RESUMEN
AIM: To evaluate effects of 6-month therapy with losartan in combination with indapamide on a clinical course, immunological, metabolic parameters, left ventricular function, exercise tolerance and quality of life in patients with coronary heart disease (CHD) associated with metabolic syndrome (MS). MATERIAL AND METHODS: Forty six CHD patients with postinfarction cardiac dysfunction in MS were randomized into two groups. Group 1 consisted of 22 patients with impaired glucose tolerance, group 2--of 24 type 2 diabetics. Treatment included combination of losartan (50 mg/day) with indapamide (1.5 mg/day), on demand nitrates, nebivolol. Basic therapy in diabetes included sugar-reducing drugs. Clinical condition, findings of echocardiography, parameters of lipid and carbohydrate metabolisms, immunoglobulins, circulating immune complexes, autoantibodies to cardiolipin (AB to CL), spectrum of proinflammatory cytokines were studied before and 3 months after course treatment. RESULTS: Overactivation of cytokines (primarily IL-2, IL-1, TNF alpha) with high expression of IgA, IgG, CIC, AB to CL was found in CHD patients with type 2 diabetes mellitus and less evident in impaired glucose tolerance. Losartan in both groups had an antihypertensive effect, stabilized LV hypertrophy, improved clinical symptoms leading to cytokines expression decline: TNF alpha by 9.8%, IL-1--by 6.1%, IL-6--by 6.7%. Losartan was well tolerated, caused no negative metabolic effects. CONCLUSION: New original facts of cytokine overactivation and humoral immunity disturbances were discovered which play an essential role in pathogenesis of postinfarction dysfunction and LV remodeling developing in type 2 diabetes mellitus. Losartan 6-month treatment in the fixed combination has a positive effect on clinicohemodynamic and immunometabolic indices. This gives grounds for wider use of losartan in CHD combined with type 2 diabetes mellitus.
Asunto(s)
Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Antihipertensivos/uso terapéutico , Cardiotónicos/uso terapéutico , Enfermedad Coronaria/tratamiento farmacológico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Factores Inmunológicos/uso terapéutico , Losartán/uso terapéutico , Adulto , Anciano , Bloqueadores del Receptor Tipo 1 de Angiotensina II/administración & dosificación , Antihipertensivos/administración & dosificación , Cardiotónicos/administración & dosificación , Enfermedad Coronaria/complicaciones , Citocinas/sangre , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Ventrículos Cardíacos/efectos de los fármacos , Ventrículos Cardíacos/inmunología , Ventrículos Cardíacos/fisiopatología , Humanos , Inmunoglobulinas/sangre , Factores Inmunológicos/administración & dosificación , Indapamida/administración & dosificación , Indapamida/uso terapéutico , Losartán/administración & dosificación , Masculino , Síndrome Metabólico/complicaciones , Síndrome Metabólico/tratamiento farmacológico , Persona de Mediana Edad , Estudios Prospectivos , Disfunción Ventricular Izquierda/tratamiento farmacológico , Disfunción Ventricular Izquierda/inmunología , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
The aim of this work was to evaluate anti-ischemic and angiographic efficiency of endovascular revascularization of ischemic myocardium by implantation of Sirolimus-eluting stents from the results of a 18 moth-long prospective study of patients with coronary heart disease and/or type 2 diabetes mellitus (DM). The study included 108 patients with angina of effort randomized into two groups: CHD with DM (n = 51) and CHD without DM (n = 57). All of them received anti-ischemic and antihypertensive therapy and two desaggregants; DM patients also used oral hypoglycemic preparations. The patients underwent implantation of Sirolimus-eluting stents. The frequency of restenosis of the target arteries, development of serious cardio-vascular events (death, MI, cerebral stroke, and the need in repeat revascularization) were compared within 18 months after primary endovascular revascularization. Although Sirolimus-eluting stents markedly improved long-term prognosis in DM patients, results of their implantation were worse than in patients with CHD without DM.
