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Issue. Articles

4(12) // 2005

 

 

1.

 

Informativity of prognostic Roccal scale for patients with erosive ulcerative acute gastroduodenal hemorrhages and myocardial infarction

V.G. Mishalov, L.Yu. Markulan, I.M. Leshchyshyn

The aim of this work is to estimate the informativity of Roccal scale for the prognosis of recurrent hemorrhage and death risk in patients with erosive ulcerative acute gastroduodenal hemorrhages and myocardial infarction.

Materials and methods. In the period from the year 2000 to 2004 17,129 patients with myocardial infarction (MI) were treated. 3,447 (20.1 %) of them had Q wave MI (big focal), 13,682 (79.1 %) had non-Q wave MI (small focal). Erosive ulcerative acute gastroduodenal hemorrhage (EUAGDH) occurred in 208 (1.2 %) patients, among them 2.4 % had Q wave MI and 0.9 % — non-Q wave MI. 144 (69.2 %) were men, 64 (30.8 %) were women. The age ranged from 35 to 89 years, (mean 63.6 ± 11.8). Q wave MI was present in 82 (39.4 %) patients, non-Q wave MI — in 126 (60.6 %). The diagnosis of MI was based on the clinical data, presence of biochemical markers of myocardium necrosis (the elevation of the serum level of creatine phosphokinase of its MV isoenzyme and/ or heart troponin I) and characteristic changes of laboratory data as well as positive troponin test, elevation of creatine kinase isoenzymes, changes of electrocardiogram (ECG), echocardiography. The diagnosis of EUAGDH was based on the clinical and laboratory data and the results of instrumental study — probe of the stomach, fibrogastroduodenoscopy (FGDS), and angiography. The cause of hemorrhage in 101 (48.5 %) patients was ulcer of the stomach and duodenum, in 107 (51.5 %) — acute ulcers and erosions. EUAGDH recurrence risk degree and the lethal outcome in scores were measured by the scale of Roccal and his co-authors. The statistical processing of the research results was performed by means of SPSS 13.0 program for Windows using the methods of non-parametric statistics according to Mann—Whitney, ?2 criterion, correlation analysis according to Spearman. The area under the ROC (Receiver Operating Characteristic line was measured.

Results. The mean score of patients with EUAGDH and MI was 6.97 ± 0.079 on Roccal scale. 92.3 % patients had the total score of 6 and higher on Roccal scale (high risk group), 7.7 % — from 3 to 5 (low risk group). The frequency of EUAGDH recurrence in low risk patients was 6.3 %, while in high risk patients it was 20.8 %. The death frequency was 6.3 % and 13.0 % respectively, (p < 0.05). In low risk patients the death frequency didn't differ substantially from that which was expected (p < 0.05), while in high risk patients it was substantially lower than expected (p = 0.042) and weak correlation with the increase of the total score could be observed (r = 0.22; p = 0.049). The opportunity ratio of hemorrhage recurrence between the groups of high and low risk is 3.9; the opportunity ratio of death reaches 2.2. The area under the ROC line as for the prognosis of hemorrhage recurrence was 0.671, the standard error (SE) — 0.045; 95 % credit interval (CI) — [0.584; 0.759]. The area under the ROC line as for the prognosis of death was 0.588, the standard error (SE) — 0.060; 95 % credit interval (CI) — [0.470; 0.705]. Conclusions. Patients with EUAGDH and MI reveal weak but probable correlation between the increase of the total score on Roccal scale and both frequency of hemorrhage recurrence (r = 0.32; p = 0.043), and death (r = 0.22; p = 0.049). Roccal scale is satisfactory for dividing patients into groups of high and low risk. The opportunity ratio of hemorrhage recurrence is 3.9, of death — 2.2. The capability of Roccal scale to make the prognosis of hemorrhage recurrence in patients with EUAGDH and MI is higher as for the prognosis of death, but in both cases it isn't high. The area under the ROC line as for the prognosis of hemorrhage recurrence is 0.671, as for the prognosis of death — 0.588.



Keywords: erosive ulcerative acute gastroduodenal hemorrhages, myocardial infarction, prognosis of hemorrhage recurrence, prognosis of death, Roccal scale

2.

