Prediction of Cardiovascular Diseases in Women With Rheumatoid Arthritis.

AIM: To develop prognostic models for arterial hypertension (AH) and atherosclerosis based on studying the totality and significance of traditional and disease-mediated risk factors (RFs) in women with rheumatoid arthritis (RA). MATERIAL AND METHODS: 223 female patients with RA aged 54.9±2.1 years were evaluated at the premises of the polyclinic of the Gulla Municipal Hospital #4 (Barnaul), the "Health Center", the City Rheumatology Department of the polyclinic, and the Hospital Department in 2016-2019. Statistical analysis was performed using Excel Microsoft Office 2007, Statistica 6.0 and 10.0, and SigmaPlot 12.5 software packages. Multivariate regression analysis was used for studying the attributes influencing the development of AH and atherosclerosis in RA and for constructing predictive models. ROC analysis was used to determine the quality of the developed models. Differences were considered statistically significant at p<0.05. RESULTS: The following RFs predominating in the onset of disease were identified: traditional (hyperglycemia, obesity, increased diastolic BP (DBP), tachycardia, dyslipidemia); disease-mediated (ESR, fibrinogen, C-reactive protein (CRP), rheumatoid factor, cyclic citrullinated peptide antibodies, moderate and high DAS-28 activity), and psychosocial (stress, anxiety, depression, sleep disorders). The highest RF incidence and their combinations were determined with a RA duration of more than a year: traditional (obesity, hyperglycemia, increased systolic BP (SBP)), and decreased glomerular filtration rate; and disease-mediated (prednisolone treatment). A highly sensitive model for AH screening was developed that included a combination of RFs: disease-mediated (RA duration, CRP); traditional (improper diet, low physical activity, history of early cardiovascular diseases, increased SBP and DBP, preeclampsia and/or eclampsia, early menopause, older age, dyslipidemia); psychosocial (anxiety, depression), and a high salt-taste threshold. A highly sensitive model was developed for probable prediction of multifocal atherosclerosis in RA in women. The model includes a complex of risk factors: disease-mediated (RA activity by DAS-28, CRP, fibrinogen, ESR, dose-dependent prednisolone treatment); traditional (AH, SBP, waist circumference, heart rate, early menopause, preeclampsia and/or eclampsia, age 55 years and older, dyslipidemia); and psychosocial (sleep disorders, depression). CONCLUSION: Algorithms for early prevention of AH and atherosclerosis were developed with consideration of identified predictors and proposed prediction models for women with RA.

[Biomarkers of brain damage and inflammation in patients with acute cerebral ischemia]. / Biomarkery povrezhdeniya mozga i vospaleniya u patsientov s ostroi tserebral'noi ishemiei.

OBJECTIVE: To study the pathogenetic and clinical significance of factors of hypoxic brain damage and inflammatory mediators in the development of stroke, to improve the diagnosis using laboratory markers of brain damage and inflammation in patients with acute cerebrovascular accident. MATERIAL AND METHODS: We examined 55 people with stroke of the ischemic type at the age of 74 (67; 80) years, the comparison group consisted of 25 volunteers at the age of 65.0 (62.0; 66.5) years. Depending on the outcome of ischemic stroke, patients were assigned to the discharged group or to the deceased group. Blood serum and cerebrospinal fluid (CSF) S100b protein, glial fibrillar acidic protein and interleukin-6 (IL-6); blood serum neurospecific enolase, and cortisol and C-reactive protein (CRP) were determined. Clinical blood test and assessment of fibrinogen content were performed on days 1, 3 and 10 of stroke. RESULTS: There is an increase in the levels of markers of brain tissue damage and systemic inflammation in the blood and CSF in response to cerebral ischemia that reflects the synergy of these pathological processes in patients with stroke, their association with the severity of stroke and its outcome. CONCLUSION: The results indicate that the postischemic release of neurospecific proteins, an increase in the content of IL-6, CRP, and cortisol make it possible to additionally characterize the severity of stroke and the body's response to damage, and predict the outcome of the disease.

Drug Therapy and Adherence in Patients With Coronary Heart Disease: Results of the Russian Part of the EUROASPIRE V International Multicenter Study.

