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Issue. Articles

1(21) // 2008

 

 

1.

 

New approach to the surgical treatment of complicated and combined forms of ischemic heart disease

V.I. Ursulenko

The aim of the work — to evaluate the results of the trial of the original method of surgical treatment of complicated and combined forms of ischemic heart disease (IHD) by means of coronary artery bypass grafting (CABG) on the working heart and the correction of the concomitant heart pathology – using heart-lung bypass (HLB).

Materials and methods. The clinical material consisted of 2 groups of patients after the operation who had IHD complicated by the left ventricular aneurysm (LVA), post-infarction rupture of the interventricular septum (PRIS) or combined with the acquired lesions of the mitral and of the aortic valves (ALMAV). Patients of the control group (n = 455) were operated on according to the classic method: both stages of the operation – CABG and the correction of the intra-cardiac pathology – were fulfilled with the use of heart-lung bypass and cardioplegia. Patients of the trial group (n = 70) were operated on according to the combined method – CABG was performed by the off pump method and the correction of the intra-cardiac pathology was done with the use of heart-lung bypass and cardioplegia or with the use of the artificial heart fibrillation. Age indices of both groups did not differ (56.1 ± 3.4 and 58.8 ± 4.7), neither did the indices of LVA frequency (70.1 % and 85.7 %), the indices of PRIS frequency (2.8 % and 2.9 %), the indices of ALMAV frequency (27.1 % and 11.4 %), the quantity of impaired coronary arteries (CA) (2.6 ± 0.3 and 2.4 ± 0.4), the ejection fraction (EF) (41.5 ± 6.1 % and 45.9 ± 5.7 %) and the frequency of concomitant pathology (47.6 % and 51.4 %).

Results and discussion. There was no difference in the quantity of bypassed CA in the groups (2.4 ± 0.2 – in the control group and 2.4 ± 0.3 – in the trial group). With the use of the classic method, the heart-lung bypass time equaled (138.1 ± 13.2) minutes, and the ischemic heart time – (87.5 ± 7.3) minutes. In case of the combined method, these indices, with the use of cardioplegia, composed (86.3 ± 2.1) min. and (47.3 ± 1.4) min., correspondingly, i.e. they reduced by more than 1.6 and 1.8 times (p < 0.05). The heartlung bypass time of LVA resection with the use of the artificial heart fibrillation equaled (50.7 ± 11.9) min. (it reduced by 2.4 times, p < 0.05), the time of the intra-cardiac stage of the operation equaled (24.2 ± 2.1) min. (it reduced by 2 times, p < 0.05).

Conclusions. The combined method of the surgical treatment of the complicated and combined forms of IHD by means of off pump CABG and the correction of the concomitant heart pathology with the use of the heart-lung bypass permits reducing the ischemic heart time by 1.8 times and the heart-lung bypass time – by 1.6 times, as well as decreasing the hospital mortality significantly. The advantages of this method should be used in cases when long heart-lung bypass time is connected with the risk of grave complications caused by concomitant heart diseases.



Keywords: complicated and combined forms of ischemic heart disease, coronary artery bypass grafting, combined method of the surgical treatment of ischemic heart disease

2.

 

Clinical signs and risk factors of acute deep veins thrombosis of lower extremities. Efficiency and safety of different types of anticoagulant therapy (retrospective research)

V.G. Mishalov, E.N. Amosova, N.Yu. Litvinova, S.V. Bejchuk, V.M. Rogovskyj

The aim of our research was to conduct the retrospective analysis of clinical signs and risk factors for patients with diagnosis of acute deep veins thrombosis (ADVT) of lower extremities, and to compare effectiveness and safety of therapy with LMWH enoxaparin and UFH.

Materials and methods. For period from 2002 to 2007 the diagnosis of ADVT was set for 518 patients, among them 256 (49.4 %) men and 262 (50.6 %) women. Among patients with ADVT with primary localization in ileofemoral and popliteal segments which treated in the departments of vascular surgery prevailed senior persons more than 60 years old (52.7 %). All of patients with ADVT got therapy with anticoagulants. Enoxaparin sodium was prescribed in 428 (82.6 %) cases, UFH in 58 (11.2 %) and in 20 (3.9 %) – others LMWH. Were have analysed efficiency and complications after antithrombotical therapy in a hospital period.

