Changes in the levels and composition of lipoproteins and apolipoproteins of blood plasma in patients with ischemic heart disease after hemosorption

Prior to and following activated charcoal hemosorption, concentrations of lipids, apolipoproteins AI and B and lipid and protein composition in lipoprotein fractions isolated by ultracentrifugation were determined in the plasma from patients with coronary heart disease. The majority of the patients showed a parallel proportional decrease in plasma atherogenic parameters and all components of very low density lipoproteins and low density lipoproteins, triglycerides in particular. Antiatherogenic parameters, such as high density lipoprotein and apo-AI cholesterol, and all the components in high density lipoprotein subfractions were less reduced. In 19% of the patients, hemosorption failed to affect plasma lipids and apolipoproteins. The findings suggest that, in case of successful hemosorption, apoB-containing lipoproteins are chiefly eliminated as whole complexes from the plasma and that this procedure is most beneficial in hypertriglyceridemia.     

Work capacity of patients with ischemic heart disease after aortocoronary bypass

A comparison was made of the clinicofunctional efficiency and social significance of surgical therapy techniques in patients with coronary heart disease (CHD). One hundred and seventy eight patients aged 25 to 59 years who had been operated on in the A. N. Bakulev Institute of Cardiovascular Surgery from 1984 to 1987 were examined. In prolonged periods (mean 2.8 +/- 0.2 years) following surgeries, 85.6% of the patients showed clinical improvement as compared to the preoperative period. At the same time, a total of 43.3% of the patients returned to work, the figure being much less than that observed in the preoperative period. (78.1%). Following the surgery, there was a high rate (94.4%) of disability. Two groups of factors were defined, which determined the patients' return to work after coronary aorta bypass grafting. The low work resumption and high disability rates after surgery are due to the lack of a national social rehabilitation programme for this group of patients.     

Lectin-induced chemiluminescence of peripheral blood neutrophils in patients with ischemic heart disease before and after blood irradiation with helium-neon laser]

The blood taken from 35 patients with coronary heart disease and 30 healthy donors was irradiated with He-Ne laser, which resulted in a decrease in its count of segmented neutrophilic granulocytes. Lectins bound to various carbohydrate determinants onto the neutrophil surface were shown to affect changes occurring after luminol-depended chemiluminescence irradiation in patients and healthy persons in different ways. The patients' neutrophils contained lower levels of radiommunologically detectable leukotriene B4. Thromboxane B2 levels also dropped following the irradiation. The laser irradiation induced elimination of some less resistant cells from blood flow, i.e. "rejuvenation" of a cell population of neutrophilic granulocytes. The remaining cells differed in the composition and reactivity of surface lectin receptors and in the content of biologically active substances, which is likely to play the key role in the mechanism responsible for the therapeutical effect of He-Ne laser.     

Changes in the hemostatic system in patients with ischemic heart disease after isovolemic hemodilution

To specify indications for isovolumic hemodilution, hemostatic parameters (fibrinogen, soluble fibrin, fibrin decomposition products, platelet aggregation, thromboelastograms) were compared with clinical manifestations of coronary heart diseases (CHD) and coronarographic and bicycle-ergometric findings in 41 coronary patients. The increased blood viscosity syndrome was found in 63% of the patients. Isovolumic hemodilution was performed to control the detected disorders in 17 patients. Hemodilution was shown to be an effective means of controlling hemostatic disorders in coronary patients, hemostatic normalization being accompanied with clinical improvement in part of the cases.     

Changes in the levels of various classes of cholesterol lipoproteins in patients with ischemic heart disease during physical training

Forty-six male coronary patients and 10 normal subjects underwent a course of rationed exercise (30 daily bicycle ergometric sessions). Total cholesterol (CS), triglycerides and CS of lipoproteins, belonging to different classes, were measured before and after exercise. Total CS was shown to decline under the effect of regular exercise drills in coronary patients with hyperlipoproteinemia (HLP) types IIa and IIb, while high-density lipoprotein CS increased in patients with HLP types IIb and IV. It is suggested that exercise may be an effective instrument of controlling HLP as a coronary risk factor.     