Aim      To study the practice of drug treatment of ischemic heart disease (IHD) and the consistency of this practice with the established guidelines.Material and methods  Results of the Russian part of the EUROASPIRE V study were compared with the general European population of the study. At ≥6 mos. and <2 years after the discharge from the hospital, patients were invited to visit the site for an interview. The drug therapy recommended upon discharge and taken by patients in the long-term as well as the patients' compliance with the treatment were analyzed. In Russian centers, 699 patients were registered, and 399 of them visited the centers for the interview.Results             Upon discharge from the hospital, patients of the Russian cohort and of the entire study population were prescribed acetylsalicylic acid or other antiplatelet drugs (99.2% and 94.1%, respectively); beta-blockers (87.2 and 81.6%, respectively); angiotensin-converting enzyme (ACE) inhibitors (69.9% and 61.1%, respectively); sartans (16.5% and 14.2 %, respectively); calcium channel blockers (19.3 and 19.4 %, respectively); nitrates (8.0% and 22.5 %, respectively); diuretics (31.1 and 32.5 %, respectively); statins (98.0% and 85.0 %, respectively); and anticoagulants (6.6 and 8.3 %, respectively). For the long-term treatment, patients of the Russian cohort and of the entire study population took antiplatelets (94.7 % and 92.5 %, respectively); beta-blockers (83.2% and 81.0 %, respectively); ACE inhibitors (60.2% and 57.3 %, respectively); sartans (19.3% and 18.4 %, respectively); calcium antagonists (21.1% and 23.0 %, respectively); nitrates (9.0% and 18.2 %, respectively); diuretics (31.8% and 33.3 %, respectively); statins (88.2% and 80.8 %, respectively); and anticoagulants (8.8% and 8.2 %, respectively). High intensity hypolipidemic therapy was prescribed to 54.0 % of patients in Russian centers and 60.3 % of patients in the entire study. Both Russian and international patients evaluated their compliance with the prescribed medication as high.Conclusion      According to results of the EUROASPIRE V study as compared to earlier studies, the practice of drug therapy in Russian patients with IHD has significantly approached European indexes. Further optimization is possible by a more extensive use of high intense hypolipidemic treatment and antidiabetic drugs with a documented positive effect on prognosis of cardiovascular diseases.

[Characteristic of infectious status in patients with acutely decompencated chronic heart failure and its impact on annual prognosis].

AIM: The assessment of infectious status in patients with acutely decompensated chronic heart faiure (ADCHF) without evident signs of acute inflammatory stress and its impact on the 1 year prognosis. MATERIAL AND METHODS: Totally, 65 patients with ADCHF of ischemic origin investigated, age 67,3±2,3 y.o. All patients were taken markers of phagocytosis and inflammatory stress as well as antibodies to Streptococcus, Cytomegalovirus (CMV), Epstein-Barr virus (VEB), Candida albicans, Toxoplasma gondii, Aspergillus, Mycoplasma hominis and pneumonia and also level of lipopolysaccharids (LPS) of gram-negative bacteriae. RESULTS: More often LPS of gram-negative bacteriae were revealed in patients with ADCHF and further in decreasing order - antibodies to CMV, VEB, Streptococcus, Candida, Aspergillus and LPS. All patients have been infected by at least 2 pathogens, more than 90 % of them had 3 ones or more. Mortality in first 12 months observation correlated with quantity of patient`s pathogenic patterns (r=0,52, p=0,004). Dependency of one-year mortality from degree of viral-bacterial mixt contamination was almost linear. CMV was a monopathogen with strongest correlation with mortality (r=0,39, p=0,001). In patients with more significant infection bigger rate of re-hospitalizations about new ADCHF correlated with number of pathogens was observed (r=0,61, p=0,001). CONCLUSION: Chronic latent infection with a significant number of pathogens is characteristic of patients with low-ejection ADCHF of ischemic genesis with a significant number of pathogens: more than 90 % of patients had three or more. The most common exogenous pathogens in the study sample of patients with chronic obstructive heart failure were CMV, EBV, and hemolytic streptococcus, of the potentially endogenous ones, gram-negative intestinal bacteria. The number of infectious agents in patients with chronic obstructive heart failure has a direct correlation with deaths and re-admission to hospital with total heart failure within 1 year after discharge from the hospital.

[New Targets in Blood Pressure Control: Arguments Pro and Contra].