 

No-dependent and mesenger processes in neutrophils and endotheliocytes in chronic hyperimmunocomplexemia and influence of quercetin bioflavonoid on them

I.V. Valchuk, V.V. Chopyak, S.I. Pavlovitch, A.V. Kotsiuruba, O.O. Moibenko

The aim. To investigate experimentally the processes of nitric oxide (NO) synthesis in neutrophils and endotheliocytes in chronic hyperimmunocomplexemia (CHIC) and the influence of quercetin bioflavonoid on them.

Material and methods. The investigation was carried out on 75 pubescent white male rats. CHIC was reproduced by the classic model of C. Cohrane and D. Kofler in 50 animals. The investigation was carried out on isolated endotheliocytes of the abdominal aorta, neutrophils and blood serum. Soluble in water quercetin («Korvitin», produced by «Borschahivsky Chemical and Pharmaceutical Plant», Ukraine) was injected in the dose of 4 mg/100g of body mass to 25 animals during 10 days. The course of injection was finished 10 days before completing the creation of the model in these animals. NO metabolism in neutrophils and endotheliocytes was estimated by assessing the activity of constitutive (cNOS) and indecibel (iNOS) NO-synthase and by assessing NO pool according to the concentration of its end metabolites - nitrite-anions (-NO2) and nitrate-anions (-NO3). The regulatory role of NO was estimated by the content of cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) in neutrophils, endotheliocytes and blood serum with the help of radioimmunoassay. The activation of polymorphonuclear leucocytes of blood was measured by assessing the activity of myeloperoxidase in neutrophils and blood serum.

Results. It was determined that the level of NO metabolite - NO2 -anions in the blood serum of rats with CHIC sharply increases (p < 0.05), in neutrophils it decreases by 31.5 % (p < 0.05), in endotheliocytes - by 48.8 % (p < 0.05) versus the control group of animals. The content of NO2 -anions reduced by 33.5 % (p < 0.05) in neutrophils and by 57.0 % (p < 0.01) in endotheliocytes. While injecting quercetin to the control animals with CHIC we fixed that the concentration of NO2 -anions increased by 1.6 times (p < 0.05) in neutrophils and by 2 times in endotheliocytes, while in the blood serum the concentration of NO2 -anions decreased by 59.0 % in comparison with the CHIC animal group (p < 0.05). Similar changes were also observed when we measured the concentration of NO3 -anions. iNOS activation (p < 0.05) was observed in neutrophils, endotheliocytes and blood serum, while cNOS activity decreased in neutrophils and blood serum (p < 0.05). In CHIC, the activity of myeloperoxidase in stimulated neutrophils increased almost by 4 times (p < 0.05) and in blood serum by 2 times (p < 0.05) versus the control animal group. Quercetin injection was accompanied by the decrease of myeloperoxidase activity both in neutrophils and in blood serum (p < 0.05).

Conclusions. Rats with CHIC manifest opposed shifts of iNOS activity (increase) and cNOS activity (decrease) in endotheliocytes and neutrophils. Administration of quercetin in CHIC substantially normalizes these biochemical shifts inhibiting iNOS activation and increasing cNOS activity in neutrophils and endotheliocytes. This process is accompanied by inhibiting the increased myeloperoxidase activity in neutrophils and blood serum. Quercetin administration leads to the increase of cAMP and cGMP which were decreased in CHIC in endotheliocytes and neutrophils as well as to normalization of cGMP level in neutrophils and blood serum.



Keywords: neutrophil, endotheliocyte, nitric oxide, cyclic nucleotides, chronic hyperimmunocomplexemia, quercetin

3.

 

Impact of sleep disturbances on the indices of twenty-four hours' arterial pressure monitoring in hypertensive patients

I.M. Khomaziuk, Zh.M. Zlatogorska


Aim. To determine the peculiarities of indices of daily sleep arterial pressure (AP) monitoring and possible changes in case of sleep disturbances in hypertensive patients.

Material and methods. 64 hypertensive clean-up workers after Chernobyl disaster were examined. They formed the groups with chronic and transient (during twenty-four hours' AP monitoring) sleep disturbances. Twenty-four hours' AP monitoring was conducted by the apparatus ABP-01 («Solvaig», Ukraine). The negative recollections about the events of the Chernobyl accident were evaluated by the «Scale of recollections about the events of Chernobyl accident».

