[Role of contrast enhancement in ultrasound examination of the aortic abdominal portion]. / Rol' kontrastnogo usileniia pri ul'trazvukovom issledovanii briushnogo otdela aorty.

Analysed herein are the data of scientific literature over several last years concerning the use of contrast-enhanced ultrasonography (CEUS) of the abdominal portion of the aorta. Based on the results of Russian and foreign studies, the authors analyse feasibility of using CEUS in various pathological conditions of the aorta, as well as sensitivity, specificity, and prognostic value of the method. Also discussed are advantages and limitations of CEUS compared with other imaging techniques. This is followed by determining appropriate approaches to using the methodology of CEUS in examination of patients after endoprosthetic repair of abdominal aortic aneurysms. Finally, described is own experience of using CEUS in examination of a patient with chronic renal insufficiency after aortic endoprosthetic repair.

[Inflammation and atherosclerosis: the role of Renin-Angiotensin system and its inhibition].

The last studies show the renin angiotensin aldosterone system plays an important role in atherosclerotic processes. Vasoconstriction and sodium and water retention, due to angiotensin II and aldosterone promote atherosclerotic processes. Theres recent evidence from animal and clinical studies to consider angiotensin II as a mediator of inflammation, which induces atherosclerotic plaque development and heart remodeling. Also angiotensin II causes endothelial dysfunction by inducing cytokine and chemokine secretion. The pharmacological blockade of the renin angiotensin system has positive influence on clinical outcomes of patients with cardiovascular diseases independently of the blood pressure lowering effect. This review summarizes studies about the role of angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists (ARA) and renin inhibitors in vascular inflammatory processes in atherosclerosis.

[Effect of myocardial revascularization on dynamics of factors of angiogenesis in patients with ischemic heart disease].

Aim of the study was to assess effect of myocardial revascularization on levels of factors of angiogenesis in early and remote period after intervention. Main group comprised 228 patients with ischemic heart disease (n=228, 194 men, 34 women, mean age 57+/-8.7 years). Coronary bypass surgery was carried out in 29 patients while other 199 were subjected to percutaneous coronary intervention (PCI). Analysis of data was performed in the group as a whole and in 2 subgroups distinguished in dependence on type of invasive treatment. Levels of factors of angiogenesis - vascular endothelial growth factor (VEGF), transforming growth factor beta (TGFbeta), and endostatin - were measured before, in 6 days, and 6 months after invasive treatment. Compared with healthy persons patients with IHD had significantly higher level of VEGF and significantly lower levels of TGFbeta and endostatin. On day 6 after revascularization in the group as a whole level of VEGF insignificantly rose while level of TGFbeta insignificantly decreased. In 6 months after invasive treatment significant lowering of VEGF level and significant increase of TGFbeta was noted. Endostatin level was measured at baseline and in 6 months after invasive treatment. Significant elevation of endostatin level took place after 6 months. Thus PCI and coronary bypass surgery lead to lowering of VEGF level and elevation of levels of TGFbeta in 6 days after intervention. In remote period reverse dynamics was observed: of VEGF level rose and those of TGFbeta and endostatin increased.

[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.

[The role of atherosclerosis risk factors in development of ischemic heart disease in young men].

AIM: To determine distribution of different atherosclerosis risk factors and their correlation with severity of coronary arteries (CA) affection in young men. MATERIAL AND METHODS: A total of 235 males aged 28-45 years were examined with coronarography which detected more than 50% narrowing in one or several major CA in 200 patients (the study group with coronary artery disease), 35 males without coronary stenosis served control. Atherosclerosis risk factors, serum lipids, lipoprotein(a), fibrinogen, C-reactive protein (CRP) were assessed. RESULTS: Smoking and hyperlipidemia (HLE) were registered in the study group more frequently. The level of lipoprotein(a) above 30 mg/dl was recorded in 98 (49%) and 7 (20%) patients of the study and control group, respectively (p = 0.001). As shown by a correlation analysis, the number of affected CA was associated with smoking (r = 0.2; p < 0.001), HLE (r = 0.23; p < 0.001), concentration of total cholesterol (r = 0.23; p < 0.0.001), lipoprotein (a) (r = 0.26; p < 0.001) and CRP (r = 0.26; p < 0.05). The level of lipoprotein(a) in patients with myocardial infarction and occluded artery was significantly higher than in patients without myocardial infarction and non-occlusive CA affection. CONCLUSION: The presence and severity of coronary atherosclerosis in young men with coronary artery disease are associated with smoking, HLE and high concentration of lipoprotein (a).

[Effect of therapy with atorvastatin on parameters of postprandial lipemia and factors of inflammation in patients with ischemic heart disease].

