[Prognostic value of atrial fibrillation in patients--survivors of acute coronary syndrome]

For the study of contribution of atrial fibrillation (AF) during acute coronary syndrome (ACS) in long-term prognosis after clinical stabilization we examined 453 patients admitted to Moscow hospitals and followed them for 2.07 +/- 0.48 years. The following events were registered: fatal and nonfatal myocardial infarction (MI), unstable angina (UA), fatal and nonfatal stroke, death of other causes. At ACS onset sinus rhythm was noted in 419 (92.5%), permanent or persistent AF-in 16 (3.5%), attack (paroxysm) of AF - in 18 (4.0%) patients. Mean length of life before end point was 884.9 +/- 23.4, 827.3 +/- 123.3 and 514.0 +/- 111.3 days in patients with sinus rhythm, permanent/persistent AF, and attack of AF during first 10 days of ACS, respectively (p<0.001). Compared with patients in sinus rhythm in patients with attack of AF relative risk (RR) of occurrence of any end point was 1.75 (95% confidence interval [CI] 1.284 to 2.873, p< 0.001), of fatal MI - 1.72 (95% CI 1.026 to 2.873, p=0.040), of UA - 2.116 (95% CI 1.249 to 3.585, p=0.005), of stroke - 2.863 (95% CI 1.300 to 6.301, p=0.009). Multifactorial analysis selected history of MI and attack of AF during first 10 days of ACS as independent predictors of unfavorable outcome. Thus paroxysmal form of AF during hospital stay because of ACS is associated with higher probability of development of unfavorable events in the next 1-2 years.

[Diastolic heart failure: are problems in its diagnosis and treatment solvable?]

The paper discusses the problem of chronic heart failure (CHF) in left ventricular diastolic dysfunction - diastolic heart failure (DHF). It considers whether DHF is an independent phenotype or nothing more than a step in the development of systolic heart failure. The results of a number of studies evaluating the efficiency of treatment for DHF with angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, spironolactone, and beta-blockers are given. It is concluded that diastolic dysfunction should be necessarily kept in mind on examining patients with CHF.

[Risk of cardiovascular complications in patients with frequent hypertensive crises]

AIM

To investigate a relative risk of cardiovascular complications in uncomplicated hypertensive crises (UHC) in hypertensive patients.

MATERIAL AND METHODS

A questionnaire retrospective case-control study covered one-third of patients registered in the data base of a hospital or outpatient clinic. The patients were matched by basic characteristics. By frequency of UHC the patients were divided into two groups. Group 1 (n = 305) comprised patients with frequent (weekly or more often) UHC, group 2 (n = 558) consisted of patients with rare UHC (monthly or less frequent).

RESULTS

Patients of group 1 had a longer history of arterial hypertension (13 +/- 9 years vs 9 +/- 7.8 years, p < 0.05). The target blood pressure was achieved in group 1 in 42% vs 56% in group 2; p < 0.05). Group 1 patients had a higher risk of non-fatal stroke/transient ischemic attack (TIA)--18 and 10% (OR 1.94, 95% CI 1.28-2.93; p < 0.05), chronic cardiac failure (44 vs 30%; OR 1.64; 95% CI 1.22-2.21; p < 0.05), left ventricular hypertrophy (72 and 56%; OR 2.11; 95% CI 1.52-2.93; p < 0.05) and myocardial ischemia (56 and 38%; OR 2.05; 95%CI 1.53-2.74; p < 0.05). UHC frequency had no significant influence on the risk of non-fatal myocardial infarction (19 vs 15%; OR 1.34; 95% CI 0.92-1.94; p > 0.05).

CONCLUSION

Frequent UHC raise the risk of non-fatal acute disorder of cerebral circulation, chronic cardiac failure, ischemia and left ventricular hypertrophy. Frequency of UHC is not related to the risk of myocardial infarction.

