Impact of microvascular injury various types on function of left ventricular in patients with primary myocardial infarction with ST segment elevation.

AIM: To analyze the long-term effect of microvascular injury various types on the structural and functional parameters of the left ventricle assessed by echocardiography in patients with primary ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS: The study included 60 patients with primary STEMI admitted within the first 12 hours after the onset of disease who underwent stenting of the infarct-associated coronary artery. Each patient included in the study underwent CMR imaging on the second day post-STEMI. MVO and IMH were assessed using late gadolinium enhancement and T2-weighted CMR imaging. Subsequently, all patients underwent the standard echocardiographic protocol on the 7th day and 3 months after MI. RESULTS: We divided all patients into 4 groups: the 1st group didn't have any phenomena of IMH and MVO, the 2nd group had only MVO, patients of the 3rd group had only IMH and in the 4th group there was a combination of MVO and IMH. LV ejection fraction was significantly lower in patients with combination of MVO and IMH, if compared to those without it. Correlation analysis showed a moderate inverse correlation between the MVO area and LV contractile function: the larger the area, the lower the LVEF (R=-0,60; p=0,000002). CONCLUSIONS: The combination of IMH and MVO is a predictor of a reduction in LVEF and an increase of volumetric measurements within 3 months after MI. In comparison with patients without microvascular injury isolated MVO is associated with lower LVEF. The size of MVO is directly correlated with the LV contractile function decrease. Isolated IMH was not associated with deterioration of left ventricular function.

Two-Stage Revascularization in Patients with Acute Myocardial Infarction and Massive Coronary Thrombosis.

AIM: to investigate safety and angiographic efficacy of two-stage revascularization with percutaneous coronary intervention (PCI) with stenting delayed by one day in patients with acute myocardial infarction (MI) and massive coronary thrombosis. MATERIALS AND METHODS: We included in this study 12 patients with massive infarct related coronary artery thrombus which length was greater than thrice the vessel diameter in the presence of TIMI grade II-III blood flow as detected by coronary angiography (CAG). The emergency PCI was not performed, and conservative antithrombotic therapy continued for 24 hours. After this day, CAG was repeated. RESULTS: Repeat CAG in all patients showed thrombus regression which visually appeared as complete lysis in 8, and partial lysis - in 4 patients. Stenting of residual stenosis was performed in 11 patients without complications. In 1 patient residual stenosis was considered insignificant (<50 %) therefore stenting was not performed. No-reflowphenomenon and recurrent MI were not observed. CONCLUSION: These data suggest that in patients with massive coronary artery thrombosis conservative antithrombotic therapy for 24 hours followed by repeated CAG and, if required, by stenting of residual stenosis, is safe treatment tactics that might reduce the risk of the no-reflow phenomenon.

[Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock Due to Fulminant Myocarditis].

This article presents a clinical case of a 40-year-old woman with fulminant myocarditis which progressed rapidly to the development of cardiogenic shock resistant to standard intensive care, but with a positive response to extracorporeal membrane oxygenation.

[In-hospital and long-term results of delayed percutaneous coronary intervention after successful thrombolytic therapy in elderly patients with acute myocardial infarction.]

The aim of this study was to investigate the efficacy and safety of percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction after thrombolytic reperfusion with indirect reperfusion signs. A total of 96 patients aged 75 years and over with acute myocardial infarction and successful thrombolysis (reduction of ST segment elevation 90 min after thrombolysis) were included in this study. Thirty patients (31%) were selected for delayed PCI. Stent implantation was performed in 70% of cases (21 patients). The bleeding rates did not differ between groups of delayed PCI and conservative therapy. The rate of contrast-induced nephropathy was 6,7%. The rates of recurrent myocardial infarction (ReMI) and lethality did not differ between groups of delayed PCI and conservative therapy. The rates of ReMI after discharge from hospital and the lethality rates within one year did not differ. Then, the patients were assigned to two groups: stented group (n=21) and non-stented group (n=75). The ReMI and lethality rates did not differ between these groups in-hospitally and within one year, but the rate of composite outcome (ReMI + lethality) within one year was lower in stented group: 33,3% vs 41,3% (p=0,039).

