[The influence of correction of iron metabolism and erythron characteristics in mild iron deficiency states on clinical manifestations of coronary heart disease].

We studied the influence of correction of iron metabolism and erythron characteristics to normal values in latent iron-deficiency states and mild iron deficiency anemia (IDA) with a hemoglobin level of 130-110 g/l on clinical manifestations of the concomitant coronary heart disease (CHD). The patients were 71 men aged 51.5 +/- 1.1 yr; the control group was comprised 18 age-matched healthy men. CHD and anemia were diagnosed as recommended by RSSC and WHO respectively. Clinical manifestations of both pathologies were compared before and after correction of iron metabolism and erythron characteristics using Sorbifer Durules (Egis, Hungary) in combination with pharmacotherapy ofcardiovascular disorders. Characteristics of iron metabolism and erythron were determined using a Stet Fax 3300 analizer and Vital reagent kits. Sorbifer (200 mg Fe) was given daily for 3 weeks with relevant dietary recommendations. All patients with latent iron-deficiency showed normalization of iron metabolism and those with IDA of both iron metabolism and erythron. In CHD patients, these effects were accompanied by a decrease in the frequency, duration, and intensity of angina, reduced requirement of nitroglycerin, increased tolerance of physical exercises. Also, the severity of co-morbid clinical manifestations (oedema, dyspnoea, palpitation) and heart rate decreased.

[Myocardial structural and functional changes in patients with chronic viral hepatitis concurrent with chronic opisthorchiasis].

The aim of the investigation was to study the myocardium in patients with chronic viral hepatitis concurrent with chronic opisthorchiasis. Ninety patients with chronic viral hepatitis, including 52 patients with this disease concurrent with chronic opisthorchiasis, were examined. Doppler echocardiography indicated a statistically significant increase in left ventricular mass regardless of the presence of Opisthorchis infestation. Analysis of left ventricular diastolic dysfunction showed its great degree in chronic hepatitis C. Single-photon emission computed tomography with 99mTc-pyrophosphate revealed focal tracer incorporation in the myocardium of most patients with Opisthorchis infestation. A third of patients with chronic viral hepatitis showed moderate diffuse trace accumulation that was significantly more frequently found in chronic hepatitis C. Single photon-emission tomography with labeled leukocytes demonstrated abnormal accumulation in none of the patients; troponin T levels were in the normal allowable range. Myocardial lesion was detected in the chronic course of viral hepatitis C concurrent with chronic opisthorchiasis that was unattended by cardiomyocyte necrosis and that was dystrophic.

[Antihypertensive treatment compliance and obstacles to its improvement. Results of Russian program ARGUS-2].

AIM: To study barriers made by the patients for adequate treatment of arterial hypertension. MATERIAL AND METHODS: The ARGUS-2 trial was made in 15 centers of 13 cities of Russia. Anonymous questionnaire survey covered 1298 patients (796 outpatients and 502 inpatients). The patients answered the following questions: 1) what are basic problems of life with hypertension; 2) compliance with intake of antihypertensive drugs; 3) causes of missed intakes of the drugs; 4) opposition to intake of drugs by the patients. Questioning procedure was preset by the trial protocol. RESULTS: Only 37.4% (38.9% outpatients, 34.6% inpatients) were the treatment adopters. Drug intake was missed most frequently because offorgetting. The problems of life with hypertension were differently interpreted by patients and physicians: for the latter main problems were financial and routine while AH complications were on the 6-7 place. The latter were of primary importance for the patients while financial problems took place 4-6 Barriers to regular intake for the patients were poor self-control and unawareness about side effects of the drugs. CONCLUSION: Complience of the patient can be improved only by complex approach: improvement of education, higher motivation, active involvement of patients into the treatment process, better contacts between the physician and the patient.

[Problems of a physician-patient interaction and control of arterial hypertension in Russia. Main results of scientific-practical program ARGUS-2].

OBJECTIVE: To study the problems of physician-patient cooperation, patient- and physician related barrieres to target blood pressure (BP) achievement and to demonstrate improvement of BP control with indapamide SR 1.5 mg, when given to patients remaining uncontrolled while receiving antihypertensive therapy without thiazide diuretics (TD). METHODS: The trial Improvement of Arterial Hypertension Control in High-Risk Hypertensive Patients (ARGUS-2) run in 15 Russian centres during the year 2006. Retrospective analysis of medical notes of 684 outpatients and 575 inpatients with arterial hypertension. Validated questionnaires were used for interview of 373 physicians and 1298 patients. The study of Arifon retard efficacy was carried out in 1438 outpatients with difficult-to-control hypertension. RESULTS: BP was above the goal level in 97.1% pts at the first analyzed visit to an outpatient department. Antihypertensive therapy was unchanged in 20.5% cases, the drug dose was increased in 46,6%, additional medication was administered in 36,8%. In 30.8% pts antihypertensive agent was substituted by another class drug. At the last analyzed visit target BP was found in 24.4% pts. BP control was poorer in pts with BP goal <130/80 mmHg (20.1%) than in those with higher target BP (25.9%). Achievement of BP goal was associated with combination therapy, higher rate of TD administration and with more frequent visits to physician. During hospitalization target BP <140/<90 mmHg was achieved in 87.1%,<130/<80 mmHg in. 76.2%. Arifon retard administration resulted in target BO achievement in 84.5% patients. Physicians percept low adherence to antihypertensive treatment, lack of patients knowledge about risk related to arterial hypertension, economical problems as main barriers to improvement of arterial hypertension management. Patients considered economical problems related to antihypertensive treatment more much less important than physicians did. CONCLUSION: The study results suggest the importance of therapeutic inertia overcome to improve arterial hypertension management in Russia. Low rate of multiple combination therapy and TD prescription are important features of therapeutic inertia. Polar perception of problems related to arterial hypertension by physicians and patients should be considered as influencing factors for educational programs development.

