[The economic analysis of the total cost of rehabilitation of the patients suffering from coronary heart disease].

OBJECTIVE: To report the results of analysis of the economic efficiency of physical rehabilitation of the patients surviving after myocardial infarction with the use of physical exercises. MATERIAL AND METHODS: The study included 110 patients (mean age 58,3±9,8 years) who were randomized into two groups: the group where the patients were treated with the use of physical training (n=53) and the control group (n=57). The physical training included natural walking over the level ground at a speed corresponding to 60% of the maximum heart rate achieved during the initial 6 minute of the walking test. RESULTS: The results of the analysis indicate that the cost of the full course of medicamental therapy for the patients of the control group was 790.043,83 rubles higher than that for the patients treated with the use of physical exercises. The expenses for the instrumental and laboratory studies in the former group proved to be 142.776,8 rubles higher than in the latter. CONCLUSION: The inclusion of controlled physical exercises in the program in the rehabilitative treatment of the patients surviving after myocardial infarction makes it possible to achieve a higher quality of their life with the more favourable cost-benefit ratio compared with use of medicamental therapy alone.

[Pharmacogenomic control of angiotensin converting enzyme gene I/D polymorphism predominant risk factor of development of chronic heart failure and target of enalapril treatment].

Aim of investigation - to study effect of angiotensin-converting enzyme (ACE) gene polymorphism as a dominant risk factor of development of chronic heart failure (CHF) and target for effective therapy with ACE inhibitor enalapril in patients with ischemic heart disease. We followed 226 patients with CHF on stable permanent basic therapy comprising -adrenoblocker, diuretic, aldosterone antagonist, digoxin, and ACE inhibitor. Seventy eight patients received enalapril (starting dose 2.5 mg twice daily with subsequent titration up to 10-20 mg twice daily). Control group comprised 136 patients without cardiovascular abnormalities. Allele D of polymorphic locus I/D of ACE gene in homozygous state was associated with high risk of development and severity of clinical manifestations of CHF. In patients with D/D genotype of ACE gene at the background of therapy with enelapril we noted more pronounced lowering of CHF functional class and augmentation of left ventricular ejection fraction compared with patients having I/I and I/D genotypes. We revealed associative interrelationships of ACE gene polymorphism (polymorphic locus I/D) with development and severity of CHF as well as effectiveness of therapy with an ACE inhibitor enalapril.

[Impact of angiotensionogen and angiotensin II receptor type 1 gene polymorphisms on the development and course of chronic heart failure].

AIM: To study the impact of angiotensinogen (AGT) and angiotensin II receptor type 1 (AGTR1) gene polymorphisms on the development and course of chronic heart failure (CHF) in patients with coronary heart disease (CHD). SUBJECTS AND METHODS: Two hundred and twenty-six patients (149 men and 77 women; mean age 55.9 +/- 5.8 years) with CHF were examined. Genotypes were identified by the restriction fragment length polymorphism analysis of polymerase chain reaction products. A control group comprised 136 subjects (63 men and 73 women; mean age 53.6 +/- 4.8 years) without signs of cardiovascular diseases, as evidenced by the examination. RESULTS: The T allele of the M235T polymorphism in the AGT gene was found to be associated with the development and unfavorable course of CHF in patients with CHD. At the same time, carriage of the M allele of the M235T polymorphism in the AGT gene reflected the favorable course of this disease. That of the C allele and A/C genotype of the A1166C polymorphism in the AGTR1 gene was associated with the development of CHF and the A allele and A/A genotype manifested themselves as protective factors. According to the severity of CHF and the nature of its course, the distribution of frequencies of the genotypes and alleles of the A1166C polymorphism in the AGTR1 gene showed no significant differences between the patient groups. CONCLUSION: There were associations of the polymorphisms of the AGT gene (the M235T polymorphic marker) and the AGTR1 gene (the A1166C polymorphic marker) with the development of CHF in patients with CHD.

[Quality of life in patients with coronary heart disease associated with metabolic syndrome: results of factor analysis].

