Lipid peroxidation in the evaluation of healing of myocardial infarction

The authors studied the time-course of lipid peroxidation with special reference to malonic dialdehyde in blood serum comparatively to the time-course of uricemia in 189 patients with acute large-focal myocardial infarction. It was established that the time-course of malonic aldehyde and uric acid is characterized by a consistent increase which reaches the maximal values at the height of the destructive phase of myocardial infarction as well as by the differences in uncomplicated and complicated healing. The joint index of destruction was developed, permitting one to compare the concentrations of malonic dialdehyde and uric acid in blood serum and to exercise an efficacious biochemical "tracing" of the healing.     

Plasma lipids: when to measure after myocardial infarction?

Current medical textbooks do not give clear advice on the optimal time to measure plasma lipids following myocardial infarction. Many physicians still defer the measurement for three months. We studied the plasma lipids in 132 patients with myocardial infarction. Measurements were made on admission and 24, 48 and 72 hours later and 103 patients had their plasma lipids measured at three months. Forty-three patients had hypercholesterolaemia (cholesterol greater than 7 mmol/1) at admission. Total cholesterol and low density lipoprotein fell appreciably in the first three days after myocardial infarction. The former returned almost to its admission level by three months, whilst the latter did not. Triglycerides showed no important changes, whilst high density lipoprotein levels had significantly increased at three months. Total cholesterol levels at three months were different from the 24, 48 and 72 hour values. Our findings suggest that plasma lipids should be measured on admission after myocardial infarction. Deferring the measurement by one or two days will give results which may not reflect pre-infarction levels.     

急性心肌梗死患者1个月内预后的临床相关因素分析

[目的]明确影响急性心肌梗死预后的独立危险因素.[方法]纳入2006年6月到2011年6月期间在广元市中心医院出院和死亡病历中诊断为急性心肌梗死的408例患者的病历资料,设计调查量表及资料提取表格.根据资料中急性心肌梗死患者发病后1个月内的死亡情况,将患者资料分为已死亡患者组和未死亡患者组进行对比分析,明确年龄、血压、血脂等是否为影响急性心肌梗死预后的独立危险因素.[结果]年龄增加、血压升高、血糖增加、血脂升高、曾有脑卒中事件可增加急性心肌梗死患者的病死率,而心肌酶及血红蛋白含量降低也有同等效应.[结论]通过回归分析可知,血压、年龄、甘油三脂、胆固醇、吸烟是影响急性心肌梗死患者入院后1个月内死亡的重要独立预测因素,其中年龄因素最为重要.     

The clinical and prognostic information value of painless myocardial ischemia in the early postinfarct period]

A study was made of painless myocardial ischemia in the early postinfarction period (day 14) in order to define its influence on the clinical course and immediate prognosis. 25 patients aged 32 to 60 years with acute primary myocardial infarction were examined. 17 patients had large-focal and 8 small-focal infarction. The patients received diurnal ECG monitoring and physical exercise test on a treadmill. An overwhelming majority of the patients manifested myocardial ischemia not correlating with the rate of angina pectoris attacks. In the patients with small-focal infarction, angina pectoris occurred more frequently and was longer. It has been discovered that the total diurnal duration of transitory myocardial ischemia in the early postinfarction period is a more informative indicator of the immediate prognosis as compared to physical exercise tolerance.     

The esterification of cholesterol in plasma after acute myocardial infarction.

The rate of plasma cholesterol esterification (LCAT activity) and the concentration of eight proteins in the plasma have been studied in the ten male patients during the course of acute myocardial infarction. Samples were drawn 22 hr, 3 days, 8 days, 2 weeks, and 7 weeks after the onset of the acute myocardial infarction. The changes of the plasma proteins were typical for the acute-phase reaction. LCAT activity decreased initially during the illness. The lowest values were found after 8 days. Concomitantly, a reducation in the plasma concentration of total and free cholesterol and cholesteryl esters was demonstrated. The rate of cholesterol esterification correlated significantly with the concentration of prealbumin, alpha-lipoprotein, and albumin. Seven weeks after onset of the infarction, the LCAT values were equal to those in a reference group. The results suggest that the synthesis of LCAT was decreased during the acute-phase reaction.     

