Stable Effort Angina Research Articles

Efficacy of various combined treatment regimens in patients with stable effort angina, functional classes II-III

Introduction: Inflammation and metabolic disorders of cardiomyocytes are undoubtedly important pathogenetic links in the development of coronary heart disease and its complications. Our study assessed the effect of various combined treatment regimens on cycle ergometry performance and plasma concentrations of pro- and anti-inflammatory interleukins in patients with stable effort angina, functional classes II-III. Materials and Methods: The clinical study included 120 patients diagnosed with coronary heart disease: stable effort angina, functional classes II–III, and 40 healthy participants who met the inclusion criteria. Further, four groups were randomly formed: a group receiving the standard treatment; a group receiving Mexicor for 10 days in addition to the standard treatment; a group receiving Mexicor and Phosphogliv for 10 days in an addition to the standard treatment; and a group receiving Mexicor and Polyoxidonium for 10 days in addition to the standard treatment. After the treatment, cycle ergometry performance and plasma concentrations of pro- and anti-inflammatory cytokines were assessed in the patients. Mathematical statistical analysis was carried out using Statistica 10.0 software. The statistical significance of differences between the qualitative indicators was assessed using the χ2 test. The results of the statistical analysis were considered statistically significant at p<0.05. Results: The combined treatment with using the above-mentioned pharmacological agents resulted in a statistically significant improvement in cycle ergometry indicators: Mexicor made it possible to increase the threshold load power by 43.0% and the total load power – by 70.3%. In the groups of patients with coronary heart disease who had received Mexicor and Phosphogliv or Mexicor and Polyoxidonium, there was an increase in the load duration by an average of 69.0% and in the rate-pressure product – by 25%, respectively. When analyzing the dynamics of plasma concentrations of pro-inflammatory cytokines, it was found that a statistically significant decrease in the concentrations of tumor necrosis factor-α, interleukin-1ß, interleukin-6 and interleukin-10 was registered only in the groups receiving Mexicor and Phosphogliv or Mexicorand Polyoxidonium in addition to the standard treatment. Conclusion: Applying the combined treatment regimens using Mexicor and Phosphogliv or Polyoxidonium results in the most effective improvement of the cycle ergometry performance and the dynamics of plasma concentrations of pro- and anti-inflammatory interleukins in patients with stable effort angina, functional classes II-III.

Prognostic value of N-terminal Brain Natriuretic Peptide (NT-proBNP) in Risk Assessment of Adverse Cardiovascular Events in Patients with Atrial Fibrillation and Heart Failure with Reduced Left Ventricular Systolic Function

According to Russian epidemiological studies, the incidence of chronic heart failure (HF) in the general population is approximately 7%, increasing from 0.3% in the group aged 2029 years to 70% in patients aged 90 years [1]. In the general population, the incidence of atrial fibrillation (AF) ranges from 1% to 2%, which increases with age, that is, from 0.5% at the age of 4050 years to 5%15% at the age of 80 years [2]. HF and AF aggravate significantly each others course and mutually increase the risk of adverse outcomes [3, 4]. Moreover, the incidence of AF in patients with HF increases with increasing New York Heart Association (NYHA) grade; that is, among patients with HF of NYHA grade I, the incidence of AF is 5%, whereas among patients with HF NYHA grade IV, the AF incidence in 50% [5].
 Chronic HF is a syndrome with complex pathophysiology, which is characterized by the activation of neurohumoral systems, namely, the reninangiotensinaldosterone system (RAAS), sympathetic nervous system (SNS), and insufficient activity of the natriuretic peptide (NUP) system. In the early stage of HF, i.e. asymptomatic dysfunction of the left ventricle, the activation of the SNS and RAAS plays a compensatory role aimed at maintaining cardiac output and circulatory homeostasis [6]. Moreover, the NUP system has a counter-regulatory function in relation to the RAAS and SNS, and with prolonged and excessive activation of the SNS and RAAS or with insufficient NUP system activity, imbalance occurs and HF progresses [7].
 The brain natriuretic peptide (BNP) and biologically inactive N-terminal fragment of BNP (NT-proBNP) are the most studied and significant in clinical practice representatives of the NUP system. BNP and NT-proBNP are secreted by cardiomyocytes of the left ventricular (LV) myocardium in response to an increase in the mechanical load and stress of the LV myocardium. NT-proBNP is widely used as a test to rule out HF in patients with dyspnea. The NUP level also correlates with the severity and prognosis in patients with an established diagnosis of HF, and studies have reported that the NUP level acts as a criterion for treatment efficiency in patients with HF [8]. NT-proBNP is a biomarker not only for HF but also for several other conditions, such as acute coronary syndrome and myocardial infarction (MI), because it is associated with an increased risk of death from all causes, regardless of age, stable effort angina grade, myocardial infarction history, and LV ejection fraction (LVEF) [9].
 NT-proBNP levels can be influenced by several additional factors such as age, obesity, or glomerular filtration rate. The prognostic value of NT-proBNP is relevant in comorbid patients with AF associated HF because AF can increase NT-proBNP levels independently [10]. Given that NUP secretion depends on intracardiac hemodynamics, the NT-proBNP levels may also depend on the approach to managing AF. Tachycardia is associated with high NT-proBNP levels [11].
 The rhythm control approach has advantages over the heart rate control approach in patients with HF and LVEF 50% to reduce mortality and the number of unplanned hospitalizations due to HF progression [12].
 To date, the prognostic significance of NT-proBNP levels in relation to the risk of adverse events in patients with HF and reduced LV systolic function associated with AF, depending on the approach of AF management, remains unresolved.
 This study aimed to assess the predictive value of NT-proBNP in relation to the development of adverse cardiovascular events in patients with permanent or persistent AF associated with HF and LVEF 50%.

