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Issue. Articles

2(6) // 2004





Combined antihypertensive therapy with angiotensinconverting enzyme inhibitor and diuretic: fashion or necessity

Yu.M. Sirenko

Pathogenesis of arterial hypertension (AH) is multicomponent process, which consists of volume of blood circulation elevation, vasoconstriction, hyperactivity of sympathetic and renin-angiotensin-aldosterone systems, metabolic disturbances. The European Society of Hypertension — European Society of Cardiology guidelines (EHS-ECS, 2003) accentuate on the expediency of combination of medications with different mechanisms of action. JNC-7 (Joint national committee) (2003) guidelines recommend combined antihypertensive therapy in most patients with BP level over 160/100 mm Hg. The essential medication in combination should be diuretics (thiazides). Today the most popular is the combination of ACE inhibitor and diuretic. According to JNC-7 guidelines, ACE inhibitors are the medication of choice for the treatment of AH in the most of special clinical situations, such as heart failure, myocardial infarction, ischemic heart disease, diabetes mellitus, renal failure, cerebrovascular complications. Diuretics may be administered to all patients with AH. Effects of these medications were proved in numerous trials. Thus, combination of these medications may be administered to all patients with AH, including special clinical indications.

Keywords: arterial hypertension, antihypertensive therapy, angiotensinGconverting enzyme inhibitor, diuretics.



Soy protein influence on the lipid exchange indices of blood serum in patients with hyperlipidemia against the background of ischemic heart

K.M. Amosova, S.S. Gulyaev-Zaitsev, N.O. Karel, N.F. Kigel', K.M. Yaremenko, N.G. Levyts'ka, G.V. Mostbauer, T.T. Podolets', L.V. Amelicheva

Objective. To conduct the double blind placebo controlled investigation of biologically active adjunct (BAA) with soy protein on the level of total cholesterol (TCH) and lipid exchange indices of blood serum in patients with ischemic heart disease (IHD) and hyperlipidemia and to evaluate it's tolerance.

Materials and methods. 40 patients at the age of 35—70 (mean 63,1±2,3) with chronic forms of IHD took part in the investigation. Exclusion criteria were the secondary hypercholesterolemia, treatment with hypolipidemic medications, congestive heart failure (HF) of IIB and above stages, acute coronary syndrome, severe arrhythmias and blocks, non-urgent surgical revascularization of myocardium, unstable angina pectoris, renal and/or hepatic insufficiency, decompensated diabetes mellitus (DM), alcohol abuse, obesity of III—IV degrees. Laboratory inclusion criteria were the same as in 4S trial: the level of TCH in blood serum of 5,5—8,0 mmol/l and/or cholesterol of low density lipoproteins (CLDL) ≥3,0 mmol/l. The desired level of TCH was <4,5 mmol/l and CLDL<2,6 mmol/l (by Recommendations for the patients with established diagnosis of IHD). All patients with inclusion and no exclusion criteria were on the hypolipidemic diet for at least 2 months. They took BAA with 32 g of soy protein as addition to conventional therapy of IHD (nitrates, aspirin, beta-blockers, calcium antagonists, ACE inhibitors, diuretics) for 42 days. At the beginning and end of investigation levels of TCH, cholesterol of high density lipoproteins (CHDL) and triglycerids (TG) were measured in capillar blood by enzyme-linked assay. The level of CLDL was calculated by Freedwald, atherogenic coefficient (AC) — by Klimov. Biochemical indices of renal and hepatic functions, electrolytes levels were determined as well.

Results. At the beginning of investigation patients of both groups were comparable by age, sex, IHD forms, concomitant diseases and treatment. Patients who took BAA with soy protein had significant (p<0,05) decrease of TCH (by 18,1%), AC (by 32,2%) and CLDL/CHDL coefficient (by 20,3%) without statistically significant changes of CLDL, CHDL and TG. Patients of group 2 (who took placebo) had no significant changes of these indices. There were no changes in clinical status and the results of biochemical blood investigation in patients of both groups. BAA "Somochol" tolerance in majority of patients was satisfactory. Only 2 (8,0%) of them had severe meteorism for 3—4 days and refused to continue the investigation. 5 more patients of this group (20,0%) had insignificant meteorism for the first 3—4 days, which disapppeared after that period of time. Frequency of meteorism was the same in group 2 (3 patients, or 20,0%; p>0,05).