Results. Chronic sleep disturbances were registered in 57.8 % and transient ones — in 18.8 % patients. These groups of patients didn't differ from the group without sleep disturbances by their clinical characteristic (all p > 0.05). Patients with chronic sleep disturbances in comparison to those without such disturbances and those with transient disturbances manifest significant elevation of average daily systolic arterial pressure (SAP) (142.2 ± 3.0mm mercury vs. 132.3 ± 3.6 mm mercury and 133.3 ± 3.3 mm mercury respectively), as well as of minimal daily SAP (112.2 ± 3.0mm mercury vs. 95.7 ± 2.3 mm mercury and 101.9 ± 4.20 mm mercury respectively), daily time index of SAP (58.4 ± 4.5 % vs. 37.8 ± 6.1 % in patients without sleep disturbances) and minimal daily diastolic arterial pressure (DAP) (65.8 ± 1.7mm mercury vs. 58.4 ± 1.9mm mercury in patients without sleep disturbances and 58.9 ± 2.9 mm mercury in patients with transient disturbances, all p < 0.05). The increase of average daily indices of arterial pressure monitoring owed mainly to the increase of AP at night-time. Thus, in patients with chronic sleep disturbances the average nightly SAP was 132.3 ± 3.4 mm mercury vs. 114.9 ± 2.4 mm mercury in patients without sleep disturbances, the minimal nightly SAP was 116.3 ± 2.9 mm mercury vs. 98.7 ± 2.4mm mercury, the nightly time index of SAP — 66.8 ± 3.9 % vs. 30.3 ± 6.3 %, the minimal nightly DAP was 70.5 ± 1.7mm mercury vs. 61.1 ± 1.98 mm mercury (all p < 0.05). Non-dipper daily AP profile was marked respectively in 43.2 % and 6.7 % patients of these groups (p < 0.05). The integral score of negative recollections about the events of the Chernobyl accident in patients with chronic sleep disturbances was 20.5 ± 1.2, whereas in patients with transient disturbances it was 14.8 ± 2.0 (p < 0.05) and in patients without sleep disturbances — 11.4 ± 2.7 (p < 0.05).

Conclusion. Hypertensive clean-up workers after Chernobyl disaster that suffer from sleep disturbances, if compared with those without sleep disturbances, typically display more elevated average and minimal daily SAP, daily time index of SAP, minimal daily DAP due to AP elevation at night-time and the formation of non-dipper daily AP profile.



Keywords: essential hypertension, twenty-four hours' arterial pressure monitoring, sleep disturbances, clean-up workers after Chernobyl

4.

 

Relationship between insulin resistance and arterial hypertension

O.N. Kovaleva, .V. Gerasymenko

The aim: to reveal the relationship between insulin resistance and/or hyperinsulinaemia and the level of arterial blood pressure elevation in hypertensive patients (HP).

Material and methods: 100 hypertensive patients aged 38 to 77 (mean age 57.8 ± 9.3) were examined in the Centre of Arterial Hypertension (AH) Diagnosing and Treatment of Kharkiv City Clinical Hospital #11. The control group consisted of 20 healthy people comparable by age and gender. According to the degree of AH the patients were divided as follows: the 1st degree was diagnosed in 34 (34 %), 2nd degree — in 35 (35 %), 3rd degree — in 31 (31 %). Along with performing the general clinical examination we measured the level of glucose in the blood of all patients using the biochemical method as well as the blood level of insulin using the radioisotope method before and 2 hours after the 70g glucose load (oral test for glucose tolerance — OTGT). The insulin sensitivity index (ISI) as the ratio between the glucose (in mg/dl) and insulin (in mcUn/ml) concentration in the blood before and after the glucose load was measured to determine the insulin resistance in the patients.

