[Interrelationship between functional state of the right ventricle and severity of heart failure in patients with ischemic heart disease and depressed left ventricular function].

Dobutamine Doppler echocardiography was carried out in 56 patients (n=56) with ischemic heart disease and depressed left ventricular function (left ventricular ejection fraction <40%) and chronic heart failure. Clinical signs of heart failure were moderate (NYHA class I-II) in 34 and severe (NYHA class III-IV) in 22 patients. Patients with moderate and severe clinical heart failure had similar degree of left ventricular myocardium impairment however those with severe symptoms had more pronounced right ventricular (RV) dysfunction (greater suppression of global and local RV contractility, greater percentage of irreversibly dysfunctional RV myocardium, lower RV contractile response to dobutamine infusion, more pronounced disturbances of RV diastolic filling). Dependence of RV pump function on pulmonary artery pressure was more evident in patients with severe clinical heart failure and marked dysfunction of RV myocardium than in patients with moderate symptoms and moderate RV myocardial dysfunction.

[Sigmental right ventricular contractile function in patients with ischemic heart disease]. / Segmentarnaia sokratitel'naia funktsiia pravogo zheludochka u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Segmental right ventricular function was assessed by dobutamine stress echocardiography in 101 patients with ischemic heart disease and multiple coronary artery lesions. At rest local wall motion abnormalities were found in 69% of patients. Overall 505 segments of the right ventricle were analyzed (5 per patient). At baseline 34% of segments were asynergic (31% - hypokinetic and 3% akinetic), right ventricular wall motion score index was 1.38+/-0.04. Low dose dobutamine infusion resulted in decrease of portion of asynergic segments (to 6%) and lowering of wall motion score index (to 1.09+/-0.02, p<0.001 vs baseline). The use of stress doses of dobutamine was associated with appearance of ischemic changes of the right ventricle accompanied with typical anginal attacks and ST-segment depressions; increases of portions of asynergic segments (up to 53% including 43% hypokinetic and 10% akinetic), and of patients with abnormalities of local contractility (up to 90%); rise of wall motion score index (up to 1.64+/-0.05, p<0.001 vs low dose dobutamine). Segmental right ventricular wall motion abnormalities reflected mostly reversible myocardial dysfunction (hibernating myocardium was revealed in 28, scar - in 6, and zone at risk of ischemia - in 47% of all segments). Right ventricular myocardial dysfunction developed in patients with predominant involvement of the right coronary artery or anterior interventricular branch.

[Risk factors and methods of prevention of complications in digestive organs after myocardial revascularization in patients with generalized atherosclerosis]. / Faktory riska i metody profilaktiki oslozhnenii so storony organov pishchevareniia pri revaskuliarizatsii miokarda u bol'nykh generalizovannoi formoi ateroskleroza.

The clinico-hemodynamic and angiographic findings in 66 patients with ischemic heart disease were analysed to identify the risk factors of complications in the digestive system and to determine the methods for their prevention after myocardial revascularization. It was found that complications in the gastrointestinal tract develop after extracorporeal circulation more often in patients with lesions of the visceral branches of the abdominal aorta than in those without them. With purposeful preventive therapy and observance of definite precautions before, during, and after the operation, the incidence of complications in abdominal organs and the organs of the retroperitoneal space reduced to one fourth while the nature of these complications was less aggressive. This was confirmed by no postoperative deaths in the group of patients who had undergone preventive treatment.

[Study of risk factors in complicated forms of ischemic heart disease in evaluating the prognosis and course of the disease (conservative and surgical treatment]. / Faktory riska pri oslozhenennykh formakh ishemicheskoi bolezni serdtsa v otsenke prognoza i techeniia zabolevaniia (terapevticheskoe i khirurgicheskoe lechenie).

