RESUMEN

Aim    To study the effectiveness of a treatment based on monitoring the soluble ST2 receptor (sST2) concentration in patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction (LVEF) after acute decompensated heart failure (ADHF).Material and methods    The study included 37 patients hospitalized for ADHF with LVEF ≤40% and sST2 concentration ≥37.8 ng/ml at the time of discharge from the hospital. Patients were randomized into two groups: a sST2 monitoring (sST2M) group (19 patients) and a standard therapy (ST) group (18 patients). The follow-up period was 12 months. At baseline, the groups practically did not differ by clinical, functional, laboratory, and instrumental characteristics. For the sST2M group, the goal was reducing the sST2 concentration by >30% of baseline or to <30 ng/ml.Results    Therapy in both groups was comparable both in doses and in frequency of administration of basic drugs. However, the diuretic therapy was more frequently adjusted in the sST2M group (3.0 [1.0; 4.0] vs. 1.0 [0; 3.0] adjustments per patient, p = 0.047), which required more visits to the clinic (7.0 [6.0; 9.0] vs. 6.0 [6.0; 6.0] visits per patient, p=0.024). In the sST2M group at 6 months, the sST2 concentration was decreased by 43.3% (p=0.001), and 13 patients (72.2%) achieved the goal. In the ST group, the sST2 concentration was decreased by 38.5% (p=0.001), and 11 patients (68.8%) reached the target values. After 12 months, the downward trend continued in both groups. In both groups, the NT-proBNP concentration decreased: in the sST2M group by 27.7% (p=0.014), and in the ST group by 31.9% (p = 0.006). By the 12th month, the decrease remained only in the sST2M group. Only the sST2M group had an increase in LVEF (+28.5%, p=0.003), a decrease in left ventricular end-systolic volume (LVESV) (-12.0%, p=0.017), and a decrease in left atrial volume (-13.4%, p=0.045); at 12 months, LVEF remained increased (26%, p=0.006), and LA volume remained decreased (-14.3%, p=0.028). Quality of life and results of 6-minute walk test (6MWT) improved in both groups. For 6 months of treatment, the sST2M group had a significantly lower incidence of composite endpoints (CEP, cardiovascular death and decompensation/hospitalization due to HF), 26.3% (5 events) of the sST2M group compared to the ST group, 83.3% (15 events) (p=0.029), primarily due to a lower incidence of decompensated HF. For 12 months of follow-up, the incidence of CEP in the ST group was 122.2% (22 events), and 47.4% (9 events) in the sST2M group (p=0.035).Conclusions    The tactics of sST2 monitoring used in the treatment of "high-risk" HFrEF patients (with high sST2 concentrations) is associated with increased LVEF, improved functional status of patients, a beneficial effect on LV remodeling, and decreased incidence of CEP.

Asunto(s)

Insuficiencia Cardíaca , Disfunción Ventricular Izquierda , Humanos , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/tratamiento farmacológico , Volumen Sistólico , Función Ventricular Izquierda/fisiología , Proteína 1 Similar al Receptor de Interleucina-1 , Pronóstico , Biomarcadores , Calidad de Vida , Pacientes Ambulatorios , Péptido Natriurético Encefálico

RESUMEN

We tested possibility of the use of apelin-12 as a biomarker of chronic heart failure (CHF). The study comprised 108 patients with I-IV functional class CHF of various etiology (ischemic heart disease, dilation cardiomyopathy) and 40 healthy volunteers. Blood samples were taken at hospital admission before prescription of pharmacological therapy. In all patients we carried out echocardiography with calculation of end-diastolic and end-systolic volumes (EDV, ESV) and ejection fraction (EF). Blood plasma apelin-12 concentration was compared with CHF market NT-proBNP. Mean apelin-12 concentrations were 0.86 ± 0.22 hg/ml in healthy volunteers and 0.8±0.35, 0.81 ± 0.29, 0.68 ± 0.38, 0.82 ± 0.35 hg/ml in patients with CHF classes I, III, III, IV, respectively. There was no significant differences between appelin-12 concentrations in various classes of CHF. No correlations were found between apelin-12 and EF, EDV, ESV, sex, age, smoking, body mass index, and NT-proBNP level. Concentration of NT pro-BNP level correlated with CHF severity. Thus apelin-12 did not show itself as reliable biomarker of CHF.