Conclusions. BAA with soy protein (32 g/day) intake for 42 days in patients with moderate (TCH 5,5—8,0 mmol/l) hyperlipidemia decreases level of TCH by 18,1%, AC — by 32,2% and CLDL/CHDL coefficient — by 20,3%. It promotes obtaining the desired level of TCH in 64,0% and CLDL in 32,0% of patients. These effects in placebo group were absent. The only side effect was meteorism during the first 3—4 days of treatment, which was severe in 8,0% of cases and became the reason of interruption the BAA intake. Frequency of moderate meteorism (20,0%) was the same in comparison with placebo.



Markers of inflammation and cerebral circulation changes in patients with different clinical course of ischemic stroke

T.M. Cheren'ko

Objective. To compare evidence of changes in local inflammation data and cerebral hemodynamics velocity with peculiarities of ischemic stroke in acute period clinical course.

Materials and methods. 68 patients (mean age (62,4 ± 7,5) years) with ischemic stroke (IS) were examined. All of them were admitted before 12 hours after beginning of disease. 29 (42,6%) of them had IS in left medial cerebral artery (MCA) pool, 26 (38,2%) — in right MCA, 13 (19,2%) — in vessels of vertebrobasilar pool. Computed tomographic scanning (CTS) or magnetic resonance imaging (MRI) procedure were made for IS verification. Severity of IS was assessed by NIHSS scale. Severe IS (13—19 points) was diagnosed in 27 (39,7%) patients on admission, IS of moderate severity (9—12) — in 25 (36,8%) patients, light IS (3—8) — in 16 (23,5%) of them. Serum interleukins — interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), interleukin-4 (IL- 4) concentrations were evaluated at first 24 hours by quantitative immune-enzyme analysis (test-system "Protein contour", St. Petersburg). Cerebral circulation was assessed by ultrasound dopplerography (USD) and transcranial dopplerography (TCD) ("Multigon 500 M", USA). Blood flow direction, it's mean velocity (MV) in intracranial vessels in patients with IS during the second day of disease were evaluated. Patients with hemodynamically significant extra- and intracranial vessels stenosis were not included.

Results. Mean indices of cytokines concentrations were significantly higher in all patients' groups in comparison with control data. Concentration of IL-6 was significantly higher and concentration of IL-6 was significantly lower in patients with inadequate regression of neurological deficiency in moderate or severe IS by the end of acute period — (221,4±32,1) and (52,4±11,2) pg/ml correspondingly (<0,05) in comparison with those in patients with adequate recovery — (141,1±30,2) and (77,2±12,3) pg/ml correspondingly (<0,05). Significant elevation of TNF-α was established in group of patients with negative neurological status dynamics during the first 48 hours after IS in comparison with patients with positive neurological status dynamics — (98,4±15,1) and (56,3±12,6) pg/ml (<0,05). Blood glucose concentration increase (> 8 mmol/l) was accompanied by almost double elevation of TNF-α level (r=0,76; <0,05) and deterioration of neurological status in acutissimus period. The higher mean cerebral circulation velocity in MCA on the side of primary lesion in comparison with the same index in patients with positive dynamics of neurological status at the first 48 hours (56,5±2,0 and 44,2±1,7; <0,05) was registered in patients with hemisphere IS in early neurological deterioration. Besides, mean cerebral circulation velocity in vertebral arteries in patients with the early neurological deterioration (in comparison with the same in MCA pool) was 47,3% on the side of primary lesion. In patients with recovering this index was significantly higher — 69,9% (<0,05).

