Expression of Genes and Proteins of the Sarcoplasmic Reticulum Са2+-Transport Systems in Cardiomyocytes in Concomitant Coronary Heart Disease and Type 2 Diabetes Mellitus.

We compared the expression of Са2+-ATPase (SERCA2a), calsequestrin (CASQ2), ryanodine receptors (RyR2) proteins and their genes (ATP2A2, CASQ2, and RYR2) in coronary heart disease (CHD) patients with and without comorbid type 2 diabetes mellitus. All studies were performed on the right atrial appendages resected during coronary bypass surgeries. Expression of SERCA2a and RyR2 proteins and their ATP2A2 (p=0.046) and RYR2 genes in comorbid pathology was significantly (p=0.042) higher (by 1.2 and 2 times; p=0.025). The expression of CASQ2 protein and its gene did not differ significantly between the groups (p=0.82 and p=0.066, respectively). It was concluded that the expression of SERCA2a and RyR2 proteins and their genes (but not CASQ2 and its gene) is elevated in CHD associated with type 2 diabetes mellitus. Expression of the studied proteins correlated with the expression of their genes. Increased expression of CASQ2 protein and its gene can probably prevent imbalance of the Ca2+-transporting systems in cardiomyocytes and contractile dysfunction of the myocardium, even in CHD associated with type 2 diabetes mellitus.

[A new method of endoscopic harvesting of the great saphenous vein in an open system]. / Novyi metod éndoskopicheskogo vydeleniia bol'shoi podkozhnoi veny v otkrytoi sisteme.

We examined a total of 246 patients subjected to coronary artery bypass grafting with the use of the great saphenous vein (GSV). The patients were subdivided into two groups. Group One (n=121) patients endured procurement of the great saphenous vein by a new endoscopic technique in an open system with the help of the equipment Karl Storz and electric dissector Ligasure. In Group Two (n=125) patients the vein was harvested by means of the traditional open method. In all patients we evaluated complications in the early postoperative period 13±2.5 days after the operation. The rate of relapsing angina pectoris in both Groups turned out to be low and did not differ (1.65% in Group One and 1.6% in Group Two). Patients of the both groups differed significantly by the incidence of postoperative complications on the lower limbs in the zone of procurement of the GSV (9.09% in Group One and 26.4% in Group Two, p=0.131). Group Two patients (open method of procurement of the GSV) were considerably more often found to have developed cases of lymphorrhoea, haematomas, disjunction of the sutures (21.6%) compared with Group One (endoscopic method) patients (3.3%) (p=0.167), which in 10.4% of cases required secondary surgical debridement of wounds in patients after the open harvest of the GSV. Eventually, the length of hospital stay for Group Two patients increased significantly (15 ± 4.5 days) compared with Group One patients (8±1.1 days) (p=0.361). Hence, the endoscopic method of harvesting the GSV in the open CO2 system makes it possible to obtain a good cosmetic effect on the lower limbs after the operation, to considerably decrease the complications rate, thus reducing the length of hospital stay.

Cell-free collagen-based scaffolds used for making blood vessels in cardiovascular surgery.

The present article deals with the technology of obtaining decellularized cell-free collagen-based scaffolds from arterial vessels and surgical assessment of the possibility of experimentally implanting them into the blood system of laboratory animals for experimental purposes. The study was performed on arterial vessels (n=60) and fragments of the human internal thoracic artery (n=20). Described herein is a method of obtaining a connective-tissue matrix of a blood vessel by means of vessel's perfusion for 2-3 hours with detergent solutions. Cell-free collagen-based conduits were implanted to a total of ten dogs. After the operation, the blood flow remained functional. The anastomoses established turned out to be leak-proof and the acellular vessels were able to withstand the haemodynamic load of the arterial blood flow.

Economical technology of creation of cell-free matrix of animal and human arterial vessels.

We present a technology of creation of blood vessel connective tissue framework by 2-3-h vessel perfusion with detergents. The technology ensures effective removal of vascular cells without damaging collagen and elastic fibers. The connective tissue frameworks prepared by this method can the used for restoring blood flow in various vascular pathologies. The presented approach attenuates the damaging effect of treatment on the vascular framework due to maximum simplification and shortening of the duration of treatment and is universal for human and animal vessels.

[Scintigraphic evaluation of cerebral circulation in prognosis of cerebrovascular complications of coronary artery bypass grafting].