[Comparative efficacy of pharmacoinvasive strategy of myocardial reperfusion and primary angioplasty in patients with acute ST elevation myocardial infarction].

In order to assess comparative efficacy of pharmacoinvasive strategy of myocardial reperfusion and primary angioplasty in ST elevation acute myocardial infarction 289 patients were randomized at prehospital stage within first 6 hours of the disease into 2 groups: primary angioplasty (group 1), and prehospital thrombolysis with subsequent rescue or delayed angioplasty depending on efficacy of thrombolysis. We analyzed clinical and anamnestic characteristics of patients, efficacy of reperfusion measures, dimensions of myocardial necrosis, and clinical course of the disease. Pharmacoinvasive myocardial reperfusion with prehospital thrombolysis compared with primary coronary angioplasty decreased time of myocardial ischemia (224.65 +/- 71 vs. 278 +/- 184 min, p < 0.03), increased rate of achievement of TIMI grade 3 flow after percutaneous coronary intervention (80.5% vs. 71.4%, p = 0.002) and more effectively preserved left ventricular ejection fraction (60.0 +/- 14.9% vs. 54.9 +/- 12.3%, p < 0.01). Prehospital thrombolysis before coronary angioplasty compared with primary angioplasty was associated with lower rate of development of no-reflow syndrome (1.4% vs. 11.6%, p < 0.003).

[Adherence to guidelines on management of acute coronary syndrome in Russian hospitals and outcomes of hospitalization (data from the RECORD-2 Registry)].

BACKGROUND: Complete following existing guidelines for management of acute coronary syndrome (ACS) is known to be associated with better outcomes. Partly this is explained by lesser adherence to recommendations in high risk patients. Aim of our study was to assess relationship between degree of following current guidelines and in hospital outcomes independently from initial assessment of risk. METHODS: Each key recommendation from guidelines issued between 2008 and 2011 (13 for STE ACS, 12 for NSTE ACS) was given weight of 1. Sum of these units constituted index of guideline adherence (IGA). IGA was retrospectively calculated for 1656 patients included in Russian independent ACS registry RECORD-2 (7 hospitals, duration 04.2009 to 04.2011). The patients were divided into 2 groups according to quartiles of IGA distribution: 1) low adherence group (quartiles I-II); 2) high adherence group (quartiles III-IV). RESULTS: In low adherence compared with high adherence group there were significantly more patients more or equal 65 years (=0.0007), with chronic heart failure [CHF] (<0.0001), previous stroke (<0.0001), atrial fibrillation [AF] (=0.0002), Killip class more or equal II (=0.0065), high risk of death by GRACE score (=0.035). Inhospital mortality was 9.3 and 2.4% in low and high adherence group, respectively (p<0.0001). The following independent predictors of inhospital death were identified: IGA quartiles I-II (odds ratio [OR] 4.0; 95% confidence interval [CI] 2.3-7.1; <0.0001), high GRACE score (OR 3.3; 95% CI 1.8-6.0; <0.0001), admission systolic BP less or equal 100 mm Hg (OR 3.1; 95% CI 1.8-5.4; <0.0001), admission serum glucose more or equal 8 mmol/l (OR 2.9; 95% CI 1.8-4.7; <0.0001), age more or equal 65 years (OR 2.3; 95% CI 1.3-4.0; =0.005), ST elevation more or equal 1 mm on first ECG (OR 1.7; 95% CI 1.1-2.5; =0.013). From groups with low and high adherence to guidelines we selected pairs of patients (n=588) with similar (or close) age, type of ACS, GRACE score, Killip class, presence of other important risk factors (CHF, AF, previous stroke), and formed 2 equal subgroups without significant differences in important demographic, anamnestic, clinical and laboratory data. Hospital mortality was 7.8 and 2.7% in low and high adherence subgroup, respectively (p<0.0001). CONCLUSIONS: In RECORD-2 ACS registry low adherence to guidelines was more frequent among high risk patients and was independent predictor of inhospital death. Association between degree of guidelines adherence and outcomes persisted after equalizing groups by some factors of risk of mortality.

