Vol 79, No 6 (2004)

Evgeny Ivanovich Chazov (the 75th anniversary of birth)
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Terapevticheskii arkhiv. 2004;79(6):6-8
Outlook from the past to the future
Chazov E.I.
Terapevticheskii arkhiv. 2004;79(6):8-15
Pilot results of stenting bifurcation stenoses of coronary arteries
Belenkov Y.N., Matchin Y.G., Savchenko A.P.
Aim. To study effectiveness of various types of coronary stenting in bifurcation stenoses. Material and methods. Fifty six patients with bifurcation stenoses were divided into 2 groups: stenting of the basic and side branch of the coronary artery (CA) was made in group 1 patients (n = 27), stenting of the basic branch and balloon angioplasty of the side branch were made in group 2 (n = 29). Primary clinical and angiographic response reached 96 and 90% in groups 1 and 2, respectively. Complications were absent in group 1, occurred in 13.7% cases in group 2 (the difference was insignificant). One year after the procedure lethal outcomes were absent. The number of unfavourable clinical outcomes was higher in group 1 (25.9 and 13.7%, respectively, p = 0.4). The rate of restenoses detected angiographically was not significantly different in group 1 and 2 (33 and 26%, respectively). Conclusion. Stenting of bifurcation stenoses brings about good short-term and satisfactory long-term results in most of the patients. The rate of the complications was low. Two stents implantation (in basic and side branches) has no significant advantages over stenting of the basic CA and balloon angioplasty of its side branch.
Terapevticheskii arkhiv. 2004;79(6):16-22
Prevention of cardiovascular diseases in Russia: successes, failures, prospects
Oganov R.G.
Terapevticheskii arkhiv. 2004;79(6):22-24
New approaches to treatment of ischemic heart disease: therapeutic angiogenesis in combination with surgical revascularization of the myocardium
Bockeria L.A., Golukhova E.Z., Eremeeva M.V., Kiselev S.L., Aslanidi I.P., Vakhromeeva M.N., Klyueva A.F., Polyakova E.S., Lukashkin M.A.
Aim. To evaluate the results of surgical treatment of patients with ischemic heart disease in combination with intraoperative intramyocardial introduction of the human gene VEGF165 (angiostimulin). Material and methods. Twenty four patients enrolled in the study were examined using 12-lead ECG, echocardiography, treadmill exercise test, single-photon emission computed tomography of the myocardium with Tc-99m-tetrophosmine, fluorodesoxyglucose (FDG) positron-emission tomography of the myocardium, selective coronarography. Out of 24 patients, 10 patients have been reexamined so far. The effect of the treatment was assessed by the data obtained at the treadmill test, transthoracic echocardiography, myocardial scintigraphy and FDG. Results. All the patients demonstrated a clinical response. The class of effort angina improved, the dose of the prescribed nitric drugs was decreased, exercise tolerance and total stress time rose, quality of life improved. Myocardial scintigraphy registered reduction of the total area and better accumulation of the radiopharmaceutical under load and at rest 3 and 6 months after the operation including myocardial areas which had not been revacularised at coronary artery bypass grafting but had been treated with the preparation of the human gene VEGF165. Conclusion. The results of the study suggest that therapeutic angiogenesis may be an alternative impact on those myocardial areas which are suppled by the affected but ineligible for bypass grafting coronary arteries.
Terapevticheskii arkhiv. 2004;79(6):25-30
Polymorphic markers of GNB3 (C825T), AGTR1 (A1166C) and ACE (A2350G and I/D) genes in patients with arterial hypertension combined with diabetes mellitus type 2
Karpov R.S., Puzyrev K.V., Koshelskaya О.A., Makeeva O.A., Suslova T.E., Efimova E.V., Falkovskaya A.Y., Atroshenkov A.V.
