Complicated and combined forms of ischemic heart disease (IHD) are one of the most difficult problems of cardiosurgery. One of the ways of decreasing the risk of complications during combined interventions is the decrease of the period of myocardial ischemia and artificial circulation (AC) duration.

The aim of the research was to evaluate the results of the approbation of the combined technique of surgical treatment of complicated and combined IHD forms by means of coronary artery bypass (CAB) on the working heart as well as the correction of the accompanying pathology with the use of AC.

Material and methods. We examined two groups of operated patients with IHD, complicated aneurism of the left ventricle (ALV), postGinfarction rupture of interventricular septum or the one combined with acquired lesions of mitral and aortal valves. The control group of patients (n = 404) was operated on using the classical method and the test group (n = 46) — using a combined method with performing of CAB on the working heart, along with the correction of the accompanying pathology with the use of AC. The groups matched each other in terms of age, gender, number of damaged coronary arteries, frequency of complications and accompanying pathology (p > 0.05).

Results and discussion. The number of the bypassed coronary arteries in the groups was equal (in both the control and the test groups, it was 2.4 ± 0.1). When using the classical method, the duration of the AC was (138.1 ± 13.2) min, myocardial ischemia (87.5 ± 7.3) min, when using the combined method, — (86.3 ± 2.1) min and (47.3 ± 1.4) min, respectively, (p < 0.05). In case of ALV resection on the fibrillating heart, these values were as follows: (50.7 ± 2.4) and (24.2 ± 2.1) min (p < 0.05). Lethality in the research group of patients was 2.2 % (1 patient) versus 5.2 % (21) in the controls (p < 0.05).

Conclusions. Combined technique of surgical treatment of complicated and combined IHD forms by means of coronary artery bypass on the working heart and the correction of the accompanying intracardiac pathology with the use of artificial circulation permits shortening the time of myocardial ischemia by 1.9 times and the AC duration — by 1.6 times.

Keywords: complicated and combined forms of IHD, coronary artery bypass, combined method of the surgical treatment

The purpose of the research was to study the functional condition of endothelium in patients with essential hypertension (EH) accompanied by ischemic heart disease (IHD).

Materials and methods: 35 patients with EH of І—ІІ stage accompanied by IHD were examined. Mean age of the patients was (50.2 ± 7.5) years. 13 (37.2 %) patients with EH had the 1st stage of this disease, 22 (62.8 %) - the 2nd stage. The control group consists of 15 persons without any signs of cardiovascular pathology. The groups were age and gender matched. Patients' blood plasma level of endothelin 1 (EТ-1) was determined by immunoenzyme method using the kits of Amersham firm (England). The intensity of the lipid peroxidation (LPO) was measured by the content of malonic dialdehyde (MDA) in the blood plasma as well as thiobarbituric acid (TBA) active products (by spectrophotometric method). Lipid blood spectrum, that is total content of cholesterol (TCS), low-density lipoprotein (LDLP) CS, high-density lipoprotein (HDLP) CS, very low-density lipoprotein (VLDLP) CS, and triglycerides (TG) were detrmined by immunoenzyme method, dyslipidemia typification was conducted using D.S. Fridrickson method (1965). Blood plasma concentration levels of cyclic guanosine monophosphate (cGMP) and cyclic adenosine monophosphate (cAMP) were investigated by immunoenzyme method using commercial standard test-systems of scientific and manufacturing enterprise «Immunotech».

