[Preprocedural high - sensitivity C-reactive protein (hsCRP) decrease during intensive atorvastatin therapy: the presumable impact on atherosclerosis progression after coronary stenting].

Proinflammatory status is the risk factor for coronary atherosclerosis progression after coronary stenting (CS). Intensive statin treatment is associated with hsCRP concentration decline. AIM: to evaluate prognostic significance of preprocedural hsCRP level reduction with intensive statin regimen for coronary atherosclerosis progression during one year after CS. MATERIALS AND METHODS: We enrolled 102 patients with stable angina who were on list for scheduled CS. Group I (n=37) patients received atorvastatin 80 mg for 7 days before and 3 months after CS with further dose adjustment according to LDL; group II (n=65) patients received atorvastatin 20-40 mg/day for LDL goal achievement. HsCRP level was assessed at baseline, before CS and after 1, 3, 6 and 12 months. Coronary atherosclerosis progression was defined as new ≥50% stenosis or ≥30% increase of ≥20% pre - existing stenosis according to coronary angiography (CA) 1 year after CS. RESULTS: Baseline concentration of hsCRP was comparable: 0.21 (0.13; 0.38) vs. 0.20 (0.1; 0.44) mg/dl in groups I and II, respectively (p>0.05). In group I significant hsCRP level decrease to 0.14 (0.07; 0.32) mg/dl (p.

[The diagnostic value of measuring the momentary blood flow reserve versus non-invasive methods to detect myocardial ischemia in assessing the functional significance of borderline coronary artery stenoses]. / Diagnosticheskaia tsennost' izmereniia momental'nogo rezerva krovotoka po sravneniiu s neinvazivnymi metodami vyiavleniia ishemii miokarda pri otsenke funktsional'noi znachimosti pogranichnykh stenozov koronarnykh arterii.

AIM: To estimate the diagnostic value of measuring the momentary blood flow reserve (MBFR) versus the surrogate non-invasive standard (SNS) for myocardial ischemia verification (MIV) (a combination of stress echocardiography and single-photon emission computed tomography). SUBJECTS AND METHODS: The investigation enrolled 50 patients with stable angina in the presence of chronic coronary heart disease (CHD) or suspected CHD, in whom coronary angiography (CA) revealed borderline coronary stenoses (50-70% lumen diameters). The examination algorithm had two options. In one option, when included in the study, patients had already CA results not older than 1 month, and MBFR was measured 4-7 days after non-invasive stress tests. In the other option, MBFR in the area of borderline coronary artery stenosis was measured simultaneously with CA; and the noninvasive stress tests were carried out in the following week. A total of 74 coronary stenoses were examined. RESULTS: SNS for MIV was positive in 14 (28%) patients. When comparing with the non-invasive methods of myocardial ischemia verification, the area under the ROC curve for MBFR was 0.961±0.019 (95% confidence interval, 0.888-0.992). The optimal cut-point was 0.92, which is corresponded by a sensitivity of 100% and a specificity of 84%. CONCLUSION: When compared with SNS for MIV, the method for measuring MBFR has a high diagnostic accuracy.

Trimetazidine in Angina Combination Therapy--the TACT study: trimetazidine versus conventional treatment in patients with stable angina pectoris in a randomized, placebo-controlled, multicenter study.

