[Serum brain natriuretic peptide and its role in acute coronary syndrome with different types of mitochondrial dysfunction].

The level of serum brain natriuretic peptide (BNP) was measured in 236 patients with acute coronary syndrome. Some of them presented with mitochondrial dysfunction. None showed diagnostically significant BNP levels within 12 hours after admittance, but patients with unstable angina and BNP level below 80 pg/ml had the lowest risk of serious cardiovascular diseases. Marked mitochondrial dysfunction was associated with maximum BNP levels 12 hr and 14 days after hospitalization and mild dysfunction with minimal BNP concentration.

[Relationship between the structure-functional state of the heart and brain natriuretic peptide level in patients with arterial hypertension].

We studied relationship between structure-functional parameters of left and right cardiac chambers and N-terminal pro-brain natriuretic peptide (NT-proBNP) level in 118 patients with arterial hypertension (AH) (35 men, 83 women) and 17 healthy volunteers. Methods comprised 24-hour arterial pressure monitoring (APM), two-dimensional echocardiography (echoCG), Doppler echoCG, and tissue echoCG of mitral and tricuspid atrioventricular annuli, treadmill test, 6-min walk test, and measurement of NT-proBNP level in blood plasma. In patients with AH blood plasma NT-proBNP level was significantly higher than in a group of healthy persons of similar age. Elevation of this biochemical marker was accompanied by significant change of characteristics of remodeling of left and right parts of the heart, abnormalities of left ventricular diastolic function according to transmitral blood flow, disturbances of left ventricular diastolic and systolic function according to tissue Doplerography data. Comparative analysis of structure-functional parameters of the heart and NT-proBNP level in patients with AH allowed to reveal more significant changes of parameters of diastolic and systolic remodeling, local and global diastolic and systolic left ventricular function in patients with NT-proBNP levels more than 306 mol/ml. Factors determining NT-proBNP level in patients with AH were age, free right ventricular wall thickness, and body mass index.

[The (PRIMA) Study. Comparison of clinical effect of trimetazidine MR in men and women].

Main objective of epidemiological part of the (PRIMA) study was elucidation of special characteristics of Russian population of patients with stable angina and more precise characterization of variety and volume of drug and nondrug therapy used in patients with stable angina in Russian Federation. In clinical part of the PRIMA program we assessed efficacy and safety of standard antianginal therapy in combination with trimetazidine with modified release of active substance (MR) in standard therapeutic dose in patients with stable angina after myocardial infarction. According to results of the study prescription of trimetazidine MR was followed by improvement of clinical course of the disease. This manifested as decrease of average number of attacks per week, reduction of mean weekly consumption of short acting nitrates, improvement of quality of life, lessening of severity of main clinical manifestations of chronic heart failure, and lowering of its functional class. It is necessary to emphasize that analysis of results of the PRIMA study has revealed similar efficacy of trimetazidine MR in men and women what allows to recommend this metabolic myocardial cytoprotector to patients with ischemic heart disease irrespective of gender.

[Renin inhibitors--new direction in the treatment of arterial hypertension].

The paper covers current problems in the treatment of arterial hypertension. Renin is an important and promising therapeutic target. The direct renin inhibitor aliskiren (Rasilez) is a promising current effective antihypertensive agent that has cardio- and nephroprotective effects. The paper considers a number of clinical studies that have proven the antihypertensive effect of aliskiren and revealed its benefits versus other drugs recommended for blood pressure lowering. It is assumed that this agent may be used in combinations with angiotensin-converting enzyme inhibitors, thiazide or thiazide-like diuretics, and calcium antagonists. Moreover, aliskiren neutralizes the effect of feedback in the compensatory increase in the activity of plasma renin.

[Possibilities of atorvastatin in complex management of extensive psoriasis in patients with arterial hypertension].

Efficacy and safety of the use of atorvastatin in complex treatment of extensive psoriasis was studied in 63 patients with psoriasis and arterial hypertension (AH). Complex clinical functional examination was carried out at study entry and after 6 months of treatment. Psoriasis severity was evaluated with PASI scale, quality of life with DLQI, PDI and SF 36 questionnaires. Degree of systemic inflammation (IL 10, TNF , hsCRP) and local (TNF , rc TNF , LFA 1) systemic immune inflammation was also assessed. Patients were randomized into either atorvastatin group (20 mg/day, n=48) or standard therapy group (n=15). Initially there was no significant difference between groups in psoriasis severity (PASI 22.2 [13.3; 24.6]) and 22.6 [19.3; 23.6], respectively). Six months of therapy with atorvastatin resulted in significant lowering of PASI (3.6 [1.6;4.8]) compared with 17.0 [15.0; 20.1] in control group, p0.01]); 47.9% of patients achieved PASI -50% in 3 weeks and 95.8% - after 6 months of therapy (0% and 13.3% in control group); 81.3% of patients achieved level of PASI -75% by 6th month of treatment. Positive dynamics of therapy was accompanied with significant improvement of quality of life according to data of PDI and DLQI. After 3 weeks of therapy significant lowering of TNF (from 1.45 [0.6; 1.8] to 1.0 [0.6; 1.4], p<0.05) and hs-CRP (from 5.4 [2.4; 7.1] to 3.3 [2.9; 5.5], p<0.05) took place in atorvastatin group. Antiinflammatory effect of atorvastatin persisted by month 6 (TNF 0.7 [0.4; 1.2] compared with 1.4 [1.3; 1.6] in control group, p0.05); hsCRP (3.1 [2.4; 5.0] 5.5 [2.2; 12.1]) in control group, p<0.05). Significant lowering of local immune inflammation was also occurred in atorvastatin group.Thus therapy with atorvastatin was effective and safe in patients with psoriasis and AH.