Estimating the Impact of Economic Fluctuations on Unemployment in Russian Regions Based on the Okun Model.

Based on the modified Okun's model, the article evaluates the impact of changes in production volumes on the dynamics of unemployment in Russia and three regional clusters differing in the unemployment rate and behavioral responses to economic shocks. Assessing the specifications of the basic Okun model on the data of 2010-2020 made it possible to identify a cyclical reaction of the unemployment rate in heterogeneous regional clusters to changes in output volumes.

[Psychiatric disturbances in patients with acute myocardial infarction and other critical states in conditions of department of reanimation and intensive therapy].

In this review we present in short data of domestic and foreign studies on somatogenic delirium in patients with acute myocardial infarction and with other critical states. The review also contains definitions of basic conceptions, contemporary approaches to diagnosis and management of this complication.

[Determination of free fatty-acid carrier protein by enzyme immunoassay and non-instrumental method in acute coronary syndrome].

The purpose of the investigation was to study changes in and relationships with the clinical and echocardiographic parameters in the serum level of cardiac fatty-acid carrier protein (cFACP) with acute myocardial infarction (MI), as well as the efficiency of non-instrumental determination of the content of cFACP, by using the test systems "CardioFACP" in the diagnosis of acute MI. The investigation showed the high diagnostic value of cFACP as the earliest marker of acute MI during both its enzyme immunoassay and non-instrumental determination. The sensitivity of the test system "CardioFACP" was found to be greater than that of the troponin test within the first hours of acute MI. The findings support the specific features of the kinetics of cFACP and its sensitivity in detecting cardiomyocyte lesions, on the one hand, and determine perspectives for its use to diagnose MI and reocclusions of the infarction-related coronary artery after reperfusion therapy, on the other.

An electron-hole spectrum of Ge/Si structures with Ge quantum dots: photoconductivity measurements.

The lateral photoconductivity of multilayer Ge/Si structures with Ge quantum dots (QDs) is investigated. Photoresponse in the range of 1.2-0.3 eV related to the optical transitions between QD hole levels and Si electron states is observed. It is shown that the main contribution to the lateral photoconductivity is made by the electron states localized in the Si band bending region. Application of a 'quantum box' model for the description of QD hole levels allows us to clear up the nature of peaks observed in the photoconductivity spectrum. A detailed energy scheme of the Ge/Si structures with Ge QDs is built up.

Antithrombotic and thrombolytic effects of a new proteolytic preparation Trombovazim (Russia).

We studied the antithrombotic and thrombolytic effects of Trombovazim, a highly-purified proteolytic enzyme preparation obtained by immobilization of bacterial proteinases (Bacillus) on polyethylene oxide with a molecular weight of 1.5 kDa. Blood absorption of the preparation was evaluated after intragastric administration. In vitro experiments showed that Trombovazim produces anticoagulant and thrombolytic effects, which manifested in inhibition of fibrin clot formation and acceleration of its lysis. Drug concentration in the blood was elevated from the 4th to the 7th hour after intragastric administration of Trombovazim in a dose of 2250 U/kg, being maximum by the 5th hour (0.044+/-0.011 U/ml). Course treatment with Trombovazim (1000 U intragastrically, twice daily for 3 days) had a thrombolytic effect on rats with experimental intravascular thrombosis. This effect was manifested in a decrease in thrombus weight and increase in the percent of rats with recanalization of the occluded carotid artery.

[Cardiomyoplasty with autological mononuclear cells of the bone marrow in patients with acute myocardial infarction].