The aim of this study was to assess the efficacy and acceptability of trimetazidine (TMZ) in combination with hemodynamic agents (beta-blockers or long-acting nitrates) in 177 stable angina patients. In this randomized, placebo-controlled study (TACT: Trimetazidine in Angina Combination Therapy), stable angina patients resistant to nitrates or beta-blockers were selected. After a 1-week selection period (W0), patients who had a difference of <10% in duration between 2 positive exercise tests, defined as 1-mm ST-segment depression (STD) 80 milliseconds after J point with angina pain or 1.5 mm without pain were randomly treated with TMZ (20 mg t.i.d., n = 90) or placebo (Pbo t.i.d., n = 87) orally. A final exercise test was performed after 12 weeks of treatment (W12). The efficacy was assessed by exercise test duration, time to 1-mm STD, time to angina onset, mean number of angina attacks, mean short-acting nitrate consumption, and rate-pressure product. Differences (W12 - W0) in these parameters were analyzed using the Student t test. All statistical tests were conducted at the 5% significance level. At inclusion and during the study, 52% of patients received long-acting nitrates, and 48% were treated with a beta-blocker as monotherapy. At the beginning of the study, the TMZ and Pbo groups were statistically homogeneous with respect to all analyzed characteristics (demographic characteristics, characteristics of anamnesis, characteristics used for evaluation of antianginal therapy efficacy). For various reasons, 11 patients (7 from the Pbo group and 4 from the TMZ group) were excluded from the trial. A total of 166 patients (80 from the Pbo group and 86 from the TMZ group) completed the study in full compliance with the protocol. After 12 weeks of therapy, exercise test duration increased from 417.7 +/- 14.2 (W0) to 506.8 +/- 17.7 seconds (W12) in the TMZ group versus 435.3 +/- 14.8 (W0) to 458.9 +/- 16.2 seconds (W12) in the Pbo group (P < 0.05). Time to 1-mm STD increased from 389.0 +/- 15.3 (W0) to 479.6 +/- 18.6 seconds (W12) in the TMZ group versus 411.8 +/- 15.2 (W0) to 428.5 +/- 17.3 seconds (W12) in the Pbo group (P < 0.05). Time to onset of anginal pain increased from 417.0 +/- 16.9 (W0) to 517.3 +/- 21.0 seconds (W12) in the TMZ group versus 415.1 +/- 16.5 (W0) to 436.4 +/- 18.5 seconds (W12) in the Pbo group (P < 0.005). The mean number of anginal attacks per week decreased from 5.6 +/- 0.6 to 2.7 +/- 0.5 in the TMZ group versus 6.8 +/- 0.7 to 5.1 +/- 0.7 in the Pbo group (P < 0.05), mean consumption short-acting nitrates per week decreased from 5.2 +/- 0.9 to 2.8 +/- 0.8 in the TMZ group versus 5.5 +/- 0.8 to 4.1 +/- 0.9 in the Pbo group (NS). No change in the rate-pressure product was seen in both. The combination of trimetazidine with beta-blockers or long-acting nitrates significantly improves exercise stress test parameters and angina symptoms compared with placebo. Due to its metabolic effect, free of any hemodynamic action, trimetazidine has proven to be beneficial for combination in patients with stable angina.

[Preliminary data on combined assessment of tolerance to exercise, left ventricular contractile function in ischemic heart disease patients taking bradycardic agents]. / Predvaritel'nye dannye o kombinirovannoi otsenke tolerantnosti k fizicheskoi nagruzke, perfuzii miokarda i sokratitelnoi funktsii levogo zheludochka u bol'nykh ishemicheskoi bolezn'iu serdtsa na fone priema preparatov s bardikardicheskim deistviem.

AIM: To study effects of bradicardia induced by atenolol, diltiazem and ivabradin on exercise tolerance, myocardial perfusion and left ventricular contractile function in patients with stable angina pectoris. MATERIAL AND METHODS: The trial included 7 male patients aged 57 +/- 2.6 years with coronary heart disease, stable angina of functional class II free of cardiac failure and severe arterial hypertension, with a positive and reproducible VEM test after therapy discontinuation. For 10 consecutive days with 5-day intervals, all the patients received atenolol, diltiazem, ivabradin in doses lowering heart rate at rest by 20% from the initial level. Before the treatment all the patients were studied with VEM test, perfusion synchronized single-photon emission computerized tomoscintigraphy of the myocardium (PSSPECT) at rest and exercise. On day 10 of each drug intake PSSPECT and VEM test were performed if the expected heart rate was achieved. RESULTS: Each of the studied drugs resulted in a 22-24% reduction in the heart rate at rest accompanied by a significant rise in exercise tolerance, improvement of performance and myocardial perfusion. There were no significant changes in left ventricular contractility. CONCLUSION: A 20% reduction in resting heart rate due to monotherapy with drugs having a bradicardic effect leads to positive changes in exercise tolerance and myocardial perfusion.