Reaction of parameters of lipid transport system to standard fat load (J.Patsch method), C-reactive protein (CRP) and fibrinogen levels were studied in 30 patients with ischemic heart disease before and after 3 months of therapy with atorvastatin (10 mg/day). Atorvastatin therapy resulted in 25, 34, 17 and 16% lowering of concentrations of total cholesterol (CH), low density lipoprotein CH, triglycerides (TG), and apolipoprotein (apo) B, respectively, 6 and 9% elevation of high density lipoprotein CH and apo A-1 levels, respectively. Moreover atorvastatin improved although not completely normalized parameters of postprandial lipemia: significant lowering of baseline (-17%), 3 (-19%) and 6 hour (-14%) post load TG levels was noted. However relative TG elevation from baseline level to 3 and 6 hours after fat load did not change (+100 and 148% before, +95 and 156% after treatment, respectively). Changes of CRP (-22%) and fibrinogen (-8%) were not significant (p>0.05).

[Effect of atorvastatin therapy on the level of secretory phospholipase A2 group IIA and on the modification of low density lipoproteins in patients with ischemic heart disease].

We studied effect of atorvastatin on secretory phospholipase A2 group IIA (sPLA2-IIA) in blood serum of patients with ischemic heart disease (IHD), lipid composition of low density lipoproteins (LDL) and process of modification of LDL induced by sPLA2-IIA in 20 patients taking 20 mg/day of atorvastatin for 3 months. In patients with initially high level of sPLA2-IIA ( > 8 mcg/l) its concentration significantly decreased. Amount of total cholesterol, triglyceride, lecithin, and lysolecithin remained unchanged, however in equimolar relations there occurred decrease of amount of total cholesterol and increase of cholesterol esters. At incubation of LDL, extracted from patient s plasma before initiation of the study, with human sPLA2-IIA from cardiac myxoma, 3.5 nmol of lysolecithin per 1 mg of LDL protein was formed while at incubation of LDL of same patients, extracted after 3 months of atorvastatin administration, amount of lysolecithin was 1.54 nmol/mg LDL protein. Thus atorvastatin therapy causes lowering of sPLA2-IIA in patients with initially high blood level of the enzyme and to a great extent precludes sPLA2-IIA induced LDL modification.

[Cardiac natriuretic peptides in patients with hypertrophic cardiomyopathy].

AIM: To study interrelation of main clinico-hemodynamic parameters and levels of natriuretic peptides (NUP) in patients with hypertrophic cardiomyopathy (HCMP). MATERIAL AND METHODS: We measured concentrations of N-terminal fragments of precursors of plasma brain and atrial natriuretic peptides (NT-proBNP and NT-proANP) and conducted complex echocardiographical examination in 94 patients (mean age 42.3 +/- 133.8 years) with obstructive (n=43) and nonobstructive (n=51) HCMP. RESULTS: Content of NUP did not depend on patients age, contractile function and dimensions of the left ventricle (LV), moderate and significant correlation between content of NT-proBNP, NT-proANP and type of ventricular filling (r=0.45 and 0.46, respectively), heart failure functional class (r=0.41 and 0.44, respectively), severity of LV hypertrophy (r=0.42 and 0.34, respectively), left atrial dimension (r=0.26 and 0.35, respectively), magnitude of pressure gradient in LV outflow tract (r=0.35 and 0.26, respectively). Degree of mitral regurgitation correlated significantly only with NT -proBNP level (r=0.34). The patients who eventually died (n=6) were characterized by higher plasma content of NUP. CONCLUSIONS: In patients with HCMP elevated plasma content of N-terminal precursors of brain and atrial natriuretic peptides are associated with severity of LV diastolic dysfunction and hypertrophy of LV as well as of hemodynamic and functional disturbances.

[Assessment of clinical course, prognosis and effectiveness of drug and nondrug treatment of patients with ischemic heart disease and occlusive coronary artery atherosclerosis (data of 5-year prospective follow-up)].

Data of 5-year prospective follow-up were used for assessment of clinical course, prognosis and effectiveness of drug and nondrug treatment of 202 patients with ischemic heart disease, occlusive coronary artery atherosclerosis and preserved left ventricular function. It was found that 5-year cardiovascular mortality and rate of nonfatal myocardial infarction did not differ significantly between groups of patients subjected to drug treatment only, transluminal balloon angioplasty, and coronary artery bypass grafting.

[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.

[Disturbances of thyroid function after coronary angiography].

Frequency of thyroid gland functional disturbances after introduction of iodine-containing radiographic contrast agents during coronary angiography was studied in 146 patients, residents of the zone of borderline iodine deficit. Frequency of thyroid pathology was high at baseline (39%). Functional state of the thyroid gland was assessed before and 1, 3, 6, 12 months after investigation. During first month after coronary angiography there were several new cases of thyrotoxicosis and hypothyroidism, as well as deterioration of preexisting functional disturbances of the thyroid. Patients with baseline pathology and functional disturbances of thyroid gland before conduction of coronary angiography should be included into risk group of development of iodine induced states.