[Efficacy of shock-wave therapy in the treatment of chronic ischemic heart failure].

INTRODUCTION: Shock-wave therapy (SWT) has proved its efficacy and safety in a number of studies in stable effort angina. METHODS: Twenty-four patients (20 men, 4 women; mean age 63.3 +/- 6.1 years) with chronic heart failure (CHF) of ischemic origin (>6 months after AMI) and left ventricular (LV) ejection fraction (EF) <40% received SWT in addition to their stable treatment. SWT was performed in 9 sessions with 100 shocks per spot in viable segments detected by low dose dobutamine stress echocardiography. Patients were examined at baseline and at 3 and 6 months after SWT. Troponin T level was measured after each week of treatment. RESULTS: Class of CHF significantly decrease from 2.2 +/- 0.8 to 1.7 +/- 0.7 at 3 and at 6 months after SWT (p<0.01). Six-minute walk test improved from 414 +/- 141 to 509 +/- 141 and 538 +/- 116 m (p<0.01) at 3 and 6 months, respectively. Significant augmentation of LVEF at rest was noted at 3 and 6 months after SWT (from 32.2 +/- 6.0 to 34.8 +/- 9.6 and 37.7 +/- 9.5, respectively p=0.03). Troponin T was negative in all cases. Significant increase of LV longitudinal deformation was registered at 6 months (from -8.84 +/- 0.38 to -9.72 +/- -0.44%, p<0.01) what evidenced for improvement of LV contractility. The latter was a result of restored hibernating segments function (longitudinal deformation of these segments rose from initial -7.52 +/- -0.5 to -9.18 +/- 0.53 and -9.63 +/- 0.59% at 3 and 6 months after SWT, respectively, p<0.01). CONCLUSIONS: In patients with CHF SWT caused significant clinical improvement as well as increases in LV EF and distance walked during 6-min walk test. These results justify conduct of a placebo controlled study.

[Affective disorders in acute myocardial infarction and possibilities of their correction with tianeptin].

AIM: to study the prevalence, pattern of and trends in affective disorders (AD) in patients with acute myocardial infarction (AMI) and to assess whether they might be corrected with the antidepressant tianeptin. SUBJECTS AND METHODS: The study enrolled 108 patients with AMI. To detect and evaluate affective spectrum disorders, all the enrolled patients were interviewed on days 2-3 of AMI, by using the screening questionnaire developed at the Moscow Research Institute of Psychiatry (MRIP), Russian Agency for Health Care, and 4-5 days and 2 and 6 months after the onset of AMI they underwent an in-depth psychopathological examination by a psychiatrist who applied the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS). To correct affective symptomatology in some patients with verified depression, the antidepressant tianeptin was added to the conventional therapy for AMI on its days 5-7. RESULTS: The screening questionnaire study revealed depressive spectrum disorders in 45.4% of the patients with AMI. The in-depth psychopathological examination confirmed the presence of AD in 40.7%. Mild and moderate depressive episodes were observed in 26.9% of the patients and adjustment disorders were seen in 13.8%. The sensitivity and specificity of the MRIP screening questionnaire for the diagnosis of depressive spectrum disorders in patients with AIM was 86.2 and 69.6%, respectively. The concomitant symptoms of anxiety were detected in 27.8% of the patients with AMI. The duration of a course of antidepressant therapy with tianeptin averaged 3.9 +/- 1.1 months. Six moths after AMI, the tianeptin group a showed significant reduction in HDRS scores by 50% (p = 0.0013) and in HARS scores by 52.7% (p = 0.0004) versus the baseline values. During a follow-up, there was no significant decrease in HDRS and HARS scores in a group of patients who refused antidepressant therapy. CONCLUSION: Affective spectrum disorders are most common in myocardial infarction (MI). The use of the MRIP screening questionnaire favors a more adequate diagnosis of depressive spectrum disorders in patients with AMI. Tianeptin therapy for AD concurrent with MI causes an evident reduction in psychopathological symptomatology and a statistically significant decrease in HDRS and HARS scores.