Results and discussion. Elevation of EТ-1 level (by 39.0 %; р < 0.05) and substantial decrease of cGMP content in blood plasma (by 25.1 %; р < 0.05) in comparison with the controls was fixed in patients of the main group. Analysis of LPO intensity was the evidence of the substantial increase (almost by 2 times) of the content of TBA-active products and MDA by (24.7 %) in comparison with the controls. Analysis of the lipid blood spectrum revealed the increase of TCS level by 24.0 % (р < 0.05) on average, LDLP CS by 21.0 % (р < 0.05), and also the decrease of HDLP CS by 13.4 % (р < 0.05) in comparison with the controls. In case of dyslipidemia (DLP) II A, cGMP content decreased by 30.4 % (to 5.21 nmol/ml ± 0.71 nmol/ml; р < 0.05) and EТ-1 level increased by 31.9 %: (to 8.44 pg/ml ± 0.47 pg/ml, р < 0.01) at the background of intensification of peroxidation processes by 37.4 %, which was evidenced by the increase of TBA-active products to (9.28 ± 1.05) μmol/l (р < 0.05). The patients with DLP II B manifested substantial decrease of cGMP in the blood plasma — by 30.9 %: (to 4.82 nmol/ml ± 0.69 nmol/ml; р < 0.05) at the background of the increase of EТ-1 level (to 6.82 pg/ml ± 0.67 pg/ml) and TBA-active products (to 10.76μmol/l ± 1.07μmol/l) by 24.6 and 35.7 %, respectively (р < 0.05).

Conclusions. Vasoconstrictive processes in the vascular endothelium of patients with EH of the I—II stage accompanied by IHD are increased, which is manifested by EТ-1 level increase and cGMP plasma concentration decrease. Endothelium function impairment in patients is accompanied by the increase of the oxidative stress, which is evidenced by the increase of LPO indices (TBA-active products and MDA). The impairment of the lipid spectrum of blood, mainly in case of DLP II B, II A and in less degree in type IV, is accompanied by the decrease of cGMP concentration and increase of EТ-1 level and LPO activity.

Keywords: essential hypertension, ischemic heart disease, endothelium, endothelin 1, lipid peroxidation, dyslipidemia

Objective: to evaluate the effectiveness of early statins and quercetin administration for patients with progressive angina pectoris (PAP) based on the study of their influence on the clinical course of the disease, tolerance to physical loading and inflammatory syndrome indices.

Material and methods. 64 patients with PAP aged (62.2 ± 1.93) years and 20 practically healthy persons were examined. The patients were randomized into 4 groups. The patients of the 1st group (n = 14) took the basic treatment for PAP, the 2nd group (n = 17) supplemented the basic treatment with simvastatin (Simvacor-Darnitsa, Darnitsa Pharmaceutical Firm, Ukraine) in dose of 40 mg/day with transition to 20 mg/day after stabilization of the disease flow. The patients of the 3rd group (n = 13) were administered water soluble form of quercetin — Corvitin (Borschahivsky Chemical and Pharmaceutical Plant, Ukraine) in the dose of 1g 3 times a day orally; the 4th group patients (n = 20) took the basic therapy supplemented with simvastatin and quercetin. Simvastatin and quercetin were taken for 6 months. The examination was carried out before the beginning of the treatment and then 2 weeks, 3 and 6 months afterwards. C-reactive protein (CRP) level was measured using CRP-Latex kit (DAC-SpectroMed S.R.L., Moldova), the content of interleukin-6 (IL-6) was determined by fluorescence immunoassay on the Stat Fax 303 Plus (USA) analyzer. Veloergometry (VEM) test was conducted on the ВЭО-2 model of bicycle ergometer using step-like technique at the background of β-adrenoblockers administration in 14 days after the beginning of therapy. The power of the last stage of loading and the double product in the 4th group of patients in 6 months of treatment became substantially higher than in the 1st group in the given period of examination (p < 0.01—0.001).

Results and discussions. According to VEM indices, patients of the 2nd, 3rd and 4th groups displayed the growth of the power of the last stage of loading in 6 months in comparison with the results of the first examination: from (38.7 ± 1.98) to (45.1 ± 1.34) W, from (38.9 ± 2.43) to (45.0 ± 1.13) W, from (38.5 ± 2.85) to (50.3 ± 2.15) W, respectively, (all p < 0.05). Early simvastatin administration in the dose of 40 mg/day helped to decrease CRP in 2 weeks of therapy by 41.5 % (р < 0.001) in comparison with the beginning of therapy and in 6 months — by 85.1 % (p < 0.001) with no substantial dynamics of this index in the patients of the 1st group (p > 0.05). These therapy results were achieved after including quercetin into the complex of treatment. We fixed that the level of IL-6 and its spontaneous production by monocytes in patients of the 2nd group decreased by 17.4 % (р < 0.01) and 28.7 % (р < 0.001), respectively, in comparison with the initial indices in 14 days and by 60 % (р < 0.001) during 6 months of therapy. In patients of the 3rd group these indices decreased by 18.7 and 28.4 % (р < 0.01—0.001), 44.0 и 52.2 % (р < 0.001), 63.1 and 70.7 % (р < 0.001) in 14 days, 3 and 6 months of therapy, respectively.