Results. Correlated dependence between the systolic arterial pressure (SAP) and the basal insulin level as well as SAP and ISI before the glucose load (r = 0.35, p < 0.01 and r = –0.28, p < 0.05, respectively) was revealed in hypertensive patients. In the group of patients with the 1st degree AH the fasting insulin level was 16.0 ± 1.59 mcUn/ml, which was substantially higher than in the healthy people, — 11.6 ± 0.76 mcUn/ml (p < 0.05), and fasting ISI was lowered (6.91 ± 0.65 arbitrary units, p < 0.05). After OTGT the insulin level substantially increased in comparison with the initial level (p < 0.05) and constituted 43.6 ± 5.41 mcUn/ml, remaining substantially higher than in the healthy (13.5 ± 1.02 mcUn/ml, p < 0.05). ISI after the load constituted 4.50 ± 0.86 arbitrary units, which was substantially lower than in the healthy and than the basal ISI level. The basal insulin level in the 2nd degree AH patients turned out to be higher (p < 0.05), than in the 1st degree patients and constituted 22.5 ± 3.31 mcUn/ml. The insulin level after OTGT in the 2nd degree AH patients constituted 64.5 ± 6.27 mcUn/ml, in the 3rd degree AH patients — 73.7 ± 6.37 mcUn/ml, which was higher in comparison with the healthy, the 1st degree AH patients and the basal level (p < 0.05). ISI after glucose load turned out to be lower in the 2nd degree AH patients than in the 1st degree AH patients (p < 0.05) and constituted 2.73 ± 0.44 arbitrary units and it was still more lowered in the 3rd degree AH patients — 2.19 ± 0.22 arbitrary units (in comparison with the 1st degree AH patients, p < 0.05).

Conclusions. AH patients manifest the increased insulin level and decreased tissue sensitivity to insulin both on an empty stomach and after the glucose load in comparison with the healthy. The intensity of these changes grows with the increase of AH degree. The positive correlation between the basal insulin level and SAP as well as the negative correlation between the fasting ISI and SAP were marked in AH patients.



Keywords: insulin resistance, hyperinsulinemia, arterial hypertension

5.

 

Hemodynamics condition of carotid arteries in patients with chronic ischemia of lower extremities combined with atherosclerotic lesion of extracranial vessels

V.G. Mishalov, Yu.I. Koshevsky, V.A. Cherniak, P.P. Minchenko

The aim of the research is to measure the brain hemodynamics indices in patients with chronic ischemia of lower extremities (CILE) and atherosclerotic lesion of brachiocephalic artery (BCA) as well as the appropriateness of their estimation when determining indications for performing the carotid endarterectomy of this category of patients.

Materials and methods. In the period from the year 2000 to 2005 we evaluated the condition of blood flow in BCA of 264 patients that underwent examination and treatment in the Surgical Centre of the Central City Clinical Hospital. The experimental group consisted of 234 patients, the control group — of 30. The experimental group was divided into 2 subgroups: A (n = 107) — patients with obliterating atherosclerosis of lower extremities arteries at different stages without BCA affliction; B (n = 127) with the accompanying lesion of one internal carotid artery (ICA). The patients of each subgroup were divided depending on the CILE stages according to the recommendations of the European Consensus. The diagnosing of atherosclerotic lesions was performed by duplex scanning of the arteries with spectral analysis. The peak systolic velocity of blood flow (Vpeak) indices and the circulatory resistance index (IR) in common carotid arteries (CCA) and ICA, the coefficient of Vpeak in CCA skewness were studied.

Results. In patients of A subgroup, who had critical CILE we registered the decrease of Vpeak in CCA by 20 % versus the control group (p1 < 0.01) and by16.0 % versus the patients with the II and III-A stages of CILE (p2, p3 < 0.05). We also revealed that IR in CCA statistically significantly increased by 11.7 % (p1 < 0.05) versus the controls, as well as by 10.2 % and 8.5 % respectively (p2, p3 < 0.05) versus the patients with II and III-A stages of CILE. In patients with critical CILE the Vpeak in ICA was by 10 % higher than in patients of the control group (p1 < 0.05). In patients of B subgroup with 50—70 % ICA stenosis, who had III-A stage of CILE, Vpeak on the side of ICA affliction was decreased by 12.0 % (p1 < 0.05) versus the control group, and in patients with critical CILE — by 24.0 % (p2 < 0.05). On the non-afflicted side in patients with critical CILE the Vpeak in CCA turned out to be decreased by 18.8 % versus the controls (p2 < 0.05) and the coefficient of skewness was 6.8 %. IR in CCA of patients with critical CILE was elevated versus the controls on the side of affliction by 17 % (p2 < 0.05) and on the non-afflicted side — by 13 % (p2 < 0.05). In patients with 70—90 % ICA stenosis and critical CILE the Vpeak in CCA was lowered by 40 % on the afflicted side versus the controls (p1 < 0.05); it was equal to 30 ± 0.62cm/sec. The IR index of this category of patients on the afflicted side was elevated by 20 % versus the controls (p1 < 0.05), by 14.0 % versus the patients with the II CILE stage (p2 < 0.05) and by16.0 % versus the patients with the III-A stage of CILE and 50—70 % ICA stenosis (p3 < 0.05). On the non-afflicted side the significant IR increase by 8.0 % was marked only in patients with critical CILE versus the controls (p1 < 0.05).