Aim. To elicit correlations of polymorphic markers of GNB3 (C825T), AGTR1 (АП66С), ACE (A2350G and I/D) genes with arterial pressure, left ventricular hypertrophy (LVH) and blood concentrations of proinflammatory cytokines in hypertensive patients with diabetes mellitus type 2 (DM2). Material and Methods. Clinical parameters (24-h arterial pressure profile, echocardiographic findings, immunoenzymes level) were studied in 89 hypertensive patients with DM2. These patients had different genotypes by the studied allele variants of the genes determined by polymerase chain reaction. Results. Polymorphism ofA1166Cgene of type 1 vascular receptor of angiotensin II (AGTR1) contributes to formation of arterial hypertension (AH) signs diversity in DM2 patients. GNB3, a gene C825T polymorphic marker, showed a correlation with diastolic arterial pressure but this variant of the gene locus is not associated with LVH. However, G-allele of ACE gene contributes much to appearance of this pathological sign. Mean values oflL-lfi and TNF-a as well as the presence of LVH depended on genotypes by ACE gene (polymorphism I/D). Conclusion. Polymorphic markers of ACE and GNB3 candidate genes influence clinical diversity of pathological signs in DM2 patients through modification of AH and LVH severity and the level of proinflammatory cytokines.
Terapevticheskii arkhiv. 2004;79(6):30-35
Ethnic differences in apolipoprotein В levels in hyperlipidemia in Russians and the Kirghiz
Mirrakhimov E.M., Noruzbaeva A.M., Lunegova O.S., Afanasyeva M.I., Adamova I.Y., Pokrovsky S.N., Poroschai E.N., Mirrakhimov M.M.
Aim. To evaluate the levels of apolipoprotein В (apo-B) and coronary heart disease (CHD) risk factors in Russians and the Kirghiz with primary hyperlipemia (PHL). Material and methods. Lipid spectrum of the blood (LDLP and HDLP cholesterol, total cholesterol, triglicerides), apo-B, CHD risk factors were studied in 60 Russian and 75 Kirghis patients with PHL aged 28 to 67years (mean age 50.0 + 7.59 years, 56females and 79 males). Results. In Russians a mean level of LDLP cholesterol and apo-B was significantly higher than in Kirghiz patients (3.95 + 1.29 mmol/l vs 3.51+1.17 mmol/l, p = 0.042; 173.3+ 57.3 mg/dl vs 145.5 + 49.3 mg/dl, p = 0.003, respectively). CHD in both ethnic groups occurred with similar rates. The multifactorial regression analysis shows that an apo-B concentration can serve an independent risk factor associated with CHD in the Kirghiz population (p = 0.25, p = 0.03) while in Russians living in Kirghizia this factor is a low content of HDLP cholesterol (p = -0.25, p = 0.05).
Terapevticheskii arkhiv. 2004;79(6):35-39
Cardiorenai interactions: ciinicai indications and roie in pathogenesis of cardiovascular and renal diseases
Mukhin N.A., Moiseev V.S., Kobalava Z.D., Moiseev S.V., Fomin V.V.
Terapevticheskii arkhiv. 2004;79(6):39-46
Detection of sodium monourate crystals in biopsies of gastric mucosa in gout patients
Nasonova V.A., Zakharova M.M., Barskova V.G., Karateev A.E., Fedorova A.A., Yakunina I.A., Nasonov E.L.
Aim. To examine gastric biopsies with polarization microscopy for detection of sodium monourate crystals (SMC). Material and methods. The trial included 20 patients with gout diagnosis (mean age 55.7years, mean duration of the disease 12.3 years)in whom esophagogastroduodenoscopy was made with biopsy of gastric mucosa from the antral part of the stomach and middle third of the gastric body. Results. Crystals in the biopsy specimens were detected in 11 of 20 examinees. The crystals were characterized by strong double refraction, length 3-20 mem, acicular or planiform shape, blue or yellow color depending on position in compensated polarized light. Quantitative distribution of the crystals within one biopsy specimen was uneven and varied from solitary crystals to clusters of 70-80 crystals in sight, up to formation of tophus-like structures. Clinical picture in detection of SMC was characterized by more frequent occurrence of cases with subcutaneous tophuses of various location combined with higher hyperuricemia. Conclusion. One of the essential lines in the research of gout concerns mechanisms of SMC formation in organs and tissues and microcrystalline gastroduodenal inflammation. Methods of correction of this inflammation are to be designed.
Terapevticheskii arkhiv. 2004;79(6):47-51
Moleculargenetic and cellular aspects of heart and vessel remodeling in essential hypertension (review)
Shlyakhto E.V., Konradi A.O., Moiseeva О.М.
essentia!hypertension, heart, vessels, remodeling, genetics
Terapevticheskii arkhiv. 2004;79(6):51-58
Pilot experience with clopidogrel in the treatment of an .ST-elevation acute myocardial infarction
Shalaev S.V., Vorobyeva N.M., Serescheva A.K., Petrik E.S., Akinina S.A.
