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Issue. Articles

2(10) // 2005





The pulse pressure wave in aorta and the systemic haemodynamics indices in patients with acquired heart lesions

G.V. Knyshov, B.L. Palets, A.N. Burkot, I.I. Savenko, V.M. Beshlyaga

The use of pulse aortic (pp) pressure for prediction of cardiovascular disorders caused keen interest because it is regarded as the result of interaction between forward and backward pulse waves (PW) in aorta. The major role is attributed, therefore, to the pulse wave (PW) velocity (vpw) and the relation to it of pp and other circulation indices.

Purpose: to find out peculiarities of relations of left ventricle (LV) stroke volume (SV) and stroke work (SW) as well as of mean aortic pressure (MAP) and total peripheral resistance (TPR) to vpw in patients with lesions of mitral (MV) or aortic (AV) valve as well as with combined lesions of aortic and mitral valves (AMV).

Material and methods. In 50 patients (namely, 19 with AV lesions, 17 with MV and 14 with AMV ones) arterial prssure was measured invasively in proximal and distal parts of aorta, and LV volumes — by means of echocardiography. The vpw, SW and TPR were calculated alongside with corresponding indices per unit of the body surface area (ISV, ISW, ITPR). The relations of pp, SV, SW, MAP and TPR to the vpw, the correlation coefficients between the vpw and those indices as well as the corresponding regression equations were determined in each group of patients. The data by S.N. Polivoda et al. were used as the control. The method is based on the analysis of the clinical data assessing haemodynamics indices by means of statistical and simulation modeling. The mathematical model of the circulatory system included heart ventricles, pulmonary arteries and veins, aorta, systemic arteries and veins and venae cavae. The ventricles are described as sources of pressure with internal resistance, and the aorta — as a tube with the parameters uniformly distributed along its length.

Results. The difference of haemodynamics indices between the groups was not significant except for MAP, ITPR and vpw which were lower in the group with AV lesions than in the group with MV lesions (73.6 ± 12.8 and 82.8 ± 13.8 mm mercury column, 2855 ± 784 and 4133 ± 2088 dynes·sec·m2/cm2, 6.52 ± 0.96 and 7.86 ± 2.1 m/sec, respectively, all < 0.05). The relations between the indices and vpw, however, appeared to differ from group to group. In all groups linear relations pp(vpw), MAP(vpw) and inverse ones ITPR(ISV) were significant. Direct relations ITPR(vpw) were significant in the MV and AMV groups, while ISW(vpw) — in AV and AMV, and ISV(vpw) — in the AV group (all < 0.05). The simulation showed that the slope of the pp(vpw) line was the greater the more rigid the systemic arteries were, and increased in the following order: «norm» — patients with lesions of MV — patients with lesions of AMV — patients with lesions of AV. In the AV group the slope increase was promoted by the increase of the systemic veins rigidity and of the blood flow resistance in aorta with the growth of its rigidity, as well as by increased LV contractility. The MV group was characterized by reduced LV contractility as well as the ITPR growth, while in the AMV group also the arteries rigidity growth with vpw increase was found to be characteristic. The slope of inverse relations ITPR(ISV) increased from group to group in the order reverse to that of the slope growth of the pp(vpw) lines. As to MAP, it was independent on both ISV and ITPR.

Conclusion. In the groups considered, the slope of pp(vpw) relations appears to be greater than normal and to increase with the growth of pulse wave reflection coefficient. A distinctive type of the LV interaction with a pulse wave, fore- and afterload is characteristic of each group; it is what determines relations of SV, MAP and SW to vpw as well as the pattern of MAP maintenance.

Keywords: acquired heart lesions, pulse pressure wave in aorta, mathematical modeling.



The interrelation between haemodynamic and biological markers of poor prognosis in congestive heart failure patients

V.A. Vizir, A.E. Berezin

The purpose of this research is to compare the prognostic value of left ventricular (LV) ejection fraction (EF) and plasma concentration of atrial and cerebral sodium-uretic peptides (ASUP and CSUP) for unfavorable outcome in patients with congestive heart failure (HF) resulting from coronary artery disease (CAD).

Material and methods. 112 patients with congestive (HF) resulting from CAD were under investigation for 3 years. They were examined every 3 months. The cardiohaemodynamics indices were estimated with the conventional echocardiography and intracardiac dopplerography. The plasma level of ASUP and CSUP, as well as NT-fragment of the latter, were determined with radioimmune analysis on Flexis apparatus (Hoffman La Roche, France) and equipment of the firm Amersham, the USA. Death and all the cases of hospitalization because of HF progression were considered 'terminal points'.