AIM: To identify the factors most substantially influencing the quality of life (QL) in patients with coronary heart disease (CHD) associated with metabolic syndrome (MS), by using the principal component method. SUBJECTS AND METHODS: One hundred and two male patients (mean age 48.6 +/- 1.02 years) with CHD associated with MS, who had experienced large-focal myocardial infarction not earlier than 6 months before, were examined. Estimation of QL (EORTC QLQ CORE 30) and emotional-personal sphere (brief multifactorial personality questionnaire test and Spielberg's trait anxiety inventory) was made along with the complete clinical, laboratory, and instrumental examination accepted in specialized clinical practice of cardiology. RESULTS: A factor analysis of the variables obtained after a thorough examination of the patients could identify 4 common QL determinants, such as postinfarction cardiac remodeling, neurotization, obesity, and the degree of heart and coronary failure. CONCLUSION: MS in patients with CHD appreciably determines the total score of physical, emotional, and social well-being. In the cluster of MS components, obesity is a major factor that influences QL in patients who have sustained myocardial infarction.

[Prospects for using non-invasive diagnostic techniques for assessment of cardiac rhythm variability in coronary restenosis].

The aim of the study was to evaluate dynamics of heart rhythm variability (HRV during a1, b1, and b2-adrenoblockade by carvedilol in patients with coronary heart disease (CHD) and recurrent angina pectoris treated by endovascular revascularization. The study included 39 men (mean age 57.5 +/- 0.8 years) who underwent stenting of coronary arteries (CA) 6 month or more before the study. For the purpose of analysis, patients with CA restenosis were allocated to group 1 (n = 17), those without restenosis or complaining of chest discomfort in the absence of restenosis during repeated coronaroventriculography comprised group 2 (n = 22). Patients having no complaints were followed up by coronarography 1 year after stenting. HRV was estimated from the analysis of short (15 min) fragments of the standard ECG obtained in the basal state and during a1, b1, b2-blockade by carvedilol (mean dose 22.88 +/- 2.1 mg/day) for 2 weeks. Carvedilol blockade of a1, b1, b2-adrenoreceptors following coronary stenting significantly improved both temporal and spectral components of HRV. This improvement may serve as an independent marker of revascularization efficiency and an earlier predictor of coronary restenosis or reflect progress of the atherosclerotic process in native arteries.

[Polymorphism of eNOS and iNOS Genes and Chronic Heart Failure in Patients With Ischemic Heart Disease].

UNLABELLED: URGENCY: Despite substantial progress in the treatment of coronary heart disease (CHD) and chronic heart failure (CHF) prognosis in these conditions remains extremely serious. This warrants their timely prevention and early detection. Aim. To study influence of inducible NO synthase (iNOS) (CCTTT)n, Glu298Asp and diallel polymorphism in the fourth intron (4a/4b polymorphism) of endothelial NO synthase gene (eNOS gene) on the state of endothelial function and risk of development of CHF in patients with CHD. MATERIALS AND METHODS: 165 patients with CHD were studied (121 male and 44 female, mean age 56.7 + or - 5.3 years). Vasomotor endothelial function was evaluated using ultrasound method in the reactive hyperemia and trinitroglycerol tests. Genotypes were identified using RFLP analysis of PCR products. Control group consisted of 114 persons (54 male and 60 female, mean age 53.2 + or - 4.9 years). RESULTS: It was determined that the number of repeats of polymorphic locus (CCTTT)n of the iNOS gene and Glu allele of the polymorphic locus Glu298Asp of eNOS gene in the homozygous state were associated with the risk of development of CHD and class of severity of CHF clinical manifestation. In addition Glu allele of the polymorphic locus Glu298Asp of eNOS gene in the homozygous state was associated with the severity and unfavorable development of CHF. The endothelial-dependent dysfunction was more severe in homozygotes of Glu allele of the polymorphic locus Glu298Asp of eNOS gene than in carrier of allele 298Asp. Associations between polymorphic variant of VNTR intron 4 gene eNOS and CHF with the risk of development and endothelial dysfunction were not found. CONCLUSION: An association between polymorphism of iNOS gene (CCTTT)n, eNOS gene (Glu298Asp) with development of CHD and severity of CHF was shown. The polymorphism of eNOS gene (Glu298Asp) was associated with endothelial dysfunction.

[Impact of Gly389Arg beta1-adrenoceptor polymorphism on the risk of chronic heart failure, the nature of its course, and on the efficiency of its treatment with carvedilol].