Results and discussion. In 83.8 % cases the most frequent symptoms of disease are an edema of extremity (in 80.1 %) and pain syndrome 75.1 %, which at a monosymptomal variant (34.4 % patients) are marked in 64.6 % and 45.4 % accordingly. Most frequent risk factors (RF) they had the prolonged (more than 7 days.) immobilization and malignant tumors. Therapy of UFH and LMWH was effective (on the average a good result is got in more than in 86 % cases) enough.Enoxaparin treatment was related to considerably less of hemorrhagic complications, than treatment of UFH ( < 0.05), that concerned all of types of such complications.

Conclusions. Efficiency of anticoagulant therapy (decreasing of the number of ascending thromboses, recurrent DVT, and episodes of pulmonary embolism (PE) was identical at enoxaparin and UFH groups, however in cases of enoxaparin application regress of clinical signs in was rapider. Treatment of with enoxaparin as compared to UFH accompanied with reduced frequency of all hemorrhagic complications in 1.8 times, serious in 2.4 times and moderate in 2.8 times



Keywords: acute deep veins thrombosis of lower extremities, Klexan, anticoagulant therapy, efficiency, complications

3.

 

Longstanding experience of the surgical treatment of patients with traumatic aneurisms of the thoracic aorta

L.L. Sitar, A.A. Antoshchenko, V.I. Kravchenko, I.M. Kravchenko, V.A. Litvinenko

The aim of the research was to improve the surgical treatment of traumatic aneurisms of the thoracic aorta.

Materials and methods. 62 patients with traumatic aneurisms of the thoracic aorta were examined. The causes of the aneurisms were as follows: car accidents – 54 (87.1 %) cases, falling down from a height – 7 (11.3 %), knife injury – 1 (1.6 %). In 56 (90.3 %) patients, the aneurism was localized in the region of isthmus, 6 (9.7 %) patients had impaired ascending aorta. The surgical correction was performed in 53 patients.

Results and discussion. Hospital lethality was 3.7 %. In the long-term period (from 1 to 20 years) almost all the patients resumed the active way of life and work. One patient died in the long-term period after the operation.

Conclusions. Operative correction is indicated in case of traumatic aneurism of the aorta. The diagnosis is based on the anamnestic data, X-ray examination of the chest organs. Aortography permits confirming the presence of an aneurism, finding out its localization, size, location in relation to brachio-cephalic vessels, which determines the choice of the tactics of the operation. In case of a traumatic aneurism of the ascending aorta, the operation of choice is supra-coronary vascular prosthesis with the preservation of the aortal valve. In case of a traumatic aneurism of the descending region of the thoracic aorta, the optimal method is the prosthesis of the damaged part with the use of a temporary vascular ascending-descending aortal bypass.



Keywords: aneurism, traumatic aneurism of the thoracic aorta, surgical treatment

4.

 

Genetic aspects of myocardial infarction

V.I. Tselujko, E.I. Popova

The aim of the work — to study the relation of polymorphism of gene IIR1 to the clinical and angiographic parameters at patients after myocardial infarction (MI).

Materials and methods. 60 patients, of mean age of (51.4 ± 8.2) years, were surveyed. 73.3 % of them were men, 26.7 % – women. All the patients had MI, MI with Q-wave – 43.3 %, MI without Q- wave – 56.7 %. The complex of the examination of the patients, along with general clinical methods, included the angiography inspection of the coronary arteries (CA), the loading test, an echocardiography, the study of the lipid spectrum in the blood serum and the research of IIR1 polymorphism. Considering the data of coronaroventriculography, the patients were divided into three groups: I group – 30 patients with angiographically intact CA, II – 30 patients with CA that underwent small changes (atherosclerotic stenosis less than 50 %), III group – 60 patients with hemodynamically significant stenosis of at least one CA. Gene typification of 1166 polymorphism of IIR1 in DNA samples, taken from the swab of the epithelium of the tunica mucosa of mouth was performed with the use of the method of allele-specific polymerase chain reaction on the «» device (« », Russia). The patients were under investigation during two years (1.8 ± 0.4 years).

