Effect of nitrous oxide on myocardial activity and blood supply in patients with ischemic heart disease

The effect of N2O at a concentration of 66 vol.% on hemodynamic parameters and myocardial oxygen supply has been studied in 46 patients with ischemic heart disease, functional class III-IV. A marked disbalance between heart work and myocardial O2 consumption manifested in a drop of blood pressure, stroke index, left ventricular stroke index, coronary perfusion pressure with retention of baseline global coronary flow, which may be indicative of the onset of "steal syndrome" in ischemic zones. Therefore, it is recommended not to use N2O in patients with severe coronary pathology.     

Reversible myocardial dysfunction in patients with ischemic heart disease

The diagnosis of viable myocardium in patients with ischemic heart disease (IHD) with left ventricular (LV) dysfunction is essential for prediction of effectiveness and validity of myocardial revascularization as well as of prognosis in such patients. Great advances in intravascular reconstructive interventions on coronary arteries makes this diagnosis still more important. For diagnosis of reversible forms of LV myocardial dysfunction (stunned and hibernating myocardium) such highly informative methods as positron-emission tomography, single-photon emission computed tomography, nuclear magnetic resonance may be applied but they are not easily available because of high cost. Introduction of stress echo-CG into cardiological practice helps solve this problem as the method is available, relatively cheap, reproducible and sufficiently precise. It detects viable myocardium in IHD patients with high sensitivity and specificity. Echocardiographically, viable myocardium is marked by increased contractility in one or more segments with initial hypo- and akinesia.     

Leu-enkephalin levels in the blood of patients with ischemic heart disease

A total of 32 CHD patients with angina pectoris of effort, functional class I-IV, aged 46 to 68 were examined. Eight patients with cervical osteochondrosis of the same age were controls. In CHD patients with angina pectoris, functional class I-II, the content of leu-enkephalin in the blood plasma did not differ from that in the control group whereas in patients with angina pectoris, functional class II-IV, it was lowered by 42%. In CHD patients aged 46 to 55 the level of leu-enkephalin in the blood plasma was raised, in the group of patients aged 55 to 68 it was considerably lowered.     

Acute myocardial infarction with left bundle-branch block: disproportional anterior ST elevation due to right ventricular myocardial infarction in the presence of left bundle-branch block

A case of inferior and right ventricular acute myocardial infarction in the presence of left bundle-branch block is presented. The electrocardiogram manifests disproportional, discordant ST elevation in leads II, III, and aVF and in leads V(1) through V(4).     

去甲乌药碱负荷心肌灌注显像评价冠心病心肌血供

目的 评价盐酸去甲乌药碱（HG）负荷核素心肌灌注显像（MPI）对冠心病（CHD）的诊断价值。方法 对65例入选患者采用交叉试验法分别先后给予HG注射液（HG组）和安慰剂注射液（安慰剂组）的负荷试验,行负荷-静息^99mTc-MIBI MPI检查,以CAG结果为金标准,计算HG负荷显像诊断CHD的灵敏度、特异度、准确率、阳性预测值和阴性预测值。结果 HG注射液心脏负荷试验MPI诊断CHD的灵敏度为69.57%（16/23）、特异度为97.62%（41/42）、准确率为87.69%（57/65）、阳性预测值为94.12%（16/17）、阴性预测值为85.42%（41/48）。在HG负荷试验中,63例患者出现不同程度的不良反应,表现为心悸（57例）、胸闷（17例）、头晕（1例）、胸痛（10例）等,症状较轻微,停药后10 min内自行缓解。结论 HG作为心脏负荷试验药物用于MPI诊断CHD,具有较好的诊断效能,其不良反应轻微,安全可行,有望成为一种新型的心脏负荷试验药物。     

多层螺旋CT心肌灌注对缺血性心脏病的应用价值

目的探讨MSCT心肌灌注在缺血性心脏病(IHD)诊断与治疗中的应用价值。方法选取35例CAG和(或)支架植入术后IHD患者行MSCT心肌灌注扫描,分别测量并比较正常心肌与缺血心肌的CT值、血流量(BF)、血容量(BV)、峰值时间(MTP)、平均通过时间(MTT)及时间-密度曲线(TDC)。结果 35例患者MSCT心肌灌注扫描均可显示低灌注区,与CAG、SPECT及ECG提示心肌缺血区域相对应。首过灌注图像上缺血心肌CT值为(90.28±7.29)HU,正常心肌CT值为(141.05±9.54)HU;缺血心肌BF、BV减低,MTP、MTT延迟,与正常心肌的差异均具有统计学意义(P均<0.05)。34例正常心肌TDC呈稍快上升继而平缓下降;20例缺血心肌TDC呈缓慢上升,10例近乎水平,5例与正常心肌TDC形态相似。结论 MSCT心肌灌注成像可用于定位及诊断心肌缺血,在缺血性心脏病的诊断及治疗决策中起重要指导作用。     