AIM: To study beta1-adrenoceptor gene (ADRB1) polymorphism on the development and course of chronic heart failure (CHF) and on the efficiency of its treatment with the beta-adrenoblocker carvedilol in patients with coronary heart failure. SUBJECTS AND METHODS: Two hundred and twenty-six patients (149 males and 77 females; mean age 55.9 +/- 5.8 years) with CHF, who received continuous basic therapy: angiotensin-converting enzyme inhibitors, a diuretic, an aldosterone antagonist, digoxin, and a beta-adrenoblocker, were examined; 68 patients were given for 24 weeks carvedilol (its starting dose was 3.125 mg twice daily with its further adjustment until an individually tolerable dose was achieved). Genotypes were identified by the restriction fragment length polymorphism analysis of polymerase chain reaction products. A control group comprised 136 subjects (63 males and 73 females; mean age 55.9 +/- 5.8 years) without signs of cardiovascular disorders, as evidenced by the examination. RESULTS: In patients with CHF, the Gly allele of the Gly389Arg polymorphic locus of the ADRB1 gene in homozygous state was associated with the high individual risk for CHF, the severity of its clinical manifestations and the nature of its course while carriage of the Arg allele of the Gly39Arg polymorphic locus manifested itself as a protective factor. During long-term carvedilol therapy, CHF patients with the Arg/Arg genotype of the ADRB1 gene were observed to have a more pronounced decrease in the functional class of heart failure, a significant increase in left ventricular ejection, and a decrease in left ventricular end-systolic and end-diastolic sizes as compared with patients with the Gly/Arg genotype. CONCLUSION: There were associations of the polymorphism of ADRB1 gene (the Gly39Arg polymorphic locus) with the development and severity of CHF and with the efficacy of therapy with beta-adrenoblocker carvedilol.

[Combined antihypertensive therapy in patients with arterial hypertension and type 2 diabetes].

The aim of the study was to assess effect of 12-week long combined therapy with quinapril (accupro), an ACE inhibitor, and diuretic indapamide SR on arterial pressure (AP), carbohydrate and lipid metabolism, and safety of the treatment in patients having arterial hypertension (AH) with and without DM2. Sixty outpatients with grade II-III AH (mean age 55.3 +/- 9.6 yr) were divided into 2 groups: group 1 (n = 30) comprised patients with AH and DM2, group 2 (n = 30) included patients with AH alone. Combined therapy with daily doses of 23.3 +/- 9.8 g accupro and 1.5 mg indapamide reduced systolic and diastolic AP by 30.2 and 27.3% respectively in group 1 and by 27.6 and 27.1% in group 2. In patients with AH and DM2, fasting and postprandial blood glucose levels decreased by 7.3 and 5.2% and HbA1c by 8.9% (p < 0.05). Total cholesterol, triglycerides, and LDL cholesterol tended to decrease in both groups. HDL cholesterol significantly (p < 0.05) increased by 11.1% in group 1 and 10% in group 2 Side effects were documented only in 8.3% of the patients and did not require withdrawal of therapy. It is concluded that antihypertensive treatment with quinapril (accupro), an ACE inhibitor, and diuretic indapamide SR may be recommended for long-term therapy of AH concomitant with DM2.

[Long-term results of coronary endovascular revascularisation with sirolimus-eluting stents in patients with ischemic heart disease comorbid with type-2 diabetes mellitus: data from 18-month prospective study].

AIM: To study long-term results of 3-42-month (mean 18.1 +/- 1.2 month) of a prospective clinically and angiologically controlled follow-up after coronary endovascular revascularisation with sirolimus-eluting stents (SES) in patients with coronary heart disease (CHD) comorbid with type 2 diabetes mellitus (DM). MATERIAL AND METHODS: A total of 108 CHD patients with angina pectoris resistant to antianginal therapy were divided into 2 groups: 51 CHD patients with mild and moderate type-2 DM (group 1); 57 CHD patients free of diabetes (group 2). All the patients have undergone successful coronary endovascular revascularisation with SES. Anti-ischemic efficacy and safety of stenting were studied in the course of 18-month prospective follow-up. RESULTS: An anti-ischemic effect of stenting in hospital setting was achieved in all the patients. 18 months after stenting frequency and severity of anginal attacks reduced in group 1 by 70.6%, daily need in nitroglycerine--by 71.9%, in group 2--by 87.1 and 93.1%, respectively. As a result, exercise tolerance improved in group 1 by 38.3%, in group 2--by 40.8%. Quality of life improved by 22.7 and 25.1%, respectively. Most of the patients showed no deterioration of carbohydrate and lipid metabolism compensation. Recurrent angina and symptoms of painless myocardial ischemia occurred in 39.3 and 14% patients of group 1 and 2, respectively. More frequent causes of the recurrence were progression of coronary artery atherosclerosis de novo and Cypher stent restenosis (11.8 and 3.5% in group 1 and 2, respectively). CONCLUSION: SES implantation provided good anti-ischemic efficacy in 60.7 and 86% CHD patients with and without DM, respectively. It significantly improved exercise tolerance and quality of life.

