Predictors of tachycardia-induced cardiomyopathy in patients with first-time decompensation of chro-nic heart failure with reduced left ventricular ejection fraction of nonischemic etiology and persistent atrial tachyarrhythmia.

Aim    To identify possible predictors of tachycardia-induced cardiomyopathy (TICMP) in patients with newly developed decompensated chronic heart failure (CHF) of nonischemic origin with reduced left ventricular ejection fraction (LV EF) and with persistent atrial tachyarrhythmias. Material and methods    This study included 88 patients with newly developed decompensated CHF of nonischemic origin with reduced LV EF and persistent atrial tachyarrhythmias. Resting 12-lead electrocardiography (EGC) and transthoracic echocardiography (EchoCG) were performed upon admission and following the electrical impulse therapy for all patients. Also, 24-h ECG monitoring was performed to confirm sinus rhythm stability. After recovery of sinus rhythm, outpatient monitoring was performed for three months, including repeated EchoCG to evaluate the dynamics of heart chamber dimensions and LV EF. Results    The patients were divided into two groups based on the increase in LV EF: 68 responders (TICMP patients with a LV EF increase by >10%) and 20 non-responders (patients with an increase in LV EF by <10% during 3 months following the sinus rhythm recovery). According to results of the baseline EchoCG, LV EF did not significantly differ in the two subgroups (TICMP, 40±8.3 %, 18-50 % and non-responders, 38.55±7.9 %, 24-50 %); moreover, the incidence of cases with LV EF <30% did not differ either (9 patients TICMP and 2 non-responders, р=1.0). TICMP patients compared to non-responders, had significantly smaller left atrial dimensions (4.53±1.14 (2-7) cm and 5.68±1.41 (4-8) cm, р=0.034; 80.8±28.9 (27-215) ml and 117.8±41.3 (46-230) ml, р=0.03, respectively) and left ventricular end-systolic volume (ESV) (67.7±33.1 (29-140) ml and 104.5±44.7 (26-172) ml, р=0.02, respectively). The effect of major EchoCG parameters on the probability of TICMP development was assessed by one-factor and multifactor regression analyses with adjustments for age and sex. The probability of TICMP increased with the following baseline EchoCG parameters: end-diastolic volume (EDV) <174 ml [odd ratio (OR), 0.115, 95 % confidence interval (CI): 0.035-0.371], ESV <127 ml [OR, 0.034, 95 % CI: 0.007-0.181], left atrial volume <96 ml [OR, 0.08 , 95 % CI: 0.023-0.274], right ventricular dimension <4 cm [OR, 0.042 , 95 % CI: 0.005-0.389].Conclusion    Among patients with newly developed decompensation of CHF with reduced LV EF of non-ischemic origin and persistent atrial arrhythmias, TICMP was detected in 72 % of patients. The probability of TICMP did not depend on baseline EF and duration of arrhythmias, but increased with the following baseline EchoCG parameters: EDV< 174 ml, ESV< 127 ml, left atrial volume <96 ml, right ventricular dimension <4 cm. The multifactorial analysis showed that a right atrial volume <96 ml is an independent predictor for the development of TICMP.

[Tachicardia-induced cardiomyopathy. Case report].

The tachycardia-induced cardiomyopathy is a rare case of reversible heart failure and left ventricle disfunction. The diagnostic approach and treatment strategy are described in this article. Also the clinical case of heart failure compensation in the patient with left ventricle dilatation and atrial flutter after the reverse to sinus rhythm is after catheter ablation presented.

[Diagnosis and treatment of myocardial infarction in patient with end - stage renal disease on chronic hemodialysis].

This review represents different aspects of myocardial infarction in patient with end - stage renal disease on chronic hemodialysis. We discuss difficulties in diagnosis, optimal method of coronary revascularization, timing of hemodialysis session, medical therapy, as well as epidemiology and prognosis. There are no unambiguous answers to these problems because patients with end - stage renal disease were excluded from most of the studies.

[Takotsubo Cardiomyopathy as a Consequence of Myocardial Infarction. It is Possible?]