[Polymorphism of ACE, angiotensin II, NO-synthase, estrogen receptor genes and gender differences in their effects on development of cardiovascular pathology]

Genetic factors determine resistance or susceptibility to development of many cardiovascular diseases. The study of polymorphisms of gene candidayes is a perpective approach in detection of risk and prognosis of outcomes of cardiovascular diseases. Most studied with the help of proven base genes are: ACE gene, angiotensin II gene, NO synthase gene, and estrogen receptor gene. Polymorphism of candidate genes has various clinical consequences in men and women. Despite small number of data devoted to gender differences our work sums up existing results of studies of polymorphisms of above mentioned 4 genes with consideration of gender peculiarities.

[Apelin--a new protein-regulator in the cardiovascular system]

Apelin is an endogenic ligand of apelin (APJ) receptors widely expressed in human tissues. This protein is a peripheral vasodilator having a powerful positive inotropic action on myocardial contractility. This review describes mechanisms of interaction and apelin role in health and pathology.

[Fosinopril in the treatment of cardiorenal syndrome in chronic cardiac failure]

Renal dysfunction is an independent risk factor of chronic cardiac failure (CCF) and death due to this disease. CCF patients are elderly patients with diabetes mellitus, arterial hypertension and long-term chronic cardiac insufficiency. CCF patients do not often have left ventricular systolic dysfunction, renal affection is not associated with low ejection syndrome. Renal affection in CCF is primarily caused by activation of the system rennin-angiotensin, inflammation, disturbed bioavailability of nitric oxide, hyperactivation of the sympathetic nervous system. ACE inhibitors correct pathophysiological disorders of renal flow in CCF. Fosinopril shows the highest efficacy and safety in management of cardiorenal syndrome in CCF patients. Fosinopril can also prevent renal dysfunction in CCF patients.

[Significance of nitrates in contemporary pharmacotherapy of cardiovascular diseases]

Results of the use of nitrates in various forms of cardiovascular pathology are presented and problems related to correctness of application of preparations of this group, development of tolerance to them are considered. Results of their use in extracardiac pathology are also outlined.

[Special features of pathogenesis and pharmacotherapy of chronic heart failure in women]

At present in Europe number of deaths due to diseases of cardiovascular system in women has exceeded number of deaths in men. It has been established that process of cardiac remodeling proceeds differently in women and men. This determines different prognosis of the course of chronic heart failure. So after acute myocardial infarction in women more often develops chronic heart failure with preserved systolic left ventricular function while in men prevails chronic heart failure with systolic dysfunction. Substantial differences exist in efficacy of pharmacotherapy: for instance thrombolysis in women is less effective than in men, women are less sensitive to angiotensin converting enzyme inhibitors, administration of digoxin, some antiarrhythmic drugs cause complications in women more often than in men.

[Brain natriuretic peptide in patients with ST segment elevation myocardial infarction. Prognostic significance]

AIM

To study changes in the level of brain natriuretic peptide (BNP) in patients with ST segment elevation myocardial infarction (MI) to assess prognostic value of this marker and validity of its use as a criterion of therapy effects.

MATERIAL AND METHODS

The trial enrolled 217 patients (102 males and 15 females, mean age 63.96 +/- 0.73 years) admitted to hospital on MI day 1. Plasmic level of BNP (Nt-proBNP) was measured 1, 7, 21 days, 8 weeks and 6 months after MI.

RESULTS

The severity of chronic cardiac failure (CCF) correlated with peptide content in the blood: it was by 46.6% higher in patients with chronic heart failure (CHF) functional class (FC) IV than in those with CHF FC I (p = 0.047), in FC III by 27.5% higher (p = 0.003) and in FCII--by 13.1% (p = 0.485). Initially high levels of BNP correlated with early development of CHF (R2 = 0.9058), with hospital lethality (in the deceased--1040.0 +/- 65.8 fmol/ml, in the survivors--461.4 +/- 26.2 fmol/ml, r = 0.35, p < 0.001) and overall lethality. A more pronounced decrease in the peptide level was seen in patients after 3 week intake of beta-adrenoblocker esmolol than in those who did not take it (by 125.2 vs 74.1 fmol/ml, respectively, p < 0.05). By BNP level, efficacy of perindopril vs captopris was studied (group 1 and group 2, respectively), in patients with ejection fraction under 40%. Initially, BNP levels were elevated and did not differ among the groups. On MI week 8 there was a decrease in the level of BNP by 25.4% (p = 0.004), 19.1% (p = 0.06) in groups 1 and 2, respectively. Six months after MI patients of group 1 had normal levels of BNP (up to 269.6 +/- 18.3 fmol/l).