Asunto(s)

Insuficiencia Cardíaca/sangre , Péptidos y Proteínas de Señalización Intercelular/sangre , Volumen Sistólico , Adulto , Anciano , Anciano de 80 o más Años , Apelina , Biomarcadores/sangre , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Índice de Severidad de la Enfermedad , Adulto Joven

RESUMEN

We tested possibility of the use of apelin-12 as a biomarker of chronic heart failure (CHF). The study comprised 108 patients with I-IV functional class CHF of various etiology (ischemic heart disease, dilation cardiomyopathy) and 40 healthy volunteers. Blood samples were taken at hospital admission before prescription of pharmacological therapy. In all patients we carried out echocardiography with calculation of end-diastolic and end-systolic volumes (EDV, ESV) and ejection fraction (EF). Blood plasma apelin-12 concentration was compared with CHF market NT-proBNP. Mean apelin-12 concentrations were 0.86+/-0.22 hg/ml in healthy volunteers and 0.8+/-0.35, 0.81+/-0.29, 0.68+/-0.38, 0.82+/-0.35 hg/ml in patients with CHF classes I, II, III, IV, respectively. There was no significant differences between appelin-12 concentrations in various classes of CHF. No correlations were found between apelin-12 and EF, EDV, ESV, sex, age, smoking, body mass index, and NT-proBNP level. Concentration of NT pro-BNP level correlated with CHF severity. Thus apelin-12 did not show itself as reliable biomarker of CHF.

Asunto(s)

Citocinas/antagonistas & inhibidores , Insuficiencia Cardíaca/terapia , Animales , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales/uso terapéutico , Enfermedad Crónica , Ensayos Clínicos como Asunto , Modelos Animales de Enfermedad , Etanercept , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/inmunología , Insuficiencia Cardíaca/mortalidad , Humanos , Inmunoglobulina G/administración & dosificación , Inmunoglobulina G/uso terapéutico , Inmunoglobulinas/uso terapéutico , Infliximab , Ratones , Placebos , Pronóstico , Receptores del Factor de Necrosis Tumoral/administración & dosificación , Receptores del Factor de Necrosis Tumoral/uso terapéutico , Proteínas Recombinantes de Fusión/uso terapéutico , Factores de Tiempo , Factor de Necrosis Tumoral alfa/administración & dosificación , Factor de Necrosis Tumoral alfa/uso terapéutico

RESUMEN

AIM: To assess effects of different variants of neurohormonal (NH) modulation with angiotensin converting enzyme (ACE-I) quinapril (Q), angiotensin-receptor blocker (ARB) valsartan (V) and their combination in addition to beta-adrenergic blocker bisoprolol (B) on functional status, quality of life (QOL), parameters of left ventricular (LV) remodeling, main indices of 24-h heart rate variability (HRV) and NH profile in patients with stable mild-to-moderate congestive heart failure (CHF). MATERIAL AND METHODS: Sixty three patients with CHF (NYHA class II-III) as a result of ischemic heart disease and dilated cardiomyopathy with LV EF < 40% were randomly assigned to one of the treatment variants on 1:1:1 basis: B+Q (n = 22), B+V (n = 23) and combination of B+Q + V (n = 18). At baseline, all the patients in this study were on background B treatment and according to the study design Q or V were then added to B at randomization. NYHA FC, 6-min walking test (6MT), QOL, 2D-echocardiography, plasma renin activity (PRA), angiotensin II (AT-II), aldosterone (Ald), norepinephrine (NE), epinephrine (E), brain natriuretic peptide (BNP) concentrations and 24-hour HRV parameters were investigated at baseline, 3 and 6 months after randomization. RESULTS: During the study NYHA FC improvement was revealed in all three treatment groups with comparative significant changes in 6MT distance by 20.4%, 19.1% and 19.4% in B+Q, B+V and B+Q+V groups, respectively. QOL maximally decreased in B+V combination (from 45 to 21 points). LV volumes significantly decreased and LV ejection fraction (EF) increased in all groups to the end of the study. Triple combination had no additional effect on LV volumes and LVEF changes compared to B+Q and B+V groups. Plasma NE concentrations decreased maximally in B+Q group (from 650 to 430 pg/ml, p = 0.007). The lesser effect was observed in the combination of B+Q+V, with any NE changes in B+ V group. The E concentration increased significantly (from 215 to 295 pg/ml, p = 0.024) in the B+Q+V group at the end of the study. Plasma A-II concentration did not differ from the baseline during the study in B+Q group, but significantly increased in B+V group and maximally in B+Q+V group (from 11.4 to 23.5 pg/ml, p = 0.009). To the end of the study plasma Ald concentrations remain reduced significantly only in B+V group. The level of BNP significantly decreased in all 3 treatment groups. Significant changes in HRV indices, both in time and frequency domain, were revealed in the B+Q group at 3-month follow-up and SDNN increased on month 24 (p = 0.039). These changes became insignificant at the end of the study. The lesser effect was revealed in B+Q+V group, with insignificant trend toward an increase of SDNN to the end of the study. HRV indices did not improve in the B+V group. CONCLUSION: During long-term treatment the triple combination of B+Q+ V has no significant advantages over B+Q and B+V by the functional status, QOL and parameters of LV remodeling in patients with mild-to-moderate CHF. The combination of B+Q has more potent effect on 24-hour HRV parameters, sympatho-adrenal activity and renal function compared to B+V and B+Q+V groups in CHF patients in our study. The combination B+Q+V may have a negative effect on NH profile (excessive activation of ATII and E) in CHF patients. The triple combination is not recommended for therapy of stable mild-to-moderate CHF patients.