[Immunomodulating, metabolic and cardioprotective effects of AT1-angiotensin receptors blocker losartan in patients with coronary heart disease and type 2 diabetes mellitus].

AIM: To evaluate effects of 6-month therapy with losartan in combination with indapamide on a clinical course, immunological, metabolic parameters, left ventricular function, exercise tolerance and quality of life in patients with coronary heart disease (CHD) associated with metabolic syndrome (MS). MATERIAL AND METHODS: Forty six CHD patients with postinfarction cardiac dysfunction in MS were randomized into two groups. Group 1 consisted of 22 patients with impaired glucose tolerance, group 2--of 24 type 2 diabetics. Treatment included combination of losartan (50 mg/day) with indapamide (1.5 mg/day), on demand nitrates, nebivolol. Basic therapy in diabetes included sugar-reducing drugs. Clinical condition, findings of echocardiography, parameters of lipid and carbohydrate metabolisms, immunoglobulins, circulating immune complexes, autoantibodies to cardiolipin (AB to CL), spectrum of proinflammatory cytokines were studied before and 3 months after course treatment. RESULTS: Overactivation of cytokines (primarily IL-2, IL-1, TNF alpha) with high expression of IgA, IgG, CIC, AB to CL was found in CHD patients with type 2 diabetes mellitus and less evident in impaired glucose tolerance. Losartan in both groups had an antihypertensive effect, stabilized LV hypertrophy, improved clinical symptoms leading to cytokines expression decline: TNF alpha by 9.8%, IL-1--by 6.1%, IL-6--by 6.7%. Losartan was well tolerated, caused no negative metabolic effects. CONCLUSION: New original facts of cytokine overactivation and humoral immunity disturbances were discovered which play an essential role in pathogenesis of postinfarction dysfunction and LV remodeling developing in type 2 diabetes mellitus. Losartan 6-month treatment in the fixed combination has a positive effect on clinicohemodynamic and immunometabolic indices. This gives grounds for wider use of losartan in CHD combined with type 2 diabetes mellitus.

[Combined antihypertensive treatment of patients with hypertension and type 2 diabetes mellitus].

AIM: To investigate antihypertensive efficacy, effects on endothelial, diastolic function of the left ventricle and metabolism of combination of ACE inhibitor quinapril (accupro) with diuretic indapamide SR in patients with hypertension of the second-third degree and type 2 diabetes mellitus (DM) and free of DM. MATERIAL AND METHODS: Outpatient treatment was given to 60 patients with AH (mean age 55.3 +/- 9.6 years) in combination with mild or moderate DM (group 1) and free of DM (group 2). The patients were observed for 12 weeks. Clinical and biochemical blood tests, ECG, echo-CG, measurements of blood pressure were made in all the patients. RESULTS: Quinapril course (mean dose 23.3 +/- 9.8 mg/day) in combination with indapamide (1.5 mg/ day) produced a complete hypotensive effect in group 1 (23 patients, 76.7%), in group 2--25 (83.3%). DM patients demonstrated reduction of fasting and postprandial glycemia and cholesterol, time of isovolumic relaxation reduced in group 1 by 9.1%, in group 2 by 19.8% (p < 0.01). Left ventricular diastolic function improved, endothelium-dependent vasodilation in diabetics rose by 40%, non-endothelium-dependent--by 21.8%, in hypertensive patients free of DM--by 51.9 and 43.2%, respectively. CONCLUSION: Combination of quinapril with indapamide produces a significant antihypertensive effect in patients with AH of degree II-III associated with type 2 DM, improves carbohydrate and lipid metabolism, left ventricular diastolic function.

[Late results of endovascular coronary revascularization in patients with type 2 diabetes mellitus].