Asunto(s)
Cateterismo Cardíaco/métodos , Enfermedad Coronaria/cirugía , Diabetes Mellitus Tipo 2/complicaciones , Revascularización Miocárdica/métodos , Enfermedad Coronaria/complicaciones , Stents Liberadores de Fármacos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
AIM: To elucidate clinical efficacy and immunocorrecting properties of recombinant immunomodulator ronkoleukin in patients with postinfarction cardiac dysfunction with NYHA FC II-III CHF. MATERIAL AND METHODS: In a 6-months prospective comparative clinically controlled study we observed 33 survivors of myocardial infarction divided into 2 groups according to FC of chronic heart failure (CHF): group I (n=17) with FC II CHF with LVEF > 45% (mean age 52 +/- 2.9 years) and group II (n=16) with FC III CHF and lowered ( 40%) LVEF (mean age 53.7 +/- 3.3 years). Comparison group comprised practically healthy subjects. Clinico-laboratory and functional assessment of state of patients was carried out before initiation of therapy with ronkoleukin and in 2 - 3 days after completion of 2 courses of therapy with 3 months interval. Immunological study included determination of subpopulation content of peripheral blood lymphocytes, blood plasma immunoglobulins, antiinflammatory cytokines Il-1a, Il-1b, Il-2, Il-6, Il-8, TNFa and AB to Cl. RESULTS: It was found that ronkoleukin is an effective immunocorrector producing no adverse effects in patients with FC II-III CHF. Most pronounced effect ronkoleukin manifested in relation to humoral immunity lowering dysimmunoglobulinemia, blood levels of IgA, IgG, CIC and antibodies to cardiolipin, inhibiting excessive cytokine activation in dependence on degree of severity of CHF. CONCLUSION: Administration of ronkoleukin to patients with postinfarction dysfunction of the heart with FC II-III CHF for correction of secondary immunodeficient state in addition to basic therapy provides positive changes of hematological, immunological parameters, intracardiac hemodynamics, facilitates regression of symptoms of CHF and improves quality of life.
Asunto(s)
Anticuerpos Anticardiolipina/sangre , Anticuerpos Anticardiolipina/efectos de los fármacos , Citocinas/metabolismo , Insuficiencia Cardíaca/tratamiento farmacológico , Factores Inmunológicos/farmacología , Factores Inmunológicos/uso terapéutico , Isquemia Miocárdica/tratamiento farmacológico , Autoanticuerpos/sangre , Autoanticuerpos/efectos de los fármacos , Citocinas/sangre , Femenino , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/epidemiología , Isquemia Miocárdica/prevención & control , Disfunción Ventricular Izquierda/epidemiologíaRESUMEN
AIM: To evaluate clinico-immunological disorders in patients with ischemic heart disease (IHD) and metabolic syndrome (MS), to study an immunocorrective action of nebivolol during 6-month treatment. MATERIAL AND METHODS: A total of 54 patients with postinfarction left ventricular dysfunction and chronic cardiac failure of NYHA functional class II-III were divided into two groups: group 1 (n=24) comprised patients with effort angina FC II-III and impaired glucose tolerance, group 2 (n=30) consisted of anginal patients associated with type 2 diabetes mellitus (DM). Clinical, laboratory and functional indices were registered before therapy with nebivolol and 6 months after it. Immunological control included determination of the subpopulation composition of lymphocytes, immunoglobulins, circulating immune complexes (CIC), antibodies to cardiolipin (CL), proinflammatory cytokines: IL-1alpha, IL-2, IL-6, IL-8, alpha-interferon, tumor necrosis factor alpha (TNFalpha). RESULTS: Nebivolol demonstrated good antihypertensive and anti-ischemic cardioprotective efficacy in IHD patients with MS, it did not deteriorate atherogenic dyslipidemia and impaired carbohydrate metabolism. As a good immunocorrector, nebivolol significantly inhibited cytokine overactivation, had a weak effect on dysimmunoglobulinemia, CIC level and expression to CL antibodies. Side effects were not recorded. CONCLUSION: IHD patients with MS (especially patients with type 2 DM) have manifest immune disorders presenting with overactivation of proinflammatory cytokines with high levels of IgA, IgG, CIC and antibodies to CL in the presence of low immunoregulatory index. Nebivolol provided good control of arterial hypertension, myocardial ischemia, positive changes in immunological indices, improved intracardiac hemodynamics.
Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Benzopiranos/uso terapéutico , Etanolaminas/uso terapéutico , Síndrome Metabólico/complicaciones , Isquemia Miocárdica/tratamiento farmacológico , Isquemia Miocárdica/inmunología , Antagonistas Adrenérgicos beta/administración & dosificación , Angina de Pecho/complicaciones , Angina de Pecho/tratamiento farmacológico , Angina de Pecho/inmunología , Angina de Pecho/metabolismo , Antígenos CD/inmunología , Benzopiranos/administración & dosificación , Citocinas/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/metabolismo , Etanolaminas/administración & dosificación , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/inmunología , Insuficiencia Cardíaca/metabolismo , Hemodinámica/efectos de los fármacos , Humanos , Inmunoglobulinas/sangre , Resistencia a la Insulina/inmunología , Recuento de Leucocitos , Leucocitos/citología , Leucocitos/inmunología , Lípidos/sangre , Masculino , Síndrome Metabólico/inmunología , Síndrome Metabólico/metabolismo , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/metabolismo , Nebivolol , Estudios Prospectivos , Linfocitos T/citología , Linfocitos T/inmunología , Factores de Tiempo , Resultado del Tratamiento , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/tratamiento farmacológico , Disfunción Ventricular Izquierda/inmunología , Disfunción Ventricular Izquierda/metabolismoRESUMEN
AIM: To characterize clinical and immune disorders in patients with ischemic heart disease (IHD), postinfarction left ventricular remodeling (PLVR), clinical manifestations of chronic cardiac failure (CCF). MATERIAL AND METHODS: A comparative clinical controlled trial of immune system was made. The immune system was assessed by diagnostic and prognostic significance of changes in population composition of T- and B-lymphocytes, by activation of proinflammatory cytokines (IL-1alpha, IL-2, IL-6, IL-8, Inf-alpha, TNF-alpha); high expression of circulating immune complexes (CIC), autoimmune complexes to cardiolipin (CL) in 94 CCF patients with PLVR. The patients were divided into 3 groups according to severity of CCF. Group 1 consisted of 32 patients with CCF (FCII by NYHA) and normal ejection fraction (EF) of the left ventricle (52.0 +/- 2.8%). Group 2--31 CCF (FCIII) patients with decreased EF (by 43.8%) (36 +/- 4.3%). Group 3--31 CCF (FCIV) patients with low (25 +/- 3.8%) EF of the left ventricle. The protocol required conduction of echocardiographic parameters, paired bicycle exercise tests, 6-min walk tests, 24-h ECG monitoring, population cell composition of T- and B-lymphocytes, concentrations of cytokines, IgG and IgG autoantibodies to CL. RESULTS: A dominating hyperactivation of cytokines TNFalpha, IL-1alpha, IL-2, IL-6 with high expression of CIC and autoAB to CL was associated with moderate or severe CCF (FCII-IV by NYHA), declined inotropic function of the left ventricle (EF 38-23%), low exercise tolerance and remodeling of the left ventricle. CONCLUSION: Immune disorders in the form of hyperactivation of proinflammatory cytokines (most of all TNFalpha, IL-1alpha, IL-2, IL-6), enhanced expression of CIC and autoAB to CL growing with severity of CCF and abnormal heart pump function play an important role in CCF pathogenesis in IHD patients with LCPR and can be markers of the disease progression.
Asunto(s)
Anticuerpos Anticardiolipina/inmunología , Citocinas/inmunología , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/inmunología , Inmunoglobulinas/inmunología , Infarto del Miocardio/epidemiología , Infarto del Miocardio/inmunología , Remodelación Ventricular/fisiología , Adulto , Enfermedad Crónica , Quimioterapia , Femenino , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/tratamiento farmacológico , Índice de Severidad de la EnfermedadRESUMEN
A three-year follow-up of patients with coronary heart disease (CHD) and type II diabetes after coronary artery bypass grafting, shows that the following pathologic conditions are significantly more frequent: arterial hypertension, visceral obesity, marked disturbances of blood lipid spectrum, an increases CHD duration, and an increased rate of myocardial reinfarction and revascularizations. The study shows that the presence of diabetes mellitus in CHD patients undergoing coronary artery bypass grafting, is associated with pronounced disturbances in blood lipid spectrum, and is an important risk factor of coronary event progression.