AIM: To study efficacy and safety of transplantation of bone marrow autologous mononuclear cells (BMAMC) in patients with acute myocardial infarction; to examine BMAMC distribution in the human body after intracoronary introduction. MATERIAL AND METHODS: The open controlled trial investigated 26 AMI patients (16 entered the study group and 10 were controls). Cell cardiomyoplasty with BMAMC was performed by intracoronary injection of the cells after stenting the coronary artery supplying blood to the infarction zone on AMI day 7-21. BMAMC were isolated by gradient centrifugation. Distribution of mononuclear cells was studied with radionuclear indication of the cells 99m-Tc-HMPAO. All the patients were examined with Tl-199 perfusion scintigraphy of the heart 2 weeks and 6 months after the treatment, echocardiography, 24-h ECG monitoring, 6-min walk test. RESULTS: All the patients were followed up for 6 months. Two patients (one in each group) developed recurrent myocardial infarction 3 months after the first. Radionuclide investigations revealed fixation of labelled mononuclear cells in the heart both in initial hours after the treatment and 24 hours after it. As shown by myocardial scintigraphy, intracoronary administration of the cells with short-term arterial occlusion was followed by much greater number of labeled cells. By follow-up month 6, in the study group, left ventricular ejection fraction increased more: 12.7 +/- 3.2% versus 10.4 +/- 2.5% in the control group (p = 0.09); moreover, a stable defect of myocardial perfusion reduced more (by 29 +/- 24% against 20 +/- 18%, respectively, p = 0.1). Malignant arrhythmia, complications during and after bone marrow aspiration, intracoronary administration of cell suspension were not registered. CONCLUSION: Intracoronary administration of BMAMC in AMI patients is safe and provides their transfer and fixation in the myocardium. BMAMC transplantation has a positive effect on recovery of perfusion and contractile function of left ventricular myocardium in AMI patients.

[System thrombolytic therapy in acute myocardial infarction in the elderly].

The paper presents a retrospective cohort study of the records of 430 patients with myocardial infarction aged 60 to 91. Group I (main group) consisted of 234 patients who received system thrombolytic therapy (TLT); group II (controls) consisted of 196 patients who received conventional therapy. Hospital and long-term lethality, the course of the disease, and the complications of thrombolysis were evaluated. The study found no effect of TLT itself on the end points; there were differences between subgroups with effective and non-effective thrombolysis. Thus, comparison of these variables in patients aged 60 to 74 showed a decrease in the hospital lethality in the main group: 6.6% vs. 20.6% in the control group (p = 0.00072), and an increase in five-year survival (p = 0.0057). Cardiac arrhythmias (CA) and chronic heart failure were much less frequent in group I. Transient hypotension occurred in 36% of patients on thrombolytic therapy; reperfusion-related CA were noted in 25% of patients receiving thrombolysis. There were no cases of serious hemorrhage or cerebral strokes. None of the complications resulted in a lethal outcome. The study demonstrates that TLT is not contra-indicated in the elderly with myocardial infarction; complications are, as a rule, insignificant and easily reversible. When reperfusion is successful, thrombolysis lowers early and long-term lethality and improves the course of the disease in this very complex category of patients.

[Changes in the binding properties of albumin in patients with myocardial infarction].