Asunto(s)

Bisoprolol/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Tetrahidroisoquinolinas/uso terapéutico , Tetrazoles/uso terapéutico , Valina/análogos & derivados , Antagonistas Adrenérgicos beta/uso terapéutico , Adulto , Anciano , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Biomarcadores/sangre , Quimioterapia Combinada , Electrocardiografía Ambulatoria , Prueba de Esfuerzo , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Quinapril , Volumen Sistólico , Resultado del Tratamiento , Valina/uso terapéutico , Valsartán

RESUMEN

AIM: To assess different variants of neurohormonal (NH) modulation with angiotensin converting enzyme (ACE-I) quinapril (Q), angiotensin-receptor blocker (ARB) valsartan (V) and their combination in addition to beta-adrenergic blocker bisoprolol (B) on functional status, quality of life (QL), parameters of left ventricular (LP) remodeling, main indices of 24-h heart rate variability (HRV) and NH profile in patients with stable mild-to-moderate CHF. MATERIAL AND METHODS: 63 patients with CHF (NYHA class II-III) as a result of ischemic heart disease and dilated cardiomyopathy with LV EF < 40% were randomly assigned to one of the treatment variants on 1:1:1 basis: B+Q (n = 22; mean daily dose of B-5.5 mg; Q-15.4 mg), B+V (n = 23; mean daily dose of B = 4.8 mg; V = 128 mg) and combination of B+Q+V (n = 18; mean daily dose of B = 4.1 mg; Q = 12 mg; V = 82 mg). At baseline, all the patients in this study were on background B treatment and according to the study design Q or V were then added to B at randomization. NYHA FC, 6-min walking test (6MT), QL, 2D-echocardiography, plasma rennin activity (PRA), angiotensin II (AT-II), aldosterone (Ald), norepinephrine (NE), epinephrine (E), brain natriuretic peptide (BNP) concentrations and 24-hour HRV parameters were investigated at baseline, 3 and 6 months after randomization. RESULTS: During the study NYHA FC improvement was revealed in all 3 treatment groups with comparative significant changes in 6MT distance by 20.4%, 19.1% and 19.4% in B+Q, B+V and B+Q+V groups. QL maximally decreased in B+V combination (from 45 to 21 points). LV volumes significantly decreased and LV ejection fraction (EF) increased in all groups to the end of the study. Triple combination had no additional effect on LV volumes and LVEF changes compared to B+Q and B+V groups. Maximally plasma NE concentrations decreased in B+Q group (from 650 to 430 pg/ml, p = 0.007). A worse effect was observed in the combination of B+Q+V, with any NE changes in B+V group. The E concentration increased significantly (from 215 to 295 pg/ml, p = 0.024) in the B+Q+V group at the end of the study. Plasma A-H concentration did not differ from the baseline during the study in B+Q group, but significantly increased in B+V group and maximally in B+Q+V group (from 11.4 to 23.5 pg/ml, p = 0.009). To the end of the study plasma Ald concentrations remain reduced significantly only in B+V group. The level of BNP significantly decreased in all 3 treatment groups. Significant changes in HRV indices, both in time and frequency domain, were revealed in the B+Q group at 3-month follow-up and SDNN increased on month 24 (p = 0.039). These changes became insignificant at the end of the study. The lesser effect was revealed in B+Q+V group, with insignificant trend toward an increase of SDNN to the end of the study. HRV indices did not improve in the B+V group. CONCLUSION: During long-term treatment the triple combination of B+Q+V has no significant advantages over B+Q and B+V by the functional status, QL and parameters of LV remodeling in patients with mild-to-moderate CHF. The combination of B+Q has more potent effect on 24-hour HRV parameters, sympatho-adrenal activity and renal function compared to B+V and B+Q+V groups in CHF patients in our study. The combination B+Q+V may have a negative effect on NH profile (excessive activation of ATII and E) in CHF patients. The triple combination is not recommended for therapy of stable mild-to-moderate CHF patients.

