[Nonpharmacological methods of prevention of thromboembolic complications in patients with atrial fibrillation].

We present in this review modern methods of prevention of thromboembolic complications in patients with atrial fibrillation and give comparative description of evidence base, efficacy and safety of available techniques.

[Immediate results of endovascular treatment of coronary arteries in patients with ischemic heart disease].

AIM: To assess immediate results of percutaneous coronary interventions (PCI) and finding the predictors of the successful outcomes in various subgroups of patients with coronary artery disease (CAD). MATERIAL: Patients (n=1066, (average age 55.7+/-9.2 years, women 12%) treated with coronary artery stenting between 1999 and 2004. According to coronary angiography, 383 (36%) patients had 1-vessel, 502 (47%) - 2-vessel, and 181 (17%) - 3-vessel CAD. The endovascular treatment was made on 1694 coronary stenoses (in average 1.6 stenosis/patient), 356 stenoses (21%) was defined as type A, 745 (44%) - type capital B, and 593 (35%) - type C. PCI was performed with use of inhibitors of glycoprotein receptors IIb/IIIa in 107 (18%) patients. RESULTS: The complete or partial immediate procedural success of PCI (elimination of at least one coronary stenosis) was achieved in 1002 (94%) patients. The immediate success was achieved in 1575 stenoses (93%). Total rate of major adverse cardiac events (MACE) was 1.3%. There were no deaths, 11 patients (1%) had acute myocardial infarctions, 3 (0.28%) patients had an emergent coronary artery bypass grafting. The immediate procedural success was significantly lower in patients with chronic coronary occlusions (76%) than in patients without coronary occlusions (97%, p<0.0001), as well in patients with stenoses type C as compared with stenoses type A, and B (success rate 77%, 98% and 100%, accordingly, p<0.0001). CONCLUSION: By multifactorial analysis, independent predictors of procedural failure were stenosis type C (small p<0.0001) and chronic occlusion of coronary artery (p=0,03).

[An experience of the use of stents with drug coating in patients with long and diffuse coronary artery lesions].

Treatment of long and diffuse lesions of coronary arteries remains one of most complicated sections of endovascular treatment. From 2003 to 2005 treatment with the use of stents with drug coating was conducted in 198 patients with long and diffuse coronary artery lesions. This made up 26% of total number of patients subjected to percutaneous coronary intervention during this time. Mean age of patients was 58 +/- 11 years, 164 (83%) of them were men, 37 (19%) had chronic occlusions of coronary arteries, in 91 (46%) side branches went out from the damaged segment. Patients were divided in two groups: 1st (n=136) comprised patients with lesion length from 22 to 33 mm, 2nd consisted of patients in whom lesion length exceeded 33 mm. Control group comprised 54 patients with lesion length less than 23 mm subjected to endovascular treatment with the use of stents with drug coating during same period of time. Average length of stented segment was 27.3 +/- 3.6 mm in the first group, 44.5 +/- 9.8 mm in the second group and 14 +/- 3.6 in the control group. Immediate success of the procedure was somewhat lower in group II compared with group I (87 and 91%, respectively). Hemopericardium and cardiac tamponade requiring urgent surgery developed in 2 group II patients (3.2%) during first 2 hours after attempt of recanalization of long chronic occlusions of the anterior descending artery. One patient (1.6%) had small-focal myocardial infarction after procedure, in another patient (1.6%) subacute occlusion developed after stenting of venous graft to the right coronary artery which we failed to eliminate. In the first group in 2 patients (1.4%) small-focal myocardial infarction developed. There were no complications in the control group. In 8 months after procedure angiographic restenosis developed in 6 patients (5%) in the 1st group, in 4 (8%) in the second and in 1 (2%) in the control group, however differences were not significant. Rates of repeat revascularizations of the target stenosis were 3, 5 and 0%, respectively. Of 10 cases of restenosis in patients with long stenoses in 5 cases restenosis was located inside stent and was focal (length less than 10 mm), in 3 cases it was located proximal or distal to stent, and in 2 patients manifested as complete occlusion of the stented segment. Treatment of long and diffuse lesions with the use of stents with drug coating appears safe and effective. Overall rate of development of perioperative complications is higher in treatment of stenoses longer than 33 mm compared with stenoses with length 23-33 cm (6.4 vs. 1.4%). Probability of restenosis and repeat revascularization of target stenosis after 8 months is not high.

