RESUMEN
We studied relationship between structure-functional parameters of left and right cardiac chambers and N-terminal pro-brain natriuretic peptide (NT-proBNP) level in 118 patients with arterial hypertension (AH) (35 men, 83 women) and 17 healthy volunteers. Methods comprised 24-hour arterial pressure monitoring (APM), two-dimensional echocardiography (echoCG), Doppler echoCG, and tissue echoCG of mitral and tricuspid atrioventricular annuli, treadmill test, 6-min walk test, and measurement of NT-proBNP level in blood plasma. In patients with AH blood plasma NT-proBNP level was significantly higher than in a group of healthy persons of similar age. Elevation of this biochemical marker was accompanied by significant change of characteristics of remodeling of left and right parts of the heart, abnormalities of left ventricular diastolic function according to transmitral blood flow, disturbances of left ventricular diastolic and systolic function according to tissue Doplerography data. Comparative analysis of structure-functional parameters of the heart and NT-proBNP level in patients with AH allowed to reveal more significant changes of parameters of diastolic and systolic remodeling, local and global diastolic and systolic left ventricular function in patients with NT-proBNP levels more than 306 mol/ml. Factors determining NT-proBNP level in patients with AH were age, free right ventricular wall thickness, and body mass index.
Asunto(s)
Ventrículos Cardíacos , Hipertensión , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Disfunción Ventricular/metabolismo , Remodelación Ventricular , Adulto , Biomarcadores/sangre , Índice de Masa Corporal , Ecocardiografía Doppler/métodos , Prueba de Esfuerzo/métodos , Femenino , Ventrículos Cardíacos/metabolismo , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/fisiopatología , Humanos , Hipertensión/complicaciones , Hipertensión/metabolismo , Hipertensión/patología , Hipertensión/fisiopatología , Hipertrofia Ventricular Derecha/etiología , Masculino , Persona de Mediana Edad , Proyectos de Investigación , Estadística como Asunto , Función Ventricular Izquierda , Función Ventricular DerechaRESUMEN
Main objective of epidemiological part of the (PRIMA) study was elucidation of special characteristics of Russian population of patients with stable angina and more precise characterization of variety and volume of drug and nondrug therapy used in patients with stable angina in Russian Federation. In clinical part of the PRIMA program we assessed efficacy and safety of standard antianginal therapy in combination with trimetazidine with modified release of active substance (MR) in standard therapeutic dose in patients with stable angina after myocardial infarction. According to results of the study prescription of trimetazidine MR was followed by improvement of clinical course of the disease. This manifested as decrease of average number of attacks per week, reduction of mean weekly consumption of short acting nitrates, improvement of quality of life, lessening of severity of main clinical manifestations of chronic heart failure, and lowering of its functional class. It is necessary to emphasize that analysis of results of the PRIMA study has revealed similar efficacy of trimetazidine MR in men and women what allows to recommend this metabolic myocardial cytoprotector to patients with ischemic heart disease irrespective of gender.
Asunto(s)
Angina de Pecho/tratamiento farmacológico , Angina de Pecho/epidemiología , Insuficiencia Cardíaca/prevención & control , Trimetazidina , Anciano , Angina de Pecho/etiología , Angina de Pecho/fisiopatología , Cardiotónicos/administración & dosificación , Cardiotónicos/efectos adversos , Monitoreo de Drogas , Prueba de Esfuerzo , Femenino , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Nitrocompuestos/administración & dosificación , Nitrocompuestos/efectos adversos , Federación de Rusia/epidemiología , Índice de Severidad de la Enfermedad , Factores Sexuales , Resultado del Tratamiento , Trimetazidina/administración & dosificación , Trimetazidina/efectos adversos , Vasodilatadores/administración & dosificación , Vasodilatadores/efectos adversosAsunto(s)