Conclusions. Inadequate regression of neurological functions in patients with moderate and severe IS at the end of acute period is associated with the higher serum concentration of IL-6 and the lower concentration of IL-4 during the first day. Patients with the early deterioration of neurological data have the higher serum TNF-α level at the first 24 hours versus the same in patients with positive dynamics. The early deterioration of neurological disturbances in patients with hemispheric IS develops against the background of hyperperfusion in mean cerebral arteries and the lower indices of mean cerebral vertebrobasilar circulation velocity versus mean cerebral arteries circulation velocity.

Keywords: ischemic stroke, IL-6, TNF-



Clinical course peculiarities and results of coarctation of aorta surgical treatment

S.O. Dykukha, L.R. Naumova, A.O. Antoschenko, L.S. Chernyakova, V.M. Khondoga, T.I. Didkova

Objective. To make assessment of the coarctation of aorta (CA) surgical treatment results by the data of more than 40 years experience in the treatment of patients with this cardiovascular anomaly according to the age and investigation of hospital and long-term effects.

Materials and methods. 3000 sequential primary operations on CA correction in patients at the age of 3 days—55 years (mean age — 11,7±2,3) were analyzed. All of them were operated in the Institute of cardiovascular Surgery of Ukrainian AMS named after M.M.Amosov since 1960 till 2003. Concomitant heart diseases were in 938 (30,9%) patients. Predominant way of CA correction was anastomosis end-to-end in 1427 (47,7%) cases. 87 (2,9%) of 3000 patients with CA were operated before the age of one, 2146 (71,5%) — at the age of 2 to 15.

Results. In-hospital mortality was 1,9%. The main reasons were acute cardiovascular insufficiency in 26 (0,9%), bleeding in 10 (0,3%), disturbances of cerebral or spinal circulation in 9 (0,3%) patients. Long-term manifestations of arterial hypertension in post-operative supervision was established in 20,6% of patients. Frequency of arterial hypertension in patients operated at the age of 30 and older was 46,6%. Aortic aneurysms were revealed in 104 patients in the late post-operative period. They were result of preexisting ascending aorta aneurysmal progression in 39 (1,3%) patients. It was connected predominantly with aortic valvular disease (stenosis, bicuspid) and residual arterial hypertension. Later on 5 of them died and 17 were operated (14 Bental's procedures, 2 supracoronary aortic prosthesis, 1 bandage). The next reason of aneurysm development was connected with the way of surgical treatment. Aneurysm at the aortoplastic area has been developed in 75 (2,77%) patients. It was more often in those with synthetic patch (4,09%) versus anastomosis end-to-end (0,57%). 16 patients with aneurysm died after aortoplasty (5 due to spontaneous aneurysm rupture and 11 — due to surgical removing attempt). 59 (84,3%) of 70 reoperations were successful. The second important reason of long-term consequences worsening was progressing of aortic valve failure, which was the cause of death in 13 cases. The overall long-term mortality was 1,6% (47 patients).

Conclusions. Femoral artery pulsation is remained because of less severity of disease, concomitant aortic insufficiency or presence of patent ductus arteriosus in 8,8% cases of CA. Phenomenon of «radial-femoral delay» has defined diagnostic value. The most difficult is CA diagnosis in newborns due to frequent absence of proximal arterial hypertension, systemic hypotension and nonspecificity of femoral pulse weakening symptom at this age. Surgical mortality is 1,9% (of 3000 CA correction operations per 40 years). We suppose that the most optimal way of correction is resection with aortic anastomosis end-to-end. 31,3% of patients with CA have another congenital heart diseases, frequently connected with aortic valve pathology (353 cases — 11,8%) and with patent ductus arteriosus (312 — 10,4%), so in some cases limitation of procedure by the only correction of coarctation is not expedient. Arterial hypertension relapses in long-term post-operative period were revealed in 20,6%, and in 46,6% of those operated at the age of 30 and older, probably because of concomitant essential arterial hypertension development. The major risk is connected with the progressing ascending aorta (39 cases — 1,3%) and area of correction (75 cases — 2,8%) aneurysms. In case of correction with synthetic patching local aneurysms are more frequent versus end-to-end anastomosis (4,1% and 0,6% correspondingly).