The review contains results of analysis of clinical studies on the problem of defining the target level of the blood pressure (BP). The rationale for selection the target systolic BP level below120 mmHg was obtained in the SPRINT study comparing the target levels <120 mmHg and <140 mmHg. A considerably lower number of cardiovascular complications and deaths was seen in the group of a stricter BP control. Nevertheless, this study had some limitations related to certain patient populations, and methods of BP measurement. More ambitious target of BP lowering was associated with elevated risk of iatrogenic hypotension and fainting. Moreover, the ACCORD study, exploring the same target levels failed to demonstrate similar risk reduction. Taking into account various literature data, the authors find it reasonable to use personalized approach to determining BP targets, and utilize assessment of central aortic pressure and state of vessels for more accurate risk stratification and selection of treatment.

[Disorders of sex development 46 XY and bilateral metachronous wilms tumor in a child with mutation in exon 7 of WT1 gene].

Denys-Drash syndrome is characterized by a triad: nephropathy, a 46, XY disorder of sex development, and nephroblastoma with mutations in the gene WT1. A clinical case of a patient with a bilateral metachronous Wilms' tumor, a 46, XY disorder of sex development in the form of a scrotal hypospadias and bilateral abdominal cryptorchidism, without nephropathy with a mutation in 7 exon of gene WT1 is presented in the article. The child underwent left-sided nephrectomy, lower pole right partial nephrectomy, bilateral orchiopexy and two-stage correction of hypospadias. After 7 years from the start of treatment and 3 years after the last procedure, the childs condition has been assessed as satisfactory. The presented case, according to the analysis of literature, has not been previously described, therefore, it currently remains as "de novo" and requires further observation.

Immunogenicity, safety and reactogenicity of the pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in 2-17-year-old children with asplenia or splenic dysfunction: A phase 3 study.

BACKGROUND: Immunization with pneumococcal vaccines is an important prophylactic strategy for children with asplenia or splenic dysfunction, who are at high risk of bacterial infections (including S. pneumoniae). This study aimed to assess immunogenicity and safety of pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV, GSK) in this at-risk population. METHODS: This phase III, multi-centre, open-label, controlled study, in which at-risk children with asplenia or splenic dysfunction were enrolled (age strata: 2-4, 5-10 and 11-17years), was conducted in Poland and the Russian Federation. For the 2-4years at-risk group, healthy age-matched children were enrolled as control. Unprimed children (not previously vaccinated with any pneumococcal vaccine) received 2 PHiD-CV doses (≥2months apart) and pneumococcal vaccine-primed children received 1 dose. Immune responses were assessed pre-vaccination and one month post-each dose. Solicited and unsolicited adverse events (AEs) were recorded for 4 and 31days post-vaccination, respectively, and serious AEs (SAEs) throughout the study. RESULTS: Of 52 vaccinated children (18 at-risk primed, 28 at-risk unprimed and 6 control unprimed), 45 (18, 23 and 4, respectively) were included in the according-to-protocol cohort for immunogenicity. Post-vaccination (post-dose 1 in primed and post-dose 2 in unprimed children), for each vaccine pneumococcal serotype and vaccine-related serotype 6A all at-risk children had antibody concentrations ≥0.2µg/mL, and for vaccine-related serotype 19A at least 94.4%. Increases in antibody geometric mean concentrations were observed. For most serotypes, all at-risk children had post-vaccination opsonophagocytic activity (OPA) titers ≥8 and increases in OPA geometric mean titers were observed. No safety concerns were raised. One non-fatal SAE (respiratory tract infection, considered not vaccine-related) was reported by one at-risk unprimed child. CONCLUSION: PHiD-CV was immunogenic and well tolerated in 2-17-year-old children with asplenia or splenic dysfunction. Clinical Trial Registry: www.clinicaltrials.gov, NCT01746108.

[First Results of Analysis of Russian Part of the European Register on Cardiac Rehabilitation EuroCaReD (European Cardiac Rehabilitation Database)].

The joint European Registry of patients with cardiovascular diseases participating in cardiac rehabilitation programs (European Cardiac Rehabilitation Database, EuroCaReD) is conducted in collaboration between the ESC and EACPR). It's main goals were to improve the routine use of cardiac rehabilitation, to develop joint standards for cardiac rehabilitation in all European countries and evidence based rehabilitation programs and to monitor any changes. In the EuroCaReD registry participated a total of 44 centers from 13 countries, including 3 centers from Russia, which enrolled 151 patients during 2010-2012. This paper is comparing the baseline demographics, clinical data and risk factors in Russian patients versus the rest of Europe. It was shown that cardiac rehabilitation patients in Russia, as in the whole cohort, are predominantly male. Elderly patients from Russia were 3 times less likely to be referred for rehabilitation than in Europe. Unlike the whole cohort Russian patients were almost never sent to rehabilitation because of heart failure or stable angina. Likewise the whole Europe Russian patients had an average of 3 cardiovascular risk factors before rehabilitation, but with some national differences in their prevalence and severity.