Aim. To examine efficacy of clopidogrel before thrombolytic therapy (TLT) in patients with acute myocardial infarction (AMI). Material and methods. A total of 72 patients (48 males and 24 females) admitted to hospital within 6 hours since the onset of acute myocardial infarction (AMI) were divided into three groups. Group 1 and 2 patients (n = 38 and 20, respectively) were given a prehospital stress dose of aspirin (250- 500 mg), group 3 patients (n = 14) received this dose at admission. TLT with streptokinase or actilise (1500000 IU and 100 mg, respectively) was given to all the patients. Before TLT group 2 received a stress dose of clopidogrel (300 mg), after TLT - 75 mg/day. 12-Lead ECG, CFK activity and troponine content examinations were made. The patients were observed for 30 days. The recovery of coronary circulation (CC) was evaluated by dynamics of a total lowering of the elevated ST segment. Results. CC completely recovered 60 min after TLT in 16, 10 and 7% patients of groups 1, 2 and 3, respectively. CC recovered partially in 24, 55 and 7% patients, respectively. In 90 min after TLT partial recovery of CC was observed in 21, 31 and 43%, respectively; in 180 min the effect was absent in 19, 15 and 38%, respectively. 30-Day lethality was 11.1% and was high in group 3. No lethal outcomes were seen in group 2. Conclusion. It is possible to achieve better myocardial reperfusion after TLT and improve 30-day outcomes in MI patients given combined antithrombocytic therapy.
Terapevticheskii arkhiv. 2004;79(6):58-62
Lipemia after fat loading and atherosclerosis of coronary arteries: correlation of expression
Bubnova M.G., Aronov D.M., Perova N.V., Mazaev V.P.
Aim. To examine relationships between lipemia, atherogenicity of blood lipoproteins spectrum after fat loading (FL) and severity of angiographic manifestations of coronary atherosclerosis. Material and methods. The study enrolled 72 males free of ischemic heart disease (IHD) - group 1; 60 IHD patients with moderate affection of the coronary arteries (CA), i.e. maximal narrowing of one CA 50% - group 2; 107 IHD patients with severe CA affection, i.e. CA narrowing > 50% - group 3. FL was given by J. R. Patsch technique, blood sampling was made before meal, 3 and 6 hours after FL. Results. It was shown that intake of food fats in IHD and IHD-free patients stimulated development of postprandial lipemia of different severity and duration. It appeared due to increased fraction of lipoproteins rich in triglycerides. In group 2 and 3 there was a definite and up to 6 hours in duration postprandial hypertriglyceridemia associated with proatherogenic deviations in lipid and protein components (LDL and HDL) by FL hour 6: growing of LDL cholesterol, apoB, apoB/apoAI and lowering of HDL cholesterol and apoAI. Patients with severe CA atherosclerosis (> 50% narrowing of three CA) had the most severe atherogenic affections in the postprandial lipoprotein spectrum. Conclusion. Postprandial lipemia/hyperthglyceridemia and atherogenic changes in the spectrum of lipoproteins after FL correlate directly with angiographic manifestations of coronary atherosclerosis.
Terapevticheskii arkhiv. 2004;79(6):62-67
Hyperhomocysteinemia and acute phase proteins in various forms of ischemic heart disease
Paramonov A.D., Moiseev S.V., Fomin V.V., Kopeleva M.V., Stankevich L.I., Martynov A.I., Mukhin N.A.
Aim. To determine clinical significance of high concentrations of homocystein, C-reactive protein, fibrinogen in various forms of ischemic heart disease. Material and methods. Enzyme immunoassay was made to measure serum concentrations of homocystein, C-reactive protein, fibrinogen in 60 patients with ischemic heart disease (IHD) in the form of stable effort angina (n = 20), painless myocardial ischemia (n = 19), unstable angina pectoris (n = 21) and 20 control patients free of IHD. Myocardial ischemia was confirmed at dobutamine stress echocardiography. Results. Serum concentrations of homocysteine, C-reactive protein and fibrinogen were higher in patients with unstable angina than in the other examinees with IHD. A statictically significant correlation exists between homocysteine serum levels and acute phase proteins (C-reactive protein, fibrinogen) in patients with unstable angina. In the other groups it was absent. Conclusion. Correlation between serum levels of homocysteine and acute phase proteins in patients with unstable angina suggests a direct participation of this amino acid in destabilization of atherosclerotic plaques and development of acute coronary syndromes.