Conclusions. Long (6 months) administration of complex therapy by PAP patients permits decreasing the destabilization period by 62.4 % and the frequency of recurrent acute coronary syndrome episodes — by 32.9 %. It also allows increasing the tolerance to physical loading by 22.4 % in comparison with the conventional therapy. Early administration of simvastatin and quercetin (both separately and in combination) by PAP patients is accompanied by the decrease of inflammation indices content (CRP and IL-6) in 2 weeks of therapy, which may help to stabilization of atherosclerotic plaques.

Keywords: progressive angina pectoris, statins, quercetin, tolerance to physical loading, C-reactive protein, interleukin-6

Selective and superselective angiography and endovascular surgery made the new approach to the treatment of patients with ischemic lesions of the visual analyzer possible.

The purpose of the research was to determine the efficacy of the prolonged intracarotid pharmacoinfusion in patients with vascular pathology of the visual analyzer.

Material and methods. We examined and treated 86 patients (115 eyes) with vascular lesions of the organ of vision, such as front ischemic neuropathy (28 patients), back ischemic neuropathy (17 patients), diabetic neuroretinopathy (15 patients), dystrophic lesions of the retina (12 patients), partial atrophy of the optic nerve (14 patients). The patients' age ranged from 14 to 77 years — mean age (56.7 ± 3.5) years. The main method of examination was Selding selective cerebral X-ray contrast angiography with the investigation of the blood circulation in the beds of the external and the internal carotid arteries and the determination of the anastomoses between them. The choice of the optimal way of delivering medical preparations to the eye was based on the angiogram (blood supply of the visual analyzer, visualization of the extra- and intracranial anastomoses). The infusion contained: pentoxifylline, heparin, papaverine hydrochloride, lidocaine hydrochloride, aminophylline, dexamethasone. The preparations were infused 3—4 days during 6—8 hours. Evaluation of the efficacy of treatment was based on the information about the functional state of the healthy analyzer, that is the determination of the visual acuity, total field of vision, the investigation of the critical frequency of flicker fusion (CFFF) in Hz, lability of visual analyzer (LVA), phosphene electrical susceptibility threshold (FEST).

Results. The prolonged address pharmacotherapy promoted the increase of the visual acuity from 0.1 ± 0.02 to 0.5 ± 0.01 (р<0.01), widening of the limits of the field of vision from (421.2 ± 11.6) to (512.4 ± 10.3) (р < 0.05), increase of CFFF from (20.2 ± 1.0) to (32.8 ± 2.3) Hz (р < 0.05), decrease of FEST from (483.2 ± 11.7) to (287.3 ± 11.3) μА (р < 0.05), increase of LVA from (35.4 ± 3.1) to (42.6 ± 2.4) Hz (p < 0.05). Positive results in the treatment of patients with vascular pathology of the organ of vision were achieved in 79 patients (91.8%) on day 7—14 after the completion of the treatment.

Conclusion. Transarterial address infusion of vasoactive preparations into the branches of the external carotid artery, which participate in the blood supply of the healthy analyzer (according to the results of the superselective angiography), is an efficient method of treating vascular pathology of the healthy analyzer and allows achieving good results in 91.8% patients.

Keywords: prolonged intracarotid pharmacotherapy, intra-arterial infusion, vascular pathology of the healthy analyzer

The aim of the research was to reveal the correlation between the basic clinical characteristics of diastolic and systolic chronic heart failure (CHF), such as NYHA functional class (FC), stage according to N.D. Strazhesko and V.D. Vasilenko classification and echocardiography indices of the left heart morphology and function.