Cellular Mechanisms of Coronary Artery Spasm.

Coronary artery spasm (CAS) is a reversible phenomenon caused by spontaneous excessive vascular smooth muscle contractility and vascular wall hypertonicity, which results in partial or complete closure of the lumen of normal or atherosclerotic coronary arteries. The clinical picture of CAS includes chest discomfort which is similar in quality to that of stable effort angina. Mechanisms underlying the development of CAS are still unclear. CAS certainly is a multifactorial disease. In this review, we paid attention to the role of the main pathophysiologic mechanisms in CAS: endothelial dysfunction, chronic inflammation, oxidative stress, smooth muscle hypercontractility, atherosclerosis and thrombosis, and mutations leading to deficient aldehyde dehydrogenase 2 (ALDH2) activity. These findings might shed novel insight on the underlying mechanisms and identify potential diagnostic and therapeutic targets for cardiovascular diseases in the future.

695 Upregulated monocyte expression of PLIN2 is associated with plaque instability in coronary artery disease

Abstract Aims Perilipin 2 (PLIN2), a protein associated with intracellular lipid droplets (LDs), is involved in lipid metabolism of macrophages resident in atherosclerotic plaques and its up-regulation leads to LDs accumulation. LDs enlargement results in the macrophage transformation into foam cells, a key step for the onset of atherosclerosis. In the present study, we investigated the role of PLIN2 and its regulation mechanisms in atherosclerosis and plaque instability in patients with a diagnosis of ST-elevation myocardial infarction (STEMI) and stable chronic angina (SA). Methods and results We enrolled 120 patients with a diagnosis of STEMI and 42 SA patients with symptoms of stable effort angina lasting more than 12 months. Peripheral blood mononuclear cells (PBMCs) were isolated from EDTA whole blood samples through standard gradient centrifugation over Ficoll-Hypaque. Monocytes were purified through indirect magnetic labelling of PBMCs. PLIN2 mRNA expression was investigated by Real Time-PCR and PLIN2 protein level was analysed in CD14+ monocytes by flow cytometry. Proteasome activity was assayed using AMC-tagged peptide substrate (Succ-LLVY-AMC), which releases free highly fluorescent AMC (Ex/Em 350/440 nm) in the presence of proteolytic activity. In CD14+ monocyte, PLIN2 protein expression was significantly increased in STEMI as compared to SA patients (P < 0.001), while PLIN2 mRNA level was not different in the two groups (P = n.s.). Despite proteasome activity was higher in STEMI as compared to SA patients (P < 0.001), significant inverse correlations were evident between PLIN2 levels and proteasome activity in the two groups (P = 0.05). Conclusions CD14+ monocyte PLIN2 protein expression was higher in STEMI as compared to SA patients suggesting an involvement in plaque instability. Despite proteasome activity was higher in STEMI patients, probably due to the elevated inflammatory burden, PLIN2 could escape proteasome degradation in a more efficient manner in STEMI as compared to SA patients.