Conclusions. Some dangerous decrease of Vpeak in CCA along with the increase of IR is registered in patients with critical CILE resulting from obliterating atherosclerosis and accompanying ICA stenosis of more than 50 % according to the ultrasonography of shanks. Carotid endarterectomy at the first stage of treatment is indicated to patients with 50—70 % stenoses of carotid arteries accompanied by the III-B and IV stages of lower extremities ischemic lesions while performing single-stage operations on both arterial pools is more appropriate in case of 70 and more per cent stenosis of ICA.



Keywords: brachiocephalic arteries, critical chronic ischemia of lower extremities, hemodynamics

6.

 

Administration of enalapril maleate in preoperative period of aortocoronary shunt

G.V. Knyshov, V.V. Lazoryshynets, A.V. Rudenko, V.P. Zakharova, A.I. Plyska, A.N. Beregovoy, O.A. Loskutov

Purpose. Evaluating the effect of preoperative administration of angiotensin converting enzyme inhibitor (ACE) enalapril maleate on the course of the early postoperative period of patients with coronary artery disease (CAD) who underwent aortocoronary shunt (ACS) in the conditions of artificial circulation (AC) and on beating heart (BH).

Materials and methods. We analyzed 1099 case histories to study the influence of renine-angiotensin system (RAS) on the postoperative course after ACS performed on beating and arrested heart. The research was based on the analysis of postoperative mortality in arrested and beating heart groups depending on the preoperative treatment as well as on the analysis of postoperative complications in these groups.

Results and discussion. The research revealed that the postoperative mortality after ACS was considerably lower in the beating heart group (6 %) than in the arrested heart group (18.9 %). The administration of ACE inhibitors decreased the postoperative mortality in both groups. It also decreased the number of postoperative complications, irrespective of the type of heart operation used to perform ACS.

Conclusions. Therapy with ACE inhibitors before ACS is associated with the substantial decrease of both mortality (p < 0.05) and the risk of such postoperative complications as acute failure of cerebral blood circulation and arrhythmia (p < 0.001).



Keywords: renine-angiotensin system, angiotensin II, angiotensin converting enzyme inhibitors, artificial blood circulation, aortocoronary shunt

7.

 

The condition of endothelium-dependent and endothelium-independent vasoregulation in patients with systemic scleroderma

Ye.N. Amosova, O.B. Yaremenko, T.A. Kovganich, I.S. Korsak, S.Kh. Ter-Vartanyan

Objective. To evaluate the condition of endothelium-dependent and endothelium-independent regulation of vascular tonus in patients with systemic scleroderma (SSD) according to the results of tests with reactive hyperemia and nitroglycerin.

Material and methods. We performed Doppler sonography of brachial artery at rest and during reactive hyperemia to 27 women with SSD aged 30—56 years (mean 44.3 ± 1.4 years). Mean duration of the disease was 11.2 ± 1.2 years. 19 patients (70.4 %) had limited scleroderma, 8 patients (29.6 %) had diffuse SSD. In 24 patients (88.9 %) the course of the disease was chronic, in 3 patients (11.1 %) it was subacute. 23 (85.2 %) patients had the I-st degree of activity of the disease, and 4 (14.8 %) patients had the II-nd degree. The disease in all the patients was in the stage of generalization.

