Vol 84, No 9 (2012)

Aim. To evaluate global left ventricular (LV) systolic longitudinal and circumferential strain rates, rotation, and axial torsion in relation to the type of postinfarction LV remodeling in patients with coronary heart disease (CHD) and severe LV dysfunction. Subjects and methods. Studies were performed in 58 patients with sustained anterior myocardial infarction, an ejection fraction of less than 40%, and NYHA Functional Class III-IV heart failure. Three types of postinfarction LV remodeling were identified: 1) with LV apical aneurysm; 2) an intermediate type; 3) with ischemic cardiomyopathy. Global LV systolic longitudinal and circumferential strain rates, end-systolic basal (RotMV/RotMV) and apical (Rotapex/RotRapex) rotation, and axial torsion axis were estimated as an indicator of global LV systolic function. Results. No differences were found in the basal global LV longitudinal and circumferential strain rates, basal rotation, and rotation rate between the patients with 3 types of LV remodeling. In the patients with type 1 LV remodeling, the basal rotation was higher than the apical one (RotMV - Rotapex: -3.085±2.821 versus 2.293±1.021; p=0,002; RotRMV - RotRapex: -22.452±19.823/с-1 versus 13.641±10.745/с-1; p=0.003). In type 2 postinfarction LV remodeling, the basal and apical rotation values did not differ statistically significantly. Impaired apical rotation (in a clockwise direction) was identified in 5 of the 16 patients with type 3 LV remodeling (Rotapex: -1.477±0.392; RotRapex: -30.572±13.735/с-1). There were no differences in the value of LV axial torsion between types 1 and 2 LV postinfarction remodeling (Type 1, 6.714±3.017; Type 2, 7.463±5.416). Conclusion. It was shown for the first time that there were no differences in global LV longitudinal and circumferential strain rates and end-systolic LV rotation between the patients with types 1 and 2 postinfarction LV remodeling.

Aim. To define the prognostic value of the indicators of left ventricular myocardial viability according to the data of pharmacological stress echocardiography in patients with acute coronary syndrome (ACS). Materials and methods. The results of examinations were analyzed in a total of 91 patients with ACS; 71 of them were found to have areas of asynergy (these cases formed the key basis for statistical processing). An analysis of the outcomes registered in the established follow-up period (mean 14.3±0.7 months) took into consideration death from cardiac diseases, a recurrent acute coronary episode (nonfatal myocardial infarction (MI), unstable angina (UA)). Results. Risk stratification for cardiac events in patients with ACS requires both the assessment of a myocardial viability testing result and the detection of stress-induced ischemia. An analysis of the impact of the indicators of myocardial viability on prognosis in the ACS group showed that the most important predictors of cardiac death were impaired segmental contractility index (ISCI), number of asynergic segments, and total ejection fraction (TEF) at rest; TEF, ISCI, number of segments with a negative response to low-dose drug infusion; TEF, ΔTEF (as compared to the baseline data), and a positive or negative peak stress testing result. The most important predictors of major cardiac events (death MI, UA) were ascertained to be ISCI, number of asynergic segments, resting TEF; TEF, ISCI, number of segments with a negative response to low-dose drug infusion; a positive or negative testing result, TEF, ΔTEF (as compared to the baseline data), and ISCI during the peak stress test. Conclusion. The low myocardial/coronary reserve increases mortality rates; the high one worsens the prognosis of major cardiac events, particularly when the test is positive, which tacitly transfers these patients to a very high risk group.

Aim. To define the pharmacogenetic features of the effect of metformin in coronary heart disease (CHD) patients with metabolic syndrome (MS) or type 2 diabetes mellitus (T2DM), by taking into consideration PPAR-γ2 Pro12Ala polymorphism. Subjects and methods. Twenty-four men with CHD and MS and 28 men with CHD and T2DM were examined. The effect of metformin as a short course in combination therapy was evaluated. A population control group consisted of 46 apparently healthy men. The genetic PPRA-γ2 Pro12Ala polymorphism was studied. A number of indicators (total cholesterol (TC), high-density lipoprotein cholesterol, total lipids, triglycerides, Β-lipoproteins, glycated hemoglobin, C-peptide) and proinflammatory markers, such as interleukin (IL)-1Β, IL-6, IL-8, and tumor necrosis factor-α (TNF-α) were determined in the blood. Results. Analysis of the frequencies of Pro and Ala alleles indicated a decrease in the latter in CHD patients with T2DM. The CHD and MS patients who carried the Pro allele showed a significant metformin-induced reduction in weight, waist circumference, body mass index, and concentrations of TC, C-peptide, and cytokines, such IL-1Β, IL-6, IL-8, and TNF-α. Conclusion. Metformin exhibits a high therapeutic efficacy in patients with CHD in the presence of T2DM or MS who have the Pro/Pro genotype, which is of interest in terms of pharmacogenetics and calls for further investigation.