Personalized trimetazidine prescription as a cytoprotective agent in patients with coronary artery disease

Aim. To develop a personalized approach to the trimetazidine use in patients with coronary artery disease (CAD) based on the criteria for predicting the cytoprotective activity tested in vitro.Material and methods. We examined 30 patients with class I-III stable effort angina with concomitant hypertension and heart failure. The patients underwent echocardiography, complete blood count, biochemical tests with determination of the lipid profile, creatine phosphokinase (CPK), CPK-MB, renal and hepatic parameters. To determine the cytoprotective activity of trimetazidine, white blood cells (WBCs) of patients were examined in vitro using an Eclipse Ti-U inverted fluorescence microscope (Nikon, Japan). Living and dead cells were determined by staining WBCs with fluorescent dyes (Calcein AM, Ethidium bromide). Cell viability index (CVI) was calculated. The statistical processing was carried out. The criteria for predicting the trimetazidine cytoprotective effect were determined using Wald statistics.Results. When trimetazidine was injected into a WBC suspension sample, two types of cell viability changes were observed: in 60% of patients, CVI increased, on average, by 37% (from 23% to 60%, p<0,001) and in 40% of patients, CVI decreased, on average, by 30% (from 54% to 24%, p<0,05).A number of conditions of the patient initial status were identified for the manifestation of trimetazidine cytoprotective activity: grade 1 hypertension; right ventricular end diastolic dimension up to 30 mm according to echocardiography; normal lipid profile with a total cholesterol <5,3 mmol/L, very-low-density lipoproteins <1 mmol/L and an atherogenic coefficient up to 3 CU, myocyte and cardiomyocyte destruction (total CPK >100 U/L and CPK-MB >15 U/L), normal liver function (alanine aminotransferase <25 U/L), renal dysfunction (total protein <75 g/L, urea >8 mmol/L and blood creatinine >100 pmol/L), normal thrombopoiesis (immature platelet fraction <5%) and the state of functional adaptive system resistance (blood lymphocytes <30% and neutrophils >4x109/L).Conclusion. According to this in vitro analysis, the trimetazidine significantly increases (by an average of 37%) the cell (WBC) viability in 60% of patients with CAD. There are conditions of patient initial status, which specifies an individual pharmacodynamic target for the cytoprotective action of the drug.

ВЛИЯНИЕ КОМБИНИРОВАННОЙ ТЕРАПИИ НА ПОКАЗАТЕЛИ СЕРДЕЧНО-СОСУДИСТОЙ СИСТЕМЫ У ПАЦИЕНТОВ С КАРДИОРЕСПИРАТОРНОЙ ПАТОЛОГИЕЙ

The study aims to analyze the effect of the combination of Mexicor and Polyoxidonium on the cardiovascular system in patients with chronic obstructive pulmonary disease (COPD) and concomitant coronary heart disease (CHD). Material and methods. We examined 94 patients with stage 3 COPD in the acute phase with concomitant stable CHD, stable effort angina class I–II, and congestive heart failure of the I–II functional class. The main group consisted of 43 patients (35 men, 8 women, average age 62.0 ± 4.3 years), who received, in addition to basic therapy, the immunomodulator Polyoxidonium (tablet form, 12 mg daily, half an hour before meals, 2 times a day for a month) and the cytoprotector Mexicor (1 capsule (100 mg) 3 times a day for a month). The comparison group included 51 patients (42 men and 9 women, average age 58.0 ± 4.1 years) who received only basic therapy, which was based on the recommendations of the Ministry of Health of the Russian Federation. Before and after treatment, patients underwent 24-hour electrocardiography, bicycle ergometry, with an analysis of the total exercise, assessment of changes in peak values of systolic and diastolic pressure, and peak heart rate. Results. A group of patients taking a combination of Polyoxidonium and Mexicor in addition to basic therapy showed a significant decrease in the frequency of chest pain, a decrease in the daily, night, and 24-hour heart rate. In the main group, there was a statistically significant decrease in the average heart rate at rest (p < 0.001), an improvement in bicycle ergometry, and an increase in exercise tolerance. The indicator of total work performed increased by 26.8% (p < 0.05). A statistically significant increase in the time of performing the load until the manifestation of ST segment depression on the electrocardiogram (p <0.05) was noted.

