[PRECONDITIONING AT THE STAGES OF INVASIVE AND REHABILITATIVE TREATMENT OF PATIENTS WITH CORONARY HEART DISEASE].

The comprehensive analysis of efficiency of different variants of preconditioning is currently of special importance since the realization of the potential of endogenous protective effects extends possibilities for anti-ischemic protection of myocardium at different stages of CHD. Today, the main principles of preconditioning are purposefully applied to the development of therapeutic strategies for the treatment of CHD. The most widely used in the clinical practice are local and distant preconditioning modalities as well as preconditioning by physical exercises whose well-known protective effects are used in cardiosurgery and routine clinical practice. Elaboration of rehabilitative and preventive programs taking account of vaso- and cardioprotective effects of preconditioning may significantly increase the effectiveness of the rehabilitative treatment of CHD patients with poor organic coronary and myocardial reserve.

[Adaptation to hypoxia and ischemic preconditioning: from basic research to clinical practice].

Experimental and clinical studies of the last ten years gave evidence of successful application of the protective effect of hypoxia in clinical practice. The view of hypoxia as an exclusively injurious factor has undergone significant changes. A promising approach to solving the problem of heart adaptation to ischemic injury is the use of cellular mechanisms realized through myocardial ischemic preconditioning (IP). Modern understanding of the mechanisms of IP protective effect takes into consideration the processes underlying the development of adaptation to hypoxia related to the changes in intracellular metabolism and accompanied by a stronger activation of the systems responsible for adaptation. All this provides a real opportunity for studying intracellular functional and metabolic mechanisms of adaptation to hypoxia and ischemia, formation of adaptive syndromes in clinical practice, development and implementation of new evidence-based medical technologies for diagnostics, prevention, and rehabilitative treatment of heart pathology.

[Cardioprotective capabilities of drug meldonium in secondary prevention after percutaneous coronary intervention in patients with documented myocardial ischemia].

The purpose of research ­ analysis of capabilities in cytoprotective drug mеldonium, in complex in the cardioprotective effect of secondary prevention after percutaneous coronary intervention (PCI). Patients with stable coronary heart disease (n=35 ) aged ≤65 years with incomplete revascularization at 6 months after PCI and positive exercise test (SFI) were randomized 1:1 to groups controlled physical training (CPT) with intensity 80% and a duration of 2 weeks (10 SFI): group 1 (n=17; 53,9±6,2 years) and group 2 (n=18; 56,1±4,8 years). Patients in Group 1, in addition to SFI mеldonium administered at a dose of 1000 mg/ml intravenously. In the 1st group on the background mеldonium adjunctive therapy showed a significant increase in the duration from 15±2 to 32±7 min for the 10th CPT (p<0.05). Index of maximum oxygen consumption after 10 intense CPT increased to 20.8±1.06 ml/kg/min compared to baseline (18.6±1.1 ml/kg/min, p<0.05) and the control group (18.5±1.5 ml/kg/min, p<0.05). Use of meldonium was also associated with decrease of maximum ST-segment depression (from -0.18±0.1 to 0.10±0.2 mV), increases of exercise duration (from 364±22 to 556±29 s) threshold heart rate (from 118±12 to 132±5 bpm), decrease of time of ST segment recovery to baseline (from 385±32 to 242±22 s, p<0.05). Final level of free fatty acids in the meldonium group was significantly lower than that in the control group (0.248±0.047 vs. 0.265±0.031 mg/dl). Inclusion of meldonium in complex treatment after PCI potentiates cardioprotective effect of intensive CPT as evidenced by the positive dynamics of ECG and biochemical markers of myocardial ischemia.

[Approaches potentiating cardioprotective effect of ambulatory physical training in patients with ischemic heart disease and multivessel coronary artery involvement after coronary stenting].

Cardiorehabilitation of patients with multivessel coronary lesions is an obligatory component of ambulatory stage of care. With the aim of potentiating cardioprotective and antiischemic impact of rehabilitative preventive measures in 36 patients with ischemic heart disease (IHD) and multivessel coronary artery involvement who had undergone percutaneous coronary intervention we studied cardioprotective and antiischemic effect of long-term (24 weeks) administration of 70 mg/day trimetazidine in combination with moderate intensity physical training with the use of distance surveillance by a physician. The chosen therapeutic approach in patients with residual ischemia after incomplete anatomical revascularization provided early persistent formation of cardioprotective and antiischemic effect proven by increase of tolerance to physical exercise, improvement of diastolic function, and positive dynamics of both ECG parameters and biochemical markers of myocardial ischemia.

[Clinico-economic aspects of physical rehabilitation of patients with coronary heart disease after endovascular interventions].

Physical rehabilitation is an important component of cardiorehabilitation and secondary prophylaxis programs for patients with coronary heart disease (CHD) especially after endovascular interventions. Of special importance among a variety of rehabilitative technologies under current conditions of financial crisis are those ensuring high-quality and cost-effective medical aid The clinico-economic analysis of the programs of long-term physical training is presented with reference to their application for rehabilitation of patients with CHD after endovascular intervention. The use of this approach on an individual basis is believed to promote the introduction of physical training methods into clinical practice, rational planning of secondary prophylaxis programs and reduction of financial burden on public health services.

[Possibilities of improvement of prognosis in patients with type 2 diabetes mellitus after coronary interventions].