Takotsubo cardiomyopathy (TCM) is a well-known complication of many conditions associated with emotional or physical stress. Abnormal catecholamine release has been hypothesized to be the main cause of TCM. Myocardial infarction (MI) is associated with release of large amounts of catecholamines. We present here two cases in which patients simultaneously suffered from acute MI and TCM. In these elderly women without prior history of severe somatic diseases we have not revealed any external stressing factor responsible for the initiation of the disease. Therefore, we have considered primary coronary event (acute MI) to be a triggering factor of TCM manifestation.

[Subacute infectious endocarditis of unusual etiology: peculiarities of diagnostics and treatment].

Infectious endocarditis (IE) is an inflammatory disease of cardiac valves and endocardium of different origin. Subacute IE is a specific form of sepsis associated with the presence of the site of infection in the heart responsible for recurrent septicemia, embolism, and progressive changes in the immune system leading to nephritis, vasculitis, synovitis, and polyserositis. This form develops in response to a low-virulent pathogen (e.g.fungi) or as a result of inefficient antibacterial therapy. A patient is described presenting with fibrous body, aortic and mitral valve infection by the alga Prototheca wickerhamii associated with primary (myeloperoxidase) immunodeficiency. Recent data on diagnostics and treatment of subacute IE are presented.

[Normal-pressure glaucoma: a hypothesis of pathogenesis]. / Glaukoma normal'novo davleniia: gipoteza patogeneza.

Normal pressure glaucoma (NPG) is a heterogeneous pathology of the optic nerve and retina. Besides, primary open-angle glaucoma (POAG) with high pressure belongs equally to the heterogeneous group. The risk factors and pathogenesis stages of NPG and those of POAG do not coincide completely. A considerable number of the NPG cases can be attributed to the glaucoma of pseudo-normal pressure. The individual norm of the intraocular pressure (IOP) does not coincide with the statistical standards. At the same time, POAG with high pressure has, to a more or less extent, the specific features peculiar to NPG. This is especially characteristic of POAG with moderately high IOP. The NPG specific features peculiar to a majority of the examined patients were related with an insufficient cerebral blood circulation caused by occlusive processes in the great and small vessels of the brain, by the nature of the collateral blood circulation and by a dysfunction of the vascular endothelium due to an exhaustion of the cerebral perfusion reserve. The latter is formed mainly at the cost of the vertrebobasilar basin. The mentioned basin supplies blood to the visual tract, as well as to the cerebral centers of the visual analyzer and of the midbrain. Ischemia of the upper corpus bigeminum and of the optic nucleus of the corpus geniculate laterale reduces the formation and supply of neurotrophines (in particular, of BNDF) with the axonal transport to the retinal ganglionic cells, which leads to their apoptosis. Cavernous dystrophy of the optic nerve is a factor preconditioning the occurrence of excavation of the optic nerve head. The mechanic factor related with excavation cannot be ruled out, either. NPG patients often have a relatively large size of the optic nerve disk (OND), therefore, their disk area is equally large. The pressure exerted on the OND is proportional not only to an IOP value, it is also proportional to a disk area. Consequently, provided the IOPs are identical, the mechanical forces exerted on the OND would differ with direct dependence on a disk area. There is every reason to suggest that a considerable share of NPG cases are preconditioned by the cerebrovascular pathology and, therefore, not only the ophthalmologist but also the neurologist must be involved in the diagnostics and treatment of such patients.

[Transpalpebral tonometer for measuring intraocular pressure]. / Transpal'pebral'nyi tonometr dlia izmereniia vnutriglaznogo davleniia.

Two new portable instruments--an ophthalmotonometer (TGDc-01) and a pressure indicator (IGD-02)--which make it possible to measure the intraocular pressure (IOP) through the eyelid, were worked out. The operation of both instruments is based on determining the acceleration of freely falling rod after its interaction with the elastic eye surface. The readings of TGDc-01 correlate with the genuine IOP, and those of IGD-2--with the tonometric pressure for Maklakov's tonometer with a weight of 10 g. The accuracy of both instruments is sufficient for clinical purposes; there is no need to use anesthetics or to sterilize the instruments, which are easy in usage. They can be used not only in ophthalmologic examination rooms but also at home.