The aim of this work was to evaluate anti-ischemic and angiographic efficiency of endovascular revascularization of ischemic myocardium by implantation of Sirolimus-eluting stents from the results of a 18 moth-long prospective study of patients with coronary heart disease and/or type 2 diabetes mellitus (DM). The study included 108 patients with angina of effort randomized into two groups: CHD with DM (n = 51) and CHD without DM (n = 57). All of them received anti-ischemic and antihypertensive therapy and two desaggregants; DM patients also used oral hypoglycemic preparations. The patients underwent implantation of Sirolimus-eluting stents. The frequency of restenosis of the target arteries, development of serious cardio-vascular events (death, MI, cerebral stroke, and the need in repeat revascularization) were compared within 18 months after primary endovascular revascularization. Although Sirolimus-eluting stents markedly improved long-term prognosis in DM patients, results of their implantation were worse than in patients with CHD without DM.

[Suppressive effect of recombinant immunomodulator ronkoleukin on the blood level of antiinflammatory cytokines, anticardiolipin autoantibodies and heart failure].

AIM: To elucidate clinical efficacy and immunocorrecting properties of recombinant immunomodulator ronkoleukin in patients with postinfarction cardiac dysfunction with NYHA FC II-III CHF. MATERIAL AND METHODS: In a 6-months prospective comparative clinically controlled study we observed 33 survivors of myocardial infarction divided into 2 groups according to FC of chronic heart failure (CHF): group I (n=17) with FC II CHF with LVEF > 45% (mean age 52 +/- 2.9 years) and group II (n=16) with FC III CHF and lowered ( 40%) LVEF (mean age 53.7 +/- 3.3 years). Comparison group comprised practically healthy subjects. Clinico-laboratory and functional assessment of state of patients was carried out before initiation of therapy with ronkoleukin and in 2 - 3 days after completion of 2 courses of therapy with 3 months interval. Immunological study included determination of subpopulation content of peripheral blood lymphocytes, blood plasma immunoglobulins, antiinflammatory cytokines Il-1a, Il-1b, Il-2, Il-6, Il-8, TNFa and AB to Cl. RESULTS: It was found that ronkoleukin is an effective immunocorrector producing no adverse effects in patients with FC II-III CHF. Most pronounced effect ronkoleukin manifested in relation to humoral immunity lowering dysimmunoglobulinemia, blood levels of IgA, IgG, CIC and antibodies to cardiolipin, inhibiting excessive cytokine activation in dependence on degree of severity of CHF. CONCLUSION: Administration of ronkoleukin to patients with postinfarction dysfunction of the heart with FC II-III CHF for correction of secondary immunodeficient state in addition to basic therapy provides positive changes of hematological, immunological parameters, intracardiac hemodynamics, facilitates regression of symptoms of CHF and improves quality of life.

[The role of cytokines in restenosing coronary stents and the efficiency of its secondary prophylaxis with statins].

This study was designed to assess the diagnostic value of dynamic patterns of anti-inflammatory cytokines (IL-1b, IL-6, TNF-alpha) in patients with ischemic heart disease (IHD) and restenosis of coronary stents 14 months after their implantation for long-term prophylaxis of dyslipoproteinemia. A total of 40 patients with IHD of advanced functional classes (FC) were examined. Blood cytokine levels were measured before, 1 day, and 12-18 months after coronary stenting. Two groups of 23 and 17 patients included cases with recurrent angina and without it respectively. The main parameters measured in the study were in-stent restenosis rate, incidence of' acute myocardial infarction (AMI), mortality rate, frequency of hospitalization for unstable angina, and the levels of proinflammatory cytokines. Considerable activation of cytokines in patients with post-infarction cardiac dysfunction who rarely resorted to therapy with statins (16.7%) was associated with the high rate of recurrent coronary insufficiency related to in-stent occlusion (8.7%), progressive atherosclerosis (65.2%), impaired myocardial perfusion, and restenosis of coronary stents (26.1%). Patients lacking apparent expression of serum cytokines after revascularization while receiving efficacious secondary prophylaxis of dyslipidemia (13.8 and 17% decrease of triglycerides (TG) and low density lipoproteins (LDL) cholesterol respectively, p = 0.04) had left ventricular ejection fraction (LVEF) improved by 12.5% (p = 0.03%), left ventricular end diastolic pressure (LVEDP) decreased by 15.8% (p = 0.03), and frequency of ischemic perfusion defect (PD) reduced by 45.3% (p = 0.01). Moreover, they showed low incidence of progressive coronary atherosclerosis (17.6%) in the absence of in-stent restenosis. It is concluded that the frequency of restenosis of coronary stents after endovascular myocardial revascularization depends on the preprocedural rise in IL-1b content (R = 0.62, p = 0.0023). It is concluded that long-term secondary prophylaxis of dyslipoproteinemia in patients with ischemic dysfunction at risk of coronary restenosis effectively (more than thrice) decreases the occurrence of coronary stent restenosis after endovascular revasularization.