[Effect of Type 2 Diabetes on Results of Endovascular Treatment of Ischemic Heart Disease With Drug Covered Stents (Results of 1 Year Follow-up).].

Aim of the study was to determine the impact of sirolimus-eluting stents (SES) on clinical outcomes in patients with type 2 diabetes mellitus (DM) undergoing coronary revascularisation. The study enrolled 99 diabetic patients with de novo lesions in native coronary arteries. Medically treated DM was present in 61 patients (62%), 7 (7%) of whom required insulin. 53 patients received 78 SES and 46 patients received 57 bare metal stents. The differences in clinical outcomes between diabetic patients treated with SES and bare metal stents were assessed. Major adverse cardiac events (MACE) defined as death, myocardial infarction (MI), repeat revascularizations, and recurrences of angina were analyzed at 12-month follow-up. In the SES group the rate of recurrence of angina was 17%, the rate of coronary artery bypass surgery was 3,8%, the rate of repeat coronary angioplasty was 5,7%. In the bare metal stent group the rate of recurrence of angina was 37,8%, the rate of coronary artery bypass surgery was 2,2%, the rate of MI was 4,4%, the rate of repeat coronary angioplasty was 22,2%. Implantation of SES in patients with type 2 diabetes mellitus reduces recurrence of angina and major adverse cardiac events during first year after coronary angioplasty.

[Comparative analysis of efficacy of endovascular interventions in native vascular bed and grafts in patients with ischemic heart disease after coronary artery bypass surgery].

AIM: Investigation of efficacy of endovascular interventions in native vascular bed and grafts, elucidation of factors, affecting immediate and remote prognosis after endovascular treatment. MATERIAL AND METHODS Coronary stenting was carried out in 212 patients who had previously undergone coronary bypass surgery. Stents were implanted into native vessels and grafts in 116 (native vessels group) and 96 (grafts group) patients, respectively. Frequency of angina recurrence and development of complications were assessed during hospitalization and after 1 year. Coronary angiography was repeated after 1 year in 47 and 36 patients in native vessels and grafts groups, respectively. Multifactorial analysis of predictors of complications and angina recurrence was performed with the use of logistic regression. RESULTS AND CONCLUSION: In grafts group signs of distal embolism were observed in 9 patients (9.4%), shunt thrombosis occurred in 2 of these patients. Risk factors of embolism in grafts group were complicated lesions (type C) and length of stenosis >20 mm. There was 1 non-Q wave myocardial infarction after stenting of native vascular bed (0.8%). Angina recurrence was observed after 1 year in 9 (7.8%) and 26 (27.1%), myocardial infarction developed during 1 year in 2 (1.7%) and 3 (3.1%) patients of native vessels and grafts groups, respectively. Risk factors of recurrence of clinic of ischemic heart disease (IHD) after stenting of grafts were time interval between stenting and bypass surgery >5 years and the use of stents without drug coating. More frequent recurrence of clinic of IHD in patients of grafts group was a consequence of higher level of restenosis in stented segments and more frequent progression of atherosclerosis in previously unaffected segments.

[Possibility of coronary angiography without hospitalization].

Coronary angiography is the necessary investigation in the diagnostic complex of patients with ischemic heart disease (IHD). The use of trans-radial access makes it possible to do the angiography without hospitalization. The algorithm of coronary angiography in day-time clinic was proposed. Non-hospital angiography in 15 patients was successful. It is the first time this method has been used in this country.

[X-ray-morphological characteristics of the coronary reperfusion phenomenon in patients with myocardial infarct during thrombolytic therapy]. / Rentgenomorfologicheskaia kharakteristika fenomena koronarnoi reperfuzii u bol'nykh infarktom miokarda pri tromboliticheskoi terapii.

