[Effect of complex rehabilitation by stages on the physical work capacity of myocardial infarct patients]. / Vliianie kompleksnoi poétapnoi reabilitatsii na fizicheskuiu rabotosposobnost' bol'nykh infarktom miokarda.

The authors examined 233 patients after myocardial infarction. The principal and control groups were formed at random. The principal group was composed of patients who had undergone complex stage-by-stage rehabilitation. The changes in the working capacity were determined by the bicycle ergometry test. It was established that the values of physical working capacity were significantly higher in patients of the principal group than in patients of the control group. The effect of the rehabilitation program was different in various age groups. It was most favourable in patients over 45 years of age. A significant difference was also disclosed in the parameters of the physical working capacity depending on the character of psychological readaptation.

[Comparative evaluation of different physical load tests in patients who have had a myocardial infarct]. / Sravnitel'naia otsenka razlichnykh prob s fizicheskoi nagruzkoi u bol'nykh, perenesshikh infarkt miokarda

A comparative analysis of the results of exercise tests conducted in 2 groups of patients following myocardial infarction was done on the basis of data from the A.L. Myasnikov Institute of Cardiology, USSR Acad. Med. Sci., and the research group of medical rehabilitation of the Humboldt University, Berlin. Continuous and interrupted step-wisely growing bicycle exercises in sitting position were compared. The duration of each step comprised 5 min with pedalling at 60 rpm. With continuous tests every step increase the workload by 25 W. With stepwise tests in half of the patients the work load was increasing by 25 W every step, in the other half--by 16.7 W, the pause between the steps lasting 10 min. It was found that the main parameters of both types of tests did not differ in the two centers, as shown by statistical processing; an identical threshold capacity of the workload, equal elevations of the arterial pressure and heart contractions rate at the peak of the test were obtained. No differences were revealed in the criteria of test interruption with both types of examinations in the two centers. A slight tendency towards a greater elevation of the heart contractions rate and systolic arterial pressure was noted with continuous tests, in contrast to the step-wise. This results in a greater variance of the workability parameters when comparing the results. Therefore it seems preferable to conduct one type of tests--the continuous one.

[Nonspecific immunity factors and elimination of circulating immune complexes in patients with myocardial infarct in the 1st phase of rehabilitation]. / Nespetsificheskie faktory immuniteta i éliminatsiia tsirkuliruiushchikh immunnykh kompleksov u bol'nykh infarktom miokarda v pervoi faze reabilitatsii.

A considerable increment of humoral immunity parameters was demonstrated during the 3d-5th week after the onset of myocardial infarction (MI). The levels of IgG and IgE were increased, and those of circulating immune complexes (CIC), decreased significantly in patients with their first diagnosed infarction, as compared to those with repeated MI. Patients with repeated MI showed significantly reduced blood C3c, C4 and the phagocyte index in the presence of high blood levels of CIC and C-reactive protein, as compared to patients with primary infarction. The results are indicative of a considerable activation of the complement and the phagocytic system and CIC elimination in patients with their first MI diagnosis, and the absence of such a stimulation in repeated MI cases.

[Amiodarone-associated thyroid dysfunction: prevalence and possibilities of correction]. / Amiodaron-assotsiirovannaia disfunktsiia shchitovidnoi zhelezy: chastota razvitiia, vozmozhnosti korrektsii.

During 1 year of amiodarone intake development of amiodarone-associated thyroid dysfunction was observed in 25% of patients (hypothyroidism and thyrotoxicosis in 19.2 and 5.8%, respectively). Development of hypothyroidism was not accompanied with loss of antiarrhythmic efficacy of amiodarone and therapy with L-thyroxin was conducted at the background of continued amiodarone intake. In all patients with clinical and in less than one half (47.6%) of patients with subclinical forms of hypothyroidism replacement therapy with L-thyroxin was carried out. Development of amiodarone-associated thyrotoxicosis was accompanied with loss of antiarrhythmic efficacy of amiodarone in all cases. In all patients with thyrotoxicosis which developed during amiodarone intake thyrostatic therapy with mercasolil was carried out and in case of its inefficacy prednisolone was added. In 87.5% of patients with thyrotoxicosis correction of the thyroid status was conducted under conditions of continued amiodarone intake as this drug had been prescribed because of life saving indications. Achievement of euthyroid state was followed by restoration of antiarrhythmic efficacy of amiodarone. Amiodarone was discontinued just in 1 patient with ventricular extrasystole as correction of thyroid status and restoration of euthyroidosis enabled effective use of other antiarrhythmic drugs.

[Prognosis of the outcome of myocardial infarction by using early dynamic exercise tests]. / Prognozirovanie iskhoda infarkta miokarda s ispol'zovaniem rannikh prob s dinamicheskoi nagruzkoi.

A total of 158 males with a history of myocardial infarction were examined. The examination involved collection of information on their histories, course of the disease and symptoms in the hospital period and early (mean, on day 13) bicycle ergometric exercise tests. A multifactorial analysis made it possible to derive the decision rule to predict the condition of a patient within the first year following the onset of myocardial infarction, which involved prognostically unfavorable history data, such as disability prior to myocardial infarction, alcohol usage, exertional anginal hospital-stage parameters, such as bradycardia, premature contraction, circulatory failure, nodal rhythm, as well as 1 mm or more of ST-segment elevation during the early bicycle ergometric exercise test. The sensitivity of the predictive rule developed was 88.5%, its specificity was 78.5%. The study shows that it is impossible to successfully solve the problem in attempting to predict the outcome from some parameters, including the bicycle ergometric test findings. It is possible to do so only when the complex of data on a patient is taken into account.

[Efficiency of antiarrhythmic therapy and resistance to it in patients with malignant ventricular tachyarrhythmias: formulation of prognosis]. / Effektivnost' antiaritmicheskoi terapii i refrakternost' k nei u bol'nykh so zlokachestvennymi zheludochkovymi takhiaritmiiami: postroenie prognoza.

AIM: To study feasibility of predicting results of drug antiarrhythmic therapy in patients with malignant ventricular arrhythmias (MVA) basing on the results of clinical and device examinations. MATERIALS AND METHODS: 136 patients with documented MVA entered the study. 100 patients were in the retrospective analysis group, 36 patients comprised the study group. All the patients underwent physical examination, resting ECG, chest x-ray, radionuclide ventriculography. Intracardiac electrophysiological examination, Holter 24-h ECG monitoring and bicycle exercise provided data for diagnosis of MVA and control over effects of antiarrhythmic drugs. The mathematical model was derived using discriminant analysis. RESULTS: Significant differences were obtained in patients with positive and negative results of drug testing by the number and recurrence time of ventricular tachycardia (VT) for 3 years, survival, cardiac and sudden death, some other parameters. A mathematic model has been designed which allows prognosis of the results of antiarrhythmic therapy (AAT) in patients with MVA. 7 independent predictors of AAT efficiency are shown: left ventricular ejection fraction, duration of P-Q interval, cardiac failure, left ventricular aneurysm, age, number of VT morphologies, insufficiency of aortic valve. Verification of the model on the study group patients showed that prognostic accuracy of the model was 82%. CONCLUSION: The results of the drug tests predict life span of MVA patients. The developed mathematical model allows prediction of AAT results in such patients before the pharmacological test with accuracy 82-87%. The model can help objectivize indications to use of non-pharmacological methods for each patient basing on prognosis of resistance to drug AAT.