Characteristics of the action of modified atherogenic-class lipoproteins on the functional activity of peripheral blood lymphocytes in patients with ischemic heart disease

In a study of the effect of lipoproteins of atherogenic classes on proliferative activity of peripheral lymphocytes in patients (n = 44) with ischemic heart disease (IHD) and healthy subjects (n = 16), VLDL isolated from hyperlipidemia blood were shown to have a more suppressive effect on proliferation of PHA-induced lymphocytes than those from healthy subjects. Effect analysis of VLDL isolated from patients with different hyperlipidemia types revealed that VLDL obtained from high triglyceride plasma depressed proliferation 85-75%, while VLDL withdrawn from high cholesterol plasma 45-55% (p less than 0.05). With addition of modified (oxidized) VLDL to PHA-activated lymphocytes oxidized VLDL were demonstrated to have a greater inhibitory effect as compared with intact VLDL. The observed peculiarities of the VLDL effect in hyperlipidemia may underlie the reduced functional activity of lymphocytes, discovered in IHD patients (n = 81).     

Lack of association between left bundle-branch block and acute myocardial infarction in symptomatic ED patients

Objective

Guidelines recommend treating patients with a new or presumed new left bundle-branch block (LBBB) similar to those with an acute ST-segment elevation myocardial infarction. It is often unclear which emergency department (ED) patients with potentially ischemic symptoms actually have an acute myocardial infarction (AMI), even in the setting of LBBB. Our null hypothesis was that in ED patients with potential AMI, the presence of a new or presumed new LBBB would not predict an increased likelihood of AMI.

Methods

This was an observational cohort study. Patients older than 30 years who presented with chest pain or other ischemic equivalent and had an electrocardiogram (ECG) to evaluate potential acute coronary syndrome (ACS) were enrolled. Data collected include demographics, history, ECG, and cardiac markers. Electrocardiograms were classified according to the standardized guidelines, including LBBB not known to be old (new or presumed new LBBB), LBBB known to be old, or no LBBB. The hospital course was followed, and 30-day follow-up was performed on all patients. Our main outcome was AMI.

Results

There were 7937 visits (mean age, 54.3 ± 15 years, 57% female, 68% black): 55 had new or presumed new LBBB, 136 had old LBBB, and 7746 had no LBBB. The rate of AMI was not significantly different between the 3 groups (7.3% vs 5.2% vs 6.1%; P = .75). Revascularization (7.8% vs old 5.2% vs 4.3%; P = .04) and coronary artery disease were more common in patients with new or presumed new LBBB (19.2% vs 11.9% vs 10.1%; P = .0004).

Conclusions

Despite guideline recommendations that patients with potential ACS and new or presumed new LBBB should be treated similar to STEMI, ED patients with a new or presumed new LBBB are not at increased risk of AMI. In fact, the presence of LBBB, whether new or old, did not predict AMI. Caution should be used in applying recommendations derived from patients with definite AMI to ED patients with potential ACS that may or may not be sustaining an AMI.     

Antiphospholipid activity of the blood in patients with ischemic heart disease and thrombogenic complications

The authors propose a method of estimating antiphospholipid activity of blood by phospholipids (PL) assays in circulating immune complexes (CIC). Screening of PL in CIC is an additional test in examination of patients with ischemic heart disease associated with thrombogenic complications and suspected antiphospholipid syndrome.     

Use of clofelin in the prevention of perioperative myocardial dysfunction in patients with ischemic heart disease

The purpose of this study was to evaluate the possibility of using clofeline in anesthesiological protocol for myocardial revascularization as a drug preventing hemodynamic disorders and perioperative myocardial dysfunction. In group 1 (27 pts.) clofelin was used in premedication (150 micrograms at night on the eve of surgery and before the operation), group 2 (29 pts.) was control. Clofelin improved the stability of the cardiovascular system, decreased the incidence of hyperdynamic reactions, episodes of myocardial ischemia, and cardiac arrhythmia during surgery. Use of clofelin for premedication decreased the need in inotropic support during the postperfusion period from 49 to 37% and ensured a higher cardiac production during transfer from artificial to spontaneous circulation.