[Diagnostic value of a thiol-disulfide groups of the antioxidant system in brucellosis].

The functional state of a thiol disulfide link of the antioxidant system was evaluated in 322 patients with brucellosis (160 and 162 with its acute and chronic forms, respectively), including the patients with that involving the cardiovascular systems (120 and 92 with acute and chronic forms, respectively). Examination of the blood antioxidant system indicated that in brucellosis patients, cardiovascular involvement was accompanied by a reduction in SH groups and thiol disulfide coefficient and by an increase in the content of SS groups, which indicates the predominance of the oxidant system over antioxidant one. At the same time, the functional insufficiency of the blood antioxidant system was more evident in patients with acute brucellosis.

[The clinical picture and treatment of depression spectrum disorders in patients with cardiovascular disease].

AIM: To study the impact of depressive and anxious disorders on the course of cardiovascular disease (CVD) and the specific features of clinical changes during combined pharmacotherapy (with cardiovascular agents and antidepressants). SUBJECTS AND METHODS: Seventy-eight patients with arterial hypertension (AH), acute myocardial infarction (AMI), chronic heart failures (CHF), or concomitant affective spectrum disorders were examined. Clinicopsychopathological and clinicofunctional studies were conducted. RESULTS: Statistically significantly higher degrees of anxiety and depression were revealed in patients with AH and in those with CHF than in patients with prior AMI. After AMI, the degree of psychopathological symptomatology reduced during treatment more rapidly than that in patients with AH and in those with CHF. In all three groups, combined therapy using the antidepressant tianeptine (coaxil) improved intracardiac hemodynamics and left ventricular structural and geometric parameters. CONCLUSION: Anxious and depressive disorders substantially affect the formation of a clinical picture in CVD. Inclusion of tianeptine (coaxil), that has antidepressive and anxiolytic activities, into the combined therapy of patients with CVD and depression spectrum disorders leads to a reduction in affective symptomatology, contributing to the positive impact on intracardiac hemodynamic and left ventricular structural and geometric parameters.

[Comparative trial of efficacy of trimethasidine MB and 3-(2,2,2-trimethylhydrasine) propionate dihydrate in chronic heart failure].

AIM: To study efficacy of the myocardial cytoprotector trimethasidine MB and metabolic drug 3-(2,2,2-trimethylhydrasine) propionate dihydrate (3-TMHP) in the treatment of chronic cardiac failure (CCF). MATERIAL AND METHODS: Sixty-five patients with CCF after myocardial infarction (> 6 months) with left ventricular ejection fraction (LV EF) <40% were randomized into 3 groups: group 1 (n=28) received basic therapy plus trimethasidine in a daily dose 70 mg; group 2 (n=25)--basic therapy plus 3-TMHP in a daily dose 1000 mg; control group (n=12) received basic therapy with ACE inhibitors, beta-blockers and diuretics. Before and after 6-month treatment all the patients have undergone stress echocardiography with dobutamine. Perfusion and myocardial metabolism were determined in 34 patients with single photon emission computed tomography of the myocardium (SPECT) with 99m-Tc-technetril and positron-emission tomography of the myocardium (PET) with F-18-fluorodesoxyglucose. RESULTS: Groups 1 and 2 significantly reduced functional class of CCF and prolonged the distance of a 6-min walk. Significant improvement of life quality was observed only in the treatment with trimethasidine. According to PET, treatment with trimethasidine MB and 3-TMHP has an anti-ischemic action manifesting with a significant attenuation of glucose hypermetabolism in the ischemic segment to normal values. However, significant improvement of systolic thickening in hybernated segments by SPECT as well as a significant rise of LV EF were recorded only in the treatment with trimethasidine MB. Stress echocardiography with dobutamine had high specificity (85.7%) but low sensitivity (50.4%) in detection of hybernated myocardium. CONCLUSION: Trimethasidine MB (preductal MB) has advantages over 3-TMHP, so it is preferable in ischemic CHF.

[Possibilities of myocardial cytoprotection in complex treatment of patients with chronic heart failure].

Efficacy of metabolic therapy with trimetazidine MR and 3-(2,2,2-trimethylhydrazyn) propionatodihydratum (3-TMHP) was compared in patients with chronic heart failure (CHF) of ischemic genesis. Clinico-functional examination included dobutamine stress echocardiography single photon emission computer tomography (SPECT) with 99mTc-technetril, and positron emission tomography (PET) with 18F-Fluoro-2-deoxyglucose. Clinical course of CHF improved during therapy with both trimetazidine MR, and 3-TMHP. According to PET data therapy with trimetazidine MR and 3-TMHP exerted antiischemic action which appeared as significant diminishment of glucose hypermetabolism in ischemic segments down to normal values. However significant improvement of regional systolic thickening in hibernating segments according to SPECT data, significant increase of left ventricular ejection fraction at rest and peak load according to data of stress-echocardiography took place only during therapy with trimetazidine.