Clinico-instrumental criteria of functional classes of patients with ischemic heart disease and stable angina pectoris

The study was undertaken to define the clinical and instrumental signs that significantly divide coronary heart disease patients with stable angina into functional classes. Diagnostic criteria constructed on the basis of various clinical and instrumental evidence were developed with regard to the results of the examination of 163 patients with stable angina by using the mathematical statistical methods. The authors provide a procedure for determining and assessing the informative value of the diagnostic index in the long-term prospective survey of patients with coronary heart disease. Concurrent application of clinical parameters and bicycle ergometric findings as part of the index enhances the accuracy and validity of definition of a functional class in patients with stable angina.     

Results of a 2-year prospective study of patients with ischemic heart disease with stable angina pectoris

Data of dynamic control of 278 coronary patients with stable angina pectoris are presented. Coronarography was performed in all cases to determine changes in the heart coronary arteries which were of varying markedness. The anginal syndrome, ECG at rest, exercise tolerance, incidence of myocardial infarction and mortality rate were assessed after one and two years of dynamic observation. The incidence of nonfatal myocardial infarction was estimated at an average of 6.3% per year, whereas the mortality rate was 3.8%. The prognosis for patients with stenosing coronary atherosclerosis depends on the number of affected coronary arteries, the functional class of angina pectoris and exercise tolerance. Data on the efficiency of long-term pharmacological treatment of patients with stable angina and stenosing coronary atherosclerosis are obtained.     

Effects of restored coronary circulation on nature and character of arrhythmia during attacks of angina pectoris in patients with ischemic heart disease]

The nature and frequency of cardiac arrhythmias were studied in 23 patients with coronary heart disease during anginal episodes accompanied by ECG ST-segment depression and elevation. All the ischemic episodes were divided into 2 periods: (1) that from the onset of ST-segment displacement to its maximum; (2) that from the first period to the return of ST segment to the baseline position. The predictive poor ventricular arrhythmias were more frequently recorded in the second period of ST-segment displacement. The occurrence of arrhythmias was demonstrated to be related to the degree of ST-segment elevation (depression) and the duration of the first period of ischemic episode in the second period of ST-segment displacement.     

Clinical and functional results of aortocoronary shunting in patients with ischemic heart disease

Survival rates were evaluated in 3 groups of patients: those with an isolated lesion of the anterior interventricular branch of the left coronary artery (group 1), multiple coronary arterial lesions (group 2) and a more than 50% narrowing of the left coronary-arterial trunk (group 3) following autovenous aortocoronary shunting of 1 to 5 coronary arteries. Drug-treated patients with similar coronary arterial lesions and clinical manifestations were taken as controls. Long-term survival rates of surgical patients were significantly higher, as compared to those of medication-treated patients in groups 2 and 3. There was no significant difference in survival rates of first-group patients. Long-term survival was dependent on the scope of revascularization and pretreatment myocardial contractility.     

Primary angina pectoris: significance of clinical, bicycle ergometric and coronarographic data in the prognosis of ischemic heart disease remission

By the first year of a follow-up, spontaneous clinical remissions (no anginal and ischemic episodes as evidenced by Holter monitoring, negative bicycle ergometric tests) in 52 (26%) out of 200 patients with primary angina pectoris. Possible predictors such as clinical signs, bicycle ergometric and coronary angiographic parameters were examined. A multifactorial stepwise discriminant analysis showed that the independent predictors of the clinical remission were heart rate and exercise power attained on bicycle ergometry, number of diseased coronary artery segments with 70% of more stenoses, disease pattern in the first month, existing and prior smoking, and myocardial infarction in the first 3 months of the disease onset.     