Risk factors, survival rate, and quality of life of non-operated and operated patients with complicated IHD (over 50% diameter narrowing of the LCA trunk, occlusion of 3-4 coronary arteries, left ventricular aneurysm and rhythm disturbances) have been studied. The disease course and prognosis are influenced by a number of risk factors. For the non-operated patients, these are the magnitude of narrowing and the number of occluded coronary arteries, the occlusion level, involvement of great coronary arteries, the dimensions of the cicatrical zone, reduced myocardial contractility, left ventricular end diastolic pressure of more than 20 mm Hg, patient's age, and rhythm disturbances revealed on standard resting ECG. The postoperative survival rate and quality of life are significantly improved as compared to the conservatively treated group. The major risk factor is incomplete postoperative myocardial revascularisation, and combined high-grade extrasystole with supraventricular arrhythmias.

[Clinical and functional results of aortocoronary shunting in patients with ischemic heart disease]. / Kliniko-funktsional'nye rezul'taty aortokoronarnogo shuntirovaniia u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Survival rates were evaluated in 3 groups of patients: those with an isolated lesion of the anterior interventricular branch of the left coronary artery (group 1), multiple coronary arterial lesions (group 2) and a more than 50% narrowing of the left coronary-arterial trunk (group 3) following autovenous aortocoronary shunting of 1 to 5 coronary arteries. Drug-treated patients with similar coronary arterial lesions and clinical manifestations were taken as controls. Long-term survival rates of surgical patients were significantly higher, as compared to those of medication-treated patients in groups 2 and 3. There was no significant difference in survival rates of first-group patients. Long-term survival was dependent on the scope of revascularization and pretreatment myocardial contractility.

[Differential diagnosis of lesions of the left coronary artery trunk and multiple hemodynamically-significant stenoses of the coronary arteries]. / Differentsial'naia diagnostika porazheniia stvola levoi koronarnoi arterii i mnozhestvennykh gemodinamicheski znachimykh stenozov koronarnykh arterii.

Clinical manifestations were compared in coronary patients with different sites and spread of coronary atherosclerosis, in order to assess the feasibility of differential diagnosis of left coronary arterial (LCA) trunk lesions versus multiple coronary arterial stenoses. Four groups of patients were examined: isolated third- or fourth-degree LCA trunk stenosis (15 patients, group 1); third- or fourth-degree stenosis of the anterior interventricular branch (AIVB) and the circumflex branch (CB) (44 patients, group 2); third- or fourth-degree stenosis of AIVB, CB or the right coronary artery (RCA) (77 patients, group 3); and third- or fourth-degree stenosis of AIVB, CB, the diagonal branch or RCA (33 patients, group 4). The clinical condition of patients with isolated LCA branch lesions was much worse than that of patients with multiple coronary arterial stenosis. Differential diagnosis is based on the severity of the pain syndrome, the spread of ischemic zone on resting ECG, the scope of past myocardial infarction, stress tolerance and the magnitude of ST depression in response to exercise.

[Remote results of the surgical and conservative treatment of ischemic heart disease patients with a lesion of the left coronary artery trunk]. / Otdalennye rezul'taty khirurgicheskogo i konservativnogo lecheniia bol'nykh ishemicheskoi bolezn'iu serdtsa s porazheniem stvola levoi koronarnoi arterii.

A study was made of the results of surgery of 37 patients and conservative therapy of 90 patients (including 53 inoperable cases) with coronary heart disease with the involvement of the left main coronary artery. Lethality in a long-term period was 16.2% in the operated patients and 45.6% in the inoperable patients. A considerable improvement of the status with the lessening or disappearance of angina attacks was noted in 27 operated patients (87%), a stable improvement of ECG at rest and a considerable increase in exercise tolerance were noted in 11 patients. There was no considerable improvement of the status in the inoperable patients, a slight decrease in the number of attacks was noted in 22% of the patients only, impairment of ECG at rest was noted in 52%, exercise tolerance decreased in most of the patients. In the operated patients the 7-year survival rates according to actuarial curves were 81%, in the operable but receiving conservative therapy 47% and in the inoperable patients 34%.

[Problem in the selection of patients with ischemic heart disease for surgical treatment (summary of 15 years' experience)]. / Problema otbora bol'nykh ishemicheskoi bolezn'iu serdtsa dlia khirurgicheskogo lecheniia (obobshchenie 15-letnego opyta).