Asunto(s)

Antagonistas Adrenérgicos beta/uso terapéutico , Bisoprolol/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Tetrahidroisoquinolinas/uso terapéutico , Tetrazoles/uso terapéutico , Valina/análogos & derivados , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Biomarcadores/sangre , Quimioterapia Combinada , Electrocardiografía Ambulatoria/efectos de los fármacos , Estudios de Seguimiento , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/fisiopatología , Humanos , Quinapril , Índice de Severidad de la Enfermedad , Volumen Sistólico/efectos de los fármacos , Volumen Sistólico/fisiología , Resultado del Tratamiento , Valina/uso terapéutico , Valsartán

RESUMEN

AIM: To compare effects of therapy with angiotensin converting enzyme inhibitor quinapril (Q), angiotensin II receptor antagonist valsartan (V), and their combination in patients with stable moderate chronic heart failure (CHF). MATERIAL AND METHODS: Patients (n=80) with NYHA class II-III CHF due to ischemic heart disease, dilated cardiomyopathy or decompensated hypertensive heart and ejection fraction <40% were randomized into 3 groups. Patients of group Q, V and Q+V received Q (average dose 13 mg/day, n=28), V (121 mg/day, n=26), and combination of Q and V (12 and 78 mg/day, n=26), respectively. Methods included assessment of clinical state and quality of life, echocardiography, 6 min walk test, Holter ECG monitoring with measurements of parameters of heart rate variability (HRV), and determination of neurohormones in peripheral blood. Examinations and measurements were made at baseline, in 3 and 6 months. RESULTS AND CONCLUSIONS: Six months therapy with Q, V and their combination resulted in improvement of clinical and functional state of patients. More pronounced augmentation of exercise tolerance and lowering of CHF functional class were observed in group Q. Combined use of Q and V had no significant advantages over monotherapy with Q and V when effect on parameters of left ventricular remodeling were concerned. Therapy with Q was associated with "escape" of blockade of aldosterone synthesis and "reactivation" of angiotensin II formation after 6 months. The use of V and combination of V+Q allowed to achieve more stable but incomplete control of aldosterone activity. The use of Q appears to be the preferential regimen to influence activity of sympathoadrenal system and parameters of 24 hour HRV compared with V and Q+V. Long term therapy with V does not improve main parameters of 24 hour HRV.

Asunto(s)

Antagonistas de Receptores de Angiotensina , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Gasto Cardíaco Bajo/tratamiento farmacológico , Tetrahidroisoquinolinas/uso terapéutico , Tetrazoles/uso terapéutico , Valina/análogos & derivados , Adulto , Anciano , Aldosterona/sangre , Angiotensina II/antagonistas & inhibidores , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Antihipertensivos/administración & dosificación , Antihipertensivos/uso terapéutico , Enfermedad Crónica , Quimioterapia Combinada , Tolerancia al Ejercicio , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Norepinefrina/sangre , Quinapril , Tetrahidroisoquinolinas/administración & dosificación , Tetrazoles/administración & dosificación , Resultado del Tratamiento , Valina/administración & dosificación , Valina/uso terapéutico , Valsartán , Remodelación Ventricular