[Treatment of inflammatory conditions of the iris and ciliary body, accompanying fibrin exudation]. / Lechenie vospalitel'nykh sostoianii raduzhki i tsiliarnogo tela, soprovozhdaiushchikhsia fibrinoidnoi ékssudatsiei.

The paper presents a description of a new method for treatment of iris and ciliary body inflammation accompanied with fibrin exudation. We used low-level blue laser destroying a fibrin clot in its initial stage of formation. We also used herapin and ascorbic acid. In the absence of the greatest impact urokinase was additionally administered.

[Effects of trans-scleral laser cyclo-coagulation on intraocular pressure and visual function in patients with far advanced open-angle glaucoma]. / Vliianie transskleral'noi lazernoi tsiklokoaguliatsii na vnutriglaznoe davlenie i zritel'nye funktsii u bol'nykh otkrytougol'noi dalekozashedshei glaukomoi.

Transscleral diode laser cyclocoagulation was modified so that laser coagulants (20-25 applications) were applied not only to the ciliary crown, but to the flat part of the ciliary body as well. Inflammation modulators forming after coagulation thus enter aqueous humor and the vitreous body and penetrate into the retina and optic disc, causing dilatation of capillaries and stimulating the blood stream in them. Forty patients (40 eyes) with far advanced glaucoma and pronounced concentrical narrowing of the visual field were operated on and observed for 6-12 months postoperation. One month after the intervention intraocular pressure decreased by 9-21 mm Hg and was below 22 mm Hg in 38 eyes; visual acuity increased by 0.1-0.3 in 11 cases; visual field widened in all patients. These results did not appreciably change till the end of the period of observation.

[Glaucomatous optic neuropathy]. / Glaukomatoznaia opticheskaia neiropatiia.

Glaucomatous optic neuropathy is the major component in the pathogenesis of all forms of glaucoma. The author describes the anatomy and blood supply to the optic nerve head, the pathohistologic changes in the optic nerve, pathogenesis of glaucomatous optic neuropathy, and the treatment philosophy. The author claims that the existence of numerous little known insufficiently verified methods of therapy of this disease necessitates multicenter controlled studies for evaluation of the efficacy of the treatments.

[Role of ciliary muscle in ocular physiology and disease]. / Rol' tsiliarnoi myshtsy v fiziologii i patologii glaza.

The ciliary muscle is the largest intraocular muscle. It is characterized by a complex structure, rich blood supply, and high activity, particularly in the daytime, when visual work is performed, and even during night sleep. The activity of the ciliary muscle involves the adjacent structures. In fact, it continuously massages the anterior and median segments of the eye. Presbiopia leads to a decrease in the activity of the ciliary muscle, deteriorates blood circulation in it, and accelerates age-associated involution processes. Presbiopia is believed to be a risk factor for glaucoma, cataract, and some other dystrophic processes. The role of the ciliary muscle in health and disease is still to be investigated.

[Prospects of using latanoprost, prostaglandin F2 alpha analog, in hypotensive therapy for glaucoma]. / Perspektivy primeneniia analoga prostaglandina F2 al'fa latanoprosta v gipotenzivnoi terapii glaukomy.

Hypotensive efficacy and tolerance of a new antiglaucoma drug lathanoprost, a 0.005% xalathane solution, prostaglandin F2 alpha analog, is studied. A single instillation of xalathane decreased ophthalmic tone in normal subjects and glaucoma patients with increased intraocular pressure. Combination of the drug with other hypotensive agents (pilocarpine + timolol) amplified their hypotensive effects. Long (3 months) follow-up showed that xalathane efficacy is comparable to that of pilocarpine and timolol combination but it is tolerated much better.

[Role and place of ophthalmological methods in the diagnosis of lesions of the main vessels of the brain]. / Rol' i mesto oftal'mologicheskikh metodov v diagnostike porazhenii magistral'nykh sosudov golovnogo mozga.

The study was aimed at detecting changes in visual functions and organ of vision in patients with involvement of the main vessels of the head and injuries to this vessels in patients with expressed ischemic diseases of the organ of vision. Twenty-four patients with occlusive disorders of the carotid arteries and 22 with retinal and ocular nerve diseases with the ischemic component were examined. The share of carotid artery abnormalities in the second group was 27.3%. Total efficacy of ophthalmological methods of diagnosis in the group with carotid artery involvement was 89.4%, this demonstrating high efficacy of ophthalmological methods for the diagnosis of involvement of the main cerebral vessels. Static quantitative perimetry proved to be the most effective method. It permits reliable detection of the slightest changes and assess the efficacy of surgical treatment.

