Remote Ischemic Preconditioning With the Use of Lower Limb Before Coronary Artery Bypass Surgery With Cardiopulmonary Bypass and Anesthesia With Propofol.

OBJECTIVE: to study potantial of remote ischemic preconditioning (RIP) as method of cardioprotection during coronary artery bypass surgery with cardiopulmonary bypass (CPB) and anesthesia with propofol. MATERIALS AND METHODS: We included in this study 87 patients (7 were excluded) with ischemic heart disease, hospitalized in the clinic of aortic and cardiovascular surgery of the I. M. Sechenov First Moscow State Medical University clinical hospital № 1. All patients had indications for direct myocardial revascularization by coronary artery bypass surgery. One day before operation patients were randomly assigned to 2 groups depending on preparation scheme: main group of RIP and the control group. The frequency of complications during surgery and in the postoperative period was assessed. Troponin I level was measured before, and in 2 and 24 hours after surgery. The level of lactate in the venous blood was measured before and after surgery. RESULTS: Numbers of intraoperative and early postoperative complications in the main and control groups were similar. There were no differences between groups in troponin I and lactate levels after surgery. CONCLUSIONS: Remote ischemic preconditioning has no effect on the outcome of coronary artery bypass surgery with cardiopulmonary bypass and anesthesia with propofol.

[Adaptation to Intermittent Hypoxia-Hyperoxia in the Rehabilitation of Patients With Ischemic Heart Disease: Exercise Tolerance and Quality of Life].

AIM: to assess effect of interval hypoxic-hyperoxic training (IT) on exercise tolerance and quality of life of patients with ischemic heart disease (IHD) receiving optimal medical therapy, as well as the safety of IHHT use. METHODS: Patients with stable IHD with functional class II and III angina (n=46) were randomized into two groups: IHHT (n=27, 15 treatments in 3 weeks), and IHHT imitation (n=19). Cardiopulmonary stress test was performed to evaluate the following parameters of exercise tolerance: peak oxygen consumption (VO2peak, VO2peak/kg), % of predicted peak oxygen consumption (%VO2 peak) and anaerobic threshold (VO2AT). MOS SF-36, SAQ, HADS questionnaires were used for assessment of quality of life (QL). RESULTS: Exercise tolerance (VO2peak/kg) after course of IHHT significantly increased (p=0.03) and remained significantly elevated during subsequent month (p=0.036). Marked improvement was also observed in patients subjective perception of QL. This was evidenced by dynamics of characteristics of physical functioning as well as of psychological state, significant increase of values on all scales of disease-specific questionnaire SAQ, reduction of depression and anxiety according to dynamics of HADS scores. These effects persisted in 1 month after IHHT. IHHT was safe and well tolerated. Side effects were minimal (transient slight dizziness, feeling of shortage of air) and did not require IHHT termination. CONCLUSION: We received clinical confirmation of safety and effectiveness in of IHHT in medically treated patients with stable angina. IHHT was associated with significant improvement of exercise tolerance, subjective perception of QL, reduction of number of angina attacks. Thus, IHHT has significant potential as component of complex treatment and rehabilitation of patients with stable angina.

[Cardiac involvement in thrombotic microangiopathies].

AIM: To describe cardiac involvement in patients with acute thrombotic microangiopathy (TMA). MATERIALS AND METHODS: The case histories of 46 patients with proven TMA, including 17 patients diagnosed with atypical hemolytic uremic syndrome (aHUS) and 29 patients with catastrophic antiphospholipid syndrome (CAPS), were analyzed. RESULTS: Different documentarily verified signs of cardiac involvement were revealed in 6 (13%) patients (5 and 1 patients diagnosed as having aHUS and CAPS, respectively). Five patients developed myocardial involvement at disease onset in the presence of multiple organ dysfunction. CONCLUSION: Cases of cardiac involvement in TMA of various genesis are presented. The exact incidence of myocardial involvement and its prognostic value are unknown so far.