An analysis was made of the findings of angiographic studies (coronary angiography and left ventriculography) performed in 57 patients with myocardial infarction along with successful coronary thrombolysis before thrombolytic therapy, at coronary reperfusion (CR), and on days 24 and 28 of the disease. The analysis defined two types of restoration of coronary blood flow: (1) gradual ("slow") and (2) single ("rapid") CR. Angiographic signs of coronary thrombosis in the first hours of myocardial infarction, complicated pattern of a residual stenosis, and more marked left ventricular myocardial dysfunction on day 28 of the disease were more frequently encountered in patients who had undergone "rapid" CR, whereas the uncomplicated pattern and high degree of a residual stenosis were seen in patients who had received "slow" CR. At the same time left ventricular myocardial contractility changed to a lesser extent on day 28 of myocardial infarction.

[Pulmonary circulation in ischemic heart diseases under bicycle ergometer load and acute strophanthin test conditions (based on data from catheterization of the right heart and pulmonary artery)]. / Sostoianie malogokruga krovobrashcheniia u bol'nykh ishemicheskoi bolezn'iu serdtsa v usloviiakh veloérgometricheskoi nagruzki i ostroi strofantinovoi proby (po dannym kateterizatsii pravykh otdelov serdtsa i legochnoi arterii)

On the basis of monitoring the systolic, diastolic and mean pulmonary artery pressur at rest, during ergometric exercises and under identical conditions following premedicatio with cardiac glycosides (48 measurements in 12 patients with ischaemic heart disease) the authors concluded on the importance of studying this parameter for the diagnosis of initial stage cardiac insufficiency, and on its high informativeness for deciding the indications for initiating therapy with cardiac glycosides.

[Decreased tonus of the epicardial coronary arteries in patients with dilated cardiomyopathy]. / Snizhenie tonusa épikardial'nykh koronarnykh arterii u bol'nykh s dilatatsionnoi kardiomiopatiei.

The tone of coronary artery (CA) was evaluated in 26 patients with dilated cardiomyopathy (DCMP) and 20 patients with atypical chest pain, intact CA, and normal left ventricular contractility served as controls. All the patients underwent selective polyviewed coronarography, left and right ventriculography. The configurations of the great CA were examined by a computer which calculated their mean diameter in diastole (Dd) and systole (Ds), their difference (d) and the elasticity index (EI) by the formula: d/Dsx 100%. Twelve patients with DCMP and 10 control patients had repeated left coronary contrasting after intracoronary injection of nitroglycerin, 150 mg, they authors calculated the baseline Dd (Dd1), Dd after nitroglycerin (Dd2), the degree of nitroglycerin-induced CA dilation. Ds was found to be greater than Dd in the two groups. The mean CA diameter was significantly more in DCMP patients who had lower D and EI. Intracoronary nitroglycerin injection caused a less marked increase ion the Dd of the anterior descending CA in DCMP patients. Thus, the computer-aided analysis of coronarograms and nitroglycerin test allowed one to quantitatively determined the decreases in CA in DCMP.

[Total and segmental contractile function of the left ventricle in acute myocardial infarction studied by angiography]. / Obshchaia i segmentarnaia sokratitel'naia funktsiia levogo zheludochka pri ostrom infarkte miokarda po dannym angiograficheskogo issledovaniia.

An angiographic study of 50 patients with acute myocardial infarction was carried out in order to assess total and segmental left-ventricular contractility. The comparison of left-ventricular activity in patients with transmural vs. nontransmural anterior myocardial infarction demonstrated no differences, related to the type of lesion. The type of affection of the infarction-linked artery largely influences left-ventricular activity. Nontransmural diaphragmatic myocardial infarction was associated with the least left-ventricular dysfunction. Various functional left-ventricular disorders corresponded to definite central hemodynamic patterns, associated with myocardial infarction.

[Angiographic study of left and right ventricular function in patients with alcoholic lesions of the heart and dilatational cardiomyopathy]. / Angiograficheskoe issledovanie funktsii levogo i pravogo zheludochkov serdtsa u bol'nykh s alkogol'nym porazheniem serdtsa i dilatatsionnoi kardiomiopatiei.