Keywords: coarctation of aorta, concomitant heart diseases, aneurysms of aorta, surgical treatment.



Valve sparing operations in congenital mitral valve insufficiency

.F. Zyn'kovskyi, .. Pishchurin, R.. Vitovskyi

Valve sparing operations in congenital insufficiency of the mitral valve (CIMV) are the operations of choice. But the problems of the residual regurgitation and unstability of remote results remain unsolved.

Objective. To improve immediate and long-term results of the valve sparing operations due to CIMV by the development of differentiated choice of plastic correction method.

Materials and methods. From 1993 till 2002 75 patients underwent the plastic correction of the lesion in the Institute of Cardiovascular Surgery AMS Ukraine named after N.M.Amosov. In 47 (63%) cases CIMV was combined with other congenital heart anomalies. At the preliminary stage of valve sparing operations' assimilation (1993—1997) the choice of plastic methods was based on the individual surgeon's opportunities and clinic's traditions (the control group included 22 operated patients). During the next years (1998—2002) classification of anatomical types of CIMV was elaborated, that was a leading factor in the choice of the correction variant in 53 patients (the main group). According to the classification, based on the definition of relations between the leaflets closure level and the plane of the mitral valve fibrous ring (FR) during systole, 3 anatomical types and 3 groups of patients were apportioned: I — level of leaflets closure is at the FR plane (20 patients), II — level of systolic leaflets closure is above the FR plane in the cavity of left atrium (16 patients), III — level of leaflets closure is under the FR plane in the cavity of left ventricle (17 patients). The main methods of CIMV correction were: in the I group — suturing of the leaflet cleft with separate knotted stitches (18) and different kinds of suturing annuloplasty (2); in the II group — creation of double valvular orifice (12), and shortening of elongated chords (2), suturing of the posterior leaflet cleft (1) and resection of the front leaflet together with elongated chords (1); in the III group — enlargement of the posterior leaflet surface with "crescent" patch from autopericardium (7), shortened chords elongation (3), creation of double foramina valve (3), shortened papillary muscles elongation (2), shortened secondary chords excision (2). Long-term results were studied from 6 months to 9 years (average 3,6 ± 0,2 years).

Results. Patients of the main group at the nearest post-operative period had decreased left ventricle end-diastolic index (EDI) from (129,6 ± 5,9) to (81,5 ± 4,6) ml/m2 (p < 0,001), level of mitral regurgitation — from 2,0 ± 0,1 to 0,5 ± 0,1 (p < 0,001)). At the same time patients of the control group had unchanged EDI and decreased level of mitral regurgitation from (2,2 ± 0,1) to (1,1 ± 0,2) (p < 0,001). 2 (2,7%) of 75 patients had died because of surgical imperfections of the procedures. 4 (5,3%) patients were re-operated during the early postoperative period. Their valve changes corresponded to the II type of CIMV. Left ventricle EDI in the immediate and long-term postoperative periods was (91,4 ± 2,6) and (98,3 ± 3,2) ml/m2 (p > 0,05) correspondingly; residual regurgitation — (0,7 ± 0,1) and (0,9 ± 0,1) (p > 0,1); EF — (59,6 ± 0,6) and (66,8 ± 0,5)% (p < 0,001). Unsatisfactory result of operation in the long-term observation period was noted in 5 (8,2%) patients.

Conclusions. Proposed classification of the mitral valve anatomy changes in its congenital insufficiency, based on the definition of relations between the leaflets closure level and the plane of the mitral valve fibrous ring during systole, permits to determine optimal types of surgical interventions in different types of the lesion. It substantially improves haemodynamic indices in operated patients in the immediate period and preserves them in the long-term period of observation.

Keywords: congenital insufficiency of the mitral valve, valve sparing operations, immediate and longGterm results.