Results. The initial diameter of brachial artery did not differ significantly in patients with SSD (3.6 ± 0.2 mm) and in healthy volunteers (3.8 ± 0.1 mm), (p > 0.05). In patients with SSD both endothelium-dependent (EDVD) and endothelium-independent vasodilation (EIVD) substantially decreased in comparison with the control group (by 45 %, p < 0.05 and by 45.8 %, p < 0.05, respectively). We performed a correlation analysis and found a strong direct relationship between EDVD and EIVD in the control group (r = 0.71; p < 0.05), which was not observed in the SSD group (r = –0.05; p < 0.05). Also, there was a moderate indirect relationship between the stage of Raynaud's syndrome and EDVD in patients with SSD (r = –0.49; p < 0.05). There was no significant correlation between the stage of Raynaud's syndrome and EIVD (r = 0.06, p < 0.05). Also, there was no correlation between duration of SSD and EDVD or EIVD (r = –0.21 and r = –0.09, respectively, p > 0.05).

Conclusion. Both EDVD and EIVD are characteristic of patients with SSD, which is revealed by high-resolution sonography. This confirms the role of smooth muscle cells besides endotheliocyte dysfunction in vasodilation disturbances. In patients with SSD, unlike in healthy subjects, there is no direct correlation relationship between EDVD and EIVD. There is a direct correlation relationship between the degree of endothelial dysfunction and the stage of Raynaud's syndrome.



Keywords: systemic scleroderma, endothelial dysfunction, endothelium-dependent and endothelium-independent vasodilation, sonography

8.

 

The investigation of brain tissue perfusion changes depending on the type of carotid arteries pathological deformation in patients with transient ischemic attacks and ischemic stroke based on the results of multispiral computed tomography

N.M. Makomela

The main cause of ischemic stroke (IS) and transient ischemic attack (TIA) is the decrease of the brain blood flow due to pathology of brachiocephalic arteries. Studying the role and place of the pathological deformation of carotid arteries (CA) in the development of brain circulation impairments is an urgent problem of vascular surgery.

Objective. The investigation of brain tissue perfusion changes depending on the type of carotid arteries pathological deformation in patients with TIA and IS based on the results of multispiral computed tomography (MSCT) method.

Materials and methods. We studied 107 TIA patients and 125 IS patients in the period from 24 to 72 hours since the onset of the disease and 62 practically healthy persons of the control group (CG). The patients' age was 22—74 years (mean 43.5 ± 4.5 years). 201(68.4%) of them were men, 93 (31.6%) were women. The CG and the groups with TIA and IS were comparable by age and gender (p>0.05). The groups with TIA and IS were formed of emergency patients hospitalized within 24—72 hours since the onset of the disease with clinically confirmed diagnosis. The examination of the patients was conducted on MSCT scanner «Somatom Volume Zoom» by programs of perfusiography (Perfusion CT) and angiography (CT Angio).

Results. In the course of the investigation different pathological deformations of CA, such as C-shaped, S-shaped, kinking, coiling, double bend, combined deformations were revealed. Pathological deformations of CA were detected in 9 persons of the CG (14.5%), 29 patients with TIA (27.1%), 66 patients with IS (52.8%). Manifestation of pathological deformations of CA occurred more often in patients with TIA than in examined persons of the CG. Pathological deformations of CA were detectable substantially more frequently in patients with IS than in the examined persons of the CG, such kinds of pathology as kinking, coiling, double bend and combined CA deformations being significantly more frequently detectable according to the statistics. We fixed that the difference between the blood flow in the conditionally intact fraction of the brain and that in the fraction of the brain on the deformation side is significant (p<0.01) in patients with TIA accompanied by S-shaped, combined deformations, kinking, coiling and double bend. The focus of ischemia was detectable on the deformation side of CA in the pool of the anterior cerebral artery (ACA) in 60.6% cases (20 patients) of IS. In the pool of the medial cerebral artery (MCA) it was detectable in 75.8% cases (25 patients). In the pool of both ACA and MCA the blood flow was more decreased on the focus of ischemia side than on the conditionally intact side (p<0.05). The blood flow was significantly more decreased in the focus of ischemia located in the ACA pool than on the intact side and on the whole focus of ischemia side (p<0.01).