A review of data reported in Soviet and foreign literature and the authors' own experience allowed specifying a number of clinical and angiographic criteria for the selection of coronary patients for surgical treatment. Clinical criteria include the pain syndrome, progressive angina pectoris, severe pain with a sharp ST displacement during an effort, low physical stress tolerance, and heart rhythm disorders. Angiographic criteria include total coronary arterial involvement reaching 75%, intact peripheral channel in all coronary arteries fit for aortocoronary shunting and satisfactory myocardial contractility.

[Analysis of the symptoms of ischemic heart disease with a lesion of the trunk of the left coronary artery by using an automated information system]. / Analiz simptomatiki ishemicheskoi bolezni serdtsa pri porazhenii stvola levoi koronarnoi arterii s pomoshch'iu avtomatizirovannoi informatsionnoi sistemy.

Using an information system, the authors compared the results of the examination of 169 patients with coronary heart disease and left coronary artery trunk lesions and of 605 patients without such lesions. The functioning of the system was controlled by a complex of programmes designed according to the modular principle. It comprises the following modules: modules of the formation and control of the data pool, modules of the formation of sub-pools according to a given set of signs and modules of data processing. The patients with coronary heart disease and a lesion of the left coronary artery trunk had a number of clinical characteristics including frequent and severe anginal attacks, a large zone of myocardial ischemia, a low exercise tolerance and a considerable depression of the ST segment on the ECG, as well as a long rehabilitation period.

[Correlation between serum lipid level and coronary bed lesions in patients with ischemic heart disease]. / Vzaimosviaz' mezhdu urovnem lipidov v syvorotke krovi i porazheniem koronarnogo rusla u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The blood lipid levels were collated with the atherosclerotic damage to the coronary bed in 124 patients with coronary heart disease. An increase in the content of total cholesterol and low density lipoprotein cholesterol directly correlated with the degree of the total lesion of the coronary bed. The concentrations of high density cholesterol and very low density cholesterol and the atherogenicity index showed no correlation with the severity of atherosclerotic changes in the coronary arteries. The level of triglycerides in these patients displayed a tendency to increase. In evaluating the severity of coronary heart disease, it is recommended to determine the levels of total cholesterol and low density lipoprotein cholesterol. Changes in the concentration of high density lipoprotein cholesterol are unreliable for assessing the degree of coronary atherosclerosis.

[Characteristics of the clinical aspects and symptomatology of ischemic heart disease with various degrees of stenosis of the left coronary artery]. / Osobennosti kliniki i simptomatiki ishemicheskoi bolezni serdtsa pri razlichnoi stepeni suzheniia stvola levoi koronarnoi arterii.

The case histories, painful syndromes, clinical pictures, ECG at rest, and the exercise ECG test data were examined in 169 patients with degrees I-IV of left coronary artery stenosis. The gravity of the clinical picture was found to be augmented with the stenosis degree. The number of daily angina pectoris attacks and their gravity increased, while the pains at rest, night time, after meal, and during transition from the vertical to the horizontal position occurred more frequently. As the stenosis degree progressed, the coronary insufficiency area on the ECG at rest became larger. The exercise tolerance threshold appeared particularly low in patients with degrees II-IV of stenosis, being slightly higher in those with degree I of stenosis. The number of patients who survived myocardial infarction declined with stenosis progression. Patients with degree I of stenosis manifested a grave clinical picture. Stenosis of the left coronary artery up to 50% of the initial trunk was a clinically significant lesion.

[Heredity and coronary artery lesions in patients with ischemic heart disease (clinico-coronarographic comparisons)]. / Nasledstvennost' i porazhenie venechnykh arterii u bol'nykh ishemicheskoi bolezn'iu serdtsa (kliniko-koronarograficheskie sopostavleniia).

The effect of aggravated heredity for coronary heart disease on the extent of coronary arterial damage and the course of the disease was studied in 575 coronary patients. An information system based on the findings was treated on a third-generation computer M-4030. Coronary patients with aggravated heredity showed high rates of coronary arteries narrowing, more severe course of the disease and frequent large-focal myocardial infarctions with aneurysms of the heart.