Predicting coronary graft occlusion in males with type 2 diabetes: an annual prospective study

Aim. Identification of factors affecting coronary bypass graft patency in patients with type 2 diabetes (T2D) during one year after coronary bypass grafting.Materials and methods. Coronary artery bypass grafting for stable effort angina was ordered in 23 men with T2D. The patients had transthoracic echocardiogram before surgery. All patients were verified for lupus anticoagulant (LA) in blood on the 14th day after surgery. A year later, the patients underwent coronary shuntography to assess bypass patency.Results. LA was detected in 15 of 23 patients (65%). One year after surgery, occlusions of coronary shunts were revealed in 10 of 23 patients. In patients with coronary shunt occlusions, end-diastolic and end-systolic dimensions, end-diastolic and end-systolic volumes, end-systolic and end-diastolic indices (EDD, ESD, EDV, ESV, ESI, EDI, respectively), as well as the LA ratio significantly exceeded those in patients without occlusions (Mann—Whitney p values 0.004, 0.012, 0.012, 0.006, 0.006, 0.004, 0.017, respectively). A method is proposed for predicting coronary shunt occlusions based on assessment of end-diastolic volume of left ventricle and the LA ratio.Conclusion. Echocardiographic values for left ventricle (EDD, ESD, EDV, ESV, ESI, EDI) and the LA ratio are predictors of coronary graft occlusions in patients with type 2 diabetes.

The Prognostic Role Of Stress Echocardiography In Cad-rad Grade 3: Complementary Or Redundant?

Introduction: There are a proportion of patients presenting with stable effort angina had coronary computed tomography angiography (CCTA) done as first line investigation. There are approximately one-fourth of them had moderate coronary stenosis (50-69%, Coronary Artery Disease Reporting and Data System, grade 3) with ongoing symptom. This retrospective study aimed to investigate the role of second stage stress echocardiography in further cardiovascular risk stratification.

Effects of prolactin on the results of echocardiography and daily multichanel intraluminal impedans-pH-monitoring of the esophagus of patients with stable angina of effort and gastroesophageal reflux disease in the dynamics of treatment

Objective — to establish the effect of complex therapy with the addition of meldonium on the results of echocardio­graphy, daily multichanel intraluminal impedans-pH-monitoring (DMII-pH-M) of the esophagus and serum prolactin level in patients with stable angina of tension (SAT) and gastroesophageal reflux disease (GERD) in the conditions of comorbidity.Materials and methods. The study included 88 patients with SAT I—II FC with comorbid endoscopically positive GERD, which was divided into 2 groups: in group 1 (43 persons) received treatment: antiaggregant (clopidogrel), β-blocker (bisoprolol), statin (rosuvastatin), prolonged Nitric Oxide Donors donor and nitroglycerin in angina pectoris, proton pump inhibitor (rabeprazole), prokinetic (domperidone) and antacid as needed. Patients in group 2 (45 subjects) received basic therapy with SAT and GERD, with the exception of prokinetics and NO donors, only nitroglycerin, if necessary, and additionally meldonium capsules 500 mg 2 g/d for 30 days. Echocardiography, DMII-pH-M of the esophagus were performed in all patients enrolled in the study and serum levels of prolactin were determined before and at day 30 of treatment.Results and discussion. Blood serum of patients with SAT with comorbid GERD remains high when prokinetic is received and adversely affects the overall contractility of the myocardium of the left ventricle, esophagitis regression, confirmation is correlated0 (r = –0.73) between the serum PL level and emission fraction of left ventricle; MNBI (mean nocturnal baseline impedance) (r = –0.71) in group 1 and (r = –0.7) in group 2. Against the background of correction of baseline therapy for SAT and GERD with cancellation of prokinetic intake and, with additional prescription of meldonium, we observed a statistically significant (р &lt; 0.05) decrease in prolactin level (OR = 3.9609, 95 % CI 1.1761—13.3398, p &lt; 0.0263), decrease in total number of refluxes per day (OR = 14.1, 95 % CI 4.9739—40.2144, p &lt; 0.0001) (р &lt; 0.05), increase of PSPW (postreflux swallow induced peristaltic wave) (OR = 3.9, 95 % CI 1.5845—9.4767, p &lt; 0.003) (р &lt; 0.05), MNBI (р &lt; 0.05) and emission fraction of left ventricle (OR = 4.2, 95 % CI 1.4802—12.2029, p = 0.0072) (p &lt; 0.05), compared with group 1.Conclusions. The correction of the basic therapy of the SAT and GERD with the prokinetics’ cancellation and the additional use of meldonium resulted in the decrease of serum prolactin levels, which closely correlated with the main indicators of echocardiography and DMII-pH-M, manifesting in an increase in the general contractility of the left myocardium ventricle and lower esophageal sphincter, increasing of the kinetic function of the esophagus and improving the regenerative capabilities of its mucous membrane.