Antiischemic efficacy of trimetazidine in patients with ischemic heart disease,stable angina pectoris and disturbances of carbohydrate metabolism

AIM: To compare antiischemic effects of trimetazidine in patients with stable angina pectoris with and without disturbances of carbohydrate metabolism. MATERIAL: Patients with ischemic heart disease, stable class II-III angina pectoris and reproducible positive results of on-treatment exercise tests (n=40, mean age 56.7-/+1.95 years, 37 men) with normal carbohydrate metabolism (group 1, n=20) and with disturbances of carbohydrate metabolism (group 2, n=20). METHODS: All patients in addition to individually selected antianginal therapy were given trimetazidine (60 mg/day) for 2 months. Bicycle exercise tests were repeated after 1 and 2 months. Patient's diaries were used for registration of anginal attacks and nitroglycerine consumption. RESULTS: Addition of trimetazidine was associated with significant (p<0.005) prolongation of exercise duration until 1 mm-ST depression in both groups. Exercise duration was 553-/+10.5 and 555-/+10.2 s (p>0.05) at baseline, 657-/+15.3 and 695-/+10.1 s (p<0.05) after 2 months in groups 1 and 2, respectively. Other effects of trimetazidine in groups 1 and 2 included increases of total work performed during exercise test (by 14 and 22%, respectively), decreases in numbers of patients with ST depression (by 40, p<0.05, and 50%, p<0.05, respectively), numbers of anginal attacks (by 30, p<0.001, and 43%, p<0.001, respectively) and nitroglycerine pills (by 13%, p<0.001 and 51%, p<0.001, respectively). The decrease in supplemental nitroglycerine consumption was significantly more pronounced in group 2 (p<0.0001). There was no significant increment in double product in both groups. CONCLUSION: Antiischemic effect of trimetazidine was greater in patients with angina pectoris and disturbances of carbohydrate metabolism than in similar patients without such disturbances. KEY WORDS. trimetazidine; diabetes, type II, ischemic heart disease; angina pectoris.     

阿托伐他汀联合曲美他嗪治疗冠心病心绞痛的疗效观察

目的观察阿托伐他汀治疗冠心病心绞痛的疗效。方法选取2016-01～2017-04收治的120例冠心病心绞痛患者,采用随机数字表法将研究对象分为观察组和对照组,各60例。对照组单纯应用曲美他嗪治疗,观察组在对照组基础上加用阿托伐他汀治疗,两组均治疗2个月。比较两组治疗效果及治疗前后血脂指标、血清超敏C反应蛋白(hs-CRP)、B型钠尿肽(BNP)水平和不良反应发生率。结果观察组显效33例,有效23例,无效4例。对照组显效24例,有效23例,无效13例。观察组临床疗效优于对照组(P 0. 05)。观察组治疗后LDL-C、TG、TC水平均低于对照组,HDL-C水平高于对照组(P 0. 05)。观察组治疗后血清hs-CRP及BNP水平均低于对照组(P 0. 05)。观察组不良反应发生率为8. 3%,与对照组(11. 7%)比较差异无统计学意义(P 0. 05)。结论应用阿托伐他汀治疗冠心病心绞痛能够显著提高疗效及调节血脂水平,值得临床推广。     

Comparison of antianginal effects of diltiazem and metoprolol in patients with ischemic heart disease with different clinical forms of angina pectoris

Diltiazem, a new calcium antagonist, and metoprolol, a cardioselective beta-adrenoblocker, were comparatively studied in 53 patients with exertional angina and 11 patients with spontaneous angina. A simple blind random method using placebo, graded physical exercise test employing a bicycle ergometer, and Holter monitoring were applied to evaluate the efficiency of the antianginal treatment. A good antianginal effect was exhibited by the both drugs in exercise-induced angina. Diltiazem was found to be effective in 74% of the patients with exertional angina, whereas metoprolol was beneficial in 62%. Unlike diltiazem (85.7%), metoprolol (50.0%) was less potent in spontaneous angina.     