The purpose of the study was to measure the levels of albumin and to evaluate its binding properties in patients with acute large-focal myocardial infarction (AMI) hospitalized within the first 24 hours of AMI onset. Two groups were formed: group one--41AMI patients without cardiogenic shock (CS) and group two--15 patients with AMI complicated by true CS. Blood samples were taken from an ulnar vein on the first, second, third, fifth, seventh, and fourteenth day after AMI onset. The properties of binding albumin centers were determined using fluorescent method (K-35 probe). Total albumin concentration (TAC), effective albumin concentration (EAC), and albumin binding reserve (ABR) were determined. The results were presented as M +/- m. A significant increase in TAC on the fifth day (from 43 +/- 1 to 40 +/- 1 g/l) and EAC on the second, third, fifth, and seventh days (from 36 +/- 1 to 32 +/- 1 g/l with the minimal level on the fifth day), and in ABR on the second day (from 83.3 +/- 1.3 to 78.8 +/- 8%) were registered in group one. TAC returned to the normal level on the seventh day, EAC did not become normal until the fourteenth day, while ABR did not normalize within the period of two weeks. Eleven patients in group two died (hospital CS-associated mortality was 73.3%). TAC and EAC in discharged patients were 43.4 +/- 0.9 g/l and 35.8 +/- 0.8 g/l, respectively, while these parameters in the deceased were 35.5 +/- 1.7 g/l (p < 0.0001) and 27.3 +/- 1.7 g/l (p < 0.0001), respectively. CS developed in 70% of cases (seven out of ten patients) in whom TAC was less than 36 g/l vs. 17.4% of cases (eight out of 46) with a TAC of 36 g/l or more (p = 0.0013). When EAC was less than 30 g/l CS developed in 72.7% of cases (eight out eleven patients) vs. 15.6% of cases (seven out of 45) with an EAC of 30 g/l or more (p = 0.0003). Six out of ten patients (60%) with a TAC of less than 36 g/l died. Lethal outcome also occurred in five cases out of 46 or 10.9% with a TAL of 36 g/l or more (p = 0.0008). Seven out of eleven or 63.6% patients with an EAC of less than 30 g/l died. Four out of 45 patients (8.9%) with an EAC of 30 g/l or more died (p = 0.0001). Thus, the study found that a low (less than 36 g/l) TAC and EAC (less than 30 g/l) during the first 24 hours of AMI was associated with a significantly higher frequency of true CS and with a significantly higher hospital lethality. Determining albumin parameters during the first 24 hours of AMI will be useful in distinguishing a group of patients with a high risk of lethal outcome, which will make it possible to begin early aggressive therapy directed towards limiting myocardial necrosis.

[Effectiveness of external mechanical recanalization in the treatment of cardiogenic shock in patients with myocardial infarction].

Attempts of mechanical coronary artery recanalization (angioplasty) were undertaken in 52 patients with acute myocardial infarction and cardiogenic shock. In 28 patients (53.9%) recanalization was successful while in 24 it was not (in-hospital mortality 39.3 and 87.5%, respectively, p<0.001). Overall 11 and 21 patients died among those with (n=28) and without (n=24) successful recanalization, respectively. Among patients with successful recanalization survivors compared with nonsurvivors had shorter time from onset of myocardial infarction to recanalization (11.44+/-2.86 vs 16.8+/-3.4 hours, respectively). No serious complications occurred during invasive interventions.

[Diagnostic and treatment characteristics of ectopic atrial tachycardia]. / Osobennosti diagnostiki i lecheniia predserdnoi éktopicheskoi takhikardii.

Reported here are 162 cases of atrial ectopic tachycardia, a specific type of the supraventricular arrhythmia, which is characterized by the distinct P waves on the ECG, which follow at the rate of 400 and more per minute. Although atrial ectopic tachycardia is similar to the supraventricular paroxysmal tachycardia and atrial flutter, it differs from them by the mechanism of the development. Atrial ectopic tachycardia is caused by the failure or weakening the sinus node and the appearance of the ectopic focus in the atria. Such arrhythmia occurs in the following 4 types: with atrial to ventricular excitation ratio 1:1; with incomplete atrio-ventricular block; with complete atrioventricular block; and in combination with atrial fibrillation. Atrial ectopic tachycardia often takes lingering course and is hardly responsive to the medical treatment. The cases of arrhythmia, characterized by the broad P waves on the ECG tend to the progressive course. 17 cases of atrial ectopic tachycardia treated by electrostimulation (ES) which had 100% positive effect are presented and ES advantages over the drug therapy are underlined. The frequent transition of this arrhythmia into the atrial fibrillation is outlined.

[Acid-base state and blood oxygenation in cardiac insufficiency treated by drug agents]. / Kislotno-shchelochnoe sostoianie i oksigenatsiia krovi u bol'nykh s serdechnoi nedostatochnost'iu pri lechenii nekotorymi lekarstvennymi sredstvami.