The effects of prolactin on ADP-induced platelet aggregation in patients with stable angina of effort and gastroesophageal reflux disease

The combination of stable angina of effort (SEA) and gastroesophageal reflux disease (GERD) is frequently observed in the clinic of internal diseases. Thrombocytic link of homeostasis is one of the main factors in the development and progression of atherosclerosis. The long-term increase of circulation prolactin levels can result in the development of pathological changes caused by hyperprolactinemia.Objective — to investigate the effect of prolactin levels on the ADP-induced platelet aggregation in patients with SEA and GERD.Materials and methods. The study included 148 persons: 30 patients with isolated SEA (1st group), 30 patients with isolated GERD (2nd group), and 88 patients with combination of SEA and GERD (3rd group). A separate group consisted of 20 practically healthy persons (PHPs). The serum levels of prolactin and the degree, rate, and time of ADP-induced platelet aggregation were investigated in all patients, included in the study.Results and discussion. The degree, rate, time of ADP­induced platelet aggregation, as well as prolactin levels, were significantly higher in patients with SEA and comorbidity of GERD than the similar results of the PHPs group, patients with isolated SEA and isolated GERD. A high direct correlation relationship was established between the degree of ADP-induced aggregation of blood platelets in patients with SEA with comorbid GERD and serum prolactin levels (r = 0.710; r = 0.696). Conclusions. It has been established that in patients with SEA with comorbid GERD, the prolactin levels were higher than in groups with isolated SEA, isolated SEA and PHPs group and increaseв proportionally to the degree and rate of ADP-induced platelet aggregation.

Assessment of effectiveness and acceptability of combination of L-carnitine and arginine hydrochloride in patients with stable effort angina

The objective: to assess the effectiveness and acceptability of combination of L-carnitine and arginine hydrochloride in patients with CHD with stable effort angina.Materials and methods. There were examined 63 patients with stable effort angina of II – III functional classes in the age of (56,7±2,3 years old). There was assessed the clinical course of the disease at the beginning and at the end of the therapy the month later. There were performed 24-hour monitoring ECG and veloergometry, was studied the function of endothelium with the use of Doppler sonography of shoulder joint. Patients were divided into two groups. Patients of the main group (n=32) against the background of basic therapy of stable angina were receiving the combination of L-carnitine and arginine hydrochloride. Patients of comparison group (n=31) received only the standard basic therapy.Results. During the research there is noted the improvement of patients’ lives, as evidenced by decrease of subjective complaints expressiveness, decrease of anginose episodes, reduction of running length of ischemia per day according to the data of 24-hour monitoring ECG is reliably more expressed in main group of patients. According to the data of veloergometry the employment of combined therapy contributed to the significant increase of parameters of tolerance to physical activity and the decrease of functional class of angina in relation to comparison group. Combination of L-carnitine and arginine hydrochloride reliably improves the endothelium-dependent vasodilation after treatment (p&lt;0,05). There is registered the 50,9% increase of such state in generally within the group, 33,0% increase – in patients with stable effort angina II FG and 64,8% – III FG.Conclusion. The data that we received illustrates that application of metabolically active combination of L-carnitine and arginine hydrochloride against the background of basic therapy in patients with stable angina leads to statistically reliable decrease of average number of anginose episodes and daily maintenance of nitroglycerin; leads to increase of physical load tolerance and improves the endothelium function relatively to the group of patients that had only basic therapy.

Transient left septal fascicular block in a patient with stable effort angina and critical proximal obstruction of left anterior descending coronary artery

Several publications from our group and others have shown that a main cause of middle fiber block or left septal fascicular block of the left bundle of His is proximal obstruction of the left anterior descending coronary artery, before its first septal perforator branch, since this fascicle is the only one of the three fascicles irrigated exclusively by this artery. We present a case in which the phenomenon occurred transiently, causing prominent anterior QRS forces, confirmed by coronary angiography.