Determining the area of myocardial damage by the method of sectorial scanning and its value for prognosis of the outcome of acute myocardial infarction

The authors describe a method for measuring the myocardial injury area, and show the prognostic value of the latter based on examination of 100 patients admitted to the Cardioresuscitation Department with a diagnosis of acute transmural or large-focal myocardial infarction. The lifetime evaluation data of the IM size by means of two-dimensional echocardiography were in a good agreement (r = 0.85) with the morbid anatomy data. Determination of the injury size and ejection was found to be the most informative method for predicting an outcome of acute myocardial infarction. The use of the different combinations of the prognostic signs expands the possibilities of the given method and makes it possible to screen patients with a high risk of a lethal outcome and development of complications on the basis of the primary care at the early disease stage.     

炎性因子和白细胞在心肌梗死急性发作期与稳定期的变化及其意义

目的探讨白介素6（interleukin-6,IL-6）、超敏C反应蛋白（high-sensitivity C-reactive protein,hsCRP）和白细胞（white blood cell,WBC）在急性心肌梗死的发作期和稳定期的水平和意义。方法测定55例心肌梗死患者急性发作期血液中IL-6、hsCRP、WBC和血脂的水平,并与健康对照组进行比较。根据血清胆固醇的含量将患者分为高中低三组,分别统计各组中IL-6、hsCRP和WBC的含量。对54例病情好转患者在稳定期第30d检测IL-6、hsCRP和WBC的水平,并与健康对照组进行比较。结果心肌梗死患者急性发作期IL-6、hsCRP和WBC含量明显高于对照组（P〈0.01）。不同水平的胆固醇组中上述炎性因子无统计学差异。在急性心肌梗死稳定期除了IL-6高于对照组外（P〈0.05）,hsCRP和WBC与健康对照组比较无统计学意义。结论在心肌梗死的急性发作期,炎症反应是高血脂外的一个独立发病因素,炎性因子IL-6、hsCRP和WBC的含量与冠状动脉的病变程度密切相关,在心肌梗死的稳定期以血管壁的局部炎症为主,此时IL-6是适宜的炎症标记物。     

Trace elements in serum from Pakistani patients with acute and chronic ischemic heart disease and hypertension

We examined sera from 159 patients with ischemic heart disease and hypertension and from 50 apparently healthy control subjects for content of trace elements, cholesterol, triglyceride, and enzymes. Concentrations of copper, cobalt, cholesterol, and triglyceride were increased in all patients, but calcium was decreased in patients with hypertension, acute myocardial ischemia, and acute myocardial infarction. Also accompanying acute myocardial infarction were decreased concentrations of zinc and iron but increases in nickel, aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase. Magnesium concentration was lower in patients with acute myocardial ischemia. In acute myocardial infarction, the concentrations of copper, zinc, and iron were higher after 21-30 h (as compared with the values at 0-10 h), by which time concentrations of calcium, magnesium, cobalt, and alanine aminotransferase had decreased. The variation in concentration of trace elements in serum from cases of ischemic heart disease and hypertension corresponds to the severity of the disorder.     

The urinary excretion of DOPA (dihydroxyphenylalanine) in patients with acute myocardial infarction.

Urinary excretion of dihydroxyphenylalanine (DOPA), dopamine and noradrenaline was studied in 36 patients with acute myocardial infarction. The group included 18 patients with uncomplicated myocardial infarction and 18 patients with infarction complicated by heart failure and/or cardiac arrhythmias. Two patients died during hospitalization.The excretion of DOPA was higher in patients with myocardial infarction than in the control group. The increase was greater in uncomplicated infarction than in infarction with a complicated clinical course. In contrast, the urinary excretion of dopamine and noradrenalin was higher in complicated infarction. The possible causes of different behaviour of DOPA and catecholamines in relation to the clinical course of myocardial infarction are discussed.     

The urinary excretion of 3-methoxy-4-hydroxyphenylglycól in acute myocardial infarction.

Urinary excretion of 3-methoxy-4-hydroxyphenylglycol (MHPG), noradrenaline, adrenaline and vanillylmandelic acid (VMA) was studied in 30 patients with acute myocardial infarction. The excretion of MHPG was higher in patients with myocardial infarction than in the control group, with no difference between uncomplicated and complicated courses of the disease. The excretion of MHPG showed a negative although not significant correlation with noradrenaline and VMA during the first days of infarction and a statistically significant positive correlation on the 5th day of the disease. The possible causes of the changes observed are discussed.     