Results and discussion. The study of the polymorphism of IIR1 1166 gene proves the presence of 3 genotypes (, AC, ). Homozygotes with genotype (60.0 %) prevailed, homozygotes with rare allele () were revealed only in 6.7 % of cases. Sick carriers of rare allele had intact C more rarely, in 12.5 % against 33.3 % ( < 0.05). The frequency of MI at the background of one-vascular defeat was 37.5 % in II group and 22.2 % ( > 0.05) – in I group. The carriers of the mutant rare allele (AC and ) more frequently had overweight (25 %), a higher stage of cardiac insufficiency (II stage) (29.2 %), the development of MI at the background of atherosclerotic lesion of CA (87.5 %) with a bigger volume of myocardium lesion ( fraction of creatine-phosphokinase – 236.5 ± 227.2 U/L). Every second patient developed recurrent MI during the two-year observation. 33.3 % of AA allele carriers developed MI at the background of angiographically intact CA; at the same time, every second patient had some abnormalities of CA development (41.7 %).

Conclusions. MI patients have different genotype of A1166C gene of the 1st type of angiotensin II receptor: genotype AA – 60.0 % patients, AC – 33.3 %, CC – 6.7 %. MI patients that are carriers of the mutant rare allele (AC and CC), as compared to the carriers of AA allele, had a bigger volume of the myocardium necrosis according to the indices of the serum level of fraction of creatine-phosphokinase.



Keywords: acute myocardial infarction, angiographically intact coronary arteries, IIR1 1166 polymorphism

5.

 

Electroanatomical mapping and catheter ablation in the cure f right atrial incisional flutter

V.K. Gryn, .V. Kravchenko, .V. Filyuk, S.I. Estrin

Intra-atrial reentrant tachycardias frequently occur after cardio-vascular surgery. Atrial incisional tachycardias are usually typical or atypical atrial flutter. These tachycardias can be successfully removed using the method of catheter radiofrequency ablation (RFA). Navigation system Carto XP and standard electrophysiology methods can be used to identify a critical isthmus between the natural and surgically created barriers in the atrium for the ablation of the tachycardia substratum.

The aim - to identify the possibilities for catheter treatment of the right atrial flutter with the use of the navigation system Carto XP in patients after cardiac surgery with extracorporeal circulation.

Materials and methods. We operated on 9 consecutive patients of different age (from 2 to 25 years) having atrial tachycardias with extracorporeal circulation on behalf of congenital and acquired heart lesions, ischemic heart disease. Flutter complicating heart surgery underwent electrophysiological study and catheter ablation. 3 patients had long-lasting form of atrial flutter, 6 patients had persistent form.

Results and discussion. 2 patients had typical and 7 - atypical atrial flutter. All the patients underwent electroanatomical mapping of the right atrium with the determination of the critical zone of the slowed impulse conducting. Circuit of tachycardias was obtained through cavotricuspid isthmus in all patients. Scars and zones of fibrosis in tachycardia circuit were observed in five patients. Successful radiofrequency ablation of the cavo-tricuspid isthmus was performed in all the patients and of the isthmus between the scars - if necessary. After the procedure the the sinus rhythm was preserved in all the patients without antiarrhythmic drug therapy. The observation period after the operation was 3-11 months.

Conclusions. The use of electroanatomic mapping of the atria with the help of the navigation system Carto XP, standard electro-physiology methods for the treatment of re-entry type of tachycardia permit us to determine the localization of the circulation of the excitement wave and to eliminate atrial flutter by means of catheter radiofrequency ablation. This approach may be the method of choice for patients with atrial flutter after operations with extracorporeal circulation.



Keywords: incisional atrial tachycardias, atrial flutter, catheter radiofrequency ablation, navigation system Carto XP

6.

 

The influence of perindopril on the endothelial factors in patients with type 1 diabetes mellitus and nephropathy

B.N. Mankovsky, A.G. Pkhakadze

The aim of the study was to investigate the influence of the treatment with angiotensine converting enzyme (ACE) inhibitor perindopril on the plasma levels of endothelial factors – endothelin-1 and von Willebrand factor in patients with type 1 diabetes mellitus (DM) and nephropathy.

