[Acute Coronary Syndrome Registry of High Risk Patients: 30-Day Outcome].

AIM: The aim of the study is to evaluate important additional cardiovascular (CV) risk factors of major adverse cardiac events (MACE) in patients with acute coronary syndrome (ACS) during the first 30 days after index event. MATERIALS AND METHODS: Overall 750 patients with ACS were enrolled in the single center prospective registry from 2012-2015yy. 569 patients received dual antiplatelet therapy and in 425 cases platelet function testing (PFT) were performed. Most of the patients characterized as high risk elderly patients with multiple CV risk factors and high comorbidity index. RESULTS: At 30-day follow-up the mortality rate was 10,1%. Singlevariate analysis showed strong association between MACE and age, atrial fibrillation, stroke, chronic kidney disease, low ejection fraction, type 2 myocardial infarction (T2MI). Multivariate analysis showed that high-on-treatment platelet reactivity (PFT> 45%) with odds ratio 4.418 (p=0.0001), chronic kidney disease (OR 6.538 p=0.001) and T2MI (OR 1.925 p=0.0001) were significantly associated with adverse outcome. CONCLUSION: ACS registry showed high mortality level in real-life practice compared with randomized clinical trials due to the high prevalence of elderly patients with high comorbidity index. Patients with T2MI have significantly more severe prognosis and chronic kidney disease associated with increased MACE. PFT in this category of patients is reasonable for more accurate risk stratification.

[Relation of Functional Activity of Platelets to Prognosis of Unfavorable Cardiovascular Events in Patients with Acute Coronary Syndrome. Results of a Registry Study].

AIM: to assess relation ofhigh functional activity ofplatelets to prognosis ofunfavorable cardiovascular events in patients with Acute Coronary Syndrome (ACS). MATERIALS: The study was based on the data of a single center ACS registry conducted in the Central Clinical Hospital of the Presidential Affairs Department of Russian Federation. Of 529 included patients in 425 without contraindications to double antiplatelet therapy we carried out analysis of dependence of 30 days level of unfavorable events on parameters of functional activity of platelets. RESULTS: High on-treatment platelet reactivity (HTPR) was found to be associated with 3.5 increase of mortality in the group of patients with high cardiovascular risk. Logistic model of prognosis of unfavorable events based on multifactorial analysis of data from patients with measured platelet aggregation included chronic kidney disease, type of myocardial infarction, and degree ofplatelet aggregation >45%. C -statistic was equal to 0.77. We also present in this paper discussion of problems related to studying approaches to individualization of anti-aggregation therapy in real clinical practice and problems of organization ofsimilar studies. CONCLUSION: The study showed that patients with ACS increased platelet aggregation, as well as chronic kidney disease and type 2 MI are associated with a 30 day prognosis of adverse events.

[Duration of Dual Antiplatelet Therapy in Patients With Ischemic Heart Disease After Implantation of Endovascular Stents].

Optimal duration of dual antiplatelet therapy (DAPT) after stent implantation is uncertain. Some patients have an extended risk of thrombotic complications including that of very late stent thrombosis after cessation of recommended course of DAPT (6-12 months). On the other hand, there is a real risk of bleeding on DAPT. In this review, we present and discuss results of clinical trials of long-term DAPT and data of their meta-analyses. The review also contains consideration of some aspects of new AHA/ACC recommendations (2016) on duration of DAPT.

[A case of primary diagnosis of patent ductus arteriosus at the age of 75 years]. / Sluchai pervichnoi diagnostiki otkrytogo arterial'nogo protoka u patsientov v vozraste 75 let.

The paper describes a case of primary diagnosis of functioning patent ductus arteriosus in a 75-year-old female patient.

[Hypolipidemic and pleiotropic effects of a combination of simvastatin and ezetimibe in patients with different types of hyperlipidemia].

The review considers trials dealing with the efficiency of combination hypolipidemic therapy with simvastatin and ezetimibe. Its synergistic potentiating effect can cause a considerable decrease in the level of total cholesterol, low-density lipoproteins, triglycerides, and C-reactive protein, which are important participants in the atherogenic process. This effect promotes the achievement of hypolipidemic therapeutic goals in many cases when this cannot be attained by high-dose statin monotherapy. The authors consider the results of trials of combination hypolipidemic therapy with simvastatin and ezetimibe performed as basic ones done in both previous and recent years.