RESUMEN

AIM: To compare effects of various regimens of long-term monotherapy with quinapril (an ACE inhibitor) and valsartan (a type 1 angiotensin II receptors blocker) and combined therapy with these drugs on the activity of heurohormonal systems and 24-h heart rate variability (HRV) in patients with stable moderate chronic cardiac failure (CCF). MATERIAL AND METHODS: A total of 80 patients with FC II-III CCF secondary to coronary heart disease (CHD), delated cardiomyopathy (DCMP) and decompensated hypertensive heart (49%/47%/4%) were randomized into 3 groups. Group 1 patients (n = 28) received quinapril, group 2 (n = 26)--valsartan, group 3 (n = 26)--quinapril + valsartan. The levels of norepinephrine (NE), angiotensin II (AT II), activity of plasmic renin (PR), aldosteron (AS), plasmic cerebral sodiumuretic peptide (CSUP) were measured and ECG with determination of HRV and heart rate disturbances was made before and 3, 6 months after the treatment. RESULTS: NE concentration lowered most significantly in group 1 (from 630 to 405 pg/ml) vs groups 2 and 3 (from 525 to 490 pg/ml and from 525 to 480 pg/ml, respectively). A 6-month treatment induced significant changes neither in concentrations of AT II nor AC. ATII concentrations rose 2-fold in group III (from 11.9 to 24.3 pg/ml) under a parallel rise of PR activity from 0.7 to 2.5 ng/ml/h and a fall in AS level from 132 to 83 pg/ml. In group 2 AS diminished also (from 165 to 126 pg/ml). CSUP decreased in all the groups, but significantly only in groups II and III (from 350 to 237 and 322 to 204 pg/ml after 6 months of treatment, respectively). Significant changes of 24-h HRV (both spectral and temporary) were observed in group 1 after 3 months of treatment. These changes lost significance to the end of the treatment. In groups 2 and 3 the changes were less pronounced. CONCLUSION: Quinapril is more potent than valsartan and quinapril + valsartan combination in relation to activity of sympathico-adrenal system and HRV in patients with moderate stable CCF. Long-term therapy with valsartan does not improve parameters of HRV in moderate CCF. If CCF patients take quinapril for a long time, they develop the effect of disappearing block of AS synthesis and reactivation of A TII production. The best mechanism of long-term control over the activity of renin-angiotensin-aldosteron system in patients with moderate CCF is combination of quinapril with valsartan.

Asunto(s)

Aldosterona/metabolismo , Angiotensina II/antagonistas & inhibidores , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/farmacología , Antihipertensivos/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Frecuencia Cardíaca/efectos de los fármacos , Norepinefrina/metabolismo , Renina/metabolismo , Tetrahidroisoquinolinas/farmacología , Tetrahidroisoquinolinas/uso terapéutico , Tetrazoles/farmacología , Tetrazoles/uso terapéutico , Valina/análogos & derivados , Adulto , Anciano , Aldosterona/sangre , Enfermedad Crónica , Quimioterapia Combinada , Electrocardiografía Ambulatoria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Norepinefrina/sangre , Quinapril , Renina/sangre , Valina/farmacología , Valina/uso terapéutico , Valsartán

Asunto(s)

Cardiomiopatía Dilatada/cirugía , Mallas Quirúrgicas , Adulto , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Carbazoles/administración & dosificación , Carbazoles/uso terapéutico , Cardiomiopatía Dilatada/diagnóstico por imagen , Carvedilol , Diuréticos/administración & dosificación , Diuréticos/uso terapéutico , Femenino , Fosinopril/administración & dosificación , Fosinopril/uso terapéutico , Humanos , Contrapulsador Intraaórtico , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Propanolaminas/administración & dosificación , Propanolaminas/uso terapéutico , Calidad de Vida , Radiografía Torácica , Espironolactona/administración & dosificación , Espironolactona/uso terapéutico , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vasodilatadores/administración & dosificación , Vasodilatadores/uso terapéutico , Remodelación Ventricular

RESUMEN

We studied the role of disturbances in cell Ca(2+) homeostasis in plasma membrane blebbing and death of thymocytes. Capacitance Ca(2+) channels of the plasma membrane and intracellular Ca(2+) stores are involved in the induction and progression of changes in the membrane and cytoskeleton and apoptosis induced by acrylonitrile.

Asunto(s)

Apoptosis/fisiología , Calcio/metabolismo , Membrana Celular/metabolismo , Capacidad Eléctrica , Timo/citología , Acrilonitrilo/farmacología , Animales , Bloqueadores de los Canales de Calcio/farmacología , Canales de Calcio/metabolismo , Carcinógenos/farmacología , Membrana Celular/efectos de los fármacos , Membrana Celular/ultraestructura , Homeostasis , Imidazoles/farmacología , Masculino , Ratones , Timo/efectos de los fármacos , Verapamilo/farmacología