Results. Relative risk (RR) of fatal outcome in patients with more than 40 % and less than 40 % of LV EF was 0.45 and 0.53 respectively (the difference of RR indices made up 15.1 %, p = 0.012), while the RR of their hospitalization was 0.24 and 0.78 respectively (the difference of RR indices made up 69.2 %, p = 0.005). Among the patients with plasma concentration of ASUP less (≤) and more (≥) than 10 mmole/l RR of fatal outcome was 0.14 and 0.86 (the difference of RR indices made up 83.7 %, p< 0.001) respectively; and the RR of hospitalization was 0.42 and 0.58 respectively (the difference of RR indices made up 27.6 %, p< 0.02). In patients with plasma concentration of NT-fragment of CSUP less (≤) and more (>) than 100 nanograms/ml the RR of fatal outcome was 0.04 and 0.96 (the difference of RR indices made up 95.8 %, p < 0.001), and of the hospitalization respectively 0.11 and 0.89 (the difference of RR indices made up 87.6 %, p < 0.001). The positive prognostic value of LV EF less than 40 %, ASUP > 10 mmole/l and NT-fragment of CSUP > 100 nanograms/ml for fatal outcome and hospitalization because of HF decompensation made up 0.37, 0.72 and 0.88 respectively. According to the results of the regressive analysis the plasma concentration of NT-fragment of CSUP correlated with end-diastolic volume of LV (r = 0.72; p < 0.0001), LVEF (r = –0.68; p < 0.001), functional class (FC) of HF (r = 0.44; p < 0.02), daily dose of furacemid (r = 0.59; p < 0.002), presence of mitral regurgitation of the II—IV degree (r = 0.50; p < 0.01).

Conclusion. The prognostic value of plasma concentration of ASUP and NT- fragment of CSUP for estimating the individual risk of unfavourable outcome in patients with congestive HF of III—IV functional class NYHA with EF < 50 % exceeds that of LV EF. The elevation of NT-fragment of CSUP in the blood plasma of such patients is a more serious predictor of high cardiovascular risk, than the elevation of ASUP level.

Keywords: heart failure, sodium-uretic peptides, diagnosis, prognostic value.



Specific features of arteries remodeling under the influence of anthracycline antibiotics

N.V. Kalinkina, .. Kashanskaya, N.. Vatutin, .Yu. Yurkevich

The purpose of this research is to estimate the specific features of arteries remodeling under influence of anthracyclines in different cumulative doses.

Materials and methods. The ultrasonic dopplerography of brachial artery in rest and at reactive hyperemia was carried out to 62 patients with oncohematological diseases in the phase of remission (the average age — 20.5 ± 3.1 years), who had taken anthracyclines in dynamics three times: after taking cumulative dose < 550 mg/m2 (1st stage), 550—1000 mg/m2 (2nd stage) and> 1000 mg/m2 (3rd stage).

Results. The thickness of intima-medial complex of the brachial artery in patients after the 1st and the 2nd stages of treatment was not changed in comparison with healthy people (0.66 ± 0.12 mm and 0.69 ± 0.13 mm versus 0.67 ± 0.12 mm). But it substantially increased after the administration of cumulative dose > 1000 mg/m2 (0.78 ± 0.04 mm, p < 0.05 in comparison with the norm and the results after the 1st and 2nd stages). The coefficient of correlation with the dose of anthracycline antibiotics was 0.41 (p < 0.05). In rest the end-diastolic velocity of blood flow (Ved) was higher in patients who had taken anthracyclines (1st stage — 10.2 ± 6.9 cm/sec, 2nd stage — 10.5 ± 5.2 cm/sec, 3rd stage — 16.1 ± 1.5 cm/sec; pI—III < 0.01 pII—III < 0.01) than in healthy people (7.1 ± 3.3 cm/sec; p < 0.05—0.01). After the decompression of the brachial artery in healthy people it enlarged (by 25.7 %; p < 0.05) and in the sick people it diminished (1st stage — by 25.3 %; 2nd stage — by 25.8 %; 3rd stage — by 59.6 %; p < 0.05—0.001). Although the diameter of the brachial artery in rest didn't change in the dynamics of therapy in comparison with healthy people (all p> 0.05), while testing with reactive hyperemia after 1st stage of treatment it increased in all sick people by 20.3 % (p < 0.05) on the average, in healthy people by 18.1 % (p > 0.05). After the 2nd stage it increased only in 19.4 % of the sick, didn't change in 53.2 % and decreased in 27.4 %. After the 3rd stage it didn't change in 43.5 % of patient and decreased in 56.4 %.

Conclusion. Anthracycline antibiotics cause remodeling and infringement of the functional condition of the arteries, which is manifested by thickening of the intima-medial complex and infringement of the endothelium dependent vasodilatation in testing with reactive hyperemia. The heaviness of these lesions of the arteries aggravates with the increase of the cumulative dose of anthracyclins.

Keywords: remodeling, arteries, anthracyclines, endothelium dependent vasodilatation.



Specific features of myocardial infarction clinical course in the presence of intracellular infections

E.N. Belotserkovskaya

The problem of involvement of different infectious agents in the development and progression of atherosclerosis as well as their role as a risk factor of coronary artery disease has been lively discussed for the recent years.

The purpose of this study was to investigate the influence of seropositiveness to herpesvirus infection and C. pneumoniae on the course and prognosis of myocardial infarction (MI).

