER) > or = 1.0. MATERIALS AND METHODS: 111 patients (83 male, mean age 60.6 +/- 12.8 years) with CHF NYHA class I-III on optimal treatment were included in the study. One third had preserved EF, 27.9%--permanent atrial fibrillation (AFib). Average followup was 19.4 +/- 9.6 months. Prognostic value of CPET indices and Heart Failure Survival Score (HFSS) for cardiovascular mortality (CVM) and combined endpoint including CVM or CHF hospitalization were evaluated using logistic regression analysis. RESULTS: CVM amounted 14.4%, combined endpoint was observed in 46.8% of patients. HFSS had the highest predictive value for CVM (in all subgroups of patients) and for combined endpoint (except patients with AFib). In men, patients younger than 65 years, with reduced LVEF and with Afib CVM was also related to ventilatory indices (VE/VCO2, ventilatory class and PetCO2 peak), and combined endpoint was related to VO2peak and its derivativatives. Only HFSS and VE/VCO2 had prognostic value for CVM in patients with AFib. Ventilatory parameters were associated with combined endpoint in all subgroups except Afib. Blood pressure response and heart rate recovery had prognostic significance only in patients with sinus rhythm. Target RER > or = 1.0 was achieved only in 40.5% patients. In patients with RER < 1.0 significant relationship between VO2 peak and combined endpoint was observed. CONCLUSIONS; Heart Failure Survival Score, VE/VCO2, ventilatory class and PetCO peak are the strongest predictors of cardiovascular mortality and heart failure hospitalizations in all subgroups of patients with CHF. CPET has the highest significance for men, age < 65 years, patients with LVEF < 45% and sinus rhythm. In these subgroups VO2 peak and Weber class have predictive value for decompensation of CHF whether RER > or = 1.0 or not. Blood pressure response and heart rate recovery have prognostic significance only in patients with sinus rhythm.

[Apical hypertrophic cardiomyopathy associated with HCV infection].

A case is reported of a female patient with apical hypertrophic cardiomyopathy with negative chest T waves associated with HCV infection.

[Interval training in patients with chronic heart failure].

Training sessions with constant level of work load are most often used in cardiological rehabilitation. They are beneficial in secondary prevention of ischemic heart disease and to some or other extent are familiar to practical physicians. At the same time interval training appearing as sequence of short periods of high and low intensity work or pauses are rarely used due to their relative novelty. This variant of training has advantages and can be a method of choice for patients with CHF. In this review we summarized data on interval training available at present, considered problems of methodology, efficacy, and safety of this training, compared its various parameters with those of training with loads of continuous intensity.

[Cardiorehabilitation of patients with stable ischemic heart disease: compliance with treatment].

AIM: To study correlation between compliance with treatment (attendance of training sessions) and clinical symptoms in patients with ischemic heart disease (IHD) in the course of 12-week program of physical training. MATERIAL AND METHODS: Ergospirometry before and after training was performed in 71 patients with stable IHD (21.1% females, 78.9% males, mean age 56.5 +/- 10.0 years) for estimation of exercise intensity and efficacy. A total of 36 training sessions were conducted for 12 weeks. Compliance with treatment was assessed by attendance of training sessions. RESULTS: A direct correlation was found between the attendance and duration of IHD (r = 0.364), number of cardiovascular complications (r = 0.526), functional class of angina pectoris (r = 0.643), plasma cholesterol (r = 0.475). Negative correlation was seen between the attendance and age of the patients (r = 0.327), body mass (r = 0.311), systolic arterial pressure at rest (r = 0.756), VO+AEA-2 peak by ergospirometry before training (r = 0.543) and time of walk to the clinic (r = 0.711). No correlation was found between the attendance and gender of the patients (r = 0.107). CONCLUSION: Some clinical features of patients with stable IHD which may indicate low compliance with treatment were identified. These features should be taken into consideration for optimization of cardiorehabilitation programs based on dose-adjusted loads.

[Chronic dyspnea in cardiological patients: prevalence and etiology].