We present results of investigation of fenofibrate in patients with ischemic heart disease and type 2 diabetes mellitus after myocardial revascularization at various terms of its administration. We have shown its efficacy in correction of diabetic dyslipidemia, positive influence on clinical status and long term result of coronary intervention. We have established that early (first 7 days) prescription of fenofibrate - Tricor to patients with ischemic heart disease and type 2 diabetes mellitus after myocardial revascularization lowers number of diagnostic coronary angiograms and repeat percutaneous coronary interventions by 11% during first year of follow-up.

[Rehabilitative and prophylactic measures including physical training for the correction of risk factors in patients presenting with ischemic heart disease following percutaneous coronary interventions].

The authors report the results of analysis of effectiveness of active rehabilitative and prophylactic measures undertaken at the outpatient treatment stage including long-term controlled physical training of moderate intensity in patients presenting with coronary heart disease following percutaneous coronary interventions. The emphasis was laid on the possibility to prevent traditional risk factors of cardiovascular diseases. It was shown that the proposed approach allows a few risk factors (dyslipidemia, hypodynamia, arterial hypertension, smoking, and obesity) to be simultaneously corrected.

[Novel approaches to assessment of rehabilitative-preventive quality measures in patients with ischemic heart disease].

Cardiorehabilitation and secondary prevention in patients with ischemic heart disease (IHD) are at present actively introduced in practical health care. However problems of standardization of methods of cardiorehabilitation and secondary prevention remain unsolved and criteria of efficacy of conducted measures in patients with IHD have not been elaborated. On the basis of analysis of clinical status, physical working capacity, blood pressure dynamics, lipid spectrum, smoking, body mass index, and quality of life of patients we have created a set of clinical indicators of efficacy of rehabilitative-preventive aid which will allow to present all components of efficacy at the level of conduction of clinically proven measures.

[Assessment of dynamics of the autonomic cardiovascular system regulation based on low-frequency rhythm synchronization in patients with ischemic heart diseases complicated by myocardial infarction treated with metoprolol].

AIM: To develop a procedure for assessing the adequacy of metoprolol use in patients with coronary heart disease (CHD) on the basis of synchronization of 0.1-Hz rhythms in cardiac rhythm variability (CRV) and vascular blood filling in the microcirculatory bed (MCB). Materials and methods. 43 patients with CHD (age 63 +/- 8 years), who had sustained myocardial infarction about 6 months before, were examined. Synchronous registration of ECG and a pulsogram were made during an orthostatic test before and after therapy with metoprolol in the maximum tolerable doses during 3 months. The presence of synchronization of 0.1-Hz rhythms identified from a series of R-R intervals and the pulsogram was determined from the difference of phases; the total percent of synchronization (S) was estimated. RESULTS: The authors identified 2 groups of CHD patients: those with positive (n=21) and negative (n=16) orthostatic S, trends during treatment. The groups were matched by major clinical characteristics. There was an inverse relationship between the values of S, in the lying and standing position prior to or following treatment. It is suggested that there is the optimum range of 0.1-Hz rhythm synchronization values in the cardiovascular system during beta-blocker therapy in patients with CHD. CONCLUSION: There is a possibility applying an objective approach to assessing the adequacy of metoprolol treatment in CHD patients on the basis of synchronization of 0.1-Hz fluctuations in variations CR V and vascular blood filling in MCB.

[Assessment of the state of myocardial contractility based on analysis of heart rate variability during exercise tests].

AIM: To elucidate stability of 0.1 Hz component of heart rate variability (HRV) spectrum in patients with different state of myocardial contractile function during bicycle exercise tests under controlled breathing with 10 sec period. MATERIAL: Male patients with class II-III effort angina and either abnormal myocardial contractile function (n=45, age 51.0+/-2.5 years, left ventricular ejection fraction <50%), or without disturbances of myocardial contractility (n=35, age 52+/-6 years, ejection fraction > 60%). METHODS: All patients underwent Doppler echocardiography and submaximal exercise tests with initial loads 25 W. Registration of series of RR-intervals was done during controlled breathing with 10 sec periods (0.1 Hz) for 5 min at rest and exercise (25 W work load). Depth and balance of phases of controlled breathing were similar to those of spontaneous breathing. Analysis of the heart rate variability was made on the basis of auto-regression algorithm. RESULTS: Stability of 0.1 Hz component of the heart rate variability spectrum to low-level exercise correlated with the severity of depression of myocardial contractility.

[Prognostication of coronary atherosclerosis for selection of tactics of management of patients with ischemic heart disease]. / Prognozirovanie koronarnogo ateroskleroza dlia vybora taktiki vedeniia bol'nykh ishemicheskoi bolezn'iu serdtsa.v ambulatornoi praktike.

AIM: To create an artificial neural network for prognostication of coronary atherosclerosis and thus selection of patients requiring invasive interventions. METHODS AND RESULTS: Efficacy of prognostication made by a physician and by a model was compared basing on probabilistic estimates with consideration of individual level of risk. Nineteen clinical and instrumental parameters were entered into multifactorial analysis. These parameters included data from anamnesis, results of instrumental examination, a priori likelihood of ischemic heart disease, and magnitude of individual risk of cardiovascular events. The following factors were selected as significant at neural network prognostication of coronary atherosclerosis: result of exercise test, typical angina, history of myocardial infarction, ECG-signs of left ventricular hypertrophy and a priori likelihood of ischemic heart disease. Basing on these data two stage scheme of prognostication of coronary atherosclerosis was suggested. CONCLUSION: Thus artificial neural network suitable for screening and selection of patients for invasive interventions in ambulatory practice was created. Prognosis made with the use of artificial neural network was 1.5-3 times more accurate than that made by a physician.