CONCLUSION

Measurements of BNP levels are useful for prediction of poor prognosis in MI patients and evaluating efficacy of the treatment.

[Trimetazidine in complex therapy of acute myocardial infarction at the background of diabetes mellitus type 2.]

Patients (n=52) with acute myocardial infarction (MI) and diabetes mellitus type 2 older than 18 years were distributed within first 24 hours of MI into 2 groups. In patients of group 1 (n=28) standard therapy was supplemented with trimetazidine (70 mg/day) for 30 days, patients of group 2 received only standard therapy. The following parameters were assessed: rate of recurrent MIs, inhospital mortality, dynamics of MB CR, rate of development and progression of heart failure, dynamics of brain natriuretic peptide, parameters of echocardiogram. Mortality in group 1 at the background of thrombolytic therapy (TLT) was 5.9% (n=1) what was significantly lower than in group 2 where this parameter was equal to 35.7% (n=5), p=0.006. A tendency was noted to lowering of rate of recurrent MIs (17.6 and 21.4% in groups 1 and 2, respectively). Analogous parameters did not differ significantly between subgroups of patients not treated with TLT. In group 1 significant 31% lowering of MB CK level was noted in TLT treated patients. In group 2 level of MB CK after 27-30 hours significantly increased by 30.16% compared with initial level (p=0.001). At analysis of analogous parameters in subgroups not treated with TLT significant differences were not obtained. There were no significant differences between groups according to echocardiography data, however ejection fraction in group 1 was 12.6% higher than in group 2 (p>0.05).

[Comparative efficacy of carvedilol and capoten in the treatment of an uncomplicated hypertensive crisis]

AIM

Efficacy and tolerability of carvedilol vs captopril were studied at 24-h monitoring of blood pressure (BP) in hypertensive patients with an uncompletated hypertensive crisis (HC).

MATERIAL AND METHODS

The trial included 43 patients (23 males and 20 females aged 58 +/- 4.1 years) with an uncomplicated HC (duration of hypertension 9.4 +/- 1.1 years). Twenty patients of group 1 received oral carvedilol (25 mg), 23 patients of group 2--oral captopril (25 mg). The criterion of efficacy was a 15-25% decrease of BP within 60-120 min.

RESULTS

Attenuation of HC symptoms and tolerability was the same in both groups. Forty five minutes after the drug intake systolic pressure lowered by 11.1% (p = 0.039) and 10.9% (p = 0.042) in group 1 and 2, respectively; diastolic pressure--by 14.9% (p = 0.037) and 17.9% (p = 0.018), respectively. Heart rate diminished significantly only in group 1 (by 10.9%, p = 0.043) 30 min after carvedilol intake. A maximal BP fall in group 1 occurred 180 min after the drug intake: systolic by 23.5% (p = 0.0001), diastolic by 26.9% (p < 0.0001). In group 2 the BP fall was 23.3% (p < 0.0001) and 29.1% (p < 0.0001) on min 165 and 150, respectively. Systolic and diastolic pressures lowered faster in group 1. The effect of carvedilol lasted longer--372.6 +/- 19.3 min and 245.1 +/- 13.7 min, respectively, p = 0. 0001.

CONCLUSION

A hypotensive effect of carvedilol and captopril in hypertensive patients with an uncomplicated HC was the same. Carvedilol produced a longer and a more stable effect.