Possibilities of antianginal therapy in improvement of quality of life of patients with stable angina of effort

Objective:High prevalence of ischemic heart disease (IHD) is currently both of medical and social concern, thus requiring treatment with drugs capable of influencing not only the prognosis of the disease but also quality of life of patients. This study was undertaken to investigate the possibilities of antianginal therapy with nicorandil and isosorbide dinitrate in order to improve quality of life of patients with stable angina pectoris.Method:The authors carried out a comprehensive examination of a total of eighty-four 44-to-76-year-old patients suffering from IHD with functional class 2-3 stable angina of effort and followed up in ambulatory settings. The patients were randomized into two groups of treatment to receive either nicorandil or isosorbide dinitrate as antianginal agents added to basic therapy. The groups of patients did not significantly differ by anamnestic and demographic characteristics. The duration of follow up amounted to 24 months. We determined the physical and mental components of health-related quality of life and their dynamics on the background of antianginal therapy with nicorandil and isosorbide dinitrate. The parameters of quality of life were evaluated by the findings of two screening tools: the General Health Questionnaire (GHQ-28) and Seattle Angina Questionnaire (SAQ).Results:The findings obtained within the timeframe of the study demonstrated that patients suffering from FC 2-3 stable angina of effort and taking standard therapy with beta-adrenoblokers, calcium antagonists, and antiplatelet drugs were found to have a decrease in their quality of life. The lowest scores were observed by the scales reflecting the psychological component of health, whereas the scores of physical limitation, angina stability, and angina frequency were considerably better. After 24 weeks of treatment with nicorandil and isosorbide dinitrate, the patients of both groups were found to have significantly improved scores for quality of life assessed by the SAQ on all scales. Initially high scores by the GHQ characterizing the patient’s psychological discomfort were revealed in both groups of patients, with no statistically significant differences between the groups. The highest score was revealed by the scales of somatic symptoms and social dysfunction in both the nicorandil group (11.8 and 13.2 points, respectively) and isosorbide dinitrate group (12.1 and 13.5 points, respectively). The mentioned alterations underline the significance of such disease as IHD in adaptation of the patient to the social environment. Angina attacks, physical limitations lead to deterioration of the emotional state and interfere with daily activity. High scores by the scales of anxiety and depression suggested a low level of mental health of IHD patients with stable angina pectoris. After 24 months of treatment, manifestations of anxiety and depression in patients of both groups significantly decreased (with the results comparable in both groups), with clear advantage in the nicorandil group.Conclusion:Nicorandil turned out to be superior to isosorbide dinitrate in improvement of physical and psychological components of quality of life of patients with stable angina of effort.

Features of platelet hemostasis changes and antiplatlet treatment sensitivity in patients with stable forms of ischemic heart disease

Aim: To study and to estimate the aggregation activity of platelets in patients with stable forms of IHD, taking into account their sensitivity to the antiplatelet treatment and influence of ITGA2 polymorphism.Materials and methods: there were examined 45 patients, who were on treatment in the Clinic “PheopHanya” (city Kyiv) and in Kyiv clinical hospital of railway transport № 2: 22 women and 23 men (mean age – 66,8±9,5 years). The study included patients with stable forms of IHD (stable effort angina of ІІ-ІІІ FC). All patients received the antiplatelet treatment with acetylsalicylic acid (48,9%), clopidrogel (37,8%) or their combination (13,3%).The functional activity of platelets was studied on the laser aggregometer Biola Aggregation Analyser. The reaction to the antiplatelet treatment was confirmed using Aggredyne-test. C807T polymorphism of ITGA2 was determined by the method of polymerase chain reaction (PCR).Based on the results of aggregation activity, sensitivity to the antiplatelet treatment, patients were distributed in two groups: І group – persons with the different degree of resistance to antiplatelet drugs (21 patients), ІІ group – sensitive to the treatment (24 persons). Polymorphism of ITGA2 and features of platelets functional activity depending on genotype were analyzed in each group.Results: Among all inductors of aggregation, only the reaction to arachidonic acid (AA) was less than control values (by 12,7%, р&lt;0,05). The degree of the spontaneous and adenosine dyphosphate (ADP)-induced aggregation didn’t differ from the norm, collagen-induced one was 1,21 times higher than the control. The quantity of patients, insufficiently sensitive to the treatment was 46,7 % (21persons), according to the data of Aggredyne-test, 24 persons had an adequate response to the treatment. At the analysis of ITGA2 polymorphism Т/Т genotype prevailed in patients “non-respondents”, in ‘respondents” - С/С genotype. Т-allele presence among respondents was 90,5% persons, so the probability of its influence on sensitivity to the antiplatelet treatment was rather high.Conclusions: The decrease of sensitivity to antiplatelet drugs, connected with ITGA 2 polymorphism was observed in 46,7% of patients with stable IHD: resistance to the antiplatelet therapy is associated with Т/Т genotype of ITGA 2, presence of Т-allele in the genotype of patients-“non-respondents” was observed in 90,5% of persons, С/С genotype prevails at a positive response to the treatment