Terapevticheskii arkhiv. 2004;79(6):67-70
Characteristics of atherosclerotic lesion of the abdominal aorta and its unpaired visceral branches in patients with chronic abdominal ischemia
Schupakova A.N., Litvyakov A.M.
Aim. To study characteristics of echocardiographycally detectable structural changes of the abdominal major arteries due to atherosclerosis with consideration of clinical symptoms. Material and methods. 174 participants of the study had chronic abdominal ischemia (CAI). 20 healthy individuals served as control. The analysis was made of the data obtained at clinical laboratory tests, endoscopic and x-ray examinations, ultrasound investigation (USI) of the abdominal organs, USI of abdominal arteries in B-mode, transabdominal USI of the vertebral column. Results. Echographically detectable signs of atherosclerotic affection of abdominal arteries in CAI patients are the following: increased lumen of the abdominal aorta (AA), unpaired visceral arteries in proximal and/or distal parts, relative narrowing of unpaired visceral arteries at the site of their origin from the aorta, lengthening of the abdominal aorta, S-shape configuration of the aorta on the longitudinal sections, thick aortal wall, unpaired visceral arteries, uneven thickness of the wall, plane foci of high echogenicity on the internal surface of the vascular wall, single or multiple hyperechogenic foci responsible for partial obstruction in the vessels. Conclusion. Degenerative changes of the intervertebral disks and corresponding atherosclerotic changes of the abdominal aorta, atherosclerotic affection of the unpaired visceral arteries may cause abdominal pain syndrome in CAI patients.
Terapevticheskii arkhiv. 2004;79(6):70-74
Cerebrovascular complications in metabolic syndrome: possible approaches to a lower risk
Chazova I.E., Mychka V.В., Mamyrbaeva К.М., Gornostaev V.V., Dvoskina I.M., Sergienko V.B.
Aim. To compare brain perfusion in hypertensive patients with diabetes mellitus type 2 (DM2) or metabolic (MS) syndrome and hypertensive patients without clinicobiochemical signs of DM2 or MS; to study enoxapahn effects on brain perfusion in DM2 and arterial hypertension (AH). Material and methods. Seventy patients included in the study were divided into three groups: 30 patients with DM2 and AH (group 1), 30 patients with MS and AH (group 2)and 10 AH patients without manifestations of MS or DM2 (group 3). All the patients have undergone single-photon emission computed tomography (SPECT) of the brain, carbohydrate and lipid metabolism were examined. Results. Deterioration of brain perfusion was more prominent in DM2 and MS patients with AH than in hypertensive patients with normal metabolism. Stress test with acetasolamide revealed defective autoregulation of cerebral blood flow in hypertensive patients with DM2. A 6-week therapy with enoxapahn significantly improved brain perfusion in hypehensive patients with DM2. Conclusion. Enoxapahn treatment of hypehensive DM2 and MS patients with abnormal perfusion of the brain can be used for prevention of cerebrovascular complications.
Terapevticheskii arkhiv. 2004;79(6):74-80
Peculiarity of hypotensive efficacy in hypertensive patients with desaturation signs of obstructive sleep apnea syndrome
Zelveian I.A., Oschepkova E.V., Buniatian M.S., Rogoza A.N.
Aim. Го estimate the efficacy of 8-week antihypertensive monotherapy in patients with arterial hypertension (AH) regarding the presence of obstructive sleep apnea syndrome (OSAS). Material and methods. We analysed the results of 24-h blood pressure (BP) monitoring of 26 inpatients (mean age 54 ± 2 years) with mild (n = 18) and moderate (n = 8) AH before and after 8 weeks of treatment with 5-10 mg amlodipine or 50-100 mg of losartan once daily to assess blood pressure profile parameters. The patients underwent nocturnal monitoring of arterial oxygen saturation (pulsoximeter NONIN-8500 M, USA). The presence of OSAS was confirmed when a characteristic clinical picture was combined with the presence of significant (> 4%) sleep desaturation episodes > 15 episodes per hour or the presence of group desaturation episodes below 90%. Seven hypertensive patients with OSAS were assigned to group 1, nineteen patients without OSAS - to group 2. The differences in estimated parameters between the groups were tested by Mann-Whitney U test, the dynamics of BP profile parameters - by Wilcoxon matched pairs test. Results. In group 1 there were no significant differences by most of ВР profile parameters before and after antihypertensive treatment, except mean nocturnal systolic BP. In group 2 a significant hypotensive effect was seen by all parameters of BP profile except BP variability. Hypotensive efficacy in group 2 was 1.5-2 times higher vs group 1, but the difficulties were not significant. Conclusion. Antihypertensive therapy in hypertensive patients with OSAS is less effective than in those without OSAS but it is not uneffective.