[Atenolol induced bradycardia in patients with stable angina: effects on exercise tolerance, myocardial perfusion and left ventricular contractility]. / Vliianie bradikardii pri monoterapii atenololom na tolerantnost' k fizicheskoi nagruzke, perfuziiu miokarda i sokratitel'nuiu sposobnost' levogo zheludochka u bol'nykh so stabil'noi stenokardiei.

AIM: To assess effects of atenolol-induced heart rate decrease on myocardial perfusion, left ventricular contractility and tolerance to exercise in patients with chronic coronary artery disease. MATERIAL AND METHODS: Twenty eight men (mean age 54,5-/+9,2 years) with stable class I-III angina and positive reproducible result of bicycle exercise test underwent rest/stress 99mTc-MIIBI gated single-photon emission computed tomography (SPECT) before and after 10 days of administration of atenolol (20 patients) or placebo (8 patients). Dose of atenolol was titrated to achieve at least 15% decrease of heart rate from baseline. RESULTS: After 10 days of treatment with atenolol heart rate decreased from 78-/+3.1 to 59-/+1.1 bpm (p=0.01), whereas in placebo group there were no significant changes. Compared with placebo, treatment with atenolol was associated with significant decreases in extent and severity of perfusion defects, ischemic score and number of ischemic segments. No significant changes of parameters of left ventricular contractility occurred. Treatment with atenolol was associated with symptomatic improvement and increase of the total exercise time. CONCLUSION: Heart rate lowering during monotherapy with atenolol was associated with improvement of myocardial perfusion and tolerance to exercise.

Trimetazidine as indirect antioxidant.

One-month therapy with trimetazidine sharply decreased the content of free radical oxidation products, lipid peroxides and malonic dialdehyde, in atherogenic low-density lipoproteins in patients with coronary heart disease. Activity of glutathione peroxidase utilizing lipid peroxides in the plasma markedly increased during trimetazidine therapy. The data suggest that trimetazidine not directly interacting with free radicals attenuates the adverse effects of intensive free radical oxidation in coronary heart disease. This effect is mediated via activation of antioxidant enzymes, which diminishes negative consequences of ischemia.

[The humoral immunity indices and vascular reactivity of patients with hypertension and an elevated blood lipid level]. / Pokazateli gumoral'nogo immuniteta i sosudistaia reaktivnost' u bol'nykh gipertonicheskoi bolezn'iu s povyshennym urovnem lipidov krovi.

Out of 60 males aged 41 +/- 1 suffering from mild arterial hypertension (158 +/- 4/100 +/- 2 mm Hg) a hereditary load by hypertension was found in 63.3%, serum cholesterol levels reached 200 mg/dl in 85% of the patients. The patients with the load and enhanced Na-Li countertransport (403 +/- 49 mumol Li/1/cell/hr against 185 +/- 28 mumol Li/1/cell/hr in those without hereditary predisposition, p < 0.05) showed a significantly higher serum level of IgA and IgE (3.68 +/- 0.33 g/l and 127 +/- 14 U/ml vs 2.61 +/- 0.33 g/l and 79 +/- 15 U/ml, respectively, in those without the load, p < 0.01, p < 0.05). An IgE level significantly correlated with the amplitude of norepinephrine vascular reactivity (r = 0.35, p < 0.05). The discussion is concerned with IgE hyperproduction significance. Correlating with the amplitude of vascular reactivity on sympathetic stimuli and being independent of hypertension magnitude, this hyperproduction may underlie a high risk of atherosclerosis and vascular complications as a result of IgE-mediated vascular reactions in young subjects with mild hypertension in hereditary loading, erythrocytic accelerated Na-Li countertransport and lipid metabolism derangement.

