[Effects of aggressive therapy with simvastatin in patients with acute coronary syndrome and initially normal level of LDLP cholesterol on cardiovascular outcomes (LAOKOON). Pilot randomized trial].

AIM: To examine anti-inflammatory effect of statins on outcomes of acute coronary syndrome (ACS). MATERIAL AND METHODS: The trial included 211 ACS patients without ST elevation at ECG. The patients were followed up for 180 days. The anti-inflammatory action was studied for 30 days. The patients were divided into two groups by the treatment: simvastatin 10 mg + aspirin 325 mg (104 patients, group 1) and simvastatin 40 mg + aspirin 325 mg (107 patients, group 2) for 30 days. RESULTS: Simvastatin in maximal dose lowed LDLP cholesterol from 101 +/- 9.8 to 72 +/- 3.3 mg/dl, in a minimal dose--from 104 +/- 11.3 to 81 +/- 2.1 mg/dl (p < 0.05). Only maximal dose simvastatin produced a significant reduction of C-reactive protein (CRP) to the disease day 14. The integral index including all cases of cardiovascular death +acute myocardial infarction+progressive angina+rehospitalization was 70 scores for group 1 and 137 for group 2 (p = 0.047). CONCLUSION: Use of simvastatin in ACS patients, initially normal level of LDLP cholesterol and elevated level of CRP produced a dose-dependent effect, alleviated inflammation and improved the disease course.

[Morphofunctional changes in the small intestine in patients with chronic cardiac failure]. / Morfofunktsional'nye izmeneniia tonkoi kishki u bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu.

AIM: To study morphological alterations in small intestinal wall in patients with chronic cardiac failure (CCF) of various severity and their relations with functional condition of the small intestine. MATERIAL AND METHODS: 63 patients (mean age 58.7 years) entered an open cohort study. By CCF and body mass index (BMI) the patients were divided into 4 groups. Estimation of ejection fraction (EF), BMI and lean body mass (LBM) was made in all the patients as well as functional intestinal activity was assessed by fat excretion and fecal protein. Small intestinal biopsies were made endoscopically for collagen quantitation. RESULTS: A rise in collagen content in the small intestine correlated with severity of CCF. In patients free of CCF relative area of collagen averaged 12.8%, in CCF FC I-II--16.5%, in CCF FC III-IV with cachexia--32.4%. Greater fibrosis of the small intestine corresponded to greater malabsorption. A 3-fold increase in collagen area led to a 2-3-fold growth in protein and fat loss with feces. In CCF, LBM was subnormal while body mass reduction correlated with relative collagen area. CONCLUSION: Morphofunctional changes of the small intestine developing in parallel with CCF severity lead to a significant loss in basic nutrients, regression of LBM and development of protein-energy insufficiency in patients with CCF.

[Effect of enteral feeding on exercise tolerance and clinical picture in patients with NYHA class III-IV chronic heart failure]. / Vliianie énteral'nogo pitaniia na tolerantnost' k fizicheskim nagruzkam i klinicheskuiu kartinu u bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu III-IV funktsional'nogo klassa.

AIM: To elucidate efficacy of enteral feeding and the role of small intestine in pathogenesis of cardiac cachexia in patients with heart failure and reduced body mass. MATERIAL: Patients with NYHA class III-IV chronic heart failure and deficient body mass (n=34). Control group comprised 32 patients. METHODS: In intervention group standard therapy was supplemented for 24 weeks with balanced nutritional mixture constituting 25% of daily energy requirements. Efficacy of treatment was assessed by 6 minute walk test, evaluation of lean body mass. Studies of intestinal functional activity and biopsies of small intestinal mucosa with morphometrical analysis of bioptates were also performed. RESULTS: Results of 6-minute walk test improved in intervention and control groups by 46.8 and 10.3%, respectively. Average lean body mass increased in intervention group (by 6.7%) and decreased in controls (by 4.9%, p=0.03). Morphometrical study of bioptates revealed augmentation of relative collagen area up to 35-37% (normal value - 10-15%) and pronounced villus atrophy.

[Role of inflammation markers in the evaluation of the clinical course of myocardial infarct]. / Rol' markerov vospaleniia v otsenke klinicheskogo techeniia infarkta miokarda.

The authors examined the time course of changes in the levels of chlorine soluble mucoprotein and glycosaminoglycans as markers of an acute period of myocardial infarction. A significant correlation was established between the mass of the infarcted myocardium and the severity of its acute reaction as evaluated from the integral volume of various inflammation markers. A mathematical model of this relationship was proposed for patients with complicated and uncomplicated myocardial infarction. It was shown that it was possible to apply these parameters to the assessment of the severity and features of a myocardial infarction course.