Conclusions. Pathological deformations of CA are observed in 14.5% practically healthy individuals, 27.1% patients with TIA, 52.8% patients with IS. The presence in healthy persons of such kinds of CA deformation as coiling, kinking, double bend and combined deformations leads to significant decrease of the brain blood flow on the deformation side in the ACA pool, which allows referring these patients to the risk group of TIA and IS development. Asymmetry of blood flow in the ACA pool and its decrease by 21.8% on the damaged side was detected in patients with TIA accompanied by pathological deformations of CA. The focus of ischemia in the ACA pool of patients with IS was characterized by the significant decrease of the blood flow, on average up to 14.7 ± 0.8ml/min/100g and in the MCA pool — up to 14.8 ± 0.8ml/min/100g.



Keywords: multispiral computed tomography, ischemic stroke, perfusion, deformation of carotid arteries

9.

 

The influence of bisoprolol therapy on the state of cardiohemodynamics, physical loading tolerance and lipid spectrum of blood in patients with chronic heart failure

I.I. Lapchynska, T.Ye. Chulakova, M.M. Koval, M.V. Ponomaryova, M.F. Stephanyuk

Aim: to determine the specific features of bisoprolol therapy influence on the parameters of the central hemodynamics, physical loading tolerance and lipid spectrum of blood in patients with moderate chronic heart failure (CHF).

Materials and methods. 60 patients, aged 50 — 71 years (mean age 61 ± 7.2years) were observed. 42 of them were men and 18 — women with CHF of II—III NYHA FC caused by chronic coronary artery disease (CAD) (stable exertional angina of II—III FC), arterial hypertension, postinfarction and diffuse cardiosclerosis. The control group consisted of 20 healthy subjects comparable by age and gender. Bisoprolol (Concor) was titrated according to the following scheme: 1st week — 1.25mg/day; 2nd — 2.5mg/day; 3rd — 3.75mg/day; 4th — 7th — 5mg/day; 8th — 11th weeks — 7.5mg/day; starting with the 12th month — 10mg/day. Before the bisoprolol therapy and 6 months after it we measured the blood serum concentration of total cholesterol (CS), cholesterol of low-density lipoproteins, very low density lipoproteins, high-density lipoproteins and triglycerides by means of enzymatic methods on biochemical analyzer "Coba Mira S" with the use of standard reagents. Conventional indices of echocardiography (EchoCG) which was conducted by the 3.5 MHz impulse sensor on the apparatus "Logic 500", GE, (USA) were used to estimate the systolic function of the left ventricle (LV) and its remodeling.

Results. The slowdown of frequency of cardiac contractions (FCC) (on average from 99.9 ± 6.3 beats/min to 73.1 ± 4.0 beats/min, p < 0.05) and lowering of the arterial pressure (systolic from 164.5 ± 5.9mm mercury to 139.7 ± 4.8mm mercury, diastolic — from 110.4 ± 4.8 to 90.2 ± 6.2 mm mercury, all p < 0.05) were revealed in the patients as a result of bisoprolol therapy at the end of 6 months of observation. We also marked the improvement of the systolic function of the LV, the increase of its ejection fraction (EF) by 25.1 % (p < 0.05) in particular, mainly at the expense of the end-systolic index decrease (by 11.3 %), p < 0.05. The LV EF increased by 5 % and more in 41 patients (68.3 %). The increase of the distance during the test with 6 minutes' walk by 10 % and more was fixed in 33 patients (55.0 %). On average the distance increased from 345 ± 10.9m at the beginning of the treatment to 398 ± 14.2m after 6 months of bisoprolol therapy (p < 0.05). Evaluating the efficiency of Concor therapy by such parameters as the decrease of CHF FC according to NYHA, the increase of the distance of the 6 minutes' walk test and of LV EF, we can state that the improvement of all the three parameters was fixed in 30 (50.0 %) patients. 24 (40.0 %) patients manifested the improvement of only one of the above-mentioned parameters. And only 6 patients (10.0 %) revealed changes of none of the parameters.

Conclusion. Administration of bisoprolol (Concor) for 6 months as part of complex therapy for patients with II—III NYHA FC of CHF accompanied by the systolic dysfunction of LV resulted in the increase of the EF by 25.1 % without any substantial changes of the end-diastolic index as well as in the decrease of FCC by 26.9 %, which was accompanied by the increase of the 6 minutes' walk distance by 12.5 % and the decrease of the NYHA FC in 50.0 % patients. The target dose of the preparation (10 mg/day) was achieved in 52 (86.9 %) patients, which wasn't accompanied by the development of side effects of clinical significance. The bisoprolol therapy didn't lead to any substantial changes of blood lipid spectrum.