[Main principles of diagnosis of primary open-angle glaucoma]. / Osnovnye printsipy diagnostiki pervichnoi otkrytougol'noi glaukomy.

Symptoms of primary open-angle glaucoma can be divided into main and accessory and risk factors. The main symptoms are increased intraocular pressure and changes in the visual field and optic disk characteristic of glaucoma. The accessory symptoms and risk factors are a family history of glaucoma, diabetes mellitus, myopia, poor discharge of aqueous humor, pseudoexfoliative syndrome, elements of goniodysgenesis and depositions of pigmented granules in the anterior chamber corner, and asymmetric intraocular pressure, humor discharge, and extent of optic disk excavation. Causes and diagnosis of nonglaucomatous hypertension and normal-pressure glaucoma are discussed.

[Effect of ciliary muscle electrical stimulation on ocular hydrodynamics and visual function in patients with glaucoma]. / Vliianie élektrostimuliatsii tsiliarnoí myshtsy na pokazateli gidrodinamiki glaza i zritel'nye funktsii u bol'nykh glaukomoí.

A course of transscleral electrostimulation of the ciliary muscle (10 sessions) using ESOF-1 device was administered to 20 patients (23 eyes) with bilateral primary open-angle glaucoma. A lens with 4 electrodes was placed on the eyeball in the ciliary body projection. Rectangular bipolar pulses up to 15 msec long were generated in the pack mode with current amplitude up to 10 mA for 3 to 7 min. Control group consisted of 17 "paired" eyes. After electrostimulation the accommodation volume increased by 54%, relative accommodation reserve by 34%, coefficient of discharge by 42%, and vision acuity by 0.1 to 0.4 diopters in 6 out of 7 eyes in which vision was lower than 1.0 diopter; intraocular pressure was 16% decreased and the number of absolute and relative scotomas in the central visual field (Humphry, 24-2) dropped by 40%. Improvement of the visual functions and hydrodynamic parameters of the eye was gradual, reaching the maximum by the end of the follow-up (6 months). In control eyes no positive changes were observed. The results indicate a positive effect of electrostimulation of the ciliary body and posterior ocular structures on intraocular fluid circulation and visual functions.

[Principles of drug therapy of inflammatory eye diseases]. / Printsipy farmakoterapii vospalitel'nykh zabolevanii glaz.

Describes the main features of an inflammatory process and the contribution of inflammation mediators to its development. Antiinflammatory drugs may be divided into two groups: corticosteroids and nonsteroid antiinflammatory agents. The advantages and drawbacks of corticosteroid therapy of ocular diseases are discussed and indications for and contraindications against the use of some drugs are enumerated. The main dosage forms of nonsteroid antiinflammatory drugs for the eyes are presented and indications for their use listed.

[Leocaine--a new generation of local anesthetics]. / Leokain--mestnyi anestetik novogo pokoleniia.

Leocaine is a new crystal beta-modification of beta-dimethylaminoethyl ether of n-butylaminobenzoic acid hydrochloride. Its chemical formula is the same as for dicaine, but it has a number of advantages over this drug. The anesthetic activity of leocaine is 2.5 times higher than that of dicaine. By the duration and depth of anesthesia 0.3% leocaine solution corresponds to 1% dicaine. Leocaine exerts no toxic effect on the corneal epithelium and its instillation into the conjunctival cavity does not result in the reactive dilatation of corneal or episcleral vessels. Leocaine solution is stable for 2 years. Clinical trials of leocaine carried out on more than 2500 patients showed virtually complete absence of side effects. Commercial manufacture of leocaine is launched at present. One of the commercial preparations represents a 0.3% solution of the active substance in isotonic NaCl solution. Another drug contains, besides leocaine, methylcellulose. Eye drops with leocaine are recommended for practical ophthalmology instead of dicaine for local anesthesia. The drugs are permitted for medical use and commercial manufacture by the Ministry of Health and Medical Industry of Russia.