Drug therapy of cardiovascular diseases: data of evidence-based medicine and clinical practice.

In the present study we summarize our fist experience in multi stage Surgical reconstruction of left ventricle, heart valves and coronary arteries in patients with the end stage dilated cardiomyopathy. 21 patients (aged 24 to 63) had been operated on during last 3 years. Five patients were presented with idiopathic cardiomyopathy and 13 – with ischemic cardiomyopathy. All patients were in NYHA class lll and lV. Cardio-thoracic ratio was more then 60% in all cases. Mean LV diastolic volume was 283,6±93,7 ml, mean LV diastolic diameter - 76,8±9,1 mm, ejection fraction 25,7±5,8%. Mean LV and diastolic pressure ranged 15-62 mm Hg. Coronary stenoses (1 to 3 arteries) were presented in all patients with ischemic cardiomyopathy. Mitral regurgitation (grade II-III ) was found in all patients and associated with tricuspid insufficiency. Five patients suffered from atrial fibrillation. Three types of procedure were performed including Batista procedure (1), mitral and/or mitral-tricuspid annuloplasty (5), Dor procedure with mitral annuloplasty and CABG where necessary (13). Four patients died postoperatively. All survivors demonstrated significant clinical improvement (2 shifted to NYHA class III and 9 – to NYHA class II) with reduction of cardio-thoracic ratio and increasing of ejection to 37,5-4,1%.

The aim of the study was to study the values of singal-averaged ECG and heart rate variability in patients with increased left ventricle mass. We have studied 105 cardiovascular patients. Left ventricle myocardial mass was measured by the method of PENN-convention, SAECG and HRV – with the help of computer complex “Kardiosistema-3”. Depending on the LV mass index, all patients were divided into groups with normal LV mass, concentric and excentric hypertrophy. We have revealed that increased LV mass is followed by increased QRSf and LAS40, decreased RMS and standard RR deviation. These changes closely correlate with the presence of high grade ventricular arrhythmias and can be used as markers of electrical instability of the myocardium in this group of patients.

We have studied 43 patients aged 15 to 18 with ventricular pre-excitation through the Kent bundle. A complex examination included ECG, echocardiography, Holter monitoring, transesophageal stimulation, and transesophageal ECG. The phenomenon of WPW was noted in 20 persons, WPW syndrome in 23. We have shown the influence of vegetative nervous system on the AV-conduction and an extra conducting pathway. A constant and transitory variant of ventricular pre-excitation was noted in the absence of high vagus tone. A hidden variant of pre-excitation is related to a significant vagus influence. In adolescents prone to high sympathetic tone ventricular pre-excitation through the Kent bundle is manifested as the WPW syndrome whereas the WPW phenomenon is observed with the nervous system inclined to a more pronounced vagal tone. Transesophageal stimulation with atropin is indicated for adolescents to assess the nature of pre-excitation through the Kent bundle adequately and reveal arrhythmias.

We have studied the nature of structural and electrophysiological changes in the heart in various forms of paroxysmal atrial fibrillation (PAF) to determine predictors of an onset and relapse. We have studied 438 patients with PAF, including 68 with the first paroxysm, 92 with rare and 278 with frequent PAF. All patients underwent echocardiography, transesophageal electrophysiology study and Holter monitoring. We have revealed a reliable and appropriate increase in left atrium size, atrium / ventricle ratio, and also decreased frequency threshold of arhythmia induction, left atrium effective refractory period, increased duration of an induced paroxysm and maximal atrial response compared to the control group and as PAF progresses. Regardless of PAF severity a high correlation was established between left atrium size and electrophysiological parameters characterizing atrial arrythmogenic “readiness”, which underlines the provoking role of left atrium dilation. 

High grade pulmonary hypertension (HGPH) determines invalidization, low quality of life and causes fatal outcomes. Aim of the study: to use echocardiography to evaluate the morphological and functional condition of ventricular myocardium and criteria determining prognosis. Materials and methods: 40 patients with HGPH aged 3 to 56 underwent echocardiography for the period of 1999-2000 in the Center and were divided into the following groups: 1) patients with congenital heart disease and Eisenmenger complex (22); 2) patients with progressing pulmonary hypertension after a vicium cordis is corrected; 3) patients with primary pulmonary hypertension (PLH) (11). Echocardiography was used to evaluate: systolic function – ejection fraction for each ventricle, fractional change in right ventricle, cardiac index of the greater circle; diastolic function of the ventricles, LV excentricity index, reflecting septum geometry, the degree of RV hypertrophy, end diastolic square of the right ventricle, hemodynamics of the lesser circle. Results: in patients with progressing pulmonary hypertension after a vicium is corrected and in patients with pulmonary hypertension we have revealed RV dysfunction and decreased cardiac index of the greater circle which defines a severe clinical course of the disease. In a group with NYHA IV we observed a marked decrease in RV systolic function, impaired RV diastolic function in a restrictive way and decreased cardiac index of the greater circle. In patients with a septum defect and Eisenmenger complex RV diastolic function was not impaired in a restrictive way (end diastolic pressure in RA and RV not increased), despite significantly dilated right heart chambers, decreased RV systolic function and cardiac index of the greater circle. Therefore we draw a conclusion that a defect levels RV failure defining a favorable prognosis. Preserved ventricular systolic function, their hypertrophy and normal cardiac index of the greater circle is typical in most cases of septum defects, persisting ductus arteriosus and Eisenmenger complex. The severe clinical course is defined by a significant hypoxemia, playing an important role in the impairment of either ventricle.