Bowel ischemia in reconstructive surgery of aortofemoral segments: causes and prophylaxis

Yu.G. Orel, I.I. Kobza, I.I. Solonynko, D.B. Sol'man, G.Yu. Yeliseev, O.M. Levchuk, A.T. Kichtiak, Ali Shreym

Objective. To analyze the frequency and causes of bowel ischemia after aortofemoral surgery and to improve their prophylaxis.

Materials and methods. 558 reconstructions of aorto-femoral zone in patients with Leriche syndrome and abdominal aortic aneurysms were analyzed. The frequency of bowel ischemia was investigated keeping in mind the type of surgery and revascularization of internal iliac and inferior mesenteric arteries.

Results. Bowel ischemia occurred in 12 cases (2.1 %). All patients with transmural necrosis have died (9 patients). Three patients with ischemia survived (25 %). The dependance of the bowel ischemia frequency upon revascularization of internal iliac arteries and inferior mesenteric artery in case of circulation in hypogastric arteries absence. No difference was found in incidence of this complication in patients with non-urgent aneurysms repair and operations due to Leriche syndrome and depending on the type of reconstruction (shunting or prosthesis).

Conclusions. The freqency of bowel ischemia after aortofemoral reconstructions does not depend on cause for reconstruction and type of operation (shunting or prosthesis). Revascularization of at least one of internal iliac arteries is one of the most important thing in prevention of the bowel ischemia if revascularization of inferior mesenteric artery is not conducted. If both internal iliac arteries are excluded from blood flow, reimplantation of inferior mesenteric artery leads to significant decrease in frequency of colon ischemia (from 15.6 to 2.3 %).

Keywords: bowel ischemia, reconstructive aortic surgery, diagnosis, treatment.



Surgical treatment of vena cava inferior thrombosis

B.M. Todurov

Objective. To study the possibilities and efficiency of the surgical treatment of vena cava inferior thrombosis (VCIT) of different genesis in artificial (ArC) or adjuvant (AdC) circulation.

Materials and methods. Article represents the experience of VCIT surgical treatment of different origin in 26 patients, including 6 patients with malignant renal tumours and extension of tumour thrombus into the inferior vena cava. 7 patients had VCIT in combination with pulmonary artery thromboembolism. All patients were 15 to 75 y.o. (mean — 45,6±7,2). Thrombectomy was fulfilled in ArC, heart fibrillation and moderate hypothermia in 18 cases, in AdC at working heart and normothermia — in 6 cases, without ArC — in 2 of them. Thrombectomy from pulmonary artery brunches in ArC, heart fibrillation and moderate hypothermia (below 31°C) was made in 7 patients.

Results. Surgical (intraoperative) mortality was 11,5 % (3 patients). The main reasons of deaths were acute heart failure (2 patients) and gastro-intestinal bleeding with disseminated intravascular coagulopathy (1 patient). Restored VCI permeability in 23 survived patients in post-operative period was verified by ultrasound examination. There were no signs of recurrent tumour and VCIT in patients with renal tumours after 3 to 12 months of operation.

Conclusions. VCI thrombectomy in artificial or adjuvant circulation is effective method of VCIT treatment, which leads to the restoration of VCI permeability and allows to avoid hemorrhages and thromboembolic complications. Artificial circulation in VCIT and pulmonary artery thromboembolism allows to fulfil single-stage thrombectomy from VCI and pulmonary artery.

Keywords: vena cava inferior thrombosis, tumour thrombus, pulmonary artery thromboembolism, cavathrombectomy, artificial circulation.



Application of retard pharmaceutical forms of pentoxifylline in the treat ment of intermittent claudication in patients with obliterating atherosclero sis of the lower extremities arteries

A.S. Nikonenko, P.I. Nikul'nikov, G.G. Vlaikov, A.A. Guch, A.A. Shtutin, V.V. Pertsov, E.V. Ermolaev

Objective. To study the clinical efficacy and tolerance of pentoxiphylline retard pharmaceutical forms in the treatment of intermittent claudication in patients with the lower extremities arteries obliterating atherosclerosis of IIa — IIb degree.