Asunto(s)
Puente de Arteria Coronaria , Enfermedad Coronaria/cirugía , Diabetes Mellitus Tipo 2/complicaciones , Enfermedad Coronaria/sangre , Enfermedad Coronaria/complicaciones , Diabetes Mellitus Tipo 2/sangre , Progresión de la Enfermedad , Estudios de Seguimiento , Humanos , Lípidos/sangre , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
The purpose of the study was to evaluate anti-ischemic and metabolic effects of the cardioselective beta-adrenoblockers nebivolol and retarded metoprolol-metaprolol CR/XL (betalok ZOK) in patients with postinfarction heart dysfunction, associated with type II diabetes mellitus (DM). 40 patients with coronary heart disease (CHD), functional class (FC) II-III exertional angina, postinfarction left ventricular (LV) dysfunction, and NYHA FC II heart failure, associated with type II DM, were randomized into 2 groups. The 20 patients of the 1st group were administered nebivolol in a dose of 1.25 to 5 mg per day, the 20 patients of the 2nd group - betalok ZOK in a dose of 12.5 to 100 mg per day. The course therapy lasted 8 weeks. The effects of the treatment were evaluated using paired veloergometry, echoCG, and lipid spectrum analysis. The study found that nebivolol in a mean dose of 4.2 +/- 0.3 mg per day and betalok ZOK in a dose of 46.5 +/- 6.2 mg per day reduced the frequency and severety of angina attacks (by 73.8% and 67.8%, respectively) and daily nitroglycerine uptake (by 78.6% and 69.1%, respectively), and increased activity tolerance (by 7.9% and 25.3%, respectively). None of the preparations displayed any adverse effects on carbohydrate exchange and blood lipid spectrum. Nebivolol, unlike betalok ZOK, significantly (p = 0.02) reduced triglyceride blood level by 29%. Thus, the new generation cardioselective beta1-adrenoblockers nebivolol and metoprolol CR/XL (betalok ZOK) provide anti-ischemic and metabolic effects in patients with CHD and postinfarction LV dysfunction, associated with type 2 diabetes mellitus. Nebivolol is preferable as far as blood lipid spectrum is concerned.
Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Benzopiranos/uso terapéutico , Circulación Coronaria/efectos de los fármacos , Etanolaminas/uso terapéutico , Lípidos/sangre , Metoprolol/análogos & derivados , Metoprolol/uso terapéutico , Infarto del Miocardio/complicaciones , Disfunción Ventricular Izquierda/tratamiento farmacológico , Antagonistas Adrenérgicos beta/administración & dosificación , Benzopiranos/administración & dosificación , Glucemia/metabolismo , Angiografía Coronaria , Circulación Coronaria/fisiología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Relación Dosis-Respuesta a Droga , Ecocardiografía , Etanolaminas/administración & dosificación , Prueba de Esfuerzo , Femenino , Estudios de Seguimiento , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Metoprolol/administración & dosificación , Persona de Mediana Edad , Infarto del Miocardio/sangre , Infarto del Miocardio/diagnóstico por imagen , Nebivolol , Resultado del Tratamiento , Disfunción Ventricular Izquierda/sangre , Disfunción Ventricular Izquierda/etiologíaRESUMEN
Coronary artery stenting was carried out in 18 patients with angina recurrence 29.3+/-7.6 after coronary artery bypass grafting. Paired bicycle exercise tests, (199)Tl single photon emission tomography and graft angiography were used in evaluation of patients. Occlusions of 1 or 2 venous grafts were found in 38.9%, stenoses of both previously bypassed and native arteries in 27.8% of patients. Implantation of stents in grafts and/or native coronary arteries was associated with 2.7 fold decrease of angina frequency, 3 fold decrease of nitroglycerine consumption, 72.5% increase of exercise tolerance. The use of statins resulted in obvious lowering of total and low density lipoprotein cholesterol.