Bioabsorbable vascular endoproteases for the treatment of patients with coronary heart disease and type 2 diabetes mellitus

Aim. To evaluate efficiency of endovascular intervention in patients with type 2 diabetes mellitus with the use of bioabsorbable vascular endoproteases and everolimus-coated stents. Material and methods. A total of 143 patients were initially selected for the study of whom 125 were randomized into 2 groups, one including 57 patients with implanted bioabsorbable vascular endoproteases, the other comprised of 68 patients treated with the use of everolimus-coated stents. Inclusion criteria: primary lesion of coronary arteries, stable angina of effort (II-III FC), myocardial ischemia (&gt;10%) confirmed in functional tests, compensated and subcompensated DM2, stenosis of middle and distal segments of the main coronary arteries (≥70%) diagnosed by digital angiography. Exclusion criteria: the target artery not more than 4 mm in diameter, acute coronary syndrome, excess vascular tortuosity, marked calcinosis of coronary arteries, bifurcation lesion, left coronary trunk lesion, history of myocardial revascularization. Criteria for the assessment of immediate outcomes: frequency of major cardiovascular events (death, myocardial infarction, emergency secondary intervention). Criteria for the assessment of long-term outcomes: frequency of major cardiovascular events (death, myocardial infarction, secondary intervention), frequency of in-scaffold/in-stent restenosis or stent thrombosis. Results of biobsorbable scaffold implantation were controlled using optical coherence tomography in the end of surgery and during 12 month during follow-up. Results. A total of 63 bioabsorbable vascular endoprostheses and 102 everolimus-coated stents were implanted to patients of groups 1 and 2 respectively. Mean diameter of the endoprostheses was 2.88±0.06 and 2.68±0.12 mm respectively (р&gt;0,05). The intervention was regarded as technically successful in 100% cases. The overall frequency of major cardiovascular complications during hospitalization in patients of groups 1 and 2 was 3.5 and 2.94% respectively. Long-term outcomes could be estimated in 41 patients of group 1 and 52 ones in group 2. All patients survived for 12 months. The frequency of non-fatal MI was 4.9 and 3.8% in groups 1 and 2 respectively (р&gt;0,05), the cause being progression of atherosclerosis in other arteries. Frequency of in-stent restenosis was 2.4 and 1.9% (р&gt;0,05). Cases of late stent thrombosis were absent whereas coherence tomography revealed severe intravascular volume depletion to 0.14±0.19 and 0.12±0,23 mm in groups 1 and 2 respectively (р&gt;0,05). Conclusion. Bioabsorbable endoprostheses implanted to patients with coronary heart disease and type 2 diabetes mellitus and stenosis of middle and distal segments of the main coronary arteries within 12 months after surgery proved as efficient and safe as everolimus-coated stents.

Evaluation of life quality in patients with postinfarction cardiosclehrosis on the background of metabolitic therapy

Aim of research – to estimate the dynamics of life quality indices in patients with postinfarction cardiosclerosis on the background of the metabolic therapy using the questionnaire MacNew Heart Disease Health-related Quality of Life.Materials and methods: in the research took part 99 patients (71 % of men and 29 % of women) with postinfarction cardiosclerosis, stable angina of effort of ІІ-ІІІ functional class. Patients of the group of comparison (n=49) continued to take the basis therapy of the ischemic heart disease, whereas patients of the main group (n=50) additionally took glutargin. All groups were representative by age and sex. The patients’ life quality estimation was realized by the questionnaire MacNew.Results: The determination of the life quality was carried out using the questionnaire MacNew Heart Disease Health-related Quality of Life, most effective for patients with the ischemic heart disease. At the comparative analysis of initial life quality indices by the questionnaire MacNew in both groups, all patients with postinfarction cardiosclerosis demonstrated the decrease of all indices of scales and didn’t differ statistically. It was established, that on the background of glutargin treatment took place the statistically reliable increment of the physical activity (from 4,3±1,0 to 5,2±0,9 points, p&lt;0,05) and reliable increase of the routine activity, limited by the pain influence (from 4,6±0,8 to 5,9±0,9 points, p&lt;0,05).Conclusions: All patients with postinfarction cardiosclerosis demonstrated the essential decrease of life quality indices in physical, emotional and social spheres. Glutargin inclusion into the standard therapy of patients with the ischemic heart disease allows to improve the life quality of patients with postinfarction cardiosclerosis essentially