RESUMEN

UNLABELLED: The use of beta-adrenoblockers in conjunction with angiotensin converting enzyme inhibitors improves quality of life and prognosis of patients with chronic heart failure. However basic mechanisms of these positive effects in severe heart failure remain to be elucidated. METHODS: Patients (n=54) with NYHA class III-IV heart failure and left ventricular ejection fraction < or =35% were randomized either to treatment with bisoprolol (1.25-10 mg/day) (n=30) or in control group (n=24) and were followed up for 12 months. RESULTS: The use of bisoprolol was associated with significant improvement of heart failure functional class, lowering of heart rate (by 14%, p<0.01), elevation of systolic blood pressure (by 7.2+/-12.3 mm Hg, p<0.01) and increase of walking distance (by 30.1+/-29.0 m, p<0.01). No significant changes of these parameters occurred in control group. After 12 months increases of left ventricular end diastolic and end systolic volumes (by 85+/-69.2 and 71+/-51.5 ml, respectively, p<0.001) and of ejection fraction (by 5.7+/-7.3%, p<0.01) took place in bisoprolol treated patients. These changes were significantly (p<0.001) higher than those in control group. After 6 months of treatment with bisoprolol noradrenaline concentration fell from 533 to 402 pg/ml (p<0.05) while in controls it rose from 369 to 474 pg/ml, p<0.01). Decreases of plasma renin activity (from 1.2 to 0.42 ng/ml/h), plasma concentrations of angiotensin II (from 17.1 to 13.1 pg/ml) and aldosterone (from 173 to 148 pg/ml, p<0.05) were also observed in bisoprolol group. No substantial dynamics of activity of main components of renin angiotensin system took place in controls. There were no significant changes of atrial natriuretic peptide in both groups. Significant positive dynamics of parameters of heart rate variability was registered only in bisoprolol group: SDNN increased by 25% (p<0.05), high frequency spectrum by 106% (p=0.03), LF/HF ratio from 2.18+/-1.41 to 1.82+/-0.7. CONCLUSION: Long term use of bisoprolol was associated with improved clinical and hemodynamic status, increased systolic BP, blocked processes of pathological left ventricular remodeling, lowered activity of not only sympathetic-adrenal but also of main components of renin-angiotensin system and improved heart rate variability.

Asunto(s)

Antagonistas Adrenérgicos beta/uso terapéutico , Bisoprolol/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Antagonistas Adrenérgicos beta/administración & dosificación , Antagonistas Adrenérgicos beta/farmacología , Adulto , Anciano , Bisoprolol/administración & dosificación , Bisoprolol/farmacología , Presión Sanguínea/efectos de los fármacos , Ecocardiografía , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/diagnóstico , Frecuencia Cardíaca/efectos de los fármacos , Hemodinámica/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Neurotransmisores , Sistema Renina-Angiotensina/efectos de los fármacos , Factores de Tiempo

RESUMEN

BACKGROUND: Hepatitis E is a major cause of acute icteric disease widespread in tropical and sub-tropical regions but rarely occurring in industrialized countries. Recently solid-phase enzyme immunoassays with recombinant antigens have been introduced for diagnosis of this infection. OBJECTIVES: The aim of this study was to evaluate the diagnostic potential of a newly developed Abbott test for the detection of IgG class antibodies to hepatitis E virus (anti-HEV IgG) in hepatitis patients and 'normal' individuals. STUDY DESIGN: Sera taken from hepatitis patients and individuals without liver disorders in endemic (Kirghizstan and Uzkbekistan) versus non-endemic (Moscow) areas were investigated. In parallel IgG class antibodies to hepatitis A virus (anti-HAV IgG) were determined by an enzyme immunoassay with native HAV antigen. RESULTS: In five groups comprising altogether 86 suspected hepatitis E patients from endemic area the rate of anti-HEV IgG seropositivity varied from 85% to 17%. In Moscow anti-HEV IgG was found in one patient (who also had acute hepatitis B) out of 19. Anti-HEV IgG persisted in an experimentally infected volunteer for at least 12 years after the acute disease. Among the individuals without liver disorders eight out of 173 (4.6%) showed anti-HEV IgG seropositivity in Kirghizstan while there was only one seropositive out of 165 (0.6%) in Moscow. In contrast, anti-HAV IgG were frequently present in the residents of both areas: in Kirghizstan over 90% of individuals from young age groups already had these antibodies; in Moscow the rate of anti-HAV IgG seropositivity constantly increased from 31% in the youngest age group to almost 85% in the oldest one. CONCLUSION: Prevalence of anti-HEV antibodies was unexpectedly low in endemic area; in Moscow anti-HEV IgG was found only in single cases. Anti-HEV IgG seropositivity in a single serum sample could be of certain diagnostic value in non-endemic areas.