不同年龄组不稳定型心绞痛患者临床特点的调查分析

目的:比较不同年龄组不稳定型心绞痛(UAP)患者的临床特点,为针对不同年龄组UAP患者行之有效的护理措施提供依据。方法:217例UAP患者根据年龄分为3组:青年组(20～44岁)24例,中年组(45～59岁)60例,老年组(60岁以上)133例。以自行设计的调查问卷进行问卷调查,用病例对照研究的方法分析比较三组的临床特点。结果:三组患者的发病诱因有显著差异(P<0.01),青年组以劳累(94.6%)为最多,老年组以情绪激动(52.4%)为最多,中年组居中;伴发病也有显著差异(P<0.05),伴有高血压,高脂血症,糖尿病的以老年组最多(81.2%,77.4%,66.9%),青年组最少(25.0%,12.5%,16.7%)。冠脉造影阳性率老年组(65.6%),中年组(62.2%)均显著高于青年组(27.3%),P<0.05。随访36个月发现:青年组、中年组、老年组患者病情控制不再复发的比率分别为66.7%、35.0%、13.5%,三组间存在显著性差异(χ2=9.67,P<0.01),且比率随年龄的增长而降低;心力衰竭(0、1.54%、10.5%),脑卒中(0、3.1%、16.5%)发生率随年龄的增加而明显上升(依次为P<0.05,<0.01)。结论:应针对不同年龄组不稳定型心绞痛的临床特点,采取相应护理对策,防治心绞痛,提高疗效,改善预后。     

复方丹参滴丸治疗缺血性心脏病心绞痛、室性早搏的临床研究

目的探讨复方丹渗滴丸对缺血性心脏病心绞痛、心肌缺血、室性早搏的疗效及相关心电图变化。方法按照随机方法将70例缺血性心脏病患者分为观察组和对照组，观察组36例用复方丹渗滴丸10粒／次，口服每日3次，心绞痛发作时加用一次舌下含服10粒。对照组34例用地奥心血康，每次0．2g，每日3次，两组病例均用药8周。两组病例心绞痛缓解症状疗效和心电图改善疗效，按全国疗效标准评定心绞痛疗效和心电图疗效对比分析。结果（1）观察组心绞痛总有效率为91．7％，对照组为70．6％（P〈0．05）。（2）观察组心肌缺血及室性早搏总有效率为66．7％，对照组为47．1％（P〈0．05）。组间比较总有效率及显效率差异有显著性（P均〈0．05）。结论两药均可改善心肌缺血、抗心绞痛，对心肌缺血所致的心电图改变，室性早博有效，但复方丹参滴丸疗效更为优越，在用药过程中未见不良反应及副作用。而地奥心血康组部分病人有头晕头痛及胃部着胀不适。     

Comparison of Clinical characteristics and long-term outcomes of patients with ischemic cardiomyopathy with versus without angina pectoris (from the Duke Databank for Cardiovascular Disease)

Myocardial ischemic origin is a significant independent predictor of mortality in patients with heart failure (HF). The implications of angina pectoris (AP) in HF are less well characterized. The aim of this study was to compare the clinical characteristics and outcomes of patients with and without AP in a cohort of patients with reduced ejection fractions and ischemic cardiomyopathy (iCM). Patients who underwent coronary angiography at Duke University Medical Center from January 2000 to September 2009 with ejection fractions <40% and diagnoses of iCM with AP in the previous 6 weeks were compared to similar patients without AP. Time to event was examined using Kaplan-Meier methods for 5 end points: death; death or nonfatal myocardial infarction (MI); death, MI, or revascularization; death or hospitalization; and cardiovascular (CV) death or CV hospitalization. Of 2,376 patients with iCM, 1,412 (59%) had AP. They had more co-morbidities and more previous revascularization than patients without AP. After multivariate adjustment, those with and without AP had similar risks for death (p = 0.32), death or MI (p = 0.15), and death or hospitalization (p = 0.37) (5-year event rates 41% vs 41%, 46% vs 47%, and 87% vs 85%, respectively), but those with AP had lower rates of death, MI, or revascularization (p = 0.01) and higher rates of CV death or CV hospitalization (p = 0.03) (5-year event rates 85% vs 87% and 77% vs 73%, respectively). In conclusion, AP is common in patients with iCM despite medical therapy and previous revascularization and is associated with increased CV death or CV rehospitalization.     