THE ROLE PLAYED BY SHIATSU AND STRETCHING IN THE FUNCTIONAL REHABILITATION OF STABLE ANGINA PATIENTS

Angina pectoris is a more or less intense coronary symptom, more or less severe, according on the associating pathology. Stable effort angina is less severe than the stable resting angina, both being less severe than the unstable angina. Taking into consideration the fact that alongside the basic treatment of this coronary disease and the emergency nitroglycerin treatment, a series of physical manifestations caused by repeated angina crises can be approached through Shiatsu and stretching, we have structured and applied a specific program on six patients with stable angina, and compared their results with the results of other six patients with the same pathology, but who only received drug treatment. The results have proven that the application of specific Shiatsu and stretching programs on stable angina patients over the course of eight weeks (three sessions per week during the first four weeks, and two sessions per week during the following four) contributes more than the drug treatment to the decrease of the intensity, frequency and duration of angina crises.

TCTAP C-044 Wiggle Wire for Percutaneous Coronary Intervention to Right Coronary Artery Severe Calcified Tortuous Lesion

### Patient initials or identifier number Y. H ### Relevant clinical history and physical exam This is a 70-year-old gentleman, known a history of hypertension and dyslipidemia. He complained of effort angina since December 2014. His family doctor referred to our hospital for stable effort angina

CLINICAL FEATURES OF MANIFESTATIONS OF MYOCARDIAL ISCHEMIA IN PATIENTS WITH STABLE ANGINA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Aim.To evaluate the comparative frequency of various manifestations of myocardial ischemia depending on chronic obstructive pulmonary disease (COPD), its severity and pulmonary hyperinflation (PHI) in patients with stable effort angina having indications for planned endovascular myocardial revascularization. Materials and methods. Systematically selected 605 patients with stable effort angina with a history of long-term smoking, among which spirography identified 142 patients with COPD, were checked for the incidence of various manifestations of myocardial ischemia, as estimated by the classification of Diamond A.G. (1983). Results.Atypical angina occurred in patients with COPD 1.6 times more often (p=0.021), and dyspnea without other manifestations of myocardial ischemia – 1.8 times more often (p=0.025) than in the control group. There was an increase in the incidence of atypical angina and dyspnea in COPD patients from grade III, and also in case of PHI. Conclusion.COPD leads to a change in the manifestations of myocardial ischemia in patients with stable angina, which is accompanied by an increase in the incidence of atypical angina and dyspnea in patients with severe COPD and in case of PHI.

PERIOPERATIVE COMPLICATIONS AND REMOTE RESULTS OF PERCUTANEOUS CORONARY INTERVENTIONS IN PATIENTS WITH STABLE ANGINA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Aim. To estimate the frequency of hospital complications and the long-term (duration of observation to 3 years) results of percutaneous coronary interventions (PCI) performed for stable effort angina in patients with chronic obstructive pulmonary disease (COPD). Materials and methods. Hospital complications were recorded after PCI in a series of 605 patients with stable effort angina with a history of long-term smoking, among which 142 patients with COPD were identified by spirography. For the prospective part of the study, 135 COPD patients and 216 patients in the control group were selected. During long-term follow-up (up to 3 years), the incidence of major cardiovascular events (MACCE) was recorded. Results. No effect of COPD on the incidence of hospital complications after PCI was found. The relative risk (RR) of major cardiovascular events in the long-term period was 1.36 (95% confidence interval 0.97-1.90). RR of revascularization was 1.77 (95% confidence interval 1.11-2.82). Conclusion. COPD does not affect the incidence of hospital complications after PCI, but increases the risk of MACCE in the long-term, mainly due to repeated myocardial revascularization.