[The renin-angiotensin-aldosterone system and arterial hypertension in patients with rheumatoid arthritis]. / Sistema renin-angiotenzin-al'dosteron i arterial'naia gipertenziia u bol'nykh revmatoidnym artritom.

Renin-angiotensin-aldosterone++ system was investigated in 60 patients suffering from rheumatoid arthritis. Forty-four of them (group 1) had arterial hypertension (144 +/- 4/94 +/- 2 mm Hg), sixteen were free of hypertension (120 +/- 3/80 +/- 1 mm Hg). Twenty-nine control subjects comparable by AH standing and demographic parameters had essential hypertension stage IB-IIA by A. L. Myasnikov classification (141 +/- 3/89 +/- 1 mm Hg). A tendency to renin suppression was dominating in 72% of group 1 patients (plasma renin activity less than 1.0 ng/ml/h). In this group there appeared high concentrations of A II (14.2 +/- 3.1 pg/ml) and plasma aldosterone++ (238 +/- 94 ng/ml). Rheumatoid vasculitis manifested in 86% of patients. Control subjects exhibited plasma renin activity greater than 3.0 ng/ml/hin 48%, average A II concentration was similar to that of group 1 (12.4 +/- 2.7 ng/ml/h, p greater than 0.05), plasma aldosterone++ level was significantly lower (176 +/- 29 ng/ml, p less than 0.05). Correlations were established between A II concentration and ESR (r = 0.39, p less than 0.05), A II and rheumatoid factor titers (r = 0.40, p less than 0.05). These indicate that immunopathological reactions are responsible for shifts in renin-angiotensin-aldosteron system in hypertensive rheumatoid arthritis subjects.

[The correlation of the indices of humoral immunity and of the activity of the renin-angiotensin-aldosterone system in hypertensive patients]. / Sootnoshenie pokazatelei gumoral'nogo immuniteta i aktivnosti renin-angiotenzin-al'dosteronovoi sistemy u bol'nykh gipertonicheskoi bolezn'iu.

The content of IgA, IgM, IgG and IgE was measured in 55 male patients with uncomplicated essential hypertension (EH) running a labile course (25 patients) and a stable course (30 patients). Analyzing the material, account was taken of aggravated heredity factor as regards arterial hypertension, established according to the anamnesis in relatives of the first degree kinship. A group of patients with the aggravated familial anamnesis as regards arterial hypertension were distinguished. They suffered from labile hypertension with a tendency to hyperreninemia and IgE overproduction, which may be unfavourable in terms of EH progression and development of cardiovascular complications.

[Endothelin in arterial hypertension]. / Endotelin pri arterial'noi gipertonii.

A study was made of the concentration of endothelin (ET) in the plasma of patients suffering from arterial hypertension (AH), heart failure (HF) and in that of healthy volunteers. The concentration of ET in the normal subjects was within 4.0-8.6 pg/ml, in the patients with AH, it varied from 5.7 to 64.5 pg/ml, and in the patients suffering from HF, from 8.8 to 94.0 pg/ml. A subgroup of patients with essential hypertension, stage II B, showed a tendency towards a rise of the ET concentration in response to orthostatic load that was associated with an increase of the concentration of angiotensin-2.

[Immunological effects of captopril and ramipril in patients with hypertension]. / Immunologicheskii éffekt kaptoprila i ramiprila u bol'nykh gipertonicheskoi bolezn'iu.

Fifteen patients with essential hypertension underwent treatment with captopril (7 patients) and ramipril (8 patients). The drugs belong to angiotensin-converting enzyme (ACE) inhibitors. Pretreatment immunological examination and that after a 10-15-week course of the above therapy involved measurements of IgG, IgA, IgE and beta 2-microglobulin. The analysis of the trend in the immunological indices demonstrated that captopril, distinct from ramipril by the presence of a sulfhydryl group, caused a decrease in immunological parameters suggesting a potential role of culfhydryl groups in mediating ACE inhibitor action on the immune system. The immunological properties of captopril may appear useful in various systemic diseases.