Materials and methods. 27 patients with type 1 DM were examined. 14 of them had micro- albuminuria (group 1) and 13 – macro-albuminuria (group 2). The mean age was (33.0 ± 3.04) and (28.9 ± 2.53) years. All the patients took insulin. DM was in the state of compensation or subcompensation. Perindopril («Prestarium» produced by «Servier», France) was prescribed as a single doze of 4–8 mg/day in the morning for 6 months. The patients were examined before the beginning of the therapy, in 3 and 6 months of the therapy. The control group consisted of 20 healthy persons, age and gender matched. The level of albumin in the daily urine was determined using quantitative radio-immunological method. The plasma level of endothelin-1 was measured by immunoenzyme method (Elisa) using the kit of «Biomedica» firm (Austria). To measure the blood level of von Willebrand factor we used Elisa immunoenzyme method using the kits of «Axis-Shield Diagnostics Limited» firm (Great Britain). The blood was taken on an empty stomach in the morning.

Results and discussion. The arterial pressure (AP) of all the patients achieved the target values and in 3 months of the therapy was (121.1 ± 2.88)/ (77.1 ± 1.87) and (118.9 ± 2.72)/ (78.5 ± 1.60) mmHg in the 1st and the 2nd groups of patients, respectively, (p < 0.05 as compared to the initial data) and didn’t change during the course of therapy. Albumin level in the 1st group was (112.91 ± 15.76), (83.22 ± 11.9) and (61.26 ± 8.36) mg/day – before the beginning of the therapy, in 3 and 6 months of the therapy, respectively (p < 0.05 as compared to the initial data). At the same time, in patients of the 2nd group, the therapy did not promote the decrease of albumin level in the daily urine and initially was (852.6 ± 147.61) mg/day, in 3 months – (833.9 ± 119.78) and in 6 months – (724.5 ± 127.19) mg/day (p > 0.05). In 6 months of therapy, the plasma levels of endothelin-1 in the patients of 1st group decreased to (0.33 ± 0.04) pmol/ml, and in the patients of the 2nd group – to (3.25 ± 1.14) pmol/ml (p < 0.05 in comparison to the initial indexes in both cases). By the 6th months of the therapy, the plasma levels of von Willebrand factor was (1.01 ± 0.03) Units/ml in the patients of 1st group and (1.01 ± 0.05) Units/ml -in the patients of 2nd group (p < 0.05 in comparison to the initial indexes and p > 0.05 in comparison to the controls).

Conclusions. In patients with type 1 DM and nephropathy, the therapy with perindopril in the doze of 4–8 mg/day during 6 months leads to the decrease of the systolic and diastolic blood pressure, the reduction of microalbuminuria (by 50 %) and it does not influence macroalbuminuria level. It is accompanied with the correction of the endothelial function manifested as the decrease of the plasma levels of endothelin-1 and von Willebrand factor in patients with both micro- and macroalbuminuria.



Keywords: type 1 diabetes mellitus, diabetic nephropathy, endothelial disfunction, perindopril, von Willebrand factor, endothelin

7.

 

System of insulin-like growth factor in patients with stable course of ischemic heart disease

D.I. Mitrushkin

The aim of the research was to study the state of insulin-like growth factor (IGF) system in patients with stable course of ischemic heart disease (IHD).

Materials and methods. 50 IHD patients with I-III functional class of stable angina of effort and hemodynamically significant atherosclerotic narrowing of coronary arteries by more than 50 % and without history of acute coronary syndromes were included into the study. The control group included 20 persons without angiographic signs of coronary atherosclerosis. None of the patients and healthy persons had any impairments of the pumping function of the heart, inflammatory, endocrine, and other diseases which could influence the state of the IGF system; as well as such risk factors as the impairment of the tolerance to carbohydrates, obesity, burdened familial history concerning cardio-vascular diseases. Hyper- and dislipidemia were present in 41 (82 %) patients, arterial hypertension – in 23 (46 %); smoking – in 18 (36 %). 44 (88 %) patients took antiaggregants, 38 (76 %) – ?-adrenoblockers, 7 (14 %) – calcium antagonists, 26 (52 %) – prolonged nitrates, 25 (50 %) – statines, 36 (72 %) – angiotensine converting enzyme inhibitors. Serum levels of IGF-I, IGF Binding Protein-3 (IGFBP-3), C-reactive protein (RP) were measured by enzyme-linked immunosorbent assay. Expression of IGF-I type 1 receptors (IGF -1R) on CD14+ cells of the peripheral blood was assessed by flow cytometry.