[Disturbances of primary hemostasis in patients with dilation cardiomyopathy].

We studied morphological characteristics of platelets and parameters of platelet aggregation in patients with dilation cardiomyopathy. Augmented aggregatory activity of platelets was found in 76% of patients. In blood of majority of patients we found circulating leukocyte-platelet aggregates. This evidenced for development of inflammatory process and could be related to disturbances of blood rheology. In 2 patients examined by virusological method we revealed presence of a virus inside platelets. This phenomenon might serve as one of possible pathological pathways of disease progression at the account of spread of viral infection along vascular bed during thrombus formation.

[Effect of therapy with rosuvastatin on lipid spectrum, factors of inflammation and endothelial function in patients with ischemic heart disease].

Rosuvastatin (10 mg) was given for 3 months to 30 men (mean age 57+/-9 years) with total cholesterol (CH) above 5.2 mmol/l. Questioning, physical examination, registration of ECG, measurement of levels of total, low density lipoprotein (LDL), high density lipoprotein (HDL) CH, and triglycerides (TG), assessment of endothelium-dependent brachial artery dilation were carried out at baseline and in 3 months. It was noted that 3 months therapy with rosuvastatin exerted positive effect on blood lipid spectrum: lowering of concentration of total CH (-31%, baseline 6.52+/-0.92, after therapy 4.47+/-0.96 mmol/l, p<0.0001), TG (-39%, baseline 2.73+/-1.56, after therapy 1.67+/-0.71 mmol/l, p<0.001), LDLCH (-44%, baseline 4.11+/-0.85, after therapy 2.40+/-0.90 mmol/l, p<0.0001), elevation of HDLCH (+6%, baseline 1.15+/-0.27, after therapy 1.22+/-0.34 mmol/l, p=0.08). Target LDL CH level (<2.6 mmol/l) was achieved in 23 patients (77%). Significant lowering of concentration of C-reactive protein (CRP) (-56%) and interleukin 6 (-25%) was also established. Before beginning of therapy mean flow dependent dilation was 6.1+/-1.64%, after therapy -- 10.4+/-5.0% (p<0.05). Treatment of men with ischemic heart disease with rosuvastatin (10 mg for 3 months) led to achievement of target values of LDLCH in 77% of them, to significant lowering of concentrations of CRP and interleukin 6, and to improvement of endothelial function.

[Platelet activation and inflammation markers in patients with coronary heart disease and depression].

AIM: To study morphological features and functional activity of platelets, their relations with the level of inflammation markers in coronary heart disease (CHD) patients with depression. MATERIAL AND METHODS: The study group consisted of 33 CHD patients with stable effort angina (NY-HA FC I-III), 14 had depression, 19 were free of depression. Sixteen healthy volunteers comprised the control group. Platelet aggregation was registered by a mean size of aggregates and turbidometrically. Platelets shape, leukocytic-thrombocytic and erythrocytic-thrombocytic aggregates (LTA, ETA) in the whole blood were studied electron-microscopically. The levels of IL-2, IL-6, TNF-alpha, sVCAM, hsCRP were measured in the blood, serotonin--in platelets. RESULTS: Spontaneous aggregation enhanced in 52.6% CHD patients (p < 0.05). The blood contained reticular platelets, high number of prothrombocytes (p < 0.05), mean volume of thrombocytes was greater (p < 0.05). This reflected changes in megakaryocytopoiesis. Some of the patients had LTA and ETA. Out of inflammation markers, only IL-6 and sVCAM were elevated (p < 0.01), hsCRP concentration rose, but not above normal range. Serotonin in platelets was the same in the patients and controls. Depression aggravated the disorders and elevated other indices. Spontaneous aggregation was high in 71.4% of depressive CHD patients. The count of reticular platelets, prothrombocytes, mean volume platelets were also elevated. LTA and ETA were high in all the depressive patients. Elevated were also concentrations of IL-6, sVCAM, IL-2, hsCRP. Serotonin in platelets was low (p < 0.05). CONCLUSION: Depression stimulates functional activity of platelets, is a factor of risk of intravascular inflammation and contributes to development of thrombotic complications in CHD patients.

[Markers of chronic inflammation in patients with ischemic heart disease with in-stent restenosis].