RESUMEN

A total of 1331 persons aged 18-53 years were screened for specific markers of hepatitis C virus (HCV) and hepatitis B virus (HBV) infections in their blood, among them 656 primary blood donors, 256 plasmapheresis donors, 111 HBsAg carriers and 306 primary donors with only anti-HBc in the blood. According to the results of assays obtained with the use of assay systems ORTHO ELISA and ABBOTT HCV EIA (USA), the detection rate of anti-HCV-C100-3 among primary blood donors in Moscow was 1.37% and was not different from that among HBsAg carriers (1.8%) and among donors with anti-HCV-C100-3 in the blood (1.6%) (p < 0.01). At the same time differences in the occurrence of anti-HCV-C100-3 circulation in significant plasmapheresis donors were detected: 2.71% (p < 0.01). Antibodies to HCV were detected significantly more frequently among male that female donors. No correlation was found between the detection of anti-HCV-C100-3 in the blood and anti-HBc IgG as the substitute marker of HCV infection.

Asunto(s)

Donantes de Sangre/estadística & datos numéricos , Hepatitis C/epidemiología , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Biomarcadores/sangre , Femenino , Hepacivirus/inmunología , Anticuerpos Antihepatitis/sangre , Anticuerpos contra la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Hepatitis C/inmunología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Moscú/epidemiología , Estudios Seroepidemiológicos , Distribución por Sexo

RESUMEN

The results indicating the same capacity of commercial "ORTHO" HCV-ELISA and "ABBOTT" HCV EIA tests in detecting antibodies to hepatitis C virus (anti-HCV-C100-3) were obtained. The study aimed at the detection in the blood serum of antibodies to hepatitis C virus (HCV) was carried out in 656 primary blood donors at the age of 18 to 53 years, 339 medical workers and 130 patients at the age of 16 to 63 years in three different haemodialysis wards of Moscow. Among 270 medical workers, anti-HCV-C100-3 were detected in 1.48%, which was similar to the findings in primary blood donors (1.37%), (p > 0.1). In a group of 69 medical workers in three haemodialysis wards antibodies to HCV were found in 10.14%. A high rate of HCV antibody detection was found in the patients of haemodialysis wards: from 30% to 49.1%.

Asunto(s)

Unidades de Hemodiálisis en Hospital , Hepatitis C/epidemiología , Adolescente , Adulto , Biomarcadores/sangre , Donantes de Sangre/estadística & datos numéricos , Unidades de Hemodiálisis en Hospital/estadística & datos numéricos , Hepacivirus/inmunología , Anticuerpos Antihepatitis/sangre , Anticuerpos contra la Hepatitis B/sangre , Antígenos de la Hepatitis B/sangre , Hepatitis C/inmunología , Humanos , Técnicas para Inmunoenzimas , Persona de Mediana Edad , Moscú/epidemiología , Sensibilidad y Especificidad , Estudios Seroepidemiológicos , Población Urbana/estadística & datos numéricos , Recursos Humanos

RESUMEN

The study has revealed the possibility of the contamination of serum with HBsAg under laboratory conditions during its treatment and preparation for analysis, which may be the cause of false positive results of HBsAg detection by the enzyme immunoassay (EIA). Excluding the factors of contamination, the authors demonstrate the efficacy of commercial systems, such as the passive hemagglutination test system "Gorky" and the EIA systems "Gorky" and "DIAplus", for the detection of HBsAg in the blood of donors in Moscow and Tashkent.

Asunto(s)

Antígenos de Superficie de la Hepatitis B/análisis , Donantes de Sangre , Técnica del Anticuerpo Fluorescente , Pruebas de Hemaglutinación , Hepatitis B/epidemiología , Humanos , Valores de Referencia , U.R.S.S./epidemiología

RESUMEN

Among 182 prematurely born babies receiving transfusions of HBsAg-negative plasma (blood), 49 (26.9%) were found to have antibodies to HBsAg (anti-HBs) in the 1st week of life, of them 29 had maternal and 20 early antibodies. Early anti-HBs and maternal antibodies detectable in blood sera of premature newborns were found to be protective, capable of preventing both icteric forms of acute posttransfusion hepatitis B and anicteric variants of this infection after plasma transfusion.