Results and discussion. Serum level of IGF-I in patients with stable course of coronary atherosclerosis was higher, than in the controls (168.3 ± 12.0 ng/ml and 140.9 ± 6.1 ng/ml, respectively) while the concentration of IGFBP-3 was lowered (2597.7 ± 90.4 ng/ml and 3036.0 ng/ml ± 131.2 ng/ml, respectively). The IGF-1R expression on CD14+ blood cells in IHD patients was lower (22.5 ± 1.9 % and 28.0 ± 3.6, % respectively; all p < 0.05) than in the controls, too. IHD patients had higher count of CD14+ cells (5.7 ± 0.4 % and 4.4 ± 0.5 %, respectively) and CRP serum level (21.2 ± 1.4 µg/ml and 17.8 ± 0.6 µg/ml; all p < 0.05).

Conclusions. Patients with the stable course of IHD reveal the increased level of IGF-I in the blood combined with the reduced expression of IGF-1R on CD14+ peripheral blood cells whose number is increased.



Keywords: insulin-like growth factor, atherosclerosis, ischemic heart disease

8.

 

Comparative evaluation of the effect of the long?term therapy with spirapril and atenolol on the blood pressure daily profile and the left ventricular morphological and functional condition in patients with arterial hypertension

A.N. Bilovol, I.I. Knyazkova, A.I. Tsygankov

The aim of this study was to evaluate the effects of the long-term treatment with spirapril as compared to atenolol on the arterial pressure (AP) daily profile, remodeling of the left ventricle (LV) and its systolic and diastolic function in patients with moderate arterial hypertension (AH).

Materials and methods. 56 patients (46 men and 10 women) aged from 42 to 60 years (mean age – 52.5 ± 3.7 years) with moderate arterial hypertension were examined. The patients were divided into two groups depending on the therapy. The first group consisted of 30 patients who were treated with spirapril (Kvadropril produced by of Pliva Company) in the dose of 6 mg/day in the morning. The second group consisted of 26 patients who were treated with atenolol (Tenormin, AstraZeneca) in the mean dose (78.8 ± 13.4) mg. The control group consisted of 12 practically healthy persons, age and gender matched with the groups under investigation. Twenty-four-hour AP monitoring (TFHAPM) was done twice (at the beginning of the investigation and in 24 weeks of treatment) with the use of the device ABPM-02 (Meditech, Hungary). The following TFHAPM indexes were measured: the mean value of the systolic (SAP) and diastolic (DAP) AP, time index (TI) hypertonic loading, AP variability (APV), daily index (DI), as well as the indexes of the velocity of the morning SAP and DAP elevation. The indexes of the morpho-functional condition of the LV myocardium at the beginning of the investigation and in 24 weeks of treatment were measured in all the patients by means of Aloka SSD-280 LS echocardiograph (Japan). The evaluation of the structural changes of the LV was conducted in B- and M- regimes with the determination of the end diastolic (EDS) and end systolic (ESS) sizes of the LV, the thickness of the posterior wall (TPW) and of the interventricular septum (TIVS) of the LV in the diastole, the index of the myocardium mass of the LV (IMMLV). The evaluation of the diastolic function of the LV was conducted in the regime of impulse DopplerEchoCG. The peak velocity of the early (E, cm/sec) and late (A, cm/sec) diastolic filling, as well as E/A relation were measured.