[Metabolic syndrome: prevalence among outpatients with arterial hypertension, the efficacy of treatment].

The purpose of the investigation was to study prevalence of specific variants of metabolic syndrome (MS) in patients with arterial hypertension (AH), and assess the efficacy of antihypertensive therapy in outpatient departments using drug-and non-drug methods. The subjects, 680 patients with MS and I to III degree AH, underwent clinico-anthropometric examination, lipidography, and fasting blood sugar measurement; outpatient and in-patient medical records were analyzed. Various variants of MS were found in 86.7% of the patients. Combination of AH, dyslipidemia, and excessive body weight (BW) was revealed in 32.5% of the patients; the same combination, but with normal BW, was revealed in 19.2% of the subjects; AH with obesity and carbohydrate metabolic disturbances was found in 19.1% of the subjects; AH with excessive BW alone was found in 6.2% of the patients; AH with hyperglycemia and dyslipidemia was revealed in 5.4% of the cases. The study also found that 30% of the patients did not receive any therapy at all, 34.3% received irregular treatment, only 35.7% of the subjects took medications on a regular basis, and only 12.4% of the patients target arterial pressure levels were had been achieved. Thus, the therapy of patients with AH and MS does not meet current requirements. Low patients'compliance with drug- and non-drug therapy and the fact that physicians do not follow scientifically based standards of treatment are the main reasons for the low efficacy of AH treatment.

[Clinico-immunological disorders in patients with ischemic heart disease combined with metabolic syndrome and modulating effect of nebivolol for their correction].

AIM: To evaluate clinico-immunological disorders in patients with ischemic heart disease (IHD) and metabolic syndrome (MS), to study an immunocorrective action of nebivolol during 6-month treatment. MATERIAL AND METHODS: A total of 54 patients with postinfarction left ventricular dysfunction and chronic cardiac failure of NYHA functional class II-III were divided into two groups: group 1 (n=24) comprised patients with effort angina FC II-III and impaired glucose tolerance, group 2 (n=30) consisted of anginal patients associated with type 2 diabetes mellitus (DM). Clinical, laboratory and functional indices were registered before therapy with nebivolol and 6 months after it. Immunological control included determination of the subpopulation composition of lymphocytes, immunoglobulins, circulating immune complexes (CIC), antibodies to cardiolipin (CL), proinflammatory cytokines: IL-1alpha, IL-2, IL-6, IL-8, alpha-interferon, tumor necrosis factor alpha (TNFalpha). RESULTS: Nebivolol demonstrated good antihypertensive and anti-ischemic cardioprotective efficacy in IHD patients with MS, it did not deteriorate atherogenic dyslipidemia and impaired carbohydrate metabolism. As a good immunocorrector, nebivolol significantly inhibited cytokine overactivation, had a weak effect on dysimmunoglobulinemia, CIC level and expression to CL antibodies. Side effects were not recorded. CONCLUSION: IHD patients with MS (especially patients with type 2 DM) have manifest immune disorders presenting with overactivation of proinflammatory cytokines with high levels of IgA, IgG, CIC and antibodies to CL in the presence of low immunoregulatory index. Nebivolol provided good control of arterial hypertension, myocardial ischemia, positive changes in immunological indices, improved intracardiac hemodynamics.

[The role of cytokines in improvement of coronary restenosis risk stratification after endovascular stenting in patients with ischemic heart disease].