Materials and methods. Results of 140 patients with obliterating atherosclerosis and chronic arterial insufficiency of the lower extremities of degree IIa — IIb (by A.V. Pokrovsky classification, 1979) treatment were analyzed. Mean age was (62,6±6,3) years. The patients were divided into two groups, each of 70 patients, with obliterating atherosclerosis of the lower extremities arteries of degree IIa (group 1) or IIb (group 2) respectively. Twenty volunteers of 60 to 65 years of age with no signs of impaired lower extremities arteries haemodynamics have formed the control group. Medication was administered as a monotherapy to 124 patients, who did not require reconstructive surgery of the lower extremities arteries and to 16 patients on the stage of preoperative preparation. Pentoxifylline retard was administered in the doses of 600 mg (1 tablet) twice daily. Treatment duration was 1 month, including 10 days of in-patient treatment and 20 days — of an out-patient one. Tablets were taken in the morning and in the evening after meals with some water without chewing. In order to assess the efficacy of treatment, the dynamics of complaints (intermittent claudication), walking distance (increase or lack of substantial changes), changes in the regional systolic pressure (RSP) measured by Doppler sphygmomanometry in the posterior tibial arteries and condition of microcirculation measured by laser Doppler flowmetry (LDF) were analysed.

Results. At the end of the treatment course, statistically significant (p < 0.05) increase in the minimum painfree walking distance from (228,7±35,1) m to (373,6±42,5) m was mentioned in group I, and from (146,3±33,7) m to (239,4±33,7) — in group II. Maximum painfree walking distance also increased significantly (p < 0,05) from (188,7±26,1) m to (259,6±39,8) m in group II and from (263,4±31,8) m to (417,2±44,9) m in group I. In physical load test (walking at a rate of 60 steps per minute), the distance covered by patients without pain in the musculus gastrocnemius, was 2,5 times longer. It was increased from (187,4±22,8) m to (316,6±42,3) m in group I and from (95,8±25,8) m to (239,5±39,3) m in group II (p < 0,05). Results of the investigation made it possible to confirm the statistically significant improvement of the functional condition of microcirculation manifested by increase in the level of tissue perfusion and positive dynamics of functional tests as compared with the baseline values. Postural tests showed decrease in tissue perfusion in patients of groups I and II by (43,7±6,5) % and (38,4±5,9) correspondingly, and such decrease was statistically significant (<0,05) in patients of group II when compared with the baseline values. Valsalva test showed the decrease in skin perfusion by (21,6±2,1) % in patients of group I and by (16,4±1,9) % — in group II. Such values significantly (<0,05) differed from the baseline values. Reactive hyperemia test showed that the maximum tissue perfusion was (312,6±22,6) % in group I and (277,4±29,8) % — in group II. The changes in these values were statistically significant in group II (<0,05) when compared with the respective baseline values, whereas in group I, such values did not differ (>0,05).

Conclusions. Investigation of efficacy of pentoxifylline retard administration in 140 patients with obliterating atherosclerosis of the lower extremities arteries showed a positive clinical result in 100 % of patients with the disease of degree IIa and in 98 % patients — with degree IIb. The obtained clinical results were due to the improvement of microcirculation in the tissues of the lower extremities arteries as a result of the increase in perfusion from (59,6±9,3) to (64,6±9,7) perfusion units (PU) in group I and from (43,5±8,2) to (58,9±9,3) PU — in group II, relieve of peripheral vascular spasm and increase in the functional reserve of the microcirculatory bed. It became apparent by increase in skin perfusion in reactive hyperemia from (283,6±27,4) to (312,6±22,6) % in group I and from (210,7±28,2) to (277,4±29,8) % — in group II.

Keywords: pentoxifylline, obliterating atherosclerosis, intermittent claudication.



Condition of erythrocytic NOsystem in patients with primary pulmonary hypertension and its changes during the treatment with diltiazem

K.M. Amosova, N.M. Gula, Yu.I. Gubs'kyi, A.V. Kotsyuruba, E.M. Zadorin, L.F. Konoplyova

Objective. To evaluate condition of erythrocytic NO-system in patients with primary pulmonary hypertension (PPH) and its changes during the long-term treatment with calcium channel blocker (CCB) diltiazem.