Terapevticheskii arkhiv. 2004;79(6):81-84
Blockers of angiotensin receptors: a novel approach to treatment of secondary pulmonary hypertension
Butorov I.V., Verbitsky О.N., Butorov S.I.
Aim. To evaluate efficacy of losartan, a blocker of angiotensin receptors, in combined treatment of secondary pulmonary hypertension (SPH) in patients with chronic obstructive bronchitis (COB). Material and methods. Losartan effects on hemodynamics, blood gases and clinical course of the disease were studied in 29patients with COB and SPH (mean age 52 ± 1.7years). A control group consisted of 15 patients (mean age 51 ± 1.5 years) treated with cardiac glycosides and diuretic drugs. Aland B-mode Doppler echocardiography registered hemodynamic parameters. 24-h monitoring of AP and ECG were made by standard methods. Blood gases and venous rheology were examined. Results. Losartan administration in COB patients with SPH improved hemodynamics. Stroke index rose from 36.3 ± 2.1 to 45.8 ± 2.1 ml/m1 (by 26.2%, p < 0.01) in SPH functional class III, from 26.3 ± 1.9 to 32.7 ± 2.1 ml/m2 (by 24.3%, p < 0.01) in functional class IV. Cardiac index rose by 22.2 and 21.1%, respectively. Pulmonary hemodynamics improved too: systolic pressure in pulmonary artery fell by 25.7% in functional class HI, by 18.6% in functional class IV. Losartan normalized a 24-h AP profile, reduced the number of painless myocardial ischemia. Conclusion. Use of losartan in combined therapy of patients with COB and SPH improves clinical status of the patients, corrects basic cardiohemodynamic parameters, has a positive effect on AP profiles without negative impact on blood gas composition and rheology.
Terapevticheskii arkhiv. 2004;79(6):84-87
Amiodarone (cordarone) efficiency in atrial extrasystoles
Reingardene D.I., Azaravichene A.P.
Aim. To assess antiarrhythmic amiodarone efficacy of suppressing atrial extrasystoles resistant to other antiarrhythmic modalities. Material and methods. The antiarrhythmic effect of amiodarone was studied in 70 patients (38 males, 32 females, mean age 49.6 ± 1.7 years, mean duration of arrhythmia 4.9 ± 1,5 years). The loading oral dose of amiodarone was 600-1200 mg/day for 10 days, mean maintenance dose - 1656.25 mg a weak, mean duration of treatment - 27.5 ± 3.2 months. The response to amiodarone was estimated by repeated 24-h Holter monitoring. Results. A complete response was observed in 78.5% patients in loading and in 65.7% patients in maintenance therapy. A partial antiarrhythmic response was seen in 8.57 and 16.41% patients, respectively. Conclusion. Amiodarone is a basic drug against ventricular arrhythmia. Its effectiveness in suppression of atrial extrasystole is weaker but also appropriate.
Terapevticheskii arkhiv. 2004;79(6):87-89
Cardiac arrest in a patient with obstructive sleep apnea
Litvin A.Y., Pevzner A.V., Mazygula E.P., Nesterenko L.Y., Galyavi R.A., Galitsyn P.V., Kalinkin A.L., Chazova I.E., Golitsyn S.P.
Terapevticheskii arkhiv. 2004;79(6):89-91
Pseudopacemaker syndrome (pacemaker syndrome in the absence of artificial pacemaker)
Kharash L.M., Kinzbrown A.I.
Terapevticheskii arkhiv. 2004;79(6):91-93
Aquired deficiency in the system of proteins С and S and acute myocardial infarction
Ryabov V.V., Stolyarov V.A., Kapilevich N.A., Gerbolinskaya T.A., Markov V.A.
Terapevticheskii arkhiv. 2004;79(6):93-94
Endothelium a new target for a therapeutic action of ACE inhibitors
Karpov Y.A.
Terapevticheskii arkhiv. 2004;79(6):94-96

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