Material and methods. We analyzed the information concerning 236 patients with CHF resulting from arterial hypertension, chronic coronary artery disease (CAD) and idiopathic dilated cardiomyopathy, including 122 patients with diastolic and 114 patients with systolic CHF, ejection fraction (EF) less than 45 %. All the patients underwent Doppler echocardiography with determination of the basic parameters of the diastolic and systolic functions of the left ventricle (LV) (according to Simpson) and its remodeling.

Results and discussion. Patients with systolic CHF revealed strong inverse relationship between the EF and NYHA FC (r = –0.838; p < 0.001) and CHF stage (r = –0.319; p < 0.01), which was absent in the patients with diastolic CHF. Direct correlation was fixed in patients with both diastolic and systolic CHF between end-systolic volume (ESV) of LV and the stage of CHF (r = 0.519 and r = 0.77, respectively), ESV and NYHA FC (r = 0.34 and r = 0.393) and also between the size of the left atrium (LA) and the stage of CHF (r = 0.484 and r = 0.41, respectively), the size of the LA and NYHA FC (r = 0.405 and r = 0.291, respectively; all р < 0.05—0.001). In case of diastolic CHF, the stage of CHF correlated with the end-diastolic volume (EDV) of LV (r = 0.508), the relative thickness of the LV wall (RTLVW) (r = 0.236), LA volume (r = 0.395, all р < 0.05—0.001).

Conclusions. In case of systolic CHF, EF is in reverse correlation with NYHA FC and the stage of CHF. ESV and LA morphology indices (size and volume) proved to be the most closely related to both the stage of CHF and NYHA FC in patients with CHF of diastolic and systolic types. In case of diastolic CHF, the growth of its stage and NYHA FC are accompanied by the increase of EDV, RTLVW and LA volume.

Keywords: diastolic heart failure, systolic heart failure, the stage of heart failure

The aim of the research was to conduct the direct comparative evaluation of the effect of therapy by different cardioselective β-adrenoblockers such as celiprololum (with inner sympathomimetic agent [ISA]) and atenolol (without ISA) on residual myocardial ischemia, tolerance to physical loading (TPL), vegetative tone and supply according to the indices of variability of cardiac rhythm (VCR) in the course of long-term observation within the open randomized research of patients after acute coronary syndrome (ACS) without Q-wave.

Material and methods. We examined 80 patients with ACS without Q-wave whose left ventricle ejection fraction was more than 45 % and who were randomized in the order of their admission into groups of 40 patients. The patients of the 1st group took atenolol in the dose of 77.08 ± 6.02 mg as part of the conventional complex therapy and the patients of the 2nd group took celiprololum in the dose of 266.67 ± 15.23 mg. The age, gender and main clinical indices of the groups matched. All the patients underwent ECG HM at the time of admission, on the 18-21 day and in 6 months with determining the number of episodes of painful and painless myocardial ischemia, their total and mean duration. Sub-maximum protocol bicycle ergometry (BEM) was performed to all the patients on the 21st day and symptom-limited protocol BEM — in 6 months. During the research of the VCR by 128 ECG complexes (when admitted, on the 18—21 day and in 6 months), we determined the conventional time (SDNN, pNN50) and frequency (HF, LF, HF/LF) indices at rest and their percentage changes during the anti-orthostatic test by means of passive raising of legs (ΔSDNN, ΔpNN50, ΔHF, ΔLF, ΔHF/LF).