Materials and methods. Erythrocytic NO-system of 10 patients with PPH and heart failure of NYHA III—IV during the treatment with diltiazem (180—360 mg, mean — 270 mg per day) was investigated. Pulmonary artery systolic blood pressure was 89 — 107 mm Hg (mean 98±9). Level of stable NO metabolites in blood erythrocytes — nitrite-anion (NO2) using Greace reactive; nitrate-anion (NO3) using brucine reactive — was evaluated. Activity of NO-synthase (2+-dependent — cNOS 2+-independent — iNOS) by spectrophotometric method was investigated. At the same time levels of hydrogen peroxide and protein, activity of arginase by urea formation, superoxide dismutase (SOD) activity were assessed. All patients were examines two times: at the beginning of investigation and after 6 months of treatment with diltiazem. Control group consisted of 10 healthy persons.

Results. Activity of cNOS decreased to (0,67 ± 0,24) pmol·min–1·mg–1 protein (versus (2,16 ± 0,19) in control group; <0,05), NO2— to (16,36 ± 2,13) pmol·min–1·mg–1 protein (versus 26,14 ± 2,29; <0,05) in erythrocytes of patients with PPH. Activity of NOS was elevated to (3,24 ± 0,58) pmol·min–1·mg–1 protein (0,61 ± 0,07 in control; <0,05), which led to increase in NO3 to (14,39 ± 1,38) nmol/mg protein (1,82± 0,13 in control; <0,05). The level of hydrogen peroxide rose to (17,87 ± 2,27) pmol·min–1·mg–1 protein (8,18 ± 0,68 in control; <0,05), that confirmed the activation of lipid peroxidation. Activity of SOD decreased to (3,23 ± 0,23) standard units/ml (7,17 ± 0,31 in control, <0,05). It contributed to the piling up of superoxide anionradicals, which took part in NO binding because of creating the toxic peroxynitrite, that may lead to disturbances in excretion of ATP by erythrocytes. ATP is helpful for synthesis of "useful" NO by endotheliocytes by means of cNOS. It promotes the decrease of NO level in vascular endothelium and causes elevation of pulmonary vascular resistance in PPH. During the treatment with diltiazem level of NOS was elevated to (2,83 ± 1,04) pmol·min–1·mg–1 protein (<0,05)and became normal. It was accompanied by NO2 increase to (44,09 ± 4,07) pmol·min–1·mg–1 protein (<0,05) and contributed to positive dynamics of the NO level in blood erythrocytes. They are donors for endotheliocytes. NOS activity, NO3 pool and 22 level were not changed: (5,35 ± 1,41) pmol·min–1·mg–1 protein, (15,15 ± 2,58) nmol/mg protein, (23,11 ± 9,50) pmol/mg protein, correspondingly. SOD activity increased to (6,56 ± 0,13) standard units/ml (<0,05). Thus, diltiazem promotes the elevation of active NO production in erythrocytes and improvement of ATP-secreting function, has positive impact on endothelial function.

Conclusions. Activity of cNOS in PPH patients erythrocytes is decreased and NO2 pool is reduced. It means that synthesis of NO, which takes part in vasodilatation, is diminished. Augmentation of iNOS activity is accompanied by NO3 pool elevation and activation of lipid peroxidation. It is confirmed by 22 level increase and reduced SOD. During the treatment with CCB diltiazem activity of cNOS and SOD in erythrocytes and NO2 pool are elevated.

Keywords: primary pulmonary hypertension, erythrocytes, NO-system, calcium channel blocker diltiazem.



Distribution dynamics of hospital patients with acute myocardial infarc tion according to age, sex and profession since 1985 till 1999

T.M. Solomenchuk, V.A. Skybchik

Objective. To follow the distribution dynamics of patients with acute myocardial infarction (AMI), admitted to the infarction unit of L'viv city emergency clinic over the period since 1985 till 1999 (for 15 years) according to age, sex and profession.

