[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.

[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.

[Cost-effect clinical analysis in choice of methods of coronary heart disease diagnosis].

AIM: To select optimal methods of coronary heart disease (CHD) diagnosis in patients with different CHD probability using cost-effect analysis. MATERIAL AND METHODS: The trial included 102 patients admitted to hospital because of suspected CHD. The initial CHD probability was determined according to G.A. Diamond table. CHD diagnosis was made with application of Holter ECG monitoring (88 patients), treadmill test (67 patients), dobutamine stress echocardiography (echo-CG, 31 patients), stress single photon emission computed tomography (SPECT, 30 patients), multislice computed tomography (MSCT) with contrast study of coronary arteries (14 patients). Non-invasive tests were followed by coronaroangiography. The cost-effect method was used for analysis of the above methods cost efficacy. RESULTS: MSCT specificity was 96%, specificity of the other methods - 70-75%. SPECT was most sensitive (96%), Holter ECG monitoring was the least sensitive (49%). Efficacy of all the diagnostic tests was maximal in moderate probability of CHD. In spite of its moderate specificity and sensitivity, treadmill test was the cheapest and, therefore, most cost effective in all the groups. Specification of CHD probability by 1% required 17.4 roubles in low risk groups, 9.4 and 24.7 roubles in moderate and high risk, respectively. CONCLUSION: CHD diagnosis should be started with treadmill test.

[Comparative analysis of methods used for coronary artery disease diagnostics].

The aim of the study was to determine effective diagnostic methods for use in patients with different probabilities of coronary artery disease (CAD). The 102 subjects were distributed into 3 groups according to CAD risk: low risk (n = 13), moderate risk (n = 29), and high risk (n = 60). The following examinations were performed: Holter ECG monitoring (88 patients), treadmill test (67 patients), stress-echoCG with dobutamine (31 patients), single phase emission computed tomography (SFECT) (30 patients), and multispiral computed tomography (MSCT) with coronary arterial contrasting (14 patients). After non-invasive tests, all patients underwent coronaroangiography. According to the study, MSCT and SPECT were the most effective techniques for CAD diagnostics. The application of all these tests is justified most in cases of moderate risk of stenosing coronary arterial lesion.

[The clinical economic analysis of the methods of ischemic heart disease diagnostics].

The clinical economical analysis was applied to assess the application of different techniques of ischemic heart disease diagnostics - the electro-cardiographic monitoring, the treadmill-testing, the stress-echo cardiographic with dobutamine, the single-photon computerized axial tomography with load, the multi-spiral computerized axial tomography with coronary arteries staining in patients with different initial probability of disease occurrence. In all groups, the best value of "cost-effectiveness" had the treadmill-test. The patients with low risk needed 17.4 rubles to precise the probability of ischemic heart disease occurrence at 1%. In the group with medium and high risk this indicator was 9.4 and 24.7 rubles correspondingly. It is concluded that to precise the probability of ischemic heart disease occurrence after tredmil-test in the patients with high probability it is appropriate to use the single-photon computerized axial tomography with load and in the case of patients with low probability the multi-spiral computerized axial tomography with coronary arteries staining.

[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.

[The effects of beta-adrenoblocker therapy on the physical working capacity of patients with chronic heart failure of various origin].

The purpose of the study was to evaluate the influence of metoprolol succinate and carvedilol on the physical ability (FA) of patients with chronic heart failure (CHF) of different etiologies. The subjects of the study were 108 patients with postinfarction cardiosclerosis and 39 patients with dilated cardiomyopathy with I to V functional class (FC) CHF and left ventricular ejection fraction of less than 45%. The dynamics of functional parameters were assessed after 6 to 12 months of carvedilol therapy (57 patients) or metoprolol (81 patients) therapy. Therapy with beta-adrenoblockers resulted in a significant decrease in CHF FC (by 0.80 +/- 0.57; p < 0.05), an increase in the distance of six-minute walking test (by 110.7 +/- 86.5 m; p < 0.001) and everyday activity according to DASI questionnaire. The improvement was more substantial in patients with non-ischemic CHF. Peak oxygen consumption during treadmill test did not change, but CO2 ventilatory equivalent increased. The results demonstrate that carvedilol and metoprolol improve subjective and submaximum parameters of the functional status of patients with CHF without changing maximal FA.

[Muscular mechanisms of lowering of physical working capacity in chronic heart failure and action of beta-adrenoblockers].