The effect of different drugs on the acid-base condition and gases of arterial blood was studied by Astrup's micromethod in 124 tests in patients with circulatory insufficiency. Cardiac glycosides correct the moderate decrease in blood oxygen tension and respiratory alkalosis in patients with left-ventricular failure. Morphine has a good arresting effect in attacks of cardiac asthma and corrects or reduces the respiratory alkalosis typical of the disease but at the same time reduces the saturation of blood with oxygen. The use of oxygen together with morphine removes this unfavourable effect of the drugs. Euphylline often intensifies respiratory alkalosis, while its effect on oxygen tension in the blood and its saturation with oxygen is poorly pronounced and diversely directed. Lasics causes a favourable correcting effect on the acid-base condition and oxygenation of blood in pulmonary edema marked by metabolic acidosis.

[Comparison of intracoronary and intravenous methods of thrombolytic streptokinase therapy of patients with myocardial infarct]. / Sravnenie vnutrikoronarnogo i vnutrivennogo metodov tromboliticheskoiterapii streptokinazoi bol'nykh ostrym infarktom miokarda.

Intracoronary streptokinase (250.000 units over 60-90 min) was administered within 7.8 +/- 0.4 hrs after the onset of myocardial infarction symptoms to 85 patients, and intravenous streptokinase (500.000 units over 5-10 min) was given within 4.8 +/- 0.4 hrs to 46 myocardial infarction patients. Coronary angiography was conducted 1 to 3 hours after intravenous streptokinase administration. Coronary arterial reperfusion was achieved in 62% of patients in the former group, and in 66% in the latter one. Reperfusion was seen in 84% of patients in the first 3 hours after the onset of infarction, and in 60-66% at later dates. Hypofibrinogenemia did not become critical and persisted for one more day in cases of intravenous streptokinase infusions, as compared to the intracoronary route. Intravenous administration of 500.000 units streptokinase at the rate of 100.000-50.000 U/min is an effective and safe method for the treatment of myocardial infarction, and its prospective application in health practices appears quite promising.

[Effect of intracoronary streptokinase infusion and verapamil treatment on the size of the affected area in myocardial infarct patients]. / Vliianie vnutrikoronarnoi infuzii streptokinazy i lecheniia verapamilom na razmer zony porazheniia u bol'nykh infarktom miokarda.

The effect of intracoronary streptokinase administration (31 patients), verapamil treatment (23 patients) and conventional therapy (27 patients) on the size of the affected area was examined in patients with acute myocardial infarction (MI). Streptokinase was administered in a dose of 250,000-500,000 IU within the first 3 to 20 hours of myocardial infarction, and verapamil, 360 to 400 mg, daily within the first 5 to 12 hours of the attack. The occluded coronary artery was recanalized in response to streptokinase administration in 21 patients. Serial measurements of CPK activity and serum myoglobin levels, and electrocardiographic precordial cartograms demonstrated a reduction in MI size following streptokinase administration. Verapamil had no basic effect on the final size of myocardial lesion, although it improved somewhat the clinical course of the disease.

[Dynamics of left ventricular remodeling in patients with acute myocardial infarction]. / Dinamika strukturnykh i funktsional'nykh pokazatelei levogo zheludochka u bol'nykh ostrym infarktom miokarda.

Dynamics of structural and functional left ventricular parameters was investigated in 51 patients with acute anterior myocardial infarction by means of serial (on days 1, 2, 3, 5, 7, 10 and 21 of infarction) echocardiographical study. Increase of end-diastolic volume index relative to initial values became significant on 5th-7th days and continued to progress until 3rd week of infarction. Left ventricular cavity became dilated and attained more occurred shape predominantly at the account of increased transverse diameters. Abnormalities of left ventricular contractile and pump functions were most pronounced during first 3 days of the disease. Between 5th and 10th days improvement and stabilization of myocardial functional state took place accompanied by progression of left ventricular dilation and increase of its sphericity with lessening of degree of myocardial asynergy.