Asunto(s)
Puente de Arteria Coronaria , Reestenosis Coronaria/terapia , Isquemia Miocárdica/cirugía , Stents , Angiografía Coronaria , Reestenosis Coronaria/diagnóstico , Reestenosis Coronaria/tratamiento farmacológico , Prueba de Esfuerzo , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Masculino , Persona de Mediana Edad , Nitroglicerina/administración & dosificación , Tomografía Computarizada de Emisión de Fotón Único , Resultado del Tratamiento , Vasodilatadores/administración & dosificaciónRESUMEN
A comparative randomized clinical study was conducted to evaluate the diagnostic and prognostic value of the activation of proinflammatory cytokines [tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1alpha, IL-2, IL-6, IL-8)] and the increased production of autoimmune complexes in the pathogenesis of chronic heart failure (CHF) in patients with coronary heart disease (CHD). The study included 47 patients with CHD who had a more than 6-month history of Q-forming myocardial infarction. The patients were randomized into 3 groups: 1) 21 patients with NYHA Functional Class (FC) II heart failure (HF); 2) 16 patients with FC III HF; and 3) 10 with FC IV HF. Basic therapy involved angiotensin-converting enzyme (ACE) inhibitors, nitrates, diuretics, beta-adrenoblockers; 27.6% received digoxin, disaggregatory agents. A study protocol involved the estimation of the parameters of EchCG, paired bicycle ergometric tests, 6-min walking test, ECG daily monitoring, the levels of proinflammatory cytokines in the serum and IgG autoantibodies to cardiolipin. The findings suggest that with the higher expression of autoimmune complexes, the activation of cytokines (primarily TNF-alpha, IL-1alpha, IL-2) plays an important role in the pathogenesis of CHF in patients with postinfarct cardiac dysfunction: the high activation of cytokines and the elevated level of autoimmune complexes are associated with moderate or severe NYHA FC II-IV HF, depressed left ventricular contractility (ejection fraction, 23-38%), low exercise tolerance, and cardiac remodeling.
Asunto(s)
Complejo Antígeno-Anticuerpo/inmunología , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/tratamiento farmacológico , Citocinas/sangre , Insuficiencia Cardíaca/etiología , Antagonistas Adrenérgicos beta/uso terapéutico , Adulto , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Enfermedad Coronaria/sangre , Enfermedad Coronaria/inmunología , Digoxina/uso terapéutico , Diuréticos/uso terapéutico , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/inmunología , Humanos , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Nitratos/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Volumen SistólicoRESUMEN
Effect of 6 months treatment with carvedilol (25 mg/day) on blood levels of cytokines (interleukins 1alpha, 2, 6, 8, tumor necrosis factor alpha) and clinical symptoms of heart failure was studied in patients with cardiac dysfunction after myocardial infarction. Patients with NYHA class II heart failure, ejection fraction 50% and moderately lowered tolerance to physical exercise (n=21) initially had enhanced cytokine expression: blood content of interleukin (IL) 2 was 2.8 times, tumor necrosis factor (TNFalpha) 78%, IL-1alpha 60% above normal level. Therapy with carvedilol in this group was associated with decreases of Il-2 (-23.8%), TNFalpha (-16.7%), IL-1alpha (-12.5%) (p<0.05-0.01). This was accompanied by alleviation of clinical symptoms and improved exercise tolerance. Patients with NYHA class III heart failure (n=16) with low left ventricular ejection fraction (30+/-2.7%) and low exercise tolerance had high levels of all studied cytokines. Levels of IL-2, TNFalpha and IL-1alpha were most elevated (3.1, 2.8 and 2 times higher than normal values, respectively). Therapy with carvedilol was associated with improvement of clinical symptoms and exercise tolerance (+35%, p<0.05)), increase of ejection fraction (+15%, p<0.05), decrease of left ventricular end systolic volume (-17.5%, p<0.05), and lowering of blood levels of TNFalpha (-31%), IL-2 (-17.4%), IL-1alpha (-15.6%). However cytokine levels remained substantially elevated compared with normal values. Carvedilol was well tolerated, and did not cause negative metabolic effects or other complications.