Parameters of physical working capacity (symptom limited treadmill test with gas analysis, 6 min walk test and usual everyday activity), activity of muscular metaboreflex, efficacy of pulmonary ventilation, and heart rate variability were studied in 50 patients with postinfarction cardiosclerosis with chronic class I-III heart failure and 30 patients without heart failure. Patients with heart failure of all functional classes had lowered parameters of working capacity while metaboloreflex hyperactivation and diminished effectiveness of ventilation were found only in patients with clinical signs of chronic heart failure but not in those with symptomless left ventricular dysfunction. Therapy with metoprolol was associated with lowering of activity of metaboloreflex, augmented effectiveness of ventilation and heart rate variability, improvement of results of 6 min test and everyday activity without considerable changes of peak oxygen consumption.

[Hyperventilation syndrome in bronchial asthma, essential hypertension and organic neurosis. Clinical picture and external respiration function]. / Giperventiliatsionnyi sindrom pri bronkhial'noi astme, gipertonicheskoi bolezni i organnom nevroze. Klinicheskaia kartina i funktsiia vneshnego dykhaniia.

The external respiration function was studied in 100 patients with hyperventilation syndrome (HVS) divided into 3 groups: 40 patients with HVS and bronchial asthma (group 1) consisting of 15 males and 25 females (age median--45 years, 25 percentile--37 years, 75 percentile--53 years); 39 patients with HVS and essential hypertension (group 2) consisting of 8 males and 31 females (age median 49, 25 percentile--40 years, 75 percentile--57 years); 21 patients with HVS without concurrent somatic diseases of group 3 (7 males, 14 females, age median 45 years, 25 percentile--28 years, 75 percentile--45 years). It is shown that different disorders of pulmonary ventilation correspond to different clinical manifestations of HVS. Thus, in bronchial obstruction (group 1) HVS manifests with "weak respiration", in restrictive pulmonary disorders (group 2) HVS manifests as "heavy respiration", in high parameters of bronchial permeability (group 3)--"shallow respiration".

[Personality disorders in postoperative period of coronary artery bypass graft surgery]. / Rasstroistva lichnosti v posleoperatsionnom periode aortokoronarnogo shuntirovaniia.

Personality disorders (PD) are recognized among key maladaptive factors in postoperative period of coronary artery bypass surgery (CABS). However studies on PD among CABS patients are predominantly under psychological approach and information on clinical features is very limited. A present investigation aimed at assessing clinical features and prognostic value of PD in late post operative period of CABS (from 1 to 3 years). Using psychiatric, cardiological and psychological methods, 48 patients (42 male, mean age 61.3 +/- 8.2 years) with diagnosis of PD and favorable cardiological status after CABS have been assessed. PD in post operative period is an important predictor of unfavorable social and occupational outcome of CABS. Three types of clinical course of PD were singled out: 1) hypohondric personality development; 2) "second life" personality development; 3) "denial of illness" reactions. Pronounced maladaptation was observed in type 1, most severe one--in type 2 and minimal maladaptation or its absence--in type 3. These types were differentiated by different repertoires of psychological defense mechanisms (PMD): type 1 was characterized by a limited number of them with a drift to mature mechanisms; PD of type 2 are featured by a narrow and rigid repertoire of defenses with predomination of immature mechanisms and in type 3 a maximum number of PMD with balanced involvement of mature and immature mechanisms was observed.

[Pyrazidol in the treatment of depression in patients with ischemic heart disease]. / Pirazidol pri lechenii depressii u bol'nykh ishemicheskoi bolezn'iu serdtsa.

AIM: To study efficacy and safety of pirazidol administration in depressive patients with ischemic heart disease (IHD). MATERIAL AND METHODS: Pirazidol was given in a dose 0.15-0.3 g/day for 4 weeks to 30 IHD patients aged 21-65 years. 21 of them had nosogenic depression, 9 patients had dysthymia. The efficacy of the antidepressive action was assessed by the Hamilton scale. RESULTS: The trend to a decrease in Hamilton scale scores was manifest by the end of the treatment week 2. To the end of the study the overall score median lowered from 17 to 9, most of the patients had the score sum under 11. Side effects were insignificant. In pirazidol combination with beta-blockers, blockers of calcium channels, antiaggregant, diuretic drugs, nitrates and other cardio- and angiotropic drugs unfavorable interactions were not registered. CONCLUSION: Pirazidol can be effectively used in the treatment of psychosomatic disorders in patients with cardiovascular diseases.