Results and discussion. The decrease of mean daily SAP in both groups was marked in 24 weeks of treatment – by 12.4 % ( < 0.001) and 18.6 % ( < 0.001), respectively. The degree of the mean daily SAP decrease was more significant in case of spirapril therapy ((130.5 ± 4.5) versus (142.4 ± 3.8) mmHg; < 0.05). The value of the morning SAP elevation decreased by 56.7 % ( < 0.001) in the spirapril group and – by 28.0 % ( < 0.05) in the comparison group. The analysis of the groups showed the advantage of spirapril over atenolol in respect of the effect on the value of the morning elevation of SAP ( < 0.05). After the therapy with spirapril, we also registered the substantial decrease of the indexes of the velocity of the morning elevation of SAP (by 63.7 %; < 0.05) and DAP (by 66.2 %; < 0.05), which was not observed after 6 months of atenolol therapy ( > 0.05). After 24 weeks of spirapril therapy, the IMMLV decreased by 10.8 % ( < 0.05) as a result of the substantial ( > 0.05) decrease of the EDS, TIVS and TPW of the LV (by 8.7, 9.4 and 10.2 %, respectively).

Conclusions. The long-term (during 24 weeks) spirapril therapy of patients with moderate AH promotes stabilization of the AP daily profile, is more favorable for AP variability and the value and velocity of its morning elevation than the therapy with atenolol. Monthly spirapril therapy promotes the decrease of the hypertrophy and LV remodeling as well as the improvement of its diastolic function, which is not observed in case of the treatment with atenolol, in spite of the same frequency of achieving the target AP.



Keywords: arterial hypertension, twenty-four-hour monitoring of the arterial pressure, left ventricular hypertrophy, spirapril, atenolol

9.

 

Heart rate variability in patients with ischemic heart disease and concomitant chronic obstructive pulmonary disease and its changes in the course of

D.Sh. Sichinava

The aim — to evaluate the heart rate vegetative regulation based on heart rate variability (HRV) data at passive straight leg-rais-ing test (PSLRT) in patients with ischemic heart disease (IHD) and concomitant chronic obstructive pulmonary disease (COPD) and effects of b-blocker therapy.

Materials and methods. We examined 38 patients with non-exacerbant chronic IHD and associated COPD, aged 48 to 72 (average age 64.0 ± 1.9), including 28 (73.7 %) men and 10 (26.3 %) women. 32 healthy people (controlling group), aged 42 to 55 (average age 48.6 ± 5.2) including 19 (59 %) men and 13 (41 %) women were also examined. IHD and COPD were diagnosed with the help of relevant diagnostic procedures. The exclusion criteria were: old myocardial infarction, chronic heart failure of stage higher than stage II and declined left ventricular ejection fraction (LVEF) < 45 %, associated acute infectious and non-infectious inflammatory diseases, or exacerbation of them, chronic liver and kidney failures and diabetes mellitus. The patients were of the same age and gender (p > 0.05) as in the controlling group. All the patients received aspirin, isosorbid dinitrate; those with arterial hypertension received angiotensin converting enzyme (ACE) inhibitor – Lizinopril. COPD treatment in all patients included b2-agonist inhalations, expectorants. COPD of stage III-IV treatment included inhalations of beclomethasone. The dosing was the same within 6 months before the study and after it; the treatment was supplemented with metoprolol-retard starting with 25mg and increasing the dose to 100 mg (daily mean 94.4 ± 25 mg). HRV was evaluated in all the patients every morning on an empty stomach after 10–15 min of rest in level position. 12-lead ECG was administered for all the patients 5 min before and during the PSLRT at an angle of 45°. The patients were observed within a year. At rest and during the 5th min of PSLRT, the following temporal indices of HRV were estimated: RRNN – average duration of RR intervals; SDNN – mean square deviation of consequent RR intervals; RMSSD – standard (mean square) deviation of the difference of the consequent RR intervals; PNN50 – the percent of the consequent RR intervals having the difference more than 50msec; CV – coefficient of variation; TP was calculated – the total power of the spectrum in the range under investigation; VLF – the power of the spectrum at frequency less than 0.05 Hz; LF – the power of the spectrum at frequency 0.05 – 0.15 Hz; HF – the power of the spectrum at frequency 0.16 – 0.4 Hz; LF/HF – the correlation of low- and high-frequency components.