The aim of the work was to study the possibility of using single-photon emission computed tomography (OECT) of brain using 99m Tc-hexamethyl propylene aminoxime for the evaluation of long-term prognosis of the development of neurocognitive deficit after coronary artery bypass grafting (CBG) and elucidation of relationship between variations of cognitive function and regional cerebral circulation. Surgical myocardial revascularization under artificial circulation was performed in 22 patients with CHD. All of them were examined for the assessment of neurologic and neuropsychological status, and OECT data before, 14 days and 6 months after CBg. Early cognitive deficit developed in 96% of the patients and persisted for 6 months in 55%. Cognitive dysfunction was manifest as post-operative impairment of short- and long-term memory, and general efficiency of remembering. Visual memory and psychomotor speed also deteriorated. Cerebral circulation decreased in frontal and parietal lobes of the right hemisphere. Deterioration of long-term memory 6 months postoperatively correlated with the early circulation decrease of in the right and left temporal lobes.

[Clinical experience of the use of autologous mononuclear bone marrow cells in patients with ischemic heart disease and dilated cardiomyopathy].

Between March 2003 and February 2005 cell therapy with mononuclear bone marrow cells (MBMC) was used in 38 and 4 patients with ischemic heart disease and dilated cardiomyopathy, respectively. Intracardiac administration of MBMC (87+/-12 millions) was carried out during coronary artery bypass surgery and/or left ventricular aneurysm resection (n=25) or in cardiac catheterization laboratory (n=17). For verification of cells fixation they were labeled with "Ceretec" 99mTc-HMPAO. Accumulation of labeled cells after 24 hours was 1.6+/-0.001%. After 6 months parameters of intracardiac hemodynamics and transitory myocardial perfusion defects improved significantly in all patients with ischemic heart 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.

[Inotropic reactions of myocardium of patients with ischemic heart disease and rats during use of amiodarone].

AIM: To study effect of amiodarone on inotropic reactions of myocardium of patients with ischemic heart disease and rats. METHODS AND RESULTS: Excitability of rat myocardium has been found to be higher than that of myocardium of patients. Sarcoplasmic reticulum of myocardium of rats has greater functional reserve, therefore rat muscle preparations respond to extrasystolic stimuli with postextrasystolic potentiation. Perfusion with a solution containing amiodarone caused diminution of amplitude of extrasystolic response of muscular strips both from rats and patients. Amiodarone augmented ability of sarcoplasmic reticulum to accumulate Ca ions as it prevented decrease of postextrasystolic contraction of human myocardium and brought about postextrasystolic potentiation of muscular strips of rat myocardium. CONCLUSION: Amiodarone affected intracellular homeostasis of calcium ions in cardiomyocytes of both rats and patients. Amiodarone lowered myocardial excitability and facilitated ability of cardiomyocyte sarcoplasmic reticulum to accumulate calcium ions.

Central hemodynamic and cognitive function in the short- and long-term periods after coronary bypass grafting.

The aim of the present work was to study cerebral hemodynamics and cognitive function in patients suffering from coronary artery disease (CAD) in the short- and long-term periods after coronary bypass grafting (CBG). The study accrued 65 patients who underwent myocardial revascularization using cardiopulmonary bypass (43 persons) and without heart interruption (22 persons). In 21 cases, CBG using cardiopulmonary bypass with a purpose of preventing cerebral events was supplemented by administration of instenon manufactured by the Nycomed Company, Perfusion tomoscintigraphy of the brain and neuropsychological testing were provided to all the patients prior to CBG, 14 days and 6 months following surgery. CBG coupled with preventive administration of instenon or beating heart operation allow to appreciably minimize the risk of disorders of cerebral hemodynamics and cognitive function in the long-term postoperative period.

[Effect of trimetazidine on regressione of ischemic dysfunction of myocardium after coronary bypass surgery on beating heart]. / Vliianie miokardial'noi tsitoprotektsii trimetazidinom na regress ishemicheskoi disfunktsii miokarda u bol'nykh, perenesshikh operatsiiu koronarnogo shuntirovaniia na rabotaiushchem serdtse.

AIM: To study effect of trimetazidine on restoration of hibernating myocardium after myocardial revascularization on beating heart. MATERIAL: Patients with ischemic heart disease subjected to direct myocardial revascularization on beating heart: 25 patients received trimetazidine (60 mg/day) in pre and postoperative periods and 30 patients did not. METHODS: Echocardiography, veloergometry, 6 minute walk test, myocardial scintigraphy with Tl-199. RESULTS: Course (35 days) treatment with trimetazidine provided significant decrease of frequency and severity of episodes of angina, reduction of nitrate consumption, enhancement of tolerance to physical exercise, improvement of myocardial perfusion manifested as significant decrease of mean size of transient perfusion defects. CONCLUSION: These results demonstrate efficacy and expediency of trimetazidine use in therapy of reversible myocardial dysfunction in patients with ischemic heart disease subjected to direct myocardial revascularization.

Initiation of stress protein synthesis in the myocardium of coronary patients.