Cholesterol-containing circulating immune complexes--a component of the blood serum in patients with ischemic heart disease that determines its atherogenic properties

In most patients with coronary heart disease (CHD) and angiographically documented stenosed 1-3 coronary arteries, serum contained cholesterol (C) in the circulating immune complexes (CIC), cholesterol levels in these complexes being directly related to serum atherogenicity, i.e. to their ability to cause a 2-5-fold accumulation of lipids in cultured smooth muscle cells (SMC) of the uninvolved human aortic intima (r = 0.91). Removal of IgG and IgM from the patients' sera led to a 75 and 37% decrease, respectively, in their atherogenic properties displayed in cultured SMC. Much more decrease in the atherogenic potential of the sera was seen in 2.5% polyethylene glycol-induced precipitation of CIC. At the same time, incubation of human aortic intimal SMC with CIC isolated from the atherogenic sera from CHD patients caused a 1.5-3-fold increase in intracellular C levels. It was suggested that CIC cholesterol was a determinant of atherogenicity of the sera from patients with coronary atherosclerosis.     

The triglyceride content in the high-density lipoproteins of patients with ischemic heart disease]

The sera and high density lipoprotein (HDL) fraction obtained from donors and patients with coronary heart disease, Functional Class II exercise-induced angina or postinfarction cardiosclerosis were studied for levels of triglycerides (TG) and cholesterol (C) and calculated for percentage of HDL cholesterol of total serum cholesterol, C/TG and HDL C/HDL TG ratios. A TG-enriched HDL fraction was detected, which had an unusual structure. Calculation of the percentage of HDL C of serum total cholesterol levels much more revealed lower concentrations of HDL C.     

Early prognosis of work capacity in patients with ischemic heart disease after direct myocardial revascularization

The study was designed to estimate the clinical status and exercise tolerance in 25 patients in the preoperative and early postoperative periods, as well as at weeks 6-8 of direct myocardial revascularization performed by applying microsurgical techniques. The clinical status improved in all the patients. Their exercise tolerance was increased by 67 and 106% 2-3 and 6-8 weeks after the surgery, respectively. Thus, with uncomplicated coronary artery reconstruction, the patients can perform graded physical exercise in the early postoperative period, which provides evidence for reduction of a patient's stay in hospital.     

冠心病患者外周血总IgE水平的变化

目的 评估不同类型冠心病（CHD）患者外周血中总免疫球蛋白E（IgE）的水平变化意义。方法 选取CHD患者56例:急性心肌梗死（AMI）患者22例,不稳定型心绞痛（UA）患者17例以及17例稳定型心绞痛（SA）患者。对照组为年龄匹配的健康个体。所有受试者均无家族及个人过敏史。采用ELISA法测定血清总IgE的水平。结果 与对照组［IgE水平(52±30)kU/L］相比,不同类型CHD患者血清总IgE的水平［AMI组:(179±159)kU/L,P<0.01;UA组:(131±78)kU/L,P<0.05;SA组:(127±65)kU/L,P<0.05］均明显增高。AMI患者发病后1,7,14,30 d血清总IgE的水平没有显著差异。结论 各种类型冠心病患者外周血总IgE的水平均升高。     

Effects of lovastatin therapy on the level of low density lipoproteins and atherogenic potential of serum in patients with ischemic heart disease and hypercholesterolemia]

The serum atherogenic potential in patients with coronary heart disease (CHD) concurrent with hypercholesterolemia (LDL cholesterol more than 200 mg/dl), which is able to cause accumulation of intracellular cholesterol in cultured cells has been recently shown to be directly related to the level of total cholesterol and LDL cholesterol. The study was undertaken to examine how a lovastatin-induced decrease in LDL levels affects serum atherogenicity in patients with CHD and hypercholesterolemia. It was shown that the therapy of 22 patients with CHD and hypercholesterolemia led to a reduction in total and LDL cholesterol levels on an average by 24% and 32%, respectively. There were 3- and 1.5-2-fold decreases in circulatory immune complexes and the atherogenic potential, respectively. The findings suggest that the significant reduction in serum LDL cholesterol levels in patients with CHD concurrent with hypercholesterolemia who take hypolipidemic therapy is followed by a decrease in the atherogenic potential.     

Effect of the intravenous administration of finoptin on coronary venous blood flow in patients with ischemic heart disease

Intravenous finoptin (verapamil), 10 mg, was tested for effects on the coronary venous blood flow by probing the coronary sinus and great vein of the heart and performing atrial pacing in 24 patients with ischemic heart disease and eukinetic central hemodynamics. In persons who had had initial high blood flow in the coronary sinus, the agent was found to induce resting coronary venous blood flow changes which were inadequate for its demand and during cardiac pacing; whereas in patients with mean initial venous blood flow values, finoptin enabled myocardial oxygen consumption to be provided both in the region of non-infarcted myocardium and in the ischemic area.     