[Interdisciplinary approach to evaluation of metabolic syndrome in locomotive crew workers].

The authors revealed features of metabolic syndrome diagnosis by means of various intradisciplinary criteria in locomotive crew workers. The locomotive crew workers, if compared to mounters, demonstrate 1.4 times more frequent excessive body weight, 1.6 times more frequent obesity, 1.4 times more frequent dyslipidemia, 2 times more common arterial hypertension. According to RSCS, metabolic syndrome in locomotive operators appeared more frequent--1.6 times than in IDF, 1.5 times than in ATP, ESN. Frequency of metabolic syndrome in males of stress occupations varies from 30% according to ATP, IDF, ESN to 49% according to RSCS--that is 2.5 times more frequent than in individuals with low occupational stress. Bioimpedometry revealed fluidsretention in 13% of train operators, water deficit in 24%, muscular mass deficiency in 55%. RSCS criteria are priority in interdisciplinary approach to metabolic syndrome evaluation in males under occupational stress. Assessment of visceral fat in locomotive crew workers helps to formulate purposeful prophylactic recommendations.

[First Results of Analysis of the Russian Part of the European Register on Cardiac Rehabilitation EuroCaReD (European Cardiac Rehabilitation Database)].

The joint European Registry of patients with cardiovascular diseases participating in cardiac rehabilitation programs (European Cardiac Rehabilitation Database, EuroCaReD) is conducted in collaboration between the ESC and EACPR). Its main goals were to improve the routine use of cardiac rehabilitation, to develop joint standards for cardiac rehabilitation in all European countries and evidence based rehabilitation programs and to monitor any changes. In the EuroCaReD registry participated a total of 44 centers from 13 countries, including 3 centers from Russia, which enrolled 151 patients during 2010-2012. This paper is comparing the baseline demographics, clinical data and risk factors in Russian patients versus the rest of Europe. It was shown that cardiac rehabilitation patients in Russia, as in the whole cohort, are predominantly male. Elderly patients from Russia were 3 times less likely to be referred for rehabilitation than in Europe. Unlike the whole cohort Russian patients were almost never sent to rehabilitation because of heart failure or stable angina. Likewise the whole Europe Russian patients had an average of 3 cardiovascular risk factors before rehabilitation, but with some national differences in their prevalence and severity.

[Effect of psychosocial stress on the level of anxiety, depression and behavioral risk factors of cardiovascular diseases in men].

AIM: To elucidate peculiarities of risk factors (RF) of cardiovascular diseases and frequency of arterial hypertension (AH) at place of work in men with various level of psychosocial stress. MATERIAL AND METHODS: We examined 224 men (and their assistants) aged 22-55 years. Examination included analysis of risk factors, assessment of psychoemotional status (self-assessment of psychosocial stress using Reeder Stress Inventory [RSI] and Hospital Anxiety and Depression Scale [HADS]), detection of AH at working place by "Mathematical calculation" stress test. Three groups were formed according to results of RSI: with high (16.1%), medium (44.6%), and low (39.3%) level of stress. RESULTS: High level of stress was associated with older age (p < 0.01), stressful occupation (locomotive drivers) (p < 0.001), threat of emergency situations (p = 0.0007), history of early cardiovascular diseases (p = 0.02), insufficient consumption of vegetables and fruits (p = 0.02), higher body mass (p = 0.02), insufficient sleep duration (p = 0.02), subclinical, clinical anxiety and depression, work place AH (p = 0.002).

[Professional stress and development of stress-induced hypertension].

AIM OF THE STUDY: to elucidate rates of development of arterial hypertension (AH) at working place (wp), risk factors of cardiovascular diseases (CVD), anxiety depressive disorders in persons with professional stress. We carried out monitoring of arterial pressure during working hours and hours of rest, assessed risk factors of CVD development, and evaluated severity of symptoms of anxiety and depression using the Hamilton scale in 138 men (mean age 40.0+/-1.2 years). Results of the study evidenced for high frequency (46.4%) of development of AHwp among representatives of stressful occupations. Patients with AHwp have risk factors of CVD development and total coronary risk comparable with those of patients with hypertensive disease. Patients with AH have more pronounced anxiety depressive disorders than healthy subjects.