Immunogenetic characteristics of patients with ischemic heart disease

The distribution of the principal erythrocyte and HLA-antigens was investigated in 202 males aged 20-50 years with a history of myocardial infarction and various courses of coronary heart disease. The occurrence of one or the other group of antigens differed both as compared with a group of healthy subjects (619 subjects) and in relation to the anamnestic and clinical characteristics of the disease course. The findings helped to draw a conclusion as to the presence of associative links between a number of the studied antigens (A (II), MN, HLA-B7, HLA-B14, HLA-B15, HLA-CW4) and the risk of the development of, at least, some forms of coronary heart disease.     

Clinical and hemodynamic characteristics of ischemic heart disease in patients with deficient body mass

AIM: To elucidate clinical and hemodynamic characteristics of patients with ischemic heart disease and low body mass. MATERIAL: Patients with stable angina (n=162) divided into 3 groups according to body mass index (below 25, 25-27 kg/m2 and above 27 kg/m2). RESULTS: Patients with low body mass index compared with those with intermediate values had worse clinical (arrhythmias, derangements of conduction, recurrent myocardial infarctions, cases with heart failure), hemodynamic (lower stroke volume and cardiac index, higher total peripheral resistance), and cardiometric (lower ejection fraction, larger diastolic volumes, greater relative myocardial mass) characteristics. CONCLUSION: These findings constitute a pathophysiological substrate for increased risk of death in patients with ischemic heart disease and deficient body mass.     

Use of bepridil in patients with angina pectoris]

The efficacy of the calcium antagonist bepridil given in a dose of 200-400 mg/day was evaluated in 22 patients with Functional Classes II-III stable angina pectoris. In addition to clinical assessments, repeated bicycle ergometric exercise tests were performed in the patients. The agent was found to be highly potent, well tolerated, and to cause no grave adverse effects.     

Effects of obsidan on hemodynamic indices and clinical manifestations of angina pectoris in patients with ischemic heart disease during psychoemotional stress

Obsidan was tested for effects on psychoemotional stress (PES) tolerance in 37 patients with coronary heart disease concurrent with angina pectoris. During PES testing, the course treatment of obsidan versus placebo resulted in a significant decrease in the pulse-pressure index by significantly bringing down heart rate. With this, blood pressure remained unchanged. The patients who were highly responsive to PES, as evidenced by heart rate measurement, showed a high rise in systolic and diastolic blood pressure when they were taking obsidan. The frequency of positive tests was 48.7% before obsidan therapy and 8.1% during its therapy; that was 29.8 and 8.1%, respectively, when the objective criterion for myocardial ischemia was used as ECG ST-segment displacement.     

通心络胶囊治疗冠心病心绞痛疗效观察

目的观察通心络胶囊治疗冠心病心绞痛的疗效。方法将268例临床确诊为冠心病心绞痛患者随机分为治疗组和对照组各134例。对照组给予基础治疗,包括阿斯匹林、硝酸酯类、β-受体阻滞剂、钙拮抗剂,降血压、血脂、血糖药物等;治疗组在与对照组基础治疗一致的基础上,加服通心络胶囊,4粒／次,3次／d,连服4周。服药开始、治疗期间及治疗结束,均进行心电图、动态心电图、血液生化等相关检查,部分病例随病情变化记录即刻心电图、心脏超声及心电图活动平板运动试验,记录相关症状、心绞痛发病情况和舌下含化硝酸甘油用量。结果治疗组总有效率为91．79％,对照组总有效率为70．15％,两组比较差异有统计学意义（P〈0．01）。结论通心络胶囊能有效缓解冠心病心绞痛患者胸痛、胸闷、心慌、气短等不适症状,显著改善心肌缺血发作,是治疗冠心病心绞痛的理想药物,值得临床推广应用。