The function of the collateral bed in patients with ischemic heart disease and isolated occlusion of the anterior descending branch of the left coronary artery]

To study the collateral bed, 39 coronary heart disease patients with isolated occlusion of the anterior descending artery without a history of large-focal myocardial infarction were examined. All the patients were subjected to coronary angiography and left ventriculography. Based on an analysis of left ventricular myocardial contractility, the patients were distributed into 2 groups. The first group included 16 patients without disorders of local contractility of the left ventricular myocardium, the second one 23 patients with derangement of local contractility of the left ventricular myocardium. The conclusion is made that in patients suffering from stable angina pectoris with isolated occlusion of the anterior descending artery without a history of large-focal myocardial infarction, exclusively intersystemic collateralization of the vessel via the conal artery (or the conal branch of the right coronary artery) is most favourable from the standpoint of the maintenance of myocardial contractility.     

Quality of life of patients in post-myocardial infarct period

Relationships between the quality of life (QL), psychological status and severity of cardiovascular impairment were studied in 96 males after anterior large-focal myocardial infarction. A positive moderately strong correlation was found between GL and left ventricular ejection fraction. Alexitimia affects the response of the patients to basic limitations diminishing QL. Alexitimia patients have harmful behavioral habits (smoking, alcohol abuse) two times more frequently than patients free of alexitimia. Adequate methods of alexitimia psychotherapeutic correction should be introduced.     

Study of blood cholesterol and triglycerides in patients with acute myocardial infarction

The levels of cholesterol (C) and triglycerides (TG) were studied by a standard biochemical assays and the amount of C and TG was examined by a fluorescence assay in 55 patients with complicated (n=32) and uncomplicated (n=23) acute myocardial infarction (AMI) and in 25 apparently healthy donors. The content of C did not differ significantly in the study groups. As compared with the controls, the patients with complicated AMI had lower values of C + TG (p < 0.01) and TG (p < 0.001). In the patients with uncomplicated AMI, these indices were also lower than those in the control, but not significantly. The patients with complicated AMI were found to have insignificantly lower levels of TG and C + TG than those with uncomplicated AMI. The lower level of TG seems to be responsible for the decreased C + TG amount detectable in AMI by a fluorescence assay.     

Lipoprotein(a) and acute-phase proteins in acute myocardial infarction.

Lipoprotein(a) (Lp(a)) and the acute-phase proteins, orosomucoid, haptoglobin and alpha 1-antitrypsin, were studied in 32 patients with acute myocardial infarction. Samples were taken at admission and, after fasting overnight, on the following 6 days. In a subgroup of 21 patients total serum cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides were also estimated. In a linear regression model a significant relation between the relative values of Lp(a) and the time in days was obtained (p = 0.001). Compared with the acute-phase proteins, however, Lp(a) showed a weak increase and the individual responses were very variable. There were no correlations between the individual changes in Lp(a) and the changes in the acute-phase proteins, but Lp(a) changes correlated significantly with the changes in total cholesterol and low-density lipoprotein (LDL) cholesterol. It is suggested that the Lp(a) reaction in myocardial infarction is linked to the reaction of the lipoproteins. There may also be several clinical conditions, including different medications, which influence the Lp(a) level.     

Cardiovascular lesion in ischemic heart disease patients with acute infections of the respiratory tract not confirmed by laboratory tests

The authors studied the effects of acute infections of the respiratory tract of unclear etiology on the coronary heart disease in 213 patients. It was established that acute respiratory infections unconfirmed by the laboratory data exert the same unfavourable effect on the CHD as influenza and other etiologically unraveled respiratory infections. The patients showed exacerbation up to the development of the foci of dystrophy and large-focal myocardial infarction. The authors make an important conclusion that all the CHD patients with acute respiratory infections need ECG control, bed regime and adequate drugs whatever the etiology of infections, the presence or lack of laboratory confirmation of the diagnosis.     