Asunto(s)
Antagonistas Adrenérgicos beta , Citocinas , Antagonistas Adrenérgicos beta/uso terapéutico , Citocinas/sangre , Tolerancia al Ejercicio/efectos de los fármacos , Insuficiencia Cardíaca , Humanos , Función Ventricular Izquierda/efectos de los fármacosRESUMEN
The antiishemic efficiency of course monotherapy with trimethazidine and its impact on myocardial perfusion were studied in patients with postinfarct dysfunction of the left ventricle (LV), which was associated with moderate heart failure (HF). This prospective controlled clinical study included 47 patients who had experienced myocardial infarction. The patients had also angina pectoris on exertion and NYHA Functional Classes (FC) II-III HF. The patients were randomized into 2 groups: Group 1 comprised patients with more than 50-W exercise tolerance (ET), FC II angina, and FC II HF; Group 2 consisted of those with 50-W or less ET, FC II-III angina, and FC II-III HF. Four-week course therapy with trimethazidine in a dose of 60 mg/day was found to exert a pronounced antiischemic effect in patients with reversible LV ischemia associated with HF. The tolerance of the drug during its 4-week course therapy was good and the drug caused no adverse reactions.
Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Aspirina/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Infarto del Miocardio , Trimetazidina/uso terapéutico , Vasodilatadores/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A randomized blind cross-over study with placebo lead-in compared efficacy of calcium antagonists diltiazem and verapamil in 71 patients with stable angina concurrent with arterial hypotension (group 1) and 38 normotensive patients with ischemic heart disease (group 2). By acute bicycle exercise test evidence, verapamil was effective in 80% and 82% patients of group 1 and 2, respectively, dilitiazem--in 67 and 77%, respectively. Cumulation of the effect (p < 0.01) to the third month of verapamil course was comparable in both groups. Tolerance to an antianginal effect of dilitazem developed in 53% patients of group 1 (against 30% in group 2, p < 001) in 2-4 weeks of therapy (against 4-12 weeks in group 2, p < 0.05). By stress 199-T1 scintigraphy of the myocardium, administration of effective doses of diltiazem reduced the number of hypoperfused segments by at least 30%.
Asunto(s)
Angina de Pecho/tratamiento farmacológico , Bloqueadores de los Canales de Calcio/uso terapéutico , Diltiazem/uso terapéutico , Verapamilo/uso terapéutico , Angina de Pecho/complicaciones , Estudios Cruzados , Humanos , Hipotensión/complicaciones , Masculino , Persona de Mediana Edad , Método Simple Ciego , Resultado del TratamientoRESUMEN
Thirty males with prior myocardial infarction concurrent with arterial hypertension (AH) were examined to study the antihypertensive and antiischemic effects of the AT1-receptor blocker irbesartran. Group 1 comprised 12 (40%) patients with mild AH; Group 2 included 18 (60%) with moderate AH. In Group 2, the standard therapy with irbesartan in a single dose of 150 mg in the morning was supplemented by the beta1-adrenoblocker atenolol in the average daily dose of 31.25 mg. In Group 1 patients there were decreases in systolic blood pressure (SBP) by 28% and diastolic blood pressure (DBA) by 19% while in Group 2 receiving combined therapy with atenolol, SBP lowered on the average of 38.3 mm Hg of the baseline values and DBA became normal in 66.7% of the patients (p < 0.00). Thus, irbesartan provides good antihypertensive and antiischemic effects in patients with grade 1 AH; the combined therapy enhances the efficiency of treatment by 92% in patients with moderate AH.