80 patients with essential hypertension were studied to evaluate the relationship between impaired sympathetic function and the way of LV remodeling in its hypertrophy. We measured daily catecholamines excretion, the degree of LV mass increase and the character of LV geometry alterations. We have found that in LVH with different ways of remodeling impairments in the sympathetic function were registered having common principles and peculiar features. In both excentric and concentric ways of LVH daily catecholamines excretion was observed to increase as LV mass grew, as well as the development of hormonal-mediator dissociation reaching its peak in marked LVH, and decreased reserve potential of catecholamines synthesis in significantly increased LV mass, as proved by decreased DOPA secretion. The peculiar feature of altered sympathetic function are different inclines in catecholamines excretion depending on the variant of LV remodeling. In the excentric variant we observed a pronounced activation of the mediator branch, appearing in early stages of increased LV mass and progressing alongside LVH. In concentric hypertrophy the hormonal branch was activated in early and marked LVH. The results point that the nature of sympathetic impairments in LVH depended on LV geometry rather than the increase of LV mass in patients with essential hypertension. 

The aim of the study was to evaluate the influence of electromagnetic radiation of the millciimeter lengths on the clinical course of myocardial infarction and the patients’ functional condition as assessed by veloergometry. We have studied 238 patients with myocardial infarction, including 164 men. 184 had primary and 54 – relapsing infar_ction. All patients were divided into 3 groups depending on the treatment regimen used: the studied one (n=121) with radiation since the first days in conjunction with conventional therapy, controls (n=67) with conventional therapy only and the placebo group (n=50). Radiation added to the standard treatment of myocardial «infarction reduced the incidence of complications, embolism and relapsing MI in particular.

Antihypertensive efficacy and metabolic influence of long-acting calcium channel blocker – altiazem RR (diltiazem) was studied in 18 mild hypertensive patients with dislipoproteinemias. It was established that the daily use of 180 mg of49 the drug led to the effective control of blood pressure in majority of pts.The drug provided 24-hour control of blood pressure and induced mild decrease of pulse rate. Moreover, it appeared to be metabolicaly neutral : it did not affect lipid prоfile and blood glucose level. We conclude that altiazem RR is a modern drug of choice in hypertensive pts with accompaning metabolic disorders. 

We have examinated 106 patients with primary acute myocardial Q-infarction. Favourable effects of carvedilol on basic parameters of central, intracardial and peripheral hemodynamic was identificated. Carvedilol did not increase general peripheral vascular resistance during long-term carvedilol administration. It is determined that carvedilol contributes to decrease in left ventricular volume values in patients with acute myocardial infarction by reducing pre- and postloading. The drug improves myocardial contractility, and so does transmitral blood flow parameters. Carvedilol promotes to stabilization left ventricular systolic and diastolic function of patients with primary acute myocardial infarction. The treatment with carvedilol reduces end-systolic size (7,1%) and volume (14,3%), general peripheral (28,5%) and specific peripheral (14%) vascular resistance. Carvedilol increases ejection fraction (14%), fraction shortening (10,1%). 

We studied the effectiveness and safety of administration of the extended-action calcium antagonist Nifedipin-Retard (Cordaflex-Retard, EGIS) in 30 patients with arterial hypertension of the 1st and 2nd degree. The study included general clinical examination, round-the-clock monitoring of the arterial pressure (AP) and of the heart rate (HR). Before the therapy and after 6 months of monitoring, examination was performed to assess the life quality and the risk factors, as well as the quantity and quality of health. Cordaflex-Retard was administered depending on the initial AP, in the daily dose of 20 to 40 mg during 24 weeks. We found not only hypotensive action with the AP level stabilization, but also reduction of the magnitude and the rate of the SAP morning rise, as well as a greater degree of the night dipping of the SAP and DAP, accompanied by improvement of the life quality. 

A few words on the history and perspectives of phramacotherapy of arrhythmias.

ECG interpretation.

A case of dilated cardiomyopathy in a patient treated from acute leukemia.

A case of right ventricle idiopathic impairment, data of a cardiology unit.

The role of cholesterol provision functional system in the development of atherosclerosis.

The background of the hypothesis of the involvement of bacterial lipopolysaccharides in initiation and development of atherosclerosis is presented. Special accent is done on the incidence of endotoxinemia, the time of persistence of bioactive endotoxin in the tissues, association between atherosclerosis and Gram-negative infections, plasma and cellular targets and proatherogenic effects of endotoxin. Suggestion on the possible role of LPS-lipoprotein complexes is proposed and detaily discussed. Literature data on the endotoxin effects upon lipoprotein metabolism and foam cell formation are presented. 

Propaphenon: clinical pharmacology and efficacy in supraventriculаr tachyarrhythmias (Part 1).

In September 2000 and January 2001 3 documents concerning the treatment and diagnosis of acute coronary syndrome without sustained ST segment elevation were published: recommendations of expert groups of the American College of Cardiology / American Heart Association (ACC/AHA), European Society of Cardiology and materials of the 6th Consensus Conference of the American College of Physicians on antithrombotic treatment. The data concerning antithrombotic treatment of coronary ex-acerbations are summarized in this report.

To the 75-th birthday of F.Z.Meerson.

To the 60-th birthday of V.L. Docshitsin.

To the 50-th birthday of E.M. Evsikov.

European Heart Journal (2001) 22, 1151-1153.