[Pilot experience in Russia with external contrapulsation in patients with coronary heart disease].

AIM: To examine effects of programmed external contrapulsation (ECP) on the clinico-functional status, quality of life (QOL) in patients with coronary heart disease (CHD), stable angina of FC II-IV resistant to medication. MATERIAL AND METHODS: Eighteen patients with CHD, stable angina of FC III-IV (2 females and 16 males, mean age 63.6 +/- 7.4 years) have completed a course of ECP including 35 one-hour procedures 5-6 times a week for 7 weeks. Ten patients had cardiac failure (NYHA FC II-III). Before and after ECP course the patients were examined using QOL assessment by Minnesota questionnaire, complex echo-cardiography, bicycle exercise test, perfusion myocardial scintigraphy with 99m-Tc-4,2-methoxy-isobutilisonitril, 24-h Holter ECG monitoring, enzyme immunoassay for plasma natriuretic propeptides. RESULTS: Significant subjective QOL improvement (p < 0.01) was noticed by all the patients. Anginal attacks and nitrates doses reduced at least 2-fold. Exercise tolerance rose significantly (p < 0.01), bicycle exercise test was positive in 5 patients, the rest stopped the test after achievement of submaximal heart rate (HR) and fatigue. Most of the patients exhibited improvement of myocardial perfusion. Patients with abnormal myocardial contractility showed a moderate trend (p < 0.03) to an increase in left ventricular ejection fraction. By 24-h ECG, mean HR diminished significantly (p < 0.02). CONCLUSION: ECP is highly effective and safe in combined therapy of CHD, stable angina resistant to drug therapy, in impossibility of myocardial revascularization, including patients with cardiac failure. This manifests in a significant abatement of angina, lower doses of nitrates, improvement of exercise tolerance, quality of life, myocardial perfusion and hemodynamic indices.

[Coronary calcium and statins therapy].

AIM: Assessment of the dynamics of coronary calcium score (CCS) evaluated with electron-beam tomography (EBT) under the influence of statin therapy in patients with coronary heart disease (CHD) and hyperlipidemia. MATERIAL AND METHODS: A total of 119 hyperlipidemic CHD patients (mean age 62.1 +/- 9.3 years, 75% males) were included in the study. 69 patients were treated with statins (the study group), 50 patients rejected statins (the control group). CCS was calculated according to Agatson. Initial study parameters in the groups were similar. Mean follow-up was 25.3 +/- 10.6 months. RESULTS: A mean increase of CCS in the study group was 62 +/- 84 units (27.1%) and 122 +/- 180 units (65.2%) in the control group (p = 0.044). Total plasma cholesterol (TC) in the study group decreased by 25.1% from 6.99 +/- 0.92 to 5.24 +/- 0.54 mmol/l), in the control group--by 0.5% (from 6.67 +/- 1.01 to 6.63 +/- 1.0 mmol/l). A weak but significant negative correlation was found between a fall in total cholesterol and CCS increment (r = -0.243, p = 0.008). CONCLUSION: Calcium scoring with EBT or multispiral computed tomography can be used both for pre-clinical diagnosis of coronary atherosclerosis and for monitoring of coronary atherosclerosis progression under influence of hyperlipidemic therapy.

[The role of mutation in cardiac beta-myosin heavy chain gene in population of patients].

One of most widely spread causes of hypertrophic cardiomyopathy (HCMP) is mutation in cardiac beta-myosin heavy chain gene. Data on contribution of this mutation to development of HCMP in Russian patients are very limited. We conducted screening of beta-myosin heavy chain gene for the presence of mutations in 116 patients with confirmed HCMP (probands). DHPLC was used with subsequent sequencing of DNA fragments. Genetic defects of beta-myosin heavy chain were found more than in every 10-th patient. These defects were represented by 13 mutations (Ala729Pro mutation was found twice). Phenotypes of majority of known mutations in Russian population did not differ substantially from their phenotypes in other populations. Six mutations had not been previously described; most of them were associated with especially severe clinical and hemodynamic signs and relatively unfavorable course of the disease. Thus beta-myosin heavy chain gene mutation play important role in etiology of HCMP in patients in Russia.

[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.

[Effects of isosorbide-5-mononitrate on clinical condition, bicycle ergometry results, endothelium-dependent vasodilation in patients with ischemic heart disease with stable effort angina].