Asunto(s)
Bloqueadores del Receptor Tipo 1 de Angiotensina II/administración & dosificación , Compuestos de Bifenilo/administración & dosificación , Presión Sanguínea/efectos de los fármacos , Circulación Coronaria/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Infarto del Miocardio/tratamiento farmacológico , Tetrazoles/administración & dosificación , Administración Oral , Adulto , Antihipertensivos/administración & dosificación , Atenolol/administración & dosificación , Angiografía Coronaria , Quimioterapia Combinada , Ecocardiografía , Estudios de Seguimiento , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Hipertensión/complicaciones , Hipertensión/fisiopatología , Irbesartán , Masculino , Infarto del Miocardio/complicaciones , Infarto del Miocardio/fisiopatología , Estudios Prospectivos , Ventriculografía con Radionúclidos , Resultado del Tratamiento , Función Ventricular Izquierda/efectos de los fármacos , Función Ventricular Izquierda/fisiologíaRESUMEN
Efficacy of balloon angioplasty, coronary bypass surgery and conservative therapy in postmyocardial infarction patients with single coronary artery disease was assessed in 3 year prospective study. Positive clinical effect persisted after coronary artery bypass grafting (CABG) in 78 and 73% of patients and after balloon angioplasty in 60 and 40% of patients in 1 and 3 years, respectively. Significant decreases of number of anginal attacks (by 94.1 and 74.1%, respectively), nitroglycerin consumption (by 93.6 and 74.8%, respectively) and dimensions of ischemic perfusion defects (by 68.8 and 33.7%, respectively) were observed 1 year after both CABG and angioplasty. Lowering of exercise tolerance (by 11.1%), increase of nitroglycerin consumption (by 15.8%) and worsening of myocardial perfusion (by 9%) were observed after 3 years in conservatively treated patients.
Asunto(s)
Angioplastia Coronaria con Balón , Puente de Arteria Coronaria , Isquemia Miocárdica/terapia , Enfermedad de la Arteria Coronaria/complicaciones , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Estudios Prospectivos , Resultado del TratamientoRESUMEN
AIM: To study free radical processes in patients with myocardial infarction (MI) aggravated by heart failure. MATERIAL AND METHODS: Forty seven patients taken to the clinic within the first 5 hours of MI were examined. The patients were divided into 2 groups: 1) those with left ventricular failure-complicated IM (n = 25); 2) those with uncomplicated MI (n = 22). A control group included 17 apparently healthy males. The activity of lipid peroxidation (LPO) and blood antioxidative defense was determined in the patients' red blood cells prewashed off the plasma with saline solution at a temperature of 4 degrees C. RESULTS: The tension of free radical lipid oxidation mechanisms in patients with MI aggravated by circulatory insufficiency is followed by an increased antiradical activity. In patients with uncomplicated higher LPO activity is attended the less marked activation of antioxidative enzymes. The examinees were found to show a correlation of the global systolic function of the left ventricle with the concentration of LPO products and with the activity of antioxidative enzymes. CONCLUSION: More significant LP activation coupled with left ventricular systolic dysfunction was noted in patients with MI aggravated by acute heart failure.
Asunto(s)
Antioxidantes , Insuficiencia Cardíaca/etiología , Peroxidación de Lípido , Infarto del Miocardio/fisiopatología , Radicales Libres , Humanos , Masculino , Infarto del Miocardio/complicaciones , Infarto del Miocardio/metabolismo , Volumen Sistólico , Factores de TiempoRESUMEN
Antianginal efficacy of atenolol (A) and isosorbide dinitrate (ID) was compared in a long-term randomized, single-blind, crossover, placebo controlled trial in 71 patients with combined stable angina pectoris and chronic hypotension (Hpts) and in 38 normotensive patients with angina of effort (Npts). Paired bicycle tests showed anti-ischemic activity of drugs: A in 75% and ID in 49% of Hpts, A in 83% and ID in 82% of Npts. Antianginal effect of 25 mg A was observed in 49% of Hpts (vs 6% of Npts; p < 0.01). Secondary resistance to A effect was developed on the treatment week 2-4 in 13% of Hpts (vs 0 in Npts) tolerance to ID effect--on week 1-2 in 71% of Hpts (vs 15% of Npts; p < 0.01) as evidenced by T1-199 exercise myocardial scintigraphy. Hpts needed individual ID therapy with a long-term ID-free period during 8-16 days (vs 3-5 in Npts; p < 0.05) to avoid tolerance. Stable antianginal ID effect manifested with a decrease of myocardial perfusion defect size by 43.1 +/- 1.3% (p < 0.05).