Increased exercise capacity after digoxin administration in patients with heart failure

Failure to objectively assess the effect of digitalis on exercise capacity has resulted in controversy regarding its use in patients with chronic congestive heart failure. To clarify this situation, maximal treadmill testing with respiratory gas exchange analysis was performed on 11 patients (mean age 57 +/- 9 years) with chronic congestive heart failure with and without digoxin therapy. Ten of the 11 had a consistent third sound gallop, and the mean ejection fraction of the group was 24 +/- 10%. Rest heart rate was significantly higher (91 +/- 16 versus 102 +/- 16 beats/min; p less than 0.05) and rest systolic blood pressure was significantly reduced in the absence of digoxin (130 +/- 23 versus 121 +/- 15 mm Hg; p less than 0.05). No differences in heart rate or blood pressure were observed during exercise. Significant increases in ventilatory oxygen uptake were observed with digoxin submaximally (3.0 mph, 0% grade), at the gas exchange anaerobic threshold and at maximal exercise (mean increase of 2.6 ml/kg per min; p less than 0.02). An improvement in the estimated ratio of ventilatory dead space to tidal volume (VD/VT), an index of physiologic efficiency, occurred throughout exercise during digoxin therapy, and there was a significant negative correlation between the change in maximal oxygen uptake and change in maximal estimated VD/VT (r = -0.63; p less than 0.05). Thus, digoxin therapy is associated with a significant improvement in exercise capacity in patients with chronic heart failure, most likely due to an improved matching of ventilation to perfusion.     

Myocardial blood flow in different regions of the heart in patients with ischemic heart disease before and after revascularization

Laser doppler flowmetry was used for the intraoperative study of myocardial blood flow before and after revascularization in 116 patients with 2-3 vessel coronary artery disease and class II-IV angina. In patients without myocardial infarction, with microfocal myocardial infarction, or operated early after myocardial infarction revascularization caused no significant increase of myocardial blood flow. In patients with macrofocal infarction surgery was associated with significant increase of myocardial blood flow. Efficacy of revascularization could be assessed by lowering of flow gradients between various regions of the myocardium.     

Changes in the platelet-vascular system of hemostasis in patients with ischemic heart disease and hypertension after the treatment

The status of platelet aggregability, cyclic nucleotides and the thromboxane-prostacyclin system was examined in 40 patients with Functional Class II-III angina pectoris treated with perdipine, a calcium antagonist, and in 40 patients with Stage II hypertensive disease treated with tenolol, a beta-adrenoblocker. The therapy was found to modify the initially abnormal parameters of platelet-vessel hemostasis both in coronary heart disease and hypertension. When the initial parameters of platelet functional activity were normal, the treatment with perdipine and tenolol caused no noticeable changes.     

Effects of beta adrenergic blocking agents and calcium antagonists on atherogenic properties of blood serum of patients with ischemic heart disease

The beta-adrenoblockers anapriline and visken and the calcium antagonist corinfar were studied for effects on the atherogenic properties of the sera from patients with coronary heart disease who took the drugs. The study was performed by using cultured atherosclerotically altered human aortic smooth muscle cells. A single dose of anapriline, 80 mg, and that of visken, 20 mg, were found to give rise to or to enhance atherogenic properties of the patients' sera, while that of corinfar, 20 mg, yielded their antiatherosclerotic properties.     

Changes in plasma lipid and apoprotein levels in patients with ischemic heart disease after hemosorption]

All the patients who had undergone a course of non-specific hemosorption (HS) for clinical indications showed lower plasma lipid levels and largely lower triglyceride concentrations. The patients with hypercholesterolemia alone simultaneously displayed decreased levels of cholesterol, high density lipoproteins, and apoprotein A-I. Apoprotein B levels reduced in patients having normal lipid values and in those with isolated hypercholesterolemia. The changes in the levels of lipids and apoproteins were different for 2 weeks after hemosorption in relation to the baseline lipid spectrum. The patients with coronary heart disease with hyperlipidemias had positive trends in lipid spectral changes: the parameters of atherogenic classes of lipids tended to decrease, whereas those of antiatherogenic lipid classes tended to show a slight increase. There was a negative direction in the dynamics of the studied parameters in renal patients, in those who had normal baseline lipid values, and in those with isolated hypo-alpha-cholesterolemia, i. e. higher plasma cholesterol and triglyceride, low density lipoprotein cholesterol and apoprotein B levels.