AIM: Assessment of efficacy of treatment of coronary heart disease (CHD) patients suffering from stable effort angina of functional class II-III with the drug isosorbide-5-mononitrate Mono Mac 50 depo (MM 50 D). MATERIAL AND METHODS: Clinical indices, exercise tolerance, endothelial function (the study of brachial artery in reactive hyperemia and sublingual intake of nitroglycerin) were studied in 30 patients with stable angina FC II-III before the treatment, 1 and 3 months after the treatment. RESULTS: MM 50D significantly widens diameter of the brachial artery (by 11.6%), lowers nitroglycerin-dependent vasodilation (from 16% to 10.4% in a month and to 10.2% in 3 months) and blood flow speed in reactive hyperemia. An absolute increment of the brachial artery diameter in reactive hyperemia test remained unchanged. The ratio flow-dependent vasodilation/nitroglycerin-dependent vasodilation increased in the course of therapy from 0.67 to 0.91. The drug produced clinical improvement (anginal attacks rate diminished by 70 and 85%, respectively) and increased exercise tolerance (the threshold performance rose by 28%, total load time--by 30%). CONCLUSION: It is important to use complex assessment of hemodynamic component of endothelial function in the treatment with nitrates.

[Expression of urokinase plasminogen activator, its receptor and plasminogen activator inhibitor type 1 in different types of atherosclerotic lesion in human aorta]. / Ekspressiia urokinazy, ee retseptora i ingibitora aktivatorov plazminogena 1-go tipa v stenke aorty cheloveka pri raznykh tipakh ateroskleroticheskogo porazheniia.

The role of plasminogen activators in the regulation of key processes of atherosclerosis progression stays unclear. The aim of this study was to evaluate the expression of urokinase plasminogen activator (uPA), its receptor (uPAR) and the plasminogen activator inhibitor type 1 (PAI-1) in human aorta, and to balance them with the stage of atherosclerotic lesion. We have shown that uPA and uPAR in normal aorta are mostly expressed by intimal smooth muscle cells. The expression of these proteins was up-regulated in diseased aorta compared to normal artery. The most part of cells in both fatty streak and fibro-fatty lesion were monocytes/macrophages, and about 60% of these cells expressed uPA and its receptor. PAI-1 was mostly localized on the lumonal part of the aorta and in the extracellular matrix of the intima. We observed a moderate increase of PAI-1 expression in atherosclerotic lesion. Thus, our data indicate participation of plasminogen system in atherogenesis.

[Clinical value of determination of digoxin concentration in blood during treatment of cardiac insufficiency]. / Klinicheskoe znachenie opredeleniia kontsentratsii digoksina v krovi pri lechenii bol'nykh s serdechnoi nedostatochnost'iu.

The concentration of digoxin in blood was determined by the radio-immunologic method in 41 patients with circulatory insufficiency and permanent form of auricular fibrillation who were treated with the drug. In 85.5% of cases the therapeutic digoxin concentrations did not exceed 2 ng/ml. The therapeutic concentrations ranged from 0.3 to 3.6 ng/ml, the toxic from 0.9 to 6 ng/ml. A relationship was established between the dose of digoxin and its concentration in the blood of patients with normal renal filtration. It is concluded that the blood digoxin concentrations alone, without the clinical data being taken into account, cannot be a reliable criterion in assessment of the level of saturation with cardiac glycosides. Study of the dynamics of blood digoxin concentration in each patient allows its determination to be used to assess the tolerance to the drug, choose the adequate maintenance dose and the time for its correction, and to confirm the clinical signs of digitalis intoxication if the concentration of digoxin is above 2.5 ng/ml.

[The prognosis of the antianginal effect of foridon compared to other antianginal preparations]. / Prognozirovanie antianginal'nogo éffekta foridona v sravnenii s drugimi antianginal'nymi preparatami.

The study covered 20 patients with angina pectoris. Antianginal drugs such as sydnopharm, kordafen, anaprilin, nitrosorbide, and foridon were tested by using pair exercise tests. All the patients had preliminary instrumental studies, including exercise test, echocardiography, hyperventilation and orthostatic tests, and variation pulsometry. A regression equation was derived, which could predict the efficacy of foridon from the findings of the tests used. The antianginal effect of foridon was found to be the weakest among the other drugs under study.

[Segmental left-ventricular contractility in patients with hypertrophic and dilated cardiomyopathies]. / Segmentarnaia sokratimost' levogo zheludochka u bol'nykh s gipertroficheskoi i dilatatsionnoi kardiomiopatiei.

Segmental left-ventricular contractility was assessed on the basis of computerized analysis of two-dimensional echocardiograms in 35 patients with hypertrophic cardiomyopathy (HCMP), 24 patients with dilatation cardiomyopathy (DCMP), 20 patients with coronary heart disease (CHD) and 30 normal subjects. The HCMP patients showed hyperkinetic segments at different sites of the left ventricle in the presence of a general rise of myocardial contractility. Segmental contractility disorders of DCMP patients were similar to dyssynergia of CHD patients. No hyperkinetic segments were found in DCMP and CHD patients showing signs of heart failure. The detected segmental contractility disorders cannot be used as a criterion in the differential diagnosis of DCMP versus CHD.