[Study of the relation of various genetic and pathophysiologic factors participating in the regulation of blood pressure in patients with hypertension]. / Izuchenie vzaimosviazi mezhdu nekotorymi geneticheskimi i patofiziologicheskimi faktorami, uchastvuiushchimi v reguliatsii arterial'nogo davleniia u bol'nykh gipertonicheskoi bolezn'iu.

A study of 35 patients with uncomplicated essential hypertension (EH) (labile hypertension, stages IB-IIA or stable hypertension, stage IIB) demonstrated a higher rate of Na+-Li+ countertransport in patients with hypertensive hereditary predisposition to EH (group 1), as compared to those with unaggravated heredity (group 2). A suppression of plasma renin activity (53%), and a higher rate of hyperlipoproteinemia (55%) were observed in group 1, as opposed to group 2 where Na+-Li+ countertransport was lower, plasma renin activity was normal, and hyperlipoproteinemia occurred in 33%. There was a direct correlation between Na+-Li+ countertransport and renin-angiotensin-aldosterone components in group 2. A conclusion is made that aggravated heredity, RAAS components and hyperlipoproteinemia should be taken into account in the assessment of Na+-Li+ countertransport in hypertensive patients.

[Disorders of humoral immunity in hypertension]. / Narushenie gumoral'nogo immuniteta pri gipertonicheskoi bolezni.

Examination included 51 patients with essential hypertension (EH) of an uncomplicated course, labile (IB-IIA stage, according to A. L. Myasnikov's classification) and stable (IIB stage) hypertension. Clinical characteristics were given to the stages and duration of EH, body weight of the patients, arterial hypertension (AH) heredity and the AP level. Immunological examination included determination of the concentration of the basic classes of immunoglobulins IgG, IgA, IgM, circulating immune complexes (CIC), concentration of IgE and beta 2-microglobulins. It was revealed that EH development is attended by an increased concentration of immunoglobulins, primarily of IgA (23 per cent), IgE (31 per cent) and CIC (21 per cent), which is associated, to a certain degree, with a factor of AH hereditary aggravation.

[The interrelation of the sodium-excretory function of the kidneys and vascular reactivity in hypertension patients]. / Vzaimosviaz' natriivydelitel'noi funktsii pochek i sosudistoi reaktivnosti u bol'nykh gipertonicheskoi bolezn'iu.

Vascular reactivity was evaluated by a modified photoplethysmographic method in 20 patients with essential hypertension before and after an acute volumetric salt load. A relationship was demonstrated between vascular reactivity and renal sodium excretion pattern under stress. Patients with "excessive" natriuresis 24 h after the test showed reduced vascular reactivity, and slow sodium and water excretion was associated with increased vascular response. A study of membrane Ca2+ transport 24 h after the test showed an increase in receptor-dependent Ca2+ uptake in response to all inductors (platelet aggregation factor, vasopressin, ADP), as compared to the baseline.

[Characteristics of the water-electrolyte metabolism of hypertension patients with stable hypertension and the principles of diuretic therapy]. / Osobennosti vodno-élektrolitnogo obmena u bol'nykh gipertonicheskoi bolezn'iu so stabil'noi gipertenziei i nekotorye printsipy terapii diuretikami.

Different levels of water-salt metabolism control were studied in patients with stable essential hypertension (SEH). The sample was found to be highly heterogeneous in terms of the magnitude of the body's water-filled spaces in relation to plasma renin activity (PRA) and the cooking salt gustatory sensitivity threshold, examined in the presence of various salt diets and diuretic treatments. Three patterns of response to salt loads were identified in SEH patients with respect to sodium and water elimination by the kidneys: the first was identical to that of normal subjects, while the second one featured increased, and the third one, decreased, diuresis and natriuresis. Prostaglandin E2 and kallikrein were shown to be involved in the formation of the second- and third-type renal response to excessive salt. Differential treatment of EH patients with diuretics alone or, where necessary, in combinations with small-dose beta-blockers or vasodilators provides effective BP control for some 1.5 to 2 years in 65% of patients.