Asunto(s)

Transfusión Sanguínea , Anticuerpos contra la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/inmunología , Hepatitis B/prevención & control , Plasma/inmunología , Adulto , Femenino , Hepatitis B/epidemiología , Hepatitis B/etiología , Hepatitis B/inmunología , Antígenos de Superficie de la Hepatitis B/sangre , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Estudios Prospectivos , Estudios Retrospectivos , Factores de Tiempo , Reacción a la Transfusión

RESUMEN

The prospective dynamic laboratory and clinical study of premature children was carried out: 55 children who received plasma transfusion during the first weeks of their life and were retrospectively (i. e. after plasma transfusion) found to have HBsAg detected by the passive hemagglutination (PHA) test, the enzyme immunoassay (EIA) and the radioimmunoassay (RIA) and 127 children who received the transfusion of plasma found to be HBsAg-negative according to the results of EIA and RIA. As revealed in this study, the risk of hepatitis B virus infection in such children after the transfusion of plasma containing HBsAg at low concentrations, determined only in the PHA test or in EIA and RIA, was, respectively, 7.5 and 6.3 times greater than in children receiving plasma found to be HBsAg-negative according to the results of EIA and RIA. The results of this investigation showed the tendency towards a decrease not only in the total contamination of plasma recipients with hepatitis B virus, but also in morbidity rate in icteric forms of acute posttransfusion hepatitis B, depending on the concentration of HBsAg in plasma used for transfusion.

Asunto(s)

Antígenos de Superficie de la Hepatitis B/sangre , Hepatitis B/epidemiología , Plasma/inmunología , Reacción a la Transfusión , Contrainmunoelectroforesis , Relación Dosis-Respuesta Inmunológica , Pruebas de Hemaglutinación , Hepatitis B/transmisión , Humanos , Técnicas para Inmunoenzimas , Recién Nacido , Recien Nacido Prematuro , Estudios Prospectivos , Radioinmunoensayo , Estudios Retrospectivos , Factores de Riesgo

RESUMEN

The prospective dynamic study of 229 premature infants with the use of highly sensitive methods, such as the passive hemagglutination test and the enzyme immunoassay, for the detection of HBsAg and anti-HBs antibodies. Of these, 182 infants received plasma (blood) transfusions in the first days of their life. Plasma (blood) used for transfusions was known to contain no HBsAg in accordance with the results of countercurrent immunoelectrophoresis. 47 infants had no plasma (blood) transfusions. In the group of 182 plasma recipients the presence of hepatitis B virus infection was detected in 17.0% of infants, the ratio of icteric, nonicteric and inapparent forms being 1:4.2:2. In the group of 47 infants no case of hepatitis B virus infection was observed.

Asunto(s)

Antígenos de Superficie de la Hepatitis B/análisis , Hepatitis B/transmisión , Plasma/inmunología , Reacción a la Transfusión , Contrainmunoelectroforesis , Brotes de Enfermedades , Estudios de Seguimiento , Hepatitis B/epidemiología , Anticuerpos contra la Hepatitis B/análisis , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Moscú , Estudios Prospectivos , Factores de Riesgo

Asunto(s)

Anticuerpos Antihepatitis/análisis , Hepatovirus/inmunología , Inmunidad Materno-Adquirida , Envejecimiento/inmunología , Formación de Anticuerpos , Femenino , Sangre Fetal/inmunología , Humanos , Lactante , Recién Nacido , Trabajo de Parto/inmunología , Embarazo

RESUMEN

The frequency of detection of HB virus infection markers was determined by sensitive methods (passive hemagglutination, immunofluorescence, radioimmunoassay) in 83 infants under 1 year receiving transfusions of HB-antigen-negative (by counter-current immunoelectrophoresis) plasma and regularly observed for one year. Among them, 12 (14.4%) infants were found to be infected with hepatitis B virus which was confirmed in 7.2% by the detection of transitory HBs-antigenemia, in 2.4% by the detection of anti-HBc alone which had not been found previously, and in 4.8% by the detection of anti-HBs- previously absent in the blood, including 2.4% with a combination of anti-HBs and anti-HBc. In one case (1.2%) hepatitis was accompanied by jaundice absent in 11 (13.2%) cases.

Asunto(s)

Hepatitis B/diagnóstico , Reacción a la Transfusión , Adulto , Femenino , Hepatitis B/transmisión , Anticuerpos contra la Hepatitis B/análisis , Antígenos de Superficie de la Hepatitis B/análisis , Antígenos e de la Hepatitis B/análisis , Humanos , Lactante , Recién Nacido , Hígado/inmunología , Hígado/patología , Estudios Prospectivos , Estudios Retrospectivos , Riesgo , Factores de Tiempo