Results. At the beginning of the research there were no differences between the HM indices which were analyzed. But in 6 months' period, the 2nd group, if compared with the 1st group, was marked with substantially smaller mean and total duration of episodes of painful myocardial ischemia (1.4 ± 0.11 vs. 3.1 ± 0.12 min. and 2.2 ± 0.2 vs. 5.0 ± 0.26 min., respectively) and painless myocardial ischemia (12.4 ± 0.93 vs. 15.7 ± 1.02min. and 12.5 ± 0.77 vs. 16.3 ± 1.06 min., respectively) as well as the number of painless myocardial ischemia episodes (1.2 ± 0.11 vs. 1.6 ± 0.12, all р < 0.05). At the beginning of the research, the frequency of heartbeat at rest was equal in both groups but in 6 months' period, it constituted 63.6 ± 0.34 beats/min. in the 1st group and 69.7 ± 1.24 beats/min. in the 2nd group (р < 0.05). During BEM the power of the last stage of loading on the 18—21 day in the 1st group was 60.4 ± 1.06, in the 2nd — 62.0 ± 1.05 W (р > 0.05) and the volume of the work which had been done — 32.5 ± 1.98 and 32.2 ± 1.47 kJ, respectively (р > 0.05). In 6 months' period, these indices constituted 90.6 ± 1.04 and 93.8 ± 1.12 W, respectively, and 36.2 ± 1.26 and 39.9 ± 1.31 kJ (р < 0.05), double product value being equal at the last stage of the test in both periods of the research. According to the results of VCR test, in 6 months' period of treatment, the patients of both groups manifested substantial increase of SDNN and ΔSDNN which were equally decreased at the beginning. In the 1st group they reached higher values than in the 2nd group (26.9 ± 1.19 vs. 22.5 ± 1.08 ms and 13.8 ± 1.67 vs 11.7 ± 1.87 %, respectively, р < 0.05), but didn't become normal in both cases. Equally increased at the beginning, if compared with the norm, LF/HF and ΔLF/HF substantially decreased by the end of the study in both groups and achieved 2.01 ± 0.04 and –23.7 ± 0.78, respectively, in the 1st group, and –2.23 ± 0.08 and –18.3 ± 2.60, (р < 0.05) in the 2nd group, the normal values being 1.88 ± 0.19 and –35.1 ± 1.08, respectively.

Conclusions. As evidenced by ECG HM, the therapy by cardioselective β-adrenoblocker with ISA celiprololum produces a stronger positive effect on final restoration of working capacity and decreasing myocardial ischemia episodes of patients with ACS without Q-wave than the therapy with atenolol (without ISA). As evidenced by VCR test at rest and anti-orthostatic test, the treatment with celiprololum produces substantial corrective effect on the initially elevated activity of the sympathetic nervous system in such patients, but this effect is less intensive than that of atenolol.

Keywords: acute coronary syndrome without Q-wave, Holter monitor of ECG, tolerance to physical loading, variability of cardiac rhythm,

The purpose of the research was to study the role of lipid metabolism disturbances and systemic inflammation activity in the development of acute left ventricular failure (ALVF) in patients with acute coronary syndrome (ACS) without ST-segment elevation.

Material and methods. 200 patients with ACS without ST-segment elevation were examined. They were all hospitalized during the first 24 hours from the onset of the disease. Among those who were examined 120 (60 %) were men and 80 (40 %) — women aged 38—76 years (mean age 56.5 ± 8.6 years). In 124 (62.0 %) patients no clinical manifestations of ALVF were observed during the hospitalization (1st clinical group), II class of ALVF according to T. Killip, J.Т. Kimball classification (1967) was present in 46 (23.0 %) patients (2nd clinical group), III class — in 30 (15 %) patients (3rd clinical group). The control group consisted of 30 patients with stable exertional angina pectoris of II—ІІІ functional class. The lipid metabolism was investigated by the enzyme method on the biochemical analyzer with the help of enzyme set «Human» (Germany). The content of fibrinogen (FG) was studied using chronometrical method (according to Clausse) based on determining the time of sedimentation of citrated blood plasma diluted with excess of highly active thrombin. The level of C-reactive protein was measured using the immunoenzyme method.

