We performed a complex study of central, cardiac and peripheral regional hemodynamics (PRH), neurohumoral activity, tolerance to dosed physical stress, as wells life quality evaluation and comparative efficacy of long-term (12 months) sole7 treatment with enalapril, atenolol, nitrosorbid and verapamil in 108 patients with a history of MI and mild heart failure, with a sinus rhythm at the baseline. We have shown enalapril to influence beneficially LV systolic and diastolic function, central hemodynamics, thromboxan-prostacyclin misbalance, enhanced PRH, decreased plasma norepinephrin and aldosterone activities by the end of the 1st week. Atenolol increased LV systolic and diastolic function by the end of the 2-3th month of treatment, in a stable manner decreasing HR, norepinephrin concentration, increased tolerance to dosed physical stress and enhanced PRH moderately. Nitrosorbid influenced central and cardiac hemodynamics in a moderate way, had no effect on neurohumoral activity, LV diastolic function; the studied values by the end of the 3-4th month were comparable with those at baseline. Verapamil had no influence on LV systolic and diastolic function, enhanced PRH, mostly in the arterial part of the vasculature, increased plasma aldosterone activity. Enalapril and atenolol are the drugs of choice in treating mild heart failure in patients with a history of MI as they exert beneficial effect on most of the pathogenetic aspects of heart failure and improve life quality.

We have studied values of daily blood pressure monitoring, echocardiography and blood reology in 75 patients (average age 57.5+1.3 years) with mild and moderate arterial hypertension with a various combination of metabolic risk factors (abdominal adiposis, NIDDM, altered glucose tolerance, dislipidemia.

We have shown that in most patients with arterial hypertension is combined with metabolic disorders aggravating the course of arterial hypertension. 

We have studied the incidence of vascular lesions in coronary, cerebral, renal and peripheral arteries and estimated sensitivity to hypotensive treatment with ACE inhibitor Enam and calcium antagonist amlodipine in 372 patients in order to19 Евсиков Е.М. - Характер сосудистых поражений и чувствительнось к гипотензивной determine the influence of obesity and baseline hyperinsulinemia on the mechanisms of arterial hypertension development and progression.

We have divided 372 patients (153 men and 219 women, aged 21-22) with chronic mild to severe (WHO classification 1996) arterial hypertension into 2 groups: 118 patients with mild to moderate hypertension and obesity (BMI ranging from 36 to 67) and baseline hyperinsulinemia (25-119 mIU/mL) and those without obesity and baseline hyperinsulinemia. The nature and frequency of the lesions were assessed by instrumental means including angiographic confirmation in part of the patients. We have determined the incidence of angina and coronary lesions in obese patients is higher in young age already, with the predominance of coronary, cerebral and peripheral form of vascular lesions becoming statistically significant after the threshold of 50 years. Decreased sensitivity to the hypotensive action of an ACE inhibitor enalapril and increased – to treatment by amlodipine, a calcium antagonist, was observed in obese patients. 

We have used the method of B-mode echo to study the values of cardiac hemodynamics: end systolic and diastolic volumes and ejection fractions for left atrium and left ventricle, mean pulmonary artery pressure, as well as LV mass in 74 patients on the 3rd, 10th and 30th days since the development of a q-MI. We have divided the patients into two groups based on the localization of the lesion. Our analysis has revealed that in those with anterior MI showed a more marked chamber enlargement and function impairment for left atrium and ventricle compared to patients with inferior infarction. In the early period of MI left atrium function is improved on the background of its dilation and is one of the compensatory mechanisms targeted at decreasing pulmonary hypertension. 

The study included 127 patients with various courses of angina and was targeted at the evaluation of myocardial functional condition with the usage of Doppler echo and Holter monitoring. LV systolic and diastolic functions, frequency, duration and prognostic relevance of silent ischemia episodes were assessed. Patients with acute coronary syndrome were divided into groups: 44 patients with I classunstable angina and 41 with I-II class unstable angina. Group of comparison consisted of 42 patients with stable angina II functional class. We have found the severity of myocardial ischemia to be directly related to the severity of angina. A severe course of ACS – unstable angina II-III class – is characterized by a high incidence and duration of silent ischemia episodes, as well as by unfavorable outcome. We have found impaired systolic and diastolic LV function in ACS. We have shown doppler parameters of transmitral flow in I class unstable angina to correlate with the I type of diastolic disfunction; a restrictive type of LV filling has been found in II-III class unstable angina. 