Materials and methods. Retrospective analysis of patients with AMI cohort for 15 years (since 1985 till 1999 yy.) in three periods (I — (1985—1989), (1990—1994) and (1995—1999)) based on archival documents of infarction unit of L'viv city emergency clinic according to age and sex was made. Able to work patients groups were analyzed by profession.

Results. Patients with AMI were predominately represented by men than women (65,0% versus 35,0% correspondingly). Sex ratio under the age of 44 was 9:1, at the age of 45—60 y.o. — 3:1, over 60 — 1:1. Women's portion in the I period was 32,5%, — 33,1% and — 38,7% (—<0,05%). At the same time women among all patients with AMI at the age of 45—60 increased from 21,6% to 26,6% (<0,05%). Among all women the part of patients under the age of 44 had decreased from 3,9% t 1,8% in its elevation for the patients over 60 from 67,0% t 76,7% (<0,05%). Absolute quantity of patients under 44 had the tendency to augmentation and in the I period was 222, in — 239, in — 227 at the expense of men (correspondingly, 191, 215 and 205 patients). But the part of young patients decreased from 9,0% in period to 7,1% in , and aged patients — increased from 47,2% to 61,7% (<0,05%). The low level of physician's attention was paid to collection of professional anamnesis. At the same time lack of knowledge limits the possible reasons and risk factors of myocardial infarction.

Conclusions. Ratio of admitted because of the AMI aged men and women is decreasing in comparison with younger patients. Since 1985—1989 period to 1995—1999 there was augmentation of women by 35,4% and of aged patients by 30,7%. Almost 2/3 of patients' jobs are connected with xenobiotics.

Keywords: myocardial infarction, age, sex, profession.



Problems of diagnosis and surgical treatment of brachiocephalic arteries occlusive and stenotic lesions due to atheroslerosis in ischemic heart disease

V.G. Mishalov, N.Yu. Litvinova

Review of the main data on surgical treatment of chronic brain circulation insufficiency caused by atheroslerotic stenoses of brachiocephalic arteries (BCA) with coexisting ischemic heart disease (IHD) is given in the article. Actuality of question is determined by frequent appearance of IHD in such patients as well as by influence of coexisting pathology on results of surgical BCA circulation reconstruction. Indications to operative reconstructive BCA treatment, stages of these operations in multifocal lesions, different methods of operations with their advantages and disadvantages, the main postoperative complications are given.

Keywords: atheroslerosic stenosis of brachiocephalic arteries, ishemic heart disease, surgical treatment.



Heart failure prophylaxis

O.Y. Zharinov

The main questions of heart failure primary and secondary prophylaxis by pharmacotherapeutical correction of the risk factors, based on the results of multicentral trials are widely covered. According to the results of EUROPA trial, longGterm administration of angiotensin-converting enzyme inhibitor perindopril in patients with chronic ischemic heart disease without left ventricle dysfunction allows to decrease the risk of heart failure development significantly. Prophylaxis of decompensation by ACE inhibitors and other neurohumoral use is the main direction of patients with compensated heart failure treatment.

Keywords: heart failure, left ventricle dysfunction, prophylaxis, angiotensinGconverting enzyme inhibitors.



Assessment of cardioselective betablocker nebivolol safety in patients with cardiovascular deseases and concomitant pathology of bronchopul monary system

M.M. Kozachok, M.M. Selyuk

Results of the modern trials of safety and clinical efficacy of cardioselective beta-blocker — nebivolol (5 mg/day) in patients with essential hypertension and ischemic heart disease accompanied by chronic obstructive lung disease were analysed in the article. Nebivolol was well tolerated, did not cause worsening of chronic obstructive bronchitis, bronchial asthma and spirometric parameters of respiratory function.

Keywords: essential hypertension, ischemic heart disease, chronic obstructive bronchitis, bronchial asthma, respiratory function, nebivolol.

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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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