Results and discussion. Patients with IHD+COPD, prior to the administration of metoprolol, demonstrated lower, as compared to normal, HRV temporal indicators: RRNN – by 40.1 % (p < 0.001); SDNN – by 22.4 %, RMSSD – by 19 % (p < 0.05). The total power () of the range was lower by 1.58 (p < 0.05) due to the decrease of low-frequency components (LF – by 11.5 %; p < 0.05 and VLF – by 29.4 %; p < 0.001), and high-frequency HF (by 33.8 %, p < 0.001), which proves the general deterioration in vegetative regulation of the cardiovascular system. While evaluating the outcome of metoprolol treatment in patients with IHD+COPD we noticed the positive effect of such treatment on HRV time and high-frequency indicators at rest. For instance, RRNN increased by 33.6 % ( < 0.001), SDNN – by 8.5 % ( < 0.05). In frequency spectrum we identified the HF growth by 20.9 % ( < 0.05), while VLF dropped by 20.7 % ( < 0.001), and LF – by 8.5 % ( < 0.05). It proved the poorer evidence of sympathetic nervous system activation at rest yet with no stabilization of these indicators in view.

Conclusions. According to time and spectral HRV indicators in patients with IHD+COPD at rest, one can observe significant changes in the vegetative balance towards the growing of the sympathetic nervous system activity, which is more evident under PSLRT. The average daily dose of metoprolol (94.4 ± 25.0 mg) in such patients helps reduce the evidence of the sympathetic nervous system activity at rest and, to a smaller extent, during PSLRT.



Keywords: chronic obstructive pulmonary disease, ischemic heart disease, heart rate variability, metoprolol

10.

 

Integrated quantitative estimation of the condition of nail laying down microcirculation according to capillarosopy

V.V. Vereshchaka, N.M. Sydorova

The aim of the research was the creation of an original technique of an integrated quantitative estimation of the morphofunctional condition of nail laying down (NLD) hemomicrocirculation channels (HMC) according to capillarosopy on the basis of a score estimation of the expressiveness of attributes and frequency of their display at healthy.

Materials and methods. 90 practically healthy persons aged from 22 to 35 years (mean age 31.03 ± 1.28 years) were under our supervision; 45 (50 %) of them were men and 45 (50 %) – women. NLD capillarosopy was conducted on the upper extremities using a three-dimensional microscope (USSR) with 150 times increase according to our own scheme. Intra-, extra- and vascular parameters (34 all in all) were studied, their gradations, estimated in scores and with the view of frequency of display at healthy persons, were allocated. The integrated index was calculated as the sum of scores of all attributes. The number of functioning NLD capillary loops was determined with the use of an eyepiece-micrometer (in 1 mm of terminal row of loops). The velocity of bloodstream in capillary loops was estimated by defining the time necessary for an erythrocyte to pass 1 mm of a capillary loop. The diameter of capillary loops, distance between them and the number per 1 mm2 was defined by means of object-micrometer.

Results and discussion. The integrated capillarosopy index constituted from 1 to 9 scores (mean 3.03 ± 0.46), did not correlate with the age (r = 0.228, > 0.05) and did not depend on the gender: 3.11 ± 0.26 scores on average at men, and 3.23 ± 0.36 scores (p > 0.05) at women. Changes of microcirculation were basically caused by extra- and intravascular parameters: turbid capillarosopy background (in 13.3 %), focal perivascular hypostasis (in 13.3 %), pathological types of blood flow (in 16.7 %). The morphological changes of the capillary loops were revealed as the impairment of the parallel arrangement of the capillary loops (in 23.3 %), non-uniformity of venule caliber (in 13.3 %) and reduction of the arterial diameter (in 13.3 %) of the knees. The capillarosopy inspection of practically healthy persons revealed that the parameters obtained on the right and left hands of the patients had no statistical difference (p > 0.05).

Conclusions.We have developed a complex system of semi-quantitative score estimation of NLD HMC condition according to capillarosopy data on the basis of the changes of 34 parameters of intra-, extra- and vascular parts with taking into account their occurrence at practically healthy persons aged from 22 to 35 years which allows making the estimation of HMC objective in the dynamics with the scientific and practical purposes. The integrated NLD capillarosopy index makes up from 1 up to 9 (3.03 ± 0.46) scores at practically healthy persons aged from 22 to 35 years and does not depend on the age and gender.