AIM: To evaluate diagnostic and prognostic significance of the levels of proinflammatory cytokines (IL-1, IL-6, TNF-alpha) in improvement of stratification, i.e. determination of coronary restenosis risk in patients with ischemic heart disease 18 months after coronary artery (CA) stenting. The patients were divided into two groups: group 1 consisted of 30 patients with ischemic heart disease and symptoms of anginal recurrence, 38 patients of group 2 had no recurrent coronary insufficiency. Baseline examination of 68 patients with ischemic heart disease and their examination 6-24 months (18.1 +/- 1.9 months) after CA stenting were performed. RESULTS: High activation of the proinflammatory cytokines in patients with postinfarction cardiac dysfunction and after CA stenting is associated with a high rate of recurrent angina, deterioration of myocardial perfusion, progression of atherosclerosis in CA native bed. Restenosis of CA stents in patients after endovascular myocardial revascularization significantly more frequently correlates with elevated blood levels of IL-6 by 56.8% (p = 0.031). Patients with anginal recurrence caused by stent restenosis, progression of atherosclerosis in native CA developed high expression (10.2-58.1%) of TNF-alpha (p = 0.038) 18 months after endovascular revascularization. Repeated angioplasty is associated with multiple CA affection (k = 0.56, p = 0.004) and predilation before stenting (k = 0.3; p = 0.001). CONCLUSION: Dynamics of proinflammatory cytokines (IL-1, IL-6 and TNF-alpha) is efficient to use in complex diagnosis for better stratification of CA restenosis risk in endovascular stenting of patients with coronary artery disease.

[Effects of a superselective beta1-adrenoblocker nebivolol on the course of coronary heart disease and insulin resistance in patients with diabetes mellitus type 2 after coronary artery bypass grafting].

AIM: To study safety and effects of nebivolol on the course of coronary heart disease (CHD) and insulin resistance (IR) in patients with diabetes mellitus type 2 (DM-2) after coronary artery bypass grafting. MATERIAL AND METHODS: The study included 53 CHD patients with DM-2 (mean age 56.7 +/- 1.3 years). All the patients were divided into two groups: 22 patients with IR (group 1) and 31 patients free of IR (group 2). All the patients received an 8 week course of nebivolol the efficacy of which was assessed by changes in coronary failure, exercise tolerance, quality of life, lipid and carbohydrate metabolism. RESULTS: In group 1 an antianginal effect of nebivolol manifested with less frequent (by 54.7%) development of angina pectoris (p = 0.0003), a 59.8% (p = 0.0004) decrease in 24-h need in nitroglycerine. In group 2 these reductions were 63.4 and 61.6% (p < 0.01), respectively. Exercise tolerance increased by 36.2 and 25.2%, left ventricular ejection fraction significantly increased by 5.9 and 5%, respectively, quality of life improved by 25 and 23%, respectively. As a result, a functional class of chronic cardiac failure lowered. Nebivolol had no negative effect on compensation of blood lipid and carbohydrate metabolism. A trend to blood insulin fall by 18.4% was found. IR index diminished by 11.9%. CONCLUSION: Administration of nebivolol in a dose 1.25-5 mg/day raised exercise tolerance, improved quality of life, reduced IR index by 11.9%, triglycerides level by 5.3%. This lowered the risk of effects of diabetic atherogenic dyslipidemia.

[Possible role of hyperinsulinemia in pathogenesis of acute and chronic cardiac failure in patients with ischemic heart disease (data of clinical studies)].

Changes of blood insulin content were studied in patients with ischemic heart disease with various functional classes of acute and chronic heart failure and at different disease stages. It was established that latent hyperinsulinemia which became evident at induced myocardial ischemia was present on all stages of development of ischemic heart disease. In acute heart failure due to developed myocardial infarction hyperinsulinemia manifested in 58.3% of patients. Amount of insulin in blood increased almost 3 times. During progression of chronic heart failure insulin content significantly decreased, probably because of exhaustion of insulin producing function and development of its relative or absolute deficit. At terminal stage of congestive heart failure insulin level was < or = 1 microU/ml. The authors believe that severity of clinical signs of acute and chronic heart failure are determined by sensitivity of myocardium to insulin, content of insulin in blood, and also depends on compensatory possibilities of insulin producing function at each stage of development of the disease.

[The long-term results of coronary artery bypass grafting in patients with type II diabetes].

A three-year follow-up of patients with coronary heart disease (CHD) and type II diabetes after coronary artery bypass grafting, shows that the following pathologic conditions are significantly more frequent: arterial hypertension, visceral obesity, marked disturbances of blood lipid spectrum, an increases CHD duration, and an increased rate of myocardial reinfarction and revascularizations. The study shows that the presence of diabetes mellitus in CHD patients undergoing coronary artery bypass grafting, is associated with pronounced disturbances in blood lipid spectrum, and is an important risk factor of coronary event progression.