The authors analyzed the medical records of 1414 patients aged 60 +/- 14 years, who were examined in a specialized cardiological clinic within a one-year period. Among the patients, 41.2% complained of dyspnea; the number of women with dyspnea prevailed over the number of men. Dyspnea was caused by chronic heart failure in 42.2% of patients, by transient myocardial ischemia in 12.3% of patients, and by paroxysmal tachyarrhythmia in 6.3% of patients. In 45.6% of the patients, mostly in women, significant non-cardial factors were revealed: obstructive or restrictive respiratory failure (20.6%), obesity (14.7%), thyroid gland dysfunction (3.9%), pulmonary arterial thromboembolism, anemia etc. A combination of two or more etiological factors took place in 22.6% of cases. The reason for respiratory discomfort remained unclear in 21.3% of the patients, mostly women. Symptom-limited load test with gas analysis (ergospirometry) was performed in 70 patients with dyspnea of unclear origin. According to its results, in 75% of elderly patients with essential hypertension and postinfarction cardiosclerosis, who did not have significant systolic dysfunction, restrictive diastolic dysfunction, valvular disorder, or atrial fibrillation, dyspnea was caused by hyperventilation, obesity, and respiratory pathology.

[Characteristics of the pathogenesis, manifestations and clinical course of psychogenically induced myocardial infarctions].

With the purpose of investigating peculiarities of psychogenically induced myocardial infarction (PIMI) 82 patients with primary myocardial infarction (MI) were chosen as the subjects of the given controlled study and divided into two groups. The main group consisted of 33 patients, the rest 49 formed the control group. The study showed that coronary atherosclerosis was more pronounced in the patients of the main group, among whom cases of exertional angina in past history were more frequent, and who had more pronounced coronary calcinosis compared to the patients of the control group. At the same time, the clinical course of MI in such patients is relatively benign, but it is more often complicated by early postinfarction angina. All this suggests that the pathogenesis of PIMI differs from that of "classic" MI. In particular, PIMI may be associated with the involvement of more distant parts of coronary vessels. Patients with PIMI seem to need to be regarded as having high risk of repeated coronary disasters.

[Anginal States provoked by psychogenic stimuli. To the problem of psychosomatic reactions in patients with ischemic heart disease]. / Psikhogenno provotsirovannye anginoznye sostoianiia (k probleme psikhosomaticheskikh reaktsii u bol'nykh ishemicheskoi bolezn'iu serdtsa).

Two types of vulnerability of coronary vessels damaged by atherosclerosis were proposed basing on results of a study of 94 patients with psychosomatic reactions accompanied with ischemia or myocardial infarction. First variant (35 patients) was characterized by stable course of the disease (high effort angina without coronary catastrophes, episodes of unstable angina, etc.) and selective sensitivity to definite key affect of high personal value. Second variant (49 patients) was distinguished by pronounced clinical manifestations (effort angina with progressive lowering of exercise tolerance). Cardiovascular system displays universal susceptibility to negative emotions of various intensity.

[Psychosomatic reactions comorbid with ischemic heart disease: psychogenically provoked infarctions and myocardial ischemia]. / Psikhosomaticheskie reaktsii, komorbidnye ishemicheskoi bolezni serdtsa: psikhogenno provotsirovannye infarkty i ishemii miokarda.

Ischemic heart disease (IHD) with psychogenic provoked myocardial infarctions (MI) and myocardial ischemic disease (MID) is considered as a psychosomatic disorder. Seventy patients, 17 female and 53 male, aged between 39-77 years, mean age 61.2 +/- 9.9 years, were observed. The presence of both somatic (prolonged atherosclerotic lesion of coronary arteries) and mental (personality disorders with symptoms of reactive lability under psychic trauma influence) predisposition is obligate for manifestation or exacerbation of this IHD type. It is suggested that atherosclerotic coronary vessels affection of heterogeneity may exist. Two types of vulnerability are described. In type 1 cardiovascular system exhibits selective sensitivity to the influence of obligate and of great personality significance cathatymic affect. A strict condition of its realization is amplification of negative emotions up to a level of pathological affective outbursts in the spectrum of paranoiac or explosive reactions. In these cases, IHD is characterized by a stable course (angina of high tensions, without instable anginal episodes etc). In type 2 cardiovascular system reveals vulnerability to negative emotions, the continuum of which is ended by polar pathological affects-cathatymic and anxiety. In contrast to cathatymic affect, a common feature of anxiety affect is a fast, like short-term emotional outburst, manifestation of instable, labile, dramatic external appearances (with tears, converse disorders etc). IHD symptom complex is distinguished by pronounced clinical manifestations (stenocardia of tension with progressive impairment of tolerability to loadings).