[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.

[Physical rehabilitation in the complex hospital therapy of patients with chronic low cardiac output]. / Fizicheskaia reabilitatsiia v kompleksnom statsionarnom lechenii bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu.

AIM: To study action of medication in combination with free-choice bicycle exercise on cerebral and peripheral hemodynamics in patients with chronic heart failure (CHF) of functional class II-III. MATERIAL AND METHODS: At admission to hospital and at discharge 100 patients with CHF of NYHA functional class (FC) II-III hospitalized for progression of CHF have undergone clinical examination, Doppler echocardiography and biomicroscopy of conjunctival vessels. The patients were randomized into two groups: group 1 of 60 patients received standard drugs and exercised on bicycle: group 2 of 40 patients received standard drugs only. RESULTS: The patients of group 2 achieved better hemodynamic effect, greater lowering of total peripheral vascular resistance. In patients with CHF FC II cardiac output increased due to improvement of left ventricular systolic function (end-systolic and end-diastolic volumes reduced by 20.3 and 38.7%, respectively, ejection fraction increased by 13.7%); in patients with FC III--due to improvement of diastolic function (end-diastolic volume reduced by 8.3%). Bicycle exercise in combined treatment of FC II CHF provides improvement in perivascular and intravascular components of microcirculation by 46.7 and 24.3%, respectively. In FC III CHF intravascular microcirculation improved by 24.3%. CONCLUSION: Bicycle exercise of patients with CHF of FC II and III used as an adjuvant to standard drugs has an additional positive effect on central hemodynamics and microcirculation.

[Systematization of data and information on delayed consequences of the effects of chemicals in humans]. / Sistematizatsiia materialov i svedenii ob otdalennykh posledstviiakh vozdeistviia na organizm cheloveka khimicheskikh veshchestv.

The systematization and analysis of the data connected with delayed consequences arising in human body from exposure to dangerous chemicals have been carried out. The paper contains the list of dangerous chemicals exerting mutagenic or carcinogenic effects and chromosome aberrations. The cytologic express method of revealing mucous membrane dysplasia resulting from exposure to some chemical mutagens have been evaluated.

[The role of physical training on the bicycle ergometer with an optimal pedalling rate in enhancing the efficacy of the sanatorium rehabilitation of patients who have had a myocardial infarct]. / Rol' fizicheskikh trenirovok na veloérgometre s optimal'noi chastotoi pedalirovaniia v povyshenii éffektivnosti sanatornoi reabilitatsii bol'nykh, perenesshikh infarkt miokarda.

The impact of physical training on a bicycle treadmill was examined in 171 patients with prior myocardial infarction by using individual pedalling rates at a sanatorium stage. During sanatorium rehabilitation, the proposed bicycle training allowed the authors to obtain the best clinical effects, more pronounced positive ECG dynamics, improved cardiac function with a simultaneous decrease in peripheral resistance, i.e. the economization and optimization of circulatory performance and considerably higher exercise tolerance. The positive effect of physical training with the optimum pedalling rate in patients with myocardial infarction at a sanatorium rehabilitative stage retained within 6 months and this was followed by a reduction in the number of anginal episodes, lower temporary disability and hospitalizations by thrice, restoration of the working capacity of a greater number (by 1.5 times) of patients than other patient groups.

[Adaptability of patients to freely selected and forced physical exercise after myocardial infarction]. / Adaptatsiia bol'nykh, perenesshikh infarkt miokarda, k svobodno izbiraemoi i naviazannoi fizicheskoi nagruzke.

In 45 patients with myocardial infarction in the rehabilitative period in health resort centers, bicycle ergometric tests with forced routine continuously gradually increasing exercise or without forced graded exercise in accordance with the "free option" motor motivation test were performed at the beginning and at the end of treatment. The work performed at the beginning and at the end of treatment. The work performed with free option is characterized by substantial differences in its volume, duration, intensity, and rate. Free option exercise is submaximal, close to tolerant, but simultaneously shows lower values in heart rates, systolic blood pressure, "double product" and cost-effective index. The free option exercise test is a more sensitive indicator of alterations in the status of a patient with myocardial infarction during health resort rehabilitation.