Concentrations of interleukins 6 and 10, tumor necrosis factor alpha, transforming growth factor beta and C-reactive protein were measured in 42 patients before and in remote period after coronary stenting. Patients with angiographically documented in-stent restenosis compared with those without restenosis had higher initial levels of interleukin 6 and more often discontinued therapy with statins.

Electrocardiographic exercise testing and ambulatory monitoring to identify patients with ischemic heart disease at high risk of sudden death.

Prognostic significance of ambulatory electrocardiographic monitoring and exercise testing was studied in 144 patients with established ischemic heart disease. A follow-up study showed that 10 sudden deaths occurred within 2 years. The univariates most strongly associated with the subsequent occurrence of sudden death included reduced maximal exercise heart rate, exercise-induced frequent ventricular arrhythmias, complex ventricular arrhythmias revealed by 24 hour ambulatory electrocardiographic monitoring and onset of S-T segment depression during exercise testing. Groups of patients at very high and very low risk of sudden death were identified using conjunction and inclusive disjunction of the foregoing variable. The presence of bivariate and trivariate combinations was associated with an increase up to 20-fold in the incidence of sudden death. Patients with the poorest prognosis were those who stopped exercise before achieving a high heart rate and who exhibited either pronounced electrocardiographic abnormalities during stress testing or complex ventricular arrhythmias during ambulatory monitoring. Combinations of exercise variables identified patients at a very high risk of sudden death, whereas combinations of monitoring variables appeared to be preferable for defining groups of patients at very low risk. The results obtained suggest that the two methods carry different prognostic information and, therefore, may complement each other in identifying potential victims of sudden cardiac death.

[Comparison of the anti-arrhythmia activity of novocainamide and obzidan in patients with ventricular extrasystole]. / Sravnenie antiaritmicheskoi aktivnosti novokainamida i obzidana u bol'nykh s zheludochkovoi ékstrasistoliei.

Comparative efficiency of obsidan, novocainamide and placebo was studied in patients with ventricular extrasystole of varying origins. Obsidan administered in a dose providing a beta-blocking effect is no less effective than novocainamide in terms of antiarrhythmic activity. Owing to this level of efficiency, obsidan can be recommended for long-term treatment of ventricular extrasystole.

[Variability and stability of ventricular extrasystole in patients with a history of myocardial infarction]. / Izmenchivost' i stabil'nost' zheludochkovoi ékstrasistolii u bol'nykh, perenesshikh infarkt miokarda.

Changes in ventricular extrasystole were examined using 3 sessions of 24-hour Holter ECG monitoring in 304 myocardial infarction survivors. The highest reproducibility was shown by the maximum ventricular extrasystole gradations 1, 3, 4b, according to the Lown-Wolff classification. Evidence of possible transformation of the maximum ventricular extrasystole gradations at repeated prolonged ECG monitoring sessions is presented.

[Relationship between ventricular extrasystole and parasystole]. / Vzaimootnosheniia zheludochkovoi ekstrasistolii i parasistolii.

Monomorphic ventricular extrasystoles, no less than 30 within an hour, were revealed in 89 of 300 patients with chronic ischemic heart disease during continuous 24-hour ECG recording on magnetic tape. A fixed type of the linkage interval (oscillations of no more than 0.1 sec) was established in 58 (62%) and the variable tupe (oscillations of more than 0.1 sec) in 31 (38%) patients. Oscillations in the linkage interval of more than 0.1 sec gave grounds to suspect parasystole. A deeper analysis revealed parasystole in 8 cases (2.6% of the total number of patients), the remaining cases were included in the group of extrasystoles with a variable non-parasystolic type of the linkage interval. This group of extrasystoles occupies an intermediate position between para- and extrasystole. The large number of transitional forms between extra- and parasystole suggests their common origin.

[Dynamic prognostic significance of ventricular extrasystole in patients with a history of myocardial infarct]. / Dinamika prognosticheskogo znacheniia zheludochkovoi ékstrasistolii u bol'nykh, perenesshikh infarkt miokarda.

Prognostic value of ventricular extrasystoles was assessed by round-the-clock Holter's ECG monitoring at different dates after myocardial infarction. Correlation between complex ventricular arrhythmias and poor vital prognosis was more obvious 1 month after myocardial infarction than it was 12 months after the infarction. Recurrent ventricular arrhythmias were associated with the poorest vital prognosis.

