[Factors associated with thrombosis of the left atrial appendage in patients with chronic atrial fibrillation].

This study was designed to elucidate hemostatic and genetic characteristics associated with thrombosis of the left atrial appendage (LAA) in patients with chronic atrial fibrillation (AF). It included 91 patients (mean age 62 ± 7.6 years) with coronary heart disease (CHD) and chronic AF. Group I was comprised of 63 patients without LAA thrombosis, group 2 contained 28 patients with LAA thrombosis diagnosed by transesophageal echocardiography. The following parameters were measured: soluble fibrin monomeric complex, fibrinogen, antithrombin, thrombin-activated fibrinolysis inhibitor levels and polymorphism of YP29, VKORC1, PAI-1 genes. Multifactor regression analysis revealed significant association of LAA thrombosis with thrombin-activated fibrinolysis inhibitor level in excess of 245%, the presence of CC genotype of the VKORC1 gene and 4G allele of the PAl-1 gene.

[Prevention of cardiovascular complications in patients undergoing aortic-iliac reconstructions by correction of inflammation and endotoxemia].

There were presented the results of examination and treatment of 130 patients with atherosclerosis. Objective is to study the role of atorvastatin in correction of inflammation, endotoxemia and prevention of cardiovascular complications in patients with atherosclerosis undergoing aorto-iliac reconstruction. There were observed initial and postoperative activation of inflammation, endotoxemia in patients with multifocal atherosclerosis. We found that short-term therapy with atorvastatin 60 mg per day had a significant advantage over low-dose in correction of pre- and postoperative endogenous inflammation, endotoxemia and prevention of cardiac events after aorto-iliac reconstruction.

[Peculiarities of the relationship between atherosclerotic lesions of carotid arteries and the severity of cardiac pathology in elderly patients].

The study was aimed at elucidating the relationship between the severity of atherosclerotic lesions in carotid arteries and cardiac pathology in 182 elderly patients subjected to vascular and extravascular surgical treatment. They were divided into 2 groups differing in the degree of atherosclerosis. Group 1 was comprised of 93 patients (mean age 64+/-05 yr) without stenosis of internal carotid artery or with stenosis of less than - 50%, group 2 included 89 patients (mean age 67+/-0.5 yr) with hemodynamically significant stenosis of internal carotid artery. It was shown that carotid stenosis over 50% is frequently associated with the history of myocardial infarction and stable angina of effort. An increase of the degree of stenosis was accompanied by a decrease of stroke and minute volumes.

[Molecular mechanisms of effects of rosuvastatin on systemic oxidative stress and endogenous inflammation in patients with atherosclerosis].

Aim of the study was to investigate peculiarities of effects of rosuvastatin on the state of oxidative stress and endogenous inflammation in patients with extensive atherosclerosis. Patients with extensive atherosclerosis included into the study (n=46, mean age 56.5 +/- 2.2 years) were distributed to 2 equivalent according to clinico-instrumental data groups. To patients of group 1 (n=24) standard therapy was prescribed (antiaggregants, ACE inhibitors, b-adrenoblockers, and nitrates when indicated), patients of group 2 (n=22) in addition to standard therapy took rosuvastatin (10 mg/day). Investigations included measurement of parameters of serum lipid profile, content of thiol groups of blood serum proteins, activity of enzyme glutathione peroxidase, in vivo oxidation of whole blood serum and HDL, concentration of 3-nitrotirosine, high sensitivity C-reactive protein and interleukin-6, activity of type 2IIA secretory phospholipase A2. It was found that level of 3-nitrotirosine and activity of secretory phospholipase A2 together with high sensitivity C-reactive protein appear to be effective markers of systemic oxidative stress and endogenous inflammation in patients with extensive atherosclerosis. Treatment with rosuvastatin in moderate doses significantly suppressed activity of endogenous inflammation and oxidative stress by way of activation of antioxidant system of plasma, decrease of oxidation of fractions of lipoproteins, suppression of " nitrotirosine " stress, as well as partial inhibition of efficacy of action of secretory phospholipase A2, lowering of content of C-reactive protein and interleukin-6.

[The role of beta-adrenoblockers and If-inhibitor ivabradine in lowering of rate of development of cardiac complications after carotid endarterectomy].

Aim of the study was to assess effect of therapy with b-adrenoblockers and If-inhibitors on the rate of development of coronary complications of carotid endarterectomy. Patients (n=111, mean age 61 +/- 4 years) subjected to carotid endarterectomy in 2006 - 2007 were divided into 3 groups according to therapy in pre-, intra-, and postoperative period. Group 1 consisted of 48 patients treated with metoprolol. Group 2 comprised 33 patients with contraindications to b-adrenoblockers who were treated with If-inhibitor ivabradine. Patients of control group 3 (n=30) received neither b-adrenoblocker nor If-inhibitor. There were no significant differences between groups in sex, age, concomitant pathology, and degree of stenosis of operated carotid artery. We assessed rate of development of ischemia and myocardial infarction during operation and in first 24 hours after surgery. In group 1 mean 24 hour heart rate according to Holter ECG monitoring after 7 days of therapy decreased by 14 +/- 3,7 beats/min, episodes of ischemia after surgery were registered in 4 patients (8%). In group 2 mean 24 hour heart rate decreased by 10 +/- 2,5 beats/min, 4 patients (12%) had signs of myocardial ischemia during first 24 hours after surgery. There were no myocardial infarctions in groups 1 and 2. In control group mean 24 hour heart rate did not significantly change. Significantly higher number of postoperative coronary complications was revealed among patients of this group: 2 (6%) developed myocardial infarctions, in 5 (17%) appeared signs of myocardial ischemia. Administration of b-adrenoblocker metoprolol and If-inhibitor ivabradine significantly lowers rate of development of coronary complications after carotid endarterectomy. Ivabradine is indicated to patients with contra indications to b-adrenoblockers.

[Lowering the risk of cardiologic complications in carotid endarterectomy].

UNLABELLED: The aim of the study was to decrease the risk of ischemia and myocardial infarction (MI) in intraoperative and early postoperative period after carotid endarterectomy (CEA). MATERIAL AND METHODS: 295 patients underwent CEA from 2001 till May 2005 in the Clinics of faculty surgery, Samarsky state medical university. Besides clinical investigation, patients underwent Doppler ultrasonography of brachiocephalic arteries, transcranial Doppler, brain CT (if appropriate), echocardiography, repeated ECG and intraoperative ECG monitoring. RESULTS: Patients were divided into 3 groups. The first group (n=78, 26.4%) did not receive any special preoperative cardiological care. Among them MI developed in 8 patients (10.2%) on the first postoperative day. The second group (n=131, 44.4%) received nitrates, desaggregants, calcium antagonists, ACE and metabolic drugs preoperatively. In this group there were 6 cases (4.6%) of MI in early postoperative period. The third group (n=86, 29.2%) received cardioselective lipophilic beta-blockers (Atenolol, Metoprolol), in addition to drugs that were given for the second group. No cases of MI in early postoperative period were registered in the third group. Differences were statistically significant (p<0.05). CONCLUSION: Inclusion of beta-blockers into preoperative medical care before CEA procedure significantly decreases the risk of myocardial ischemia and infarction in early postoperative period (24 hours).