Aim. To assess whether the serum levels of autoantibodies (auto-Abs) interacting with myocardial and vascular wall antigens might be used for the differential diagnosis of myocardial inflammatory diseases.Subjects and methods. Seventeen patients with morphologically documented myocarditis were examined. A comparison group comprised 9 patients with acute myocardial infarction (AMI). A control group included 18 apparently healthy individuals and 8 patients with chronic erosive gastritis (CEG). Serum auto-Abs levels were estimated by the ELI test systems standardized for enzyme immunoassay. Results. The individual profiles that reflect relative changes in the levels of 16 study auto-Abs and characterize the integral autoreactivity of a patient have clear intergroup differences. Using the profiles of auto-Abs could confirm the diagnosis of myocarditis in 94% of cases or assign the patient to a group of apparently healthy individuals. The informative value of the method in patients with AMI and CEG was 81.8 and 87.5%, respectively. Conclusion. The proposed method may be used for the noninvasive screening diagnosis of myocardial inflammatory diseases.

Aim. To comparatively analyze the following parameters of the subclinical manifestations of atherosclerosis: carotid intima-media thickness (IMT), the presence and number of carotid atherosclerotic plaques (ASP), ankle brachial pulse wave velocity (ABPWV) in patients from 2 (active and conventional observation) groups at low and moderate risks according to the SCORE scale in two-year outpatient practice. Subjects and methods. A screening could select 600 able-bodied persons (445 women and 155 men) aged 30 to 65 years at low and moderate risks (according to the SCORE scale without atherosclerosis-associated diseases who were divided into 2 groups: A) active observation (n=400) and B) conventional medical management tactics (n=200). Five hundred and seven (85%) persons (339 in Group A and 168 in Group B) completed the study following 2 years. Carotid duplex scanning, computed sphygmography, and biochemical tests for blood lipid composition were performed. The delta index (%) calculated by the special formula, by subtracting the results during the first visit from those obtained 2 years later, was used to statistically analyze the time course of changes in the parameters under study. Results. Delta IMT (%) statistically significantly increased in Group B men as compared to that in Group A men (p=0.042). The delta parameter of total carotid stenosis, which reflected the percentage of the latter, proved to be high in both Group B women and men (p=0.0001) and the persons with a larger number of ASP were statistically significantly more in Group B (p=0.035). Delta ABPWV (%) was also greater in Group B (p=0.001). Conclusion. Just after 2 years, the active medical observation tactics in patients at low and moderate risks (according to the SCORE scale) can result in a reduction in the rate of subclinical atherosclerosis progression in the carotid artery.

Aim. To study the prognostic value of therapy-induced changes in plasma NT-proBNP levels in patients with left ventricular (LV) systolic dysfunction. Subjects and methods. The study covered 84 patients aged 23 to 70 years (mean 54±8.1 years) with LV systolic dysfunction (an ejection fraction of <40%). Plasma NT-proBNP levels were determined in all the patients at baseline and 3 months later to evaluate the efficiency of therapy for heart failure (HF). The median follow-up was 18 months. The follow-up recorded the following outcomes (end points): death from decompensated HF and unplanned hospital admissions for progressive HF symptoms. Results. The baseline and therapy high plasma levels of NT-proBNP (more than 3000 pg/ml) were associated with worsening prognosis. The therapy-induced decrease in NT-proBNP levels was associated with more favorable prognosis. Conclusion. Repeat dynamic determination of plasma NT-proBNP levels allows identification of patients at increased risk of poor outcomes for a more intensive observation and more aggressive pathogenetic therapy.

Aim. To carry out radionuclide evaluation of renal function in patients with arterial hypertension (AH) and chronic kidney disease (CKD). Subjects and methods. Thirty-one AH patients with CKD were examined using dynamic nephroscintigraphy. A control group consisted of 8 CKD patients without AH. Results. The scintigraphic findings reflected statistically significant differences in renal secretory and excretory functions depending on the level of glomerular filtration rate (GFR) decrease in AH patients with CKD. If GFR was 30-59 ml/min, there was a deceleration in the secretory phase in the histogram; but when it was lower than 30 ml/min, the secretory function tended to accelerate, which appeared as a 3-fold reduction in achieving the peak radio tracer concentration (p<0.001).Conclusion. Dynamic nephroscintigraphy can detect early renal secretory and excretory dysfunctions and it is of prognostic value in assessing renal dysfunction, which necessitates early drug correction of revealed disorders.

Pulmonary hypertension is a complex multidisciplinary problem in modern medicine. This review discusses its clinical and pathophysiological type associated with rheumatic heart disease. Current approaches to the pathogenesis and diagnosis of the disease are reflected; basic approaches to its treatment are discussed in terms of current clinical guidelines and new scientific achievements.

The paper gives basic facts from the life and work of Sergey Petrovich Botkin, one of the coryphaei of Russian medicine, who played a prominent role in the formation and development of Russian clinical medicine and became the founder of the most well-known therapeutic school in Russia. S.P. Botkin's greatest merit is emphasized to be his neurogenic theory of medicine, which has played a great role in the understanding of physiological and pathological processes in the entire organism.