Keywords: technique of research, microcirculation, capillarosopy, skin, nail laying down

11.

 

Statins from efficiency to safety: focus on rosuvastatin

E.N. Amosova

The importance of optimum doses of statins administration to reach the goals in treatment of dyslipidemia and their dependence on the degree of cardiovascular risk in each case is proved on the basis of the latest recommendations of the European Society of Cardiologists (2003) and the American Association of Cardiologists. It causes the importance of the use of drugs with expressed lipid lowering activity, like rosuvastatin (Krestor), which provides the achievement of lipid lowering goals at much greater number of patients, than all other statins. The most serious, though also rather rare, side effects of statins are myopathy or rhabdomyolysis and the increase in ALT. The risk of these complications depends on the dose of statin, the character of the accompanying pharmacotherapy, age, functions of the liver and kidneys, and also, to some extent, the pharmacological properties and pharmacokinetics of the drug. The importance of the latter was proved by the negative experience of cerivastatin administration which has been banned to use because of the increased by 10-80 times risk of rhabdomyolysis in comparison with others statins. It causes the importance of the estimation of new statins tolerance, rosuvastatin, in particular. The data available at present allow us to think that rosuvastatin is not less safe, than those statins which have been used for more than 10 years, such as simvastatin, atorvastatin, pravastatin and others. The research results included those of big observation trials executed in the Netherlands and the USA in which they estimated the frequency of myopathy, hepatic and renal insufficiency demanding hospitalization, as well as the results of CORONA study of elderly patients with expressed chronic heart failure whose frequency of side effects at the background of rosuvastatin therapy did not differ from that after taking placebo. The analysis of the pharmacokinetic properties of rosuvastatin testifies to the fact that its hydrophylic properties, small specific gravity discharge through kidneys, rather low system bioavailability and weak expressiveness of interaction with other medicines in the system of cytochrome 450 favourably distinguish it from cerivastatin and cause low risk of side effects.



Keywords: statins, efficacy, safety, rosuvastatin

12.

 

Isolated systolic hypertension in elderly patients

.J. Zharinov, .B. Detsyk

The review provides contemporary data about epidemiology, pathogenesis, features of diagnosis and treatment of elderly patients with isolated systolic hypertension (SH). Pathological increase of systolic blood pressure (SBP) is registered in the majority of subjects achieving very old age. The epidemiological studies show that the increase of SBP, as well as low level of diastolic blood pressure (DBP) is an informative risk factor of cardiovascular complications in elderly patients. The investigation of elderly patients with ISH should be specially directed at the evaluation of intima-media thickness, search for atherosclerotic plaques in the carotid arteries, the study of elastic properties of the aorta and large arteries. The possibilities of the prevention of cardiovascular complications in patients with ISH depend on the absolute SBP reduction. According to the evidence-based data, low-dosage diuretics, prolonged dihydropiridine calcium antagonists and angiotensin II receptor blockers may be considered basic drugs for the treatment of ISH. In clinical practice the target levels of SBP are achieved more rarely than DBP.



Keywords: blood pressure, isolated systolic hypertension, prognosis, diagnostics, treatment

13.

 

The infarction of the right ventricle

V.J. Tseluiko, N.E. Mishchuk

We described the clinical study of the course of hemodynamically significant right ventricle (RV) myocardial infarction (MI) in a patient with acute MI of the posterior wall of the left ventricle (LV). The management of such patients differs from the conventional management in case of the isolated lesion of the LV and presupposes limited use of vasodilators and diuretics, volume load, inotropic support, control of the rhythm and frequency of heart beats. Timely diagnosis of the RV MI, early thrombolysis and the correction of the complex of therapy permitted the patient to survive the critical period of the cardiogenic shock. The long-term prognosis is relatively favorable and does not differ from the one in case of posterior RV MI without RV involvement.



Keywords: myocardial infarction of the right ventricle, myocardial infarction of the left ventricle, treatment, course

Current Issue Highlights

4(60) // 2017

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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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