The results of the rehabilitative treatment of myocardial infarct patients activated at the hospital stage according to an accelerated program

The authors provide data obtained during long-term follow up of patients with myocardial infarction, activated at the hospital stage according to the accelerated program (50 persons) and within the generally accepted period (50 persons). Account was taken of the clinical course of the disease exercise tolerance, its hemodynamic and oxygen supply in the acute period and throughout the whole observation time. It has been shown that referral of patients to the sanatorium stage of rehabilitation should be determined by functional preparedness of the patient rather than by the time of myocardial infarction. It is desirable that the program of accelerated activation may be implemented in patients with uncomplicated macrofocal and restricted transmural myocardial infarction in the absence of marked painful syndrome while the threshold power should not be less than 50 watt during bicycle ergometry performed 2 weeks after the disease onset.     

Effect of smoking on lipid profile, lipid peroxidation and antioxidant status in normal subjects and in patients during and after acute myocardial infarction

We studied changes in lipid peroxidation, vitamin E status and lipid profile due to smoking in healthy subjects, patients with acute myocardial infarction (MI), and in stabilized patients surviving MI. A significant increase in malondialdehyde (MDA) concentrations was observed in MI patients, more than in smokers (P<0.05), as compared to control. The plasma vitamin E as well as the ratio of vitamin E/lipids were significantly lower in MI patients as compared to stable ischemic heart disease (IHD) patients and controls. Our data show that smoking is associated with lowered antioxidant status in MI.     

The response of plasma fibronectin to acute myocardial infarction in humans

The purpose of this study was to investigate the plasma fibronectin response to complicated and uncomplicated acute myocardial infarction. All patients admitted to a Coronary Care Unit over a six-month period were prospectively assessed by measuring admission and daily plasma fibronectin levels using an electroimmunoassay. Of 166 patients admitted to the Unit, 66 were diagnosed as having an acute myocardial infarction. Plasma fibronectin levels were significantly lower 48 h after the onset of symptoms in 15 patients with a complicated acute myocardial infarction, compared to fibronectin levels in patients with an uncomplicated course; patients who had received intracoronary streptokinase had consistently higher plasma fibronectin levels than those seen in patients who did not receive this thrombolytic agent. This hepatocyte-derived plasma protein not only has diagnostic potential, but alterations in its levels may also provide insight into the systemic response to acute myocardial injury.     

肺炎衣原体感染与急性心肌梗死的相关性

目的探讨肺炎衣原体(Cpn)感染与冠心病心肌梗死的关系。方法测定51例急性心肌梗死(AMI)和42例陈旧性心肌梗死(OMI)患者及31例冠脉造影正常者(NC)的Cpn抗体(CpnIgG、CpnIgM)水平及DAN,同时观测C反应蛋白(CRP)、血脂[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDLC)、高密度脂蛋白胆固醇(HDLC)]变化。结果AMI组CpnIgG、CpnIgM阳性率及水平高于NC组(P<0.05),CpnDNA检测结果与之吻合。校正冠心病危险因素前、后,CpnIgG阳性与AMI均有相关关系(OR=3.653,P=0.025;OR=3.174,P=0.033)。AMI组中Cpn(+)组CRP、TC、TG、LDLC高于同组中Cpn(-)组(均P<0.05),且IgG与CRP、TC、LDLC呈正相关(P<0.05),调整与CRP相关的冠心病危险因素后,IgG与CRP仍呈正相关;OMI组中Cpn(+)组TG明显高于Cpn(-)组(P<0.05),IgG与TG呈正相关。结论Cpn感染与AMI之间存在明显的相关性,与血脂、CRP也存在相关性。     

Analysis of the amount of plasma cholesterol and triglycerides in patients with coronary heart disease

Fluorescence technique was used to study the time course of changes in the amount of blood cholesterol and triglycerides (C+TG) in 43 patients with Q- and non-Q-wave myocardial infarction (MI) on days 1, 2, 3, and 10 of the disease, in 82 patients with chronic coronary heart disease (CHD), and in 43 apparently healthy donors. Within the first 3 days of the disease, the level of C+TG in the patients with acute MI (AMI) was significantly lower than that in the patients with chronic CHD and in the donors. By day 10 of their hospital stay, the level of lipids in patients with AMI increased and reached the levels observed in the control group.