[Effect of beta-blockers metoprolol CR/XL and carvedilol on left ventricular contractility in patients with chronic low cardiac output]. / Vliianie beta-blokatorov metoprolola CR/XL i karvedilola na sokratitel'nuiu funktsiiu levogo zheludochka u bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu.

AIM: To compare effects of metoprolol CR/XL and carvedilol on global and regional contractility of the left ventricle in patients with chronic cardiac failure (CCF). MATERIAL AND METHODS: The results of two trials were compared: the effects of metoprolol CR/XL and on carvedilol left ventricular contractility in patients with chronic cardiac failure (CCF). A total of 52 patients with ischemic heart disease (IHD) and dilated cardiomyopathy (DCMP) entered the studies. Of them, the treatment was completed in 19 and 20 patients, respectively. Ejection fraction (EF), left ventricular end systolic and diastolic volumes were measured at radionuclide ventriculography before and 6 months after the start of the treatment. RESULTS: Both beta-blockers significantly increased EF and reduced the volumes. In both groups the rise of contractility in EF < 30% was similar. EF augmentation in patients with DCMP was greater than that in patients with IHD and depended on improvement of segmental contractility. CONCLUSION: Significant differences were not found in the action of two beta-blockers on global and regional contractility of the left ventricle in patients with CCF.

[Effect of metoprolol CR/XL on remodeling of the heart and cardiac rhythm disturbances after myocardial infarction in patients with chronic heart failure]. / Vliianie metoprolola CR/XL na postinfarktnoe remodelirovanie i narusheniia ritma serdtsa u bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu.

Metoprolol succinate was given to 60 patients with class I-III heart failure and ejection fraction <45% after myocardial infarction. Forty seven patients (mean age 59.3+/-9.8 years) completed 6 months of therapy. Dynamics of ventricular arrhythmias was assessed by Holter ECG monitoring, registration of parameters of high resolution ECG and heart rate variability. and echocardiography. Functional class of heart failure decreased in 93%, that of angina - in 55% of patients. Antiarrhythmic effect was achieved in 72% of patients. This was associated with diminishment of left ventricular volumes and increased ejection fraction, shortening of TotQRSF, and improvement of autonomic regulation of cardiac action. No dynamics of myocardial contractility and electrophysiological remodeling occurred in patients without antiarrhythmic effect.

[Results of the multicenter controlled study of the hypolipidemic drug polycosanol in Russia]. / Rezul'taty rossiiskogo mnogotsentrovogo kontroliruemogo issledovaniia gipolipidemicheskogo preparata polikosanol.

AIM: To compare efficacy and tolerance of polycosanol vs besafibrate in patients with hypercholesterolemia (HCE). MATERIAL AND METHODS: A multicenter controlled double blind randomised trial entered 113 patients with HCE. After 5 weeks of diet the patients were randomised into two groups. 59 patients of group 1 received polycosanol (10 mg/day), 54 patients of group 2 were given besafibrate (400 mg/day) for 8 weeks. RESULTS: The 8-week course of treatment was completed by 103 patients (91%): 57(97%) patients of group 1 and 46(85%) patients of group 2. In group 1 total cholesterol diminished by an average of 15%, LDLP cholesterol fell by 18%, triglycerides by 15%, while in group 2 a respective decrease was 8, 11 and 6%. Side effects in group 1 were mild. CONCLUSION: A hypolipidemic effect of polycosanol in a daily dose 10 mg is superior to that of besafibrate in a daily dose 400 mg.

[The metabolic characteristics of nonesterified fatty acids in the myocardium of patients with paroxysmal tachycardias and their pathogenetic role in the origin of the heart rhythm disorders]. / Osobennosti metabolizma neésterifitsirovannykh zhirnykh kislot v miokarde bol'nykh s paraksizmal'nymi takhikardiiami i ikh patogeneticheskaia rol' v vozniknovenii narushenii ritma serdtsa.

Twenty-one patients suffering from paroxysmal tachycardia (PT) were examined for metabolism of nonesterified fatty acids (NEFA) in the myocardium as well as for interrelations with the parameters of clinical electrophysiology. It has been shown that the main features of NEFA metabolism in the myocardium of RT patients lie in their high concentration in arterial blood and in the blood of the coronary heart sinus and in their high ratio of extraction by the myocardium both in the presence of sinus rhythm and during RT, which is of the pathogenetic importance in the origin of heart rhythm disturbances. NEFA exert different effects on the antegrade and retrograde (functional and effective) refractory periods of different parts of the conduction system of the heart, favouring the onset of their electrophysiological heterogeneity.