We studied myocardial biopsy specimens from the right atrium of cardiological patients with different degree of cardiac ischemia obtained during surgery. No inducible HSP70 stress proteins were detected in atrial cardiomyocytes of patients with the WPW syndrome without signs of ischemic injuries of the heart. These proteins were detected in the myocardium of coronary patients. Their expression was more intense in patients with coronary disease paralleled by the development of myocardial dyskinesia. Two-dimensional electrophoresis showed only acid HSP70 but no alkaline isoforms in coronary patients even with pronounced dyskinesia. Presumably, alkaline HSP70 isoforms are present in the myocardium directly involved in the dyskinesia zone.

[Reperfusion syndrome after direct myocardial revascularization on beating heart in patients with ischemic heart disease. Possibilities of prevention with amlodipine]. / Vozmozhnosti profilaktiki reperfuzionnogo sindroma amlodipinom u bol'nykh ishemicheskoi bolezn'iu serdtsa, perenesshikh priamuiu revaskuliarizatsiiu miokarda na rabotaiushchem serdtse.

Possibilities of secondary prevention of reperfusion syndrome with amlodipine was assessed in 46 patients (39 with class III-IV angina after myocardial infarction and 7 with non ST elevation acute coronary syndrome). Twenty six patients received basic therapy, in 20 patients this therapy was supplemented with amlodipine (5-10 mg/day). In all patients complete direct arterial myocardial revascularization on beating heart was carried out. Methods of dynamic control included echocardiography, paired bicycle exercise tests, 6 minute walk test, myocardial scintigraphy with thallium-199. The results evidence for efficacy and feasibility of secondary prevention of reversible myocardial dysfunction with amlodipine.

[Effect of calcium antagonists verapamil and amlodipine on the risk of development of atrial fibrillation after coronary artery bypass grafting]. / Vliianie antagonistov kal'tsiia verapamila i amlodipina na risk razvitiia fibrilliatsii predserdii u bol'nykh posle aortokoronarnogo shuntirovaniia.

AIM: To assess effect of calcium antagonists amlodipine and verapamil on the risk of development of atrial fibrillation after coronary artery bypass surgery. MATERIAL: Of 74 patients subjected to mammary artery and venous coronary bypass grafting with the use of cardiopulmonary bypass 19 received amlodipine and 21 - verapamil. RESULTS AND CONCLUSION: Attacks of atrial fibrillation during 24 hour ECG monitoring were registered in 22.9% of patients mostly on days 2 and 3 after surgery. In verapamil treated patients atrial fibrillation occurred 1.5-2 times more often than in amlodipine treated patients or in patients receiving no calcium antagonists. This could possibly be explained by pronounced slowing of atrio-ventricular conduction by verapamil at the background of postoperative general "irritation" of the atrial myocardium.

[Pharmacological prevention of cerebrovascular complications in cardiac patients after coronary artery bypass surgery]. / Medikamentoznaia profilaktika tserebrovasculiarnykh oslozhnenii u bol'nykh ishemicheskoi bolezn'iu serdtsa posle aortokoronarnogo shuntirovaniia.

The aim of the study was to evaluate cognitive functions and cerebral perfusion in cardiac patients following coronary artery bypass graft surgery (CABG) and to investigate a potential of pharmacological prevention of neurocognitive deficit and cerebral perfusion disorders. Forty patients undergone CABG with cardiopulmonary bypass (CPB) were included in the study. For prevention of cerebral perfusion impairments and cognitive deficit, instenon ("Nycomed") was administered to 18 of the patients. The results revealed that the use of instenon allowed reducing a negative effect of CABG with CPB on neuropsychological state of the patients, thus preventing cerebral perfusion disturbances during surgery intervention.

Optimal electrical stimulation for latissimus dorsi muscle after cardiomyoplasty.

The aim of this study was to evaluate the functional state of latissimus dorsi muscle (LDM) during electrical stimulation following cardiomyoplasty. Both single pulses and bursts of impulses were used for electrical stimulation. In 15 dogs, studies were carried out for 2 months, while in 19 patients, the follow-up period after cardiomyoplasty was 10 +/- 3.1 months. The LDM was punctured by needle electrodes at various intervals following cardiomyoplasty, and the changes of the rheomyosignal (RMS) curve were registered on the "Reostim-06." During the follow-up study, it was found that: (1) signal amplitude decreased 30%; (2) the contraction duration of LDM increased 38%; (3) the contraction velocity decreased 43%; and (4) relaxation velocity decreased 61%. There is a correlation between LDM mechanical contractile force and RMS indices (r = 0.8). The RMS index was a function of the electrical burst duration and the number of impulses in the bursts. Thus, RMS parameters can characterize the functional state of LDM, and they may be used in designing a new generation of electromyostimulators for optimal LDM stimulation at different periods after cardiomyoplasty.