An angiographic study of left- and right-ventricular function in 57 patients with alcoholic heart and dilatation cardiomyopathy demonstrated preclinical disorders of left-ventricular myocardial contractility and more marked right-ventricular changes in patients with second-stage chronic alcoholism. In cases of dilatation cardiomyopathy, left-ventricular dysfunction was predominant, while right-ventricular changes were less pronounced.

[Rhythm and conduction disorders in alcoholic lesions of the heart]. / Narusheniia ritma i provodimosti pri alkogol'nom porazhenii serdtsa.

Combined investigation (bicycle ergometry, daily ECG monitoring, electrophysiologic studies, coronarography and ventriculography) in 46 alcoholic patients established ventricular extrasystole, paroxysmal atrial fibrillation, atrioventricular block as well as reduced ejection fraction and increased end systolic ventricular volume in the majority of those. Daily ECG recording, bicycle ergometry and electrophysiologic studies proved to be particularly sensitive in detecting cardiac arrhythmias in the alcohol-damaged heart.

[Use of dipyridamole and the radioactive 133Xe clearance method for assessing the coronary reserve of stenocardia patients]. / Primenenie dipiridamola i metods klirensa radioaktivnogo 133Xe dlia otsenki koronarnogo rezerva u bol'nykh so stenokardiei.

Coronary flow reserve was assessed by means of the 133Xe clearance test making use of dipyridamole in the left coronary artery of 11 patients with angina of effort and coronary arterial stenoses involving also the basin of the left coronary artery (group 1), 6 patients with the anginal syndrome showing no angiographic evidence of coronary lesions (group 2A), and 6 patients with cardialgias and intact coronarograms (group 2B). Coronary reserve was shown to be decreased in groups 1 and 2A, as compared to the values shown by group 2B patients.

[Effect of ritmilen and allapinin on prostanoid and cyclic nucleotide levels in patients with cardiac rhythm disorders]. / Vliianie ritmilena i allapinina na soderzhanie prostanoidov i tsiklicheskikh nukleotidov u bol'nykh s narusheniiami ritma serdtsa.

The effect of antiarrhythmic drugs, ritmilen and allapinin, on endogenic prostanoid and cyclic nucleotide levels was examined in patients with heart rhythm disorders. Intravenous administration of antiarrhythmic agents is shown to be accompanied with increased release of prostacyclin that has antiarrhythmic properties into myocardial outflow. Both ritmilen and allapinin promoted the predominance of prostacyclin over thromboxane, with its intrinsic arrhythmogenic properties. Ritmilen- or allapinin-induced changes in prostaglandins E and F2 alpha consisted in that PGE prevailed, as compared to PGF2 alpha. There were no significant changes in cyclic nucleotide ratios (cAMP/cGMP) in response to treatment.

[Changes in segmental and general left ventricular myocardial contractility and intracardiac hemodynamics in the dipyridamole test of patients with ischemic heart disease (data of roentgenocontrast ventriculography)]. / Izmeneniia segmentarnoi i obshchei sokratimosti miokarda levogo zheludochka, vnutriserdechnoi gemodinamiki pri dipiridamolovoi probe u bol'nykh ishemicheskoi bolezn'iu serdtsa po dannym rentgenokontrastnoi ventrikulografii.

The dipyridamole test was performed during diagnostic coronaro-ventriculography in 7 patients showing no angiographic signs of coronary atherosclerosis (group 1) and 15 patients with a 75% stenosis in one or more coronary arteries (group 2). The test provoked an anginal attack in 11 (73%) second-group patients that was accompanied with the emergence or aggravation of asynergy in 10 (67%) or ischemic electrocardiographic changes in 7 (47%). In all cases, the anginal attack was associated with a rise in end diastolic pressure. All first-group patients showed no response to the dipyridamole test as evidenced clinically and electrocardiographically. No asynergic zones were identified on any of the ventriculograms recorded after dipyridamole administration.