[Tissue hypoxia in non-massive pulmonary arterial thromboembolism in patients with an implanted electrocardiostimulator].

The subjects of the study were 64 patients with coronary heart disease, atherosclerotic cardiosclerosis, constant atrial fibrillation, and total artificial atrioventricular blockade corrected by means of electrocardiostimulation, complicated by non-massive pulmonary arterial thromboembolism. Twenty-one patients had lowered arterial oxygen partial pressure, (paO2 whereas in 15 patients this variable was increased; both conditions were associated with vestibuloatactic and asthenic syndromes, as well as cognitive function decrease. The presence of sympathicotonia in 93% of the patients with increased paO2 made it possible to describe hyperventilation syndrome, which had not been described before and which takes place in cases of constantly relapsing non-massive embolization of pulmonary artery's small branches, associated with endocardial electrocardiostimulation.

[The role of opisthorchiasis in development of the secondary neurocirculatory dystonia and myocardial metabolic changes]. / Rol' opistorkhoza v razvitii vtorichnoi neirotsirkuliatornoi distonii i metabolicheskikh izmenenii miokarda.

AIM: Clarification of opisthorchiasis role in development of secondary neurocirculatory dystonia (NCD) and assessment of myocardial condition in patients with chronic opisthorchiasis (CO) with consideration of the disease duration and intensity of opisthorchotic invasion. MATERIAL AND METHODS: The trial enrolled 120 patients with CO, 35 patients with cardial NSD and 33 healthy controls. RESULTS: In long history of opisthorchiasis and severe invasion, autonomic cardiovascular regulation was abnormal. If CO patients have NCD, myocardial 99mTc-pyrophosphate scintigraphy reveals diffuse metabolic lesion of the myocardium. Long-term autonomic dysregulation of the cardiovascular system in CO and absence of adequate therapy lead to formation of progressive autonomic imbalance syndrome with sympathetic hypertonicity provoking metabolic disturbances of the myocardium.

[Peripheral oxygenation and perfusion in patients with chronic ischemic heart disease complicated by left-ventricular failure]. / Perifericheskie oksigenatsiia i perfuziia u bol'nykh khronicheskoi ishemicheskoi bolezn'iu serdtsa, oslozhnennoi lebozheludochkovoi nedostatochnost'iu.

Examination of 33 normal subjects and 91 patients with coronary heart disease (CHD) ascertained that during CHD (diffuse atherosclerotic and postinfarction cardiosclerosis) without clinically marked heart insufficiency, oxygen tension in the arterialized capillary blood and subcutaneous fat of the forearm was normal in the overwhelming majority of cases. Only some of the patients manifested negligible arterial hypoxemia and/or tissue hypoxia. Left ventricular failure was always accompanied by arterial hypoxemia and tissue hypoxia the degree of which was proportional to the gravity of heart insufficiency. In isolated left ventricular failure without congestion in the greater circulation, CHD patients demonstrated abnormal peripheral circulation and tissue perfusion. In particular, the distensibility of the forearm veins was decreased by 43-50%, their capacity was reduced by 28-43%, and the volumetric velocity of the peripheral blood flow in this area was lessened by 34-58%.

[Effect of various drugs on peripheral hemodynamics in left-ventricular insufficiency in patients with chronic ischemic heart disease]. / Sostoianie perifericheskoi gemodinamiki i vliianie na nee nekotorykh lekarstv pri levozheludochkovoi nedostatochnosti u bol'nykh khronicheskoi ishemicheskoi bolezn'iu serdtsa.

It is established that in the majority of patients at the height of left ventricular insufficiency (LVI) low cardiac output is not recorded, it is within the normal limits and at times even higher than normal. In isolated LVI present only with pulmonary hypertension, despite the absence of insufficiency of the right heart considerable disorders of peripheral haemodynamics are present in the shape of decreased volume of tissue blood flow, venous capacity and extensibility of the peripheral veins. The degree of this decrease is proportional to the severity of LVI and upset of the pulmonary circulation. The more persistent and considerable effect correcting decreased capacity and extensibility of the peripheral veins and enhancing the perfusion of tissues with isolated LVI is exerted by furosemide, nitroglycerine is somewhat less effective. Strophanthin exerts such effect in roughly 50% of cases, and obsidan is unreliable in its effect.