The role of cytokines in restenosing coronary stents and the efficiency of its secondary prophylaxis with statins

This study was designed to assess the diagnostic value of dynamic patterns of anti-inflammatory cytokines (IL-1b, IL-6, TNF-alpha) in patients with ischemic heart disease (IHD) and restenosis of coronary stents 14 months after their implantation for long-term prophylaxis of dyslipoproteinemia. A total of 40 patients with IHD of advanced functional classes (FC) were examined. Blood cytokine levels were measured before, 1 day, and 12-18 months after coronary stenting. Two groups of 23 and 17 patients included cases with recurrent angina and without it respectively. The main parameters measured in the study were in-stent restenosis rate, incidence of' acute myocardial infarction (AMI), mortality rate, frequency of hospitalization for unstable angina, and the levels of proinflammatory cytokines. Considerable activation of cytokines in patients with post-infarction cardiac dysfunction who rarely resorted to therapy with statins (16.7%) was associated with the high rate of recurrent coronary insufficiency related to in-stent occlusion (8.7%), progressive atherosclerosis (65.2%), impaired myocardial perfusion, and restenosis of coronary stents (26.1%). Patients lacking apparent expression of serum cytokines after revascularization while receiving efficacious secondary prophylaxis of dyslipidemia (13.8 and 17% decrease of triglycerides (TG) and low density lipoproteins (LDL) cholesterol respectively, p = 0.04) had left ventricular ejection fraction (LVEF) improved by 12.5% (p = 0.03%), left ventricular end diastolic pressure (LVEDP) decreased by 15.8% (p = 0.03), and frequency of ischemic perfusion defect (PD) reduced by 45.3% (p = 0.01). Moreover, they showed low incidence of progressive coronary atherosclerosis (17.6%) in the absence of in-stent restenosis. It is concluded that the frequency of restenosis of coronary stents after endovascular myocardial revascularization depends on the preprocedural rise in IL-1b content (R = 0.62, p = 0.0023). It is concluded that long-term secondary prophylaxis of dyslipoproteinemia in patients with ischemic dysfunction at risk of coronary restenosis effectively (more than thrice) decreases the occurrence of coronary stent restenosis after endovascular revasularization.     

Endovascular treatments in coronary heart disease patients with restenosis after primary ballon angioplasty

The study was undertaken to comparatively assess the results of stenting and transluminal balloon angioplasty (TBAP) of coronary arteries in patients with chronic forms of coronary heart disease concurrent with restenosis of primary TBAP. The data on 77 patients undergone endovascular procedures for restenosis of prior primary TBAP of coronary arteries at the Moscow Research and Practical Center of Interventional Cardioangiology in