[The clinical characteristics of ischemic heart disease in patients with arterial hypertension of different origins]. / Osobennosti kliniki ishemicheskoi bolezni serdtsa u bol'nykh s arterial'noi gipertenziei razlichnogo geneza.

To study the clinical picture of coronary heart disease with concomitant arterial hypertension of various genesis, 172 patients were examined, out of them the cause of arterial hypertension was hypertensive disease in 54, chronic pyelonephritis in 40, chronic glomerulonephritis in 37, and stenotic atherosclerosis of renal arteries in 29, endocrine disease in 12 patients. The patients were divided into 2 groups: (1) 148 with stenotic atherosclerosis of coronary arteries and (2) 24 patients with intact coronary arteries. Comparison of these patient groups revealed no clear-cut correlation between the age and the detection of exercise-induced angina, as well as the duration of arterial hypertension. There was no correlation between the detection of the anginal syndrome and ECG changes. The incidence of the anginal syndrome was 62.2% in Group 1 and 47.7% in Group 2. It was established that the detection of the anginal syndrome correlated well with the severity of left ventricular hypertrophy and values of blood pressure, despite nosological entities.

[Prognostic significance of various qualitative and quantitative indicators of coronary angiography in patients with unstable stenocardia]. / Prognosticheskoe znachenie nekotorykh kachestvennykh i kolichestvennykh pokazatelei koronarnoi angiografii u bol'nykh s nestabil'noi stenokardiei.

The coronary bed was qualitatively and quantitatively examined in 41 patients with unstable angina pectoris. The patients were divided into two groups: (1) those with uncomplicated angina and (2) those with complicated angina in relation of follow-up (mean 3.1 +/- 0.8 years) findings. In patients with a poor coronary heart disease outcome a symptom-related lesion was more frequently located mainly in the left coronary trunk during clinical manifestations of unstable angina pectoris, along with more severe overall lesion in the coronary bed. They had also higher incidence rates of complicated lesions and higher values of three quantitative parameters (stenosis extent, the mean and proper diameters of a stenotic segment in the symptom-related vessel) determined by semiautomatic stenosis configuration analysis.

[Effect of non-ionic roentgenocontrast preparation Omnipaque-350 on central hemodynamics and myocardial contraction]. / Vliianie neionnogo rentgenokontrastnogo preparata Omnipak-350 na tsentral'nuiu gemodinamiku i sokratimost' miokarda.

The authors studied the effect of the non-ionic radiopaque substance Omnipaque-350 on the central hemodynamics and myocardial contractility. A comprehensive angiographic examination was conducted in 25 patients. Omnipaque-350, when administered intravascularly, was found to induce the same general reactions as ionic triiod-containing radiopaque. It did not exert direct myocardiodepressive effect; yet, upon intracoronary administration it caused uniform changes in myocardial contractility and elasticity which corresponded to transitory alterations in its perfusion. During left ventriculography, Omnipaque-350 as compared with Urografin-76, has less marked hypervolemic properties and a less significant impact on the central hemodynamics and the pump function of the heart.

[Clinical aspects and diagnosis of ischemic heart disease in patients with arterial hypertension]. / Klinicheskaia kartina i diagnostika ishemicheskoi bolezni serdtsa u bol'nykh arterial'noi gipertoniei.

Twenty-six patients with arterial hypertension and chest pain were examined using echocardiography, bicycle ergometry, pharmacological tests with the intravenous administration of dipiridamol and isoproterenol, coronary angiography and left ventriculography. With regard to the painful syndrome the patients were divided into 2 groups: Group 1 with angina, Group 2 with cardialgia. The majority of the group 1 patients showed extensive atherosclerosis of the coronary arteries. The results of bicycle ergometry and pharmacological tests in this group were positive in the majority of cases. The group 2 patients displayed minor atherosclerosis of the coronary arteries or intact arteries which correlated with negative results of the bicycle ergometry and pharmacological tests. Echocardiographic and ventriculographic examinations of the functional state of the left ventricle revealed circulation insufficiency in none of the patients.