Vol 80, No 12 (2008)

Aim. To study prevalence of androgen deficiency and its relations with clinicopsychological disorders in males with ischemic heart disease (IHD). Material and methods. A total of 87 males aged 31-60 years (58 with stable angina of effort FCII- III, 29 with progressive angina of effort) participated in the study. Clinical symptoms of androgen deficiency, severity of anxiety and depression, quality of life were characterized with scales AMS, HADS, D.M. Aronov and V.P. Zaitsev method (2002), respectively. Left ventricular myocardial mass (LVMM) was calculated according to R.Devereux and N. Reichek formula. Results. Symptoms of male sexual hormones deficiency were seen in 67.8% examinees. In the age groups 31-40, 41-50, 51-60 years androgenic deficiency was diagnosed in 50, 85.7 and 82.9% patients, respectively. A direct correlation was found between androgenic deficiency and total cholesterol (R = 0.38), prothrombin index (R = 0.39), LVMM index (R = 0.48), severity of depression (R = 0.71), anxiety (R = 0.5) and inverse correlation - between androgenic deficiency and quality of life (R = -0.69). Conclusion. Young and middle-aged patients with ischemic heart disease have symptoms of androgenic deficiency in 67.8% cases. This fact necessitates screening testing of such patients with AMS questionnaire. Male sex hormones deficiency is associated with high anxiety and depression, while quality of life is subnormal.

Aim. To compare effects of atorvastatin treatment and carbohydrate metabolism compensation on lipid spectrum and a C-reactive protein (CRP) level in patients with type 2 diabetes mellitus (DM). Material and methods. The lipid spectrum was studied in a random sample of 165 patients (66 males, 99 females) with type 2 DM (age median 57 years, duration of the disease 7 years). Out of this sample 26 patients with LDLP cholesterol > 3 mmol/l were randomized into 2 groups. The study group received 20 mg/day atorvastatin for 3 months, the control group received no inhibitors of GMG-Coa-reductase. The patients' blood was tested for glycosylated hemoglobin, aminotransferase, creatinphosphokinase, total, HDLP, LDLP cholesterol. Results. Changes in the lipid spectrum were detected in 98.2% patients, 42.4% of them had combined dyslipidemia: elevated total cholesterol (TC), LDLP cholesterol, triglycerides (TG) and low HDLP cholesterol. After 3 months of therapy both groups demonstrated the same significant lowering of HbA1c. The control group had also elevated level of HDLP cholesterol, unchanged levels of TC, LDLP cholesterol, TG. 3-month therapy with atorvastatin lowered TC from 6.41 to 4.76 mmol/l, LDLP cholesterol from 4.19 to 1.87 mmol/l, TG from 2.69 to 1.62 mmol/l, apo B from 1.64 to 1.13 mg/dl, raised HDLP from 0.99 to 1.21 mmol/l (p < 0.05). CRP fell from 5.65 to 2.33 mg/dl (p = 0.026) irrespective of carbohydrate metabolism compensation (CRP in the control group did not change). Conclusion. More than 98% type 2 diabetics have atherognic impairment of the lipid spectrum. Atorvastatin produces an antiatherogenic effect due to both improvement of the lipid metabolism and CRP level reduction irrespective of the degree of compensation of carbohydrate metabolism in type 2 DM.

Aim. To study ECG changes after transcatheter correction of the interatrial defect (IAD) with Amplatzer occluder. Material and methods. Secondary transcatheter IAD correction was made with Amplatzer Septal Occluder (AGA Medical Corporation, USA) in 33 adults (mean age 33.5 ± 2.3 years) and 22 children (mean age 11.2 ± 1.3 years). Short- and long-term outcomes of the defect correction were followed up for 1 to 12 months. Results. Ectopic atrial rhythm registered initially in 2 adult patients was corrected to 1 month after the operation. Normalization or reduction of the electric axis of the heart (EAH) deviation were achieved in 45.5% adults and 66.7% children who had vertical axis or right shift of the axis. Baseline right ventricular hypertrophy (RV1+SV5,6 > 10.5 mm) was diagnosed in 10 adults and 9 children. To the end of the first year after IAD correction this hypertrophy was detected in 5 adults and 3 children (50 and 33.3%, respectively). Blockade of the right bundle of His (complete in 5 cases and incomplete in 23 cases) was diagnosed before treatment in 18 adults and 10 children. To month 12 after the defect correction incomplete blockade persisted only in 2 (11.1%) adults and 1 (10%) child. In 6 months P wave amplitude diminished in adults from 1.9 ±0.12 to 1.7 ± 0.10 mm (p < 0.01), in children - from 1.8 ± 0.07 to 1.6 ± 0.11 mm (p < 0.05). QRS complex duration decreased both in adults and children (from 0.10 ± 0.003 to 0.08 ± 0.004 s, p < 0.01 and from 0.09 ± 0.003 to 0.08 ± 0.002 s, p < 0.05, respectively). In the latter duration of the interval P-Q reduced significantly in 3 months from 0.18 ± 0.005 to 0.17 ± 0.005 s (p < 0.05). Conclusion. ECG changes after transcatheter correction of IAD manifest with normalization of the EAH or reduction of its shift to the right, regress of right ventricular hypertrophy, elimination or reduction of the right bundle of His and absence of significant deterioration of cardiac arrhythmia.