Keywords: chronic heart failure, physical loading tolerance, lipid spectrum of blood, therapy, bisoprolol

10.

 

Arterial hypertension in Russia: prophylaxis and treatment of arterial hypertension complications research as a way of proving the possibilities of modern therapy

S.A. Shalnova, S.Yu. Martsevich, A.D. Deyev, N.P. Kutishenko, R.G. Oganov

Aim: To prove the advantage of the long controlled antihypertensive therapy compared with the real usual standard therapy in patients with mild to moderate arterial hypertension.

Material and methods: It was multicenter, randomized, prospective parallel-group study in patients with mild to moderate hypertension. One part of patients (treatment group) received the strongly regulated stepped based on ACE-inhibitor spirapril antihypertensive therapy, the second one (control group) continued their usual standard therapy prescribed by the doctors of the polyclinics or other patient care institutions. The study lasted one year.

Results: 1742 patients were enrolled in the study, 854 patients were included in the treatment group and 888 - in the control group. 220 patients leaved the study by the different reasons, and 1552 patients finished the study. There were 651 (37,6%) men and 1081 (62,4%) women. It was substantial decrease of blood pressure in both group, but the reliability of distinctions between systolic and diastolic blood pressure in the treatment and control group during the study was very high. The goal means of blood pressure (systolic < 140 mm Hg and diastolic < 90 mm Hg) were registered substantially more frequently in the patients of treatment group than in control group (69,4% and 39,3% after three months and 83,6% and 66,9% after 12 months of the treatment correspondingly). As a result of controlled stepped antihypertensive therapy the more decrease of systolic and diastolic blood pressure and more often achievement of goal means of blood pressure supposes the better prognosis of patients if compared with control group.



Keywords: arterial hypertension, angiotensin converting enzyme inhibitors, spirapril

11.

 

Endovascular treatment of restenosis in stent of patients with coronary artery disease: the state of the problem

Yu.V. Panichkin, S.V. Salo

The effectiveness of stenting for treating and preventing acute complications of percutaneous transluminal coronary angioplasty (PTCA) in patients with coronary artery disease (CAD) was proved in the 90s of the 20th century. The wide application of endoprosthesis replacement for CAD treatment revealed a new problem - occurrence of restenosis in stent (RS), leading to angina pectoris recurrence. RS is a pathophysiological process of neointimal hyperproliferation caused by the trauma of the vascular wall and implantation of the endoprosthesis. Thus, it's an iatrogenic phenomenon. Traditional PTCA was used for treatment of RS, then, other methods appeared: angioplasty with cutting balloon catheter, derect atherectomy, rotablation, angioplasty with excimer laser, intravascular brachitherapy, as well as application of stents with medicinal antiprolifarative coating (elution stents). Up to now brachitherapy has been the only way of RS treatment which proved to be effective. At present we pin our hopes on the application of stents with medicinal antiprolifarative coating and on the advances in the sphere of genetic engineering which may become efficient methods of RS preventing and treating.



Keywords: percutaneous transluminal coronary angioplasty, coronary arteries, stenting, restenosis

12.

 

The importance of identifying cardiac troponins for diagnosing myocardial damage

N.T. Vatutin, N.V. Kalinkina, A.L. Demidova, T.S. Kirienko, S. Zakhama

In this review the structure and physiology of troponins and methods of their identification are illustrated. The diagnostic capacities of troponins in myocardial infarction, unstable angina, heart failure, anthracyclines-induced cardiomyopathy and myocardial damage after cardio surgery intervention are described in detail. The possibilities of coronary risk stratification and making prognosis for patients with acute coronary syndrome and heart failure, as well as optimization of their treatment methods are evaluated.



Keywords: troponins, myocardial damage

Current Issue Highlights

4(60) // 2017

Cover preview

K. M. Amosova 1, I. I. Gorda 1, A. B. Bezrodnyi 1, G. V. Mostbauer 1, Yu. V. Rudenko 1, A. V. Sablin 2, N. V. Melnychenko 2, Yu. O. Sychenko 1, I. V. Prudkiy 1&a

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