The aim of the study was to assess the presence and extent of hyperuricemia in patients with metabolic syndrome features of various severity, as well as possible relationship between altered purin metabolism and other components of the syndrome. We enrolled 97 patients suffering essential hypertension with a various number of metabolic syndrome components and without such and 13 normotensive patients with metabolic syndrome. Insulin, carbohydrate, lipid and purin metabolism were studied and echo was done in all the patients.

Uric acid concentration in patients with metabolic syndrome correlated reliably with the parameters of obesity, values of insulin metabolism, triglyceridemia, glycemia and renin-angiotensin-aldosterone system activity. Uric acid level of 415 мM and higher occurred reliably more often in patients with the clinical picture of the “deadly quartet” than in hypertensives without insulin resistance. Hyperuricemia in metabolic syndrome accompanied alterations in lipid metabolism and progressed with the severity of the metabolic syndrome itself.

We conclude that hyperuricemia is an alteration of metabolism characteristic of the syndrome of insulin resistance and suggest it be viewed as an integral component of the metabolic syndrome. 

Usage of olicard-40-retard in treatment of patients with unstable angina.

Long-term usage of various drug combinations in treatment of moderate to severe arterial hypertension: clinical efficacy, hemodynamics and heart morpho-functional values.

Antiarrhythmic effect of pentamin.

We have practiced courses of treatment with dipyridamol (Curantil, Berlin-Chemie), 25 to 225 mg daily, 1-3 months long, in 55 patients with congestive heart failure NYHA III-IV class in conjuction with baseline treatment with ACE inhibitors, prolonged nitrates and diuretics. Treatment efficacy was controlled by thromboelastography, ADP-induced platelet aggregation and bifunctional daily BP and ECG monitoring. A dose-dependent and modulating antiaggregating effect of dipyridamol has been shown in the study. The usage of 225 mg Curantil daily (75 mg 3 times a day) resulted in an antiaggregating action in the first day, however, it was characterized by a higher risk of hypotension with concomitant baseline vasodilating therapy. Considerable antiaggregating effect of 75 mg Curnatil daily (25 mg 3 times a day) and 50-25 mg daily developed by the end of the first and, respectively, second week of treatment; the risk of arterial hypotension was non-significant. We conclude that for long-term prevention in patients with CHF administration of Curantil 75-25 mg daily is preferable. Determining individual sensitivity to the chosen dose (by BP dynamics) is rational before initiating the treatment.

We performed a comparative evaluation of effectiveness of Energostim and refracterin in 58 coronary patients following 5 to 7 years after CABG and/or resection of post-MI LV aneurysm in which angina at effort or rest had recurred, heart failure NYHA I-IV had developed, with atherosclerosis progressing.

A 10-days course of Energostim in patients with NYHA I-II and LV EF of 45% (once the maximal effect of nifedipine, nitrates and aspirin has been reached) clearly decreases angina and heart failure severity, almost eliminates angina at rest, decreases by 50% the incidence of ST depression and results in a marked decrease of ventricular extrasystoles, accompanied by LV EF increased by 6.5% (p<0.01) and increased heart resistance to stress and improved life quality.

A 10-days course of Refracterin combined with diuretics, ACE inhibitors, nitrates and aspirin, performed in 31 coronary patients with NYHA III-IV and EF<45%, decreases the functional class of angina to a greater extent than traditional treatment, promotes deremodeling and increases pump function, decreases creatinine and urea levels, as well as atherogenity index, markedly improves life quality.

We therefore recommend Refracterin and Energostim as drugs of choice in the remote floow-up after CABG in patients with heart failure and arrhythmias.

Discussion points in pathogenetic treatment of acute coronary syndromes.

Pathogenesis of arterial hypertension in diabetes mellitus and adverse effects of hypotensive medications used.

Information of noncommercial welfared fund «Heart of Russia».

Newsletter on the Russian national Congress of Cardiology “Effectiveness and Safety of Diagnosis and Treatment”.

The newsletter concerning the 2-nd European Meeting on Vascular Biology and Medicine.