Aim. To study changes of cytokine production and lymphocytic-thrombocytic adhesion (LTA) in patients with rheumatic heart disease. Material and methods. Concentrations of interleukine-1beta, interleukine-4, tumor necrosis factor alpha in the blood serum and lymphocytic-thrombocytic adhesion by Yu.A. Vitkovsky's method were measured in 84 patients with rheumatic fever and 26 healthy ones. Results. A correlation was found between icreased production of inflammatory cytokines, lymphocytic-thrombocytic adhesion and activation of rheumatic process. Conclusion. A monodirection of changes of inflammatory cytokine production, lymphocytic-thrombocytic adhesion and rheumatic fever activation allows using them as nonspecific diagnostic methods in assessment of inflammation activity.

Aim. To evaluate clinico-immunological disorders in patients with ischemic heart disease (IHD) and metabolic syndrome (MS), to study an immunocorrective action of nebivolol during 6-month treatment. Material and methods. A total of 54 patients with postinfarction left ventricular dysfunction and chronic cardiac failure of NYHA functional class II-III were divided into two groups: group 1 (n = 24) comprised patients with effort angina FC II-III and impaired glucose tolerance, group 2 (n = 30) consisted of anginal patients associated with type 2 diabetes mellitus (DM). Clinical, laboratory and functional indices were registered before therapy with nebivolol and 6 months after it. Immunological control included determination of the subpopulation composition of lymphocytes, immunoglobulins, circulating immune complexes (CIC), antibodies to cardiolipin (CL), proinflammatory cytokines: IL-1alpha, IL-2, IL-6, IL-8, alpha-interferon, tumor necrosis factor alpha (TNFa). Results. Nebivolol demonstrated good antihypertensive and anti-ischemic cardioprotective efficacy in IHD patients with MS, it did not deteriorate atherogenic dyslipidemia and impaired carbohydrate metabolism. As a good immunocorrector, nebivolol significantly inhibited cytokine overactivation, had a weak effect on dysimmunoglobulinemia, CIC level and expression to CL antibodies. Side effects were not recorded. Conclusion. IHD patients with MS (especially patients with type 2 DM) have manifest immune disorders presenting with overactivation of proinflammatory cytokines with high levels of IgA, IgG, CIC and antibodies to CL in the presence of low immunoregulatory index. Nebivolol provided good control of arterial hypertension, myocardial ischemia, positive changes in immunological indices, improved intracardiac hemodynamics.

Aim. To study effects of different treatments on erectile and endothelial functions in patients with erectile dysfunction (ED) and age-related hypogonadism (HG). Material and methods. The study included 66 males with ED who had clinical and laboratory signs of HG. All the patients were examined using questionnaires (international index of erectile function, AMS), blood hormones tests. Endothelial function was assessed with postcompression tests on the cavernous arteries and blood homocystein assay. All the patients were divided into two matched groups. Group 1 (20 males, mean age 54.6 ± 11.5 years) received androgens only, replacement therapy consisted of testosterone undecanoate (Nebido, Shering) 1000 mg each 10-12 weeks intramuscularly, interval between the first and second injection was 6 weeks. Group 2 (46 males, mean age 53.98 ± 10.03 years) was given combined treatment (androgens and PDE 5 inhibitors), wardenafil (Levitra, Buer Shering Pharma) was used in a dose 20 mg. The treatment lasted 6 months. Results. AMS points decreased in group 1 from 38.3 ± 0.29 to 29.2 ± 0.32 , in group 2 - from 39.02 ± 0.21 to 28.6 ± 0.95, while testosterone rose from 9.86 ± 0.4 to 17.77 ± 0.42 and 9.35 ± 0.25 to 17.21 ± 0.63 nmol, respectively. Homocystein lowering was significantly more manifest in group 2. EF index in group 2 rose from 11.4 ± 0.77 to 25.54 ± 0.25 points versus 11.2 ± 1.01 to 23.95 ± 0.71 points in group 1, improvement of EF in group 2 occurred sooner. Endothelial function by diameter of the cavernous arteries differed after treatment in group 1 and 2 (19.55 ± 2.88 to 39.2 ± 0.84% and 19.51 ± 1.28 to 48.5 ± 1.76, respectively, p < 0.001). Conclusion. Combined therapy improves blood homocistein, acts faster and stronger on endothelial and erectile functions and can be recommended as first line for ED and HG patients.