[Anti-arrhythmia effect of prolecophen in patients with extrasystole in comparison with other anti-arrhythmia drugs]. / Antiaritmicheskoe deistvie prolekofena u bo'lnykh s ékstra- sistoliei v sravneni s drugimi antiaritmicheskimi sredstvami.

Oral prolecohen (LEK, Yugoslavia) was given in a single dose of 300 mg to 15 patients with extrasystole of various genesis. The drug produced an antiarrhythmic effect in 50% of patients with ventricular extrasystole, but in those with supraventricular extrasystole. Prolecophenum showed a good tolerance. In 20% of the patients the adverse reactions appeared as mild headache, dizziness, dry mouth, malaise in the epigastric region. There is also evidence for efficacy of other antiarrhythmic agents used in this group of patients.

[Synergism of the anti-anginal action of beta-blockers and calcium antagonists in patients with ischemic heart disease]. / Izuchenie sinergizma antianginal'nogo deistviia beta-blokatorov i antagonistov kal'tsiia u bol'nykh ishemicheskoi bolezn'iu serdtsa.

A variety of anti-anginal drugs and their combinations were selected in a group of patients with stable angina of effort, with the effects assessed by bicycle ergometry. Effective doses of propranolol, corinfar, finoptin provided for at least 3 minutes' increment in the duration of the effort. Combinations of these drugs in doses reduced by half produced a more pronounced increment in the duration of the effort, an observation suggestive of synergistic anti-anginal effects of calcium antagonists and beta-blockers.

[Comparative effectiveness of finoptin, corinfar and their combination in patients with angina pectoris]. / Sravnitel'naia éffektivnost' finoptina, korinfara i ikh sochetaniia ubol'nykh so stenokardiei.

In a series of 20 patients with stable angina of effort, the authors, using repeated exercise tests, attempted to select the effective antianginal doses of verapamil (finoptine) and nifedipine (corinfar) and to assess the effectiveness of their combination in lower doses following a single administration of the drugs. Verapamil was found to be a more effective antianginal drug than nifedipine. The antianginal effect of both drugs was comparatively short-term. A combined use of verapamil and nifedipine in low doses was demonstrated to be a good alternative choice in cases of side effects arising upon the separate employment of high doses of the drugs.

[Pharmacodynamics of a nitroglycerin ointment in patients with stenocardia of effort]. / Farmakodinamika nitroglitserinovoi mazi u bol'nykh so stenokardiei napriazheniia.

Antianginal efficiency and the duration of effect of a 2% nitroglycerin ointment were assessed in 20 patients with angina of effort, using repeated bicycle ergometric tests. It was demonstrated that the 2% nitroglycerin ointment was an effective antianginal agent, the effect of its minimal dose (2 cm) exceeding considerably that of 10 mg isosorbide dinitrate. The antianginal effect of nitroglycerin ointment became apparent 15 minutes after the application and lasted for 6 hours of follow-up in most patients. There was individual variation in the duration of the ointment's effect, which was, however, less pronounced, as compared to the variation observed with oral prolonged-action nitroglycerin preparations.

[Synergism of the anti-angina effect of obzidan and finoptin in patients with effort stenocardia]. / Sinergizm antianginal'nogo deistviia obzidana i finoptina u bol'nykh so stenokardiei napriazheniia.

The effect of propranolol-finoptin combinations was examined in 27 patients with angina of effort. Repeated exercise testing showed this combination to provide an essential antianginal effect that exceeded a mere sum of individual effects of each of the two drugs taken alone in the same doses. The high anti-anginal effect of the combination is suggestive of a synergy in their antianginal action resulting in a further reduction of myocardial oxygen requirement. Side effects necessitating discontinuation of the drugs were only recorded during the early days of the treatment; therefore, patients should be adequately monitored during the first days of the regular use of this combination.

[Evaluation of antianginal effectiveness of nicardipine in patients with angina pectoris]. / Otsenka antianginal'noi éffektivnosti nikardipina u bol'nykh so stenokardiei.

The new calcium antagonist nicardipine was studied for its potency in 73 patients with coronary heart disease concurrent with angina pectoris, including 16 with vasospastic angina. Nicardipine given in a mean daily dose of 70.1 +/- 12.4 mg induced an increase in exercise test duration by 1-2 min in 71.9% of the patients as compared with placebo. The agent was slightly less potent than nifedipine. In vasospastic angina, nicardipine was effective in 81.3% of the patients.