Material and methods. 63 MI patients were examined at the age of 42 to 92, the average age — 68.6 ± 1.38 years. Among them were 36 males and 27 females. IgG and IgM antibodies to herpes simplex virus-1type (HSV-1) and C.pneumoniae were tested in the blood serum and their titers were determined by solid phase immune-enzyme analysis in all patients at admission and on the 14 day. With regard to the presence of antibodies all the patients were divided into 2 groups: 1) those with antibodies to both infections; 2) those with antibodies to one of the abovementioned infections.

Results. IgG class antibodies to HSV in titers exceeding 1:400 were found in all examined patients. C.pneumoniae infection markers (IgG) were detected in 37 (58.7 %) patients. 11 (26.8 %) patients revealed IgM antibodies to C.pneumoniae in titers 1:200—1:400. The quantity of patients with Q-MI in both groups didn't differ substantially and constituted 78.4 and 76.9 % respectively (p< 0.05); 23.1 % of patients in group 2 had diabetes mellitus (p < 0.05 in comparison with group 1). Hospital lethality of patients in group 1 was 1.9 times (p < 0.05) higher than in group 2. The patients of group 1 had higher fibrinogen level than the patients of group 2 (p < 0.05) as well as higher content of leukocytes in the blood — (10.5 ± 0.43) ×109/l versus (8.8 ± 0.47) ×109/l, p < 0.05, — despite the fact that the number of MI patients with Q tooth and without it was equal. The progression of MI is much more often complicated with pericarditis (8.1 % versus 3.8 %, p < 0.05) based on autoimmune reactions in patients with antibodies to both infections.

Conclusion. 58.6 % of examined MI patient revealed IgG class antibodies both to C.pneumoniae and herpes simplex virus. The progression of MI in patients with serologic markers of C.pneumoniae and herpes simplex virus presence is more often accompanied with the development of pericarditis and more frequent hospital lethality.

Keywords: myocardial infarction, risk factors, C.pneumoniae, herpes simplex virus.



The influence of statin and macrolide antibiotic therapy on the dynamics of serum C-reactive protein concentrations in patients with unstable angina

V.A. Chupina

The aim of the study was to assess C-reactive protein (CRP) levels dynamics in patients (pts) with unstable angina (UA) receiving simvastatin and spiramycin as an addition to the standard therapy.

Material and methods. 83 pts with UA (the average age — 56.7 ± 3.4 y.o.) were enrolled to the study. First, the titers of IgG IgM antibodies to Chlamydia pneumoniae (C.pneumoniae) were tested at all pts. 43 seronegative persons were divided into 2 comparable groups: Ia (n = 21) and Ib (n = 22). The pts of group Ia received the standard therapy for UA; the pts of group Ib — basic treatment and simvastatin (20 mg/day). From 40 pts with diagnostic titers of antichlamidial antibodies two other comparable groups were formed: IIa (n = 20) and IIb (n = 20). Group IIa received simvastatin (20 mg/day) as the addition to the standard therapy; group IIb — simvastatin (20 mg/day) and spiramycin (6 mln U/day during 10 days). First, in 30 and in 60 days from the therapy beginning the CRP levels in frozen serums were detected by the immune-enzyme analysis using the reactants DSL 10-42100 CRP ELISA, USA.

Results. First, the average CRP concentrations were higher (up 5 mg/l) in all the groups under investigation (p < 0.05). In 30 days of therapy CRP level in the group of standard treatment (3.23 ± 0.24 mg/l) was considerably higher than in pts receiving statins independently of the presence or absence in them of the increased titers of anty-chlamydial antibodies signs (1.72 ± 0.27; 1.77 ± 0.25 and 1.64 ± 0.25 mg/l in groups Ib, IIa and IIb respectively). In 60 days since the beginning of therapy CRP concentrations in seronegative patients were significantly lower in pts receiving simvastatin than in the group of standard therapy (0.65 ± 0.28 mg/l in group Ib in comparison with 1.22 ± 0.25 mg/l in group Ia, < 0,05). In seropositive to C.pneumoniae pts the spiramycin administration didn't result in additional CRP concentration reduction (0.81 ± 0.23mg/l in IIa, 0.60 ± 0.29 mg/l in group IIb, > 0,05).

Conclusion. Simvastatin administration in the dose of 20 mg to the pts with UA at the background of standard therapy leads to more significant decrease of CRP levels in about 30 days of treatment in comparison with the patients who hadn't taken simvastatin independently of the presence or absence in them of the increased titers of anty-chlamydial antibodies signs. The spiramycin addition to the basic UA treatment is not followed by the tendency to the additional CRP levels reduction in seropositive to C.pneumoniae pts.

Keywords: coronary artery disease, inflammation, C-reactive protein, infection, statins, spiramycin.

Current Issue Highlights

4(60) // 2017

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K. M. Amosova 1, I. I. Gorda 1, A. B. Bezrodnyi 1, G. V. Mostbauer 1, Yu. V. Rudenko 1, A. V. Sablin 2, N. V. Melnychenko 2, Yu. O. Sychenko 1, I. V. Prudkiy 1&a

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