Results. In comparison with the control group, the patients of all three clinical groups with ACS without ST-segment elevation revealed higher levels: of total cholesterol (TCS) by 11, 13.9 and 21.3 % (р < 0.05—0.01); cholesterol of low-density lipoproteins (CS LDLP) — by 11, 17.5 and 22 % (р < 0.05—0.01); CS of very low-density lipoproteins (VLDLP) — by 31.6, 32.7 and 40.9 % (all р < 0.001) and triglycerides (TG) — by 31.5, 32.5 and 40.7 % (all р < 0.001). Atherogenesis coefficient was by 21.8 (р < 0.01), 31.3 (р < 0.001) и 44.7 % (р < 0.001), respectively, higher than in the controls. The patients of all three clinical groups also manifested substantially higher levels of FG — by 1.6 (р < 0.01), 2 (р < 0.001) and 2.4 times (р < 0.001); С-reactive protein — by 3 (р < 0.001), 4.9 (р < 0.001) and 5.8 (р < 0.001) times; leucocytes — by 1.5 (р < 0.01), 1.9 (р < 0.01) and 2.3 (р < 0.001) times and erythrocyte sedimentation rate (ESR) — by 1.4 (р < 0.01), 1.9 (р < 0.01) и 2.3 (р < 0.001) times, respectively.

Conclusion. Patients with ACS without ST-segment elevation, complicated with ALVF, manifest pronounced lipid metabolism disturbances, whose degree is directly correlated with the class of ALVF. ALVF in patients with ACS without ST-segment elevation is associated with more pronounced activity of systemic inflammation indices than in patients without this complication.

Keywords: lipid metabolism, systemic inflammation, acute left ventricular failure, acute coronary syndrome without ST-segment elevation

Conventional vascular repair of thoracic aortic pathology is represented by a sufficient number of different surgical procedures developed to meet particular requirements of each clinical case. Such procedures are performed by the most experienced surgeons and suggest the use of the latest technical and anesthesiologycal approaches. At the same time, mortality in case of operative interventions and the number of serious postoperative complications remain constantly high even at the best world clinics. In 1987, a low-traumatic method of treating patients with the aneurysm of thoracic aorta was introduced into clinical practice. It was endovascular aneurysm repair (EVAR) which gained wide popularity throughout the world and passed several important stages of development. Clinical results of EVAR of the aorta allow us to consider it a full-fledged method of treating aneurysms and other pathologies of the thoracic aorta. The development of the method is accompanied by extensive scientific and clinical research. The industrial production of stent graft systems of the thoracic aorta in combination with the developed protocols of the procedure provides secure and reliable performance of EVAR even by specialists without previous practical skill of using such devices. Today's continuing extensive development of the method guaranties its wider clinical application in the nearest future.

Keywords: aneurysm, thoracic aorta, endovascular aneurysm repair, stent

Major sections of American Thoracic Society regulations on the order of conducting 6 minutes' walk test have been presented in the article. Current literature data regarding the methods of implementation and the diagnostic opportunities of incremental shuttle walking test have been delivered. The indications and contraindications have been presented, the techniques of conducting the tests have been described in detail, their advantages and restrictions, the causes of pre-term interruption of the tests, interpretation of test results and the principles of the selection of the method for patients with cardioGvascular and broncho-pulmonary diseases were characterized.

Keywords: physical activity, 6 minutes' walk test, incremental shuttle walking test, cardio-vascular diseases, pulmonary diseases

The review discusses the role of kidneys in pathogenesis and development of arterial hypertension. Diagnostic possibilities of detecting microalbuminuria and the role of the latter in the evaluation of the prognosis are considered. The problem of choosing hypotensive medications, including angiotensin converting enzyme inhibitors, in case of the signs of kidney dysfunctions and diabetes mellitus was given careful consideration. According to the results of the investigation, effective decrease and maintenance of arterial hypertension on the normal level prevents or slows down the development of both nephropathy and cardiovascular complications.

Keywords: arterial hypertension, microalbuminuria, kidney failure, angiotensin converting enzyme inhibitors, spirapril

The article introduces the possibility of using the endothelial dysfunction as a precursor of cardiovascular risk in patients with risk factors of atherosclerosis, coronary artery disease and arterial hypertension. The article also presents the information about the possible prognostic value of endothelial dysfunction in the development of coronary «events». The possibility of the potential use of endothelial function as a criterion of stratification of individual risk of cardiovascular prognosis is discussed.

Keywords: endothelial dysfunction, precursor of cardiovascular risk, coronary artery disease, arterial hypertension