Angina de Pecho/tratamiento farmacológico , Benzazepinas/uso terapéutico , Canales Catiónicos Regulados por Nucleótidos Cíclicos/uso terapéutico , Infarto del Miocardio/tratamiento farmacológico , Anciano , Angina de Pecho/diagnóstico , Angina de Pecho/diagnóstico por imagen , Benzazepinas/administración & dosificación , Canales Catiónicos Regulados por Nucleótidos Cíclicos/administración & dosificación , Ecocardiografía , Estudios de Seguimiento , Humanos , Ivabradina , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/diagnóstico por imagen , Factores de Tiempo , Tomografía Computarizada de Emisión , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Efficacy and safety of the use of atorvastatin in complex treatment of extensive psoriasis was studied in 63 patients with psoriasis and arterial hypertension (AH). Complex clinical functional examination was carried out at study entry and after 6 months of treatment. Psoriasis severity was evaluated with PASI scale, quality of life with DLQI, PDI and SF 36 questionnaires. Degree of systemic inflammation (IL 10, TNF , hsCRP) and local (TNF , rc TNF , LFA 1) systemic immune inflammation was also assessed. Patients were randomized into either atorvastatin group (20 mg/day, n=48) or standard therapy group (n=15). Initially there was no significant difference between groups in psoriasis severity (PASI 22.2 [13.3; 24.6]) and 22.6 [19.3; 23.6], respectively). Six months of therapy with atorvastatin resulted in significant lowering of PASI (3.6 [1.6;4.8]) compared with 17.0 [15.0; 20.1] in control group, p0.01]); 47.9% of patients achieved PASI -50% in 3 weeks and 95.8% - after 6 months of therapy (0% and 13.3% in control group); 81.3% of patients achieved level of PASI -75% by 6th month of treatment. Positive dynamics of therapy was accompanied with significant improvement of quality of life according to data of PDI and DLQI. After 3 weeks of therapy significant lowering of TNF (from 1.45 [0.6; 1.8] to 1.0 [0.6; 1.4], p<0.05) and hs-CRP (from 5.4 [2.4; 7.1] to 3.3 [2.9; 5.5], p<0.05) took place in atorvastatin group. Antiinflammatory effect of atorvastatin persisted by month 6 (TNF 0.7 [0.4; 1.2] compared with 1.4 [1.3; 1.6] in control group, p0.05); hsCRP (3.1 [2.4; 5.0] 5.5 [2.2; 12.1]) in control group, p<0.05). Significant lowering of local immune inflammation was also occurred in atorvastatin group.Thus therapy with atorvastatin was effective and safe in patients with psoriasis and AH.
Asunto(s)
Ácidos Heptanoicos/uso terapéutico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipertensión/tratamiento farmacológico , Psoriasis/tratamiento farmacológico , Pirroles/uso terapéutico , Atorvastatina , Presión Sanguínea/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Estudios de Seguimiento , Ácidos Heptanoicos/administración & dosificación , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Hipertensión/complicaciones , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Psoriasis/complicaciones , Psoriasis/patología , Pirroles/administración & dosificación , Calidad de Vida , Índice de Severidad de la Enfermedad , Piel/patología , Resultado del TratamientoAsunto(s)
Angina de Pecho/tratamiento farmacológico , Infarto del Miocardio/complicaciones , Calidad de Vida , Trimetazidina/uso terapéutico , Vasodilatadores/uso terapéutico , Angina de Pecho/etiología , Angina de Pecho/psicología , Preparaciones de Acción Retardada , Relación Dosis-Respuesta a Droga , Humanos , Resultado del Tratamiento , Trimetazidina/administración & dosificación , Vasodilatadores/administración & dosificaciónRESUMEN
INTRODUCTION: Shock-wave therapy (SWT) has proved its efficacy and safety in a number of studies in stable effort angina. METHODS: Twenty-four patients (20 men, 4 women; mean age 63.3 +/- 6.1 years) with chronic heart failure (CHF) of ischemic origin (>6 months after AMI) and left ventricular (LV) ejection fraction (EF) <40% received SWT in addition to their stable treatment. SWT was performed in 9 sessions with 100 shocks per spot in viable segments detected by low dose dobutamine stress echocardiography. Patients were examined at baseline and at 3 and 6 months after SWT. Troponin T level was measured after each week of treatment. RESULTS: Class of CHF significantly decrease from 2.2 +/- 0.8 to 1.7 +/- 0.7 at 3 and at 6 months after SWT (p<0.01). Six-minute walk test improved from 414 +/- 141 to 509 +/- 141 and 538 +/- 116 m (p<0.01) at 3 and 6 months, respectively. Significant augmentation of LVEF at rest was noted at 3 and 6 months after SWT (from 32.2 +/- 6.0 to 34.8 +/- 9.6 and 37.7 +/- 9.5, respectively p=0.03). Troponin T was negative in all cases. Significant increase of LV longitudinal deformation was registered at 6 months (from -8.84 +/- 0.38 to -9.72 +/- -0.44%, p<0.01) what evidenced for improvement of LV contractility. The latter was a result of restored hibernating segments function (longitudinal deformation of these segments rose from initial -7.52 +/- -0.5 to -9.18 +/- 0.53 and -9.63 +/- 0.59% at 3 and 6 months after SWT, respectively, p<0.01). CONCLUSIONS: In patients with CHF SWT caused significant clinical improvement as well as increases in LV EF and distance walked during 6-min walk test. These results justify conduct of a placebo controlled study.
Asunto(s)
Insuficiencia Cardíaca/terapia , Ondas de Choque de Alta Energía/uso terapéutico , Isquemia Miocárdica/terapia , Terapia por Ultrasonido/métodos , Ecocardiografía de Estrés , Electrocardiografía , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/fisiopatología , Volumen Sistólico/efectos de la radiación , Resultado del Tratamiento , Función Ventricular Izquierda/efectos de la radiaciónAsunto(s)
Angina de Pecho/tratamiento farmacológico , Infarto del Miocardio/complicaciones , Trimetazidina/uso terapéutico , Vasodilatadores/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Angina de Pecho/epidemiología , Angina de Pecho/etiología , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Estudios Retrospectivos , Federación de Rusia/epidemiología , Tasa de Supervivencia/tendencias , Resultado del Tratamiento , Trimetazidina/administración & dosificación , Vasodilatadores/administración & dosificaciónAsunto(s)
Gasto Cardíaco Bajo/psicología , Depresión , Antidepresivos/uso terapéutico , Gasto Cardíaco Bajo/inmunología , Gasto Cardíaco Bajo/metabolismo , Enfermedad Crónica , Depresión/tratamiento farmacológico , Depresión/etiología , Depresión/psicología , Depresión/terapia , Humanos , PsicoterapiaRESUMEN
AIM: To study efficacy of the myocardial cytoprotector trimethasidine MB and metabolic drug 3-(2,2,2-trimethylhydrasine) propionate dihydrate (3-TMHP) in the treatment of chronic cardiac failure (CCF). MATERIAL AND METHODS: Sixty-five patients with CCF after myocardial infarction (> 6 months) with left ventricular ejection fraction (LV EF) <40% were randomized into 3 groups: group 1 (n=28) received basic therapy plus trimethasidine in a daily dose 70 mg; group 2 (n=25)--basic therapy plus 3-TMHP in a daily dose 1000 mg; control group (n=12) received basic therapy with ACE inhibitors, beta-blockers and diuretics. Before and after 6-month treatment all the patients have undergone stress echocardiography with dobutamine. Perfusion and myocardial metabolism were determined in 34 patients with single photon emission computed tomography of the myocardium (SPECT) with 99m-Tc-technetril and positron-emission tomography of the myocardium (PET) with F-18-fluorodesoxyglucose. RESULTS: Groups 1 and 2 significantly reduced functional class of CCF and prolonged the distance of a 6-min walk. Significant improvement of life quality was observed only in the treatment with trimethasidine. According to PET, treatment with trimethasidine MB and 3-TMHP has an anti-ischemic action manifesting with a significant attenuation of glucose hypermetabolism in the ischemic segment to normal values. However, significant improvement of systolic thickening in hybernated segments by SPECT as well as a significant rise of LV EF were recorded only in the treatment with trimethasidine MB. Stress echocardiography with dobutamine had high specificity (85.7%) but low sensitivity (50.4%) in detection of hybernated myocardium. CONCLUSION: Trimethasidine MB (preductal MB) has advantages over 3-TMHP, so it is preferable in ischemic CHF.
Asunto(s)
Fármacos Cardiovasculares/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Metilhidrazinas/uso terapéutico , Trimetazidina/uso terapéutico , Vasodilatadores/uso terapéutico , Antagonistas Adrenérgicos beta/uso terapéutico , Anciano , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Enfermedad Crónica , Terapia Combinada , Diuréticos/uso terapéutico , Esquema de Medicación , Femenino , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/epidemiología , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
Efficacy of metabolic therapy with trimetazidine MR and 3-(2,2,2-trimethylhydrazyn) propionatodihydratum (3-TMHP) was compared in patients with chronic heart failure (CHF) of ischemic genesis. Clinico-functional examination included dobutamine stress echocardiography single photon emission computer tomography (SPECT) with 99mTc-technetril, and positron emission tomography (PET) with 18F-Fluoro-2-deoxyglucose. Clinical course of CHF improved during therapy with both trimetazidine MR, and 3-TMHP. According to PET data therapy with trimetazidine MR and 3-TMHP exerted antiischemic action which appeared as significant diminishment of glucose hypermetabolism in ischemic segments down to normal values. However significant improvement of regional systolic thickening in hibernating segments according to SPECT data, significant increase of left ventricular ejection fraction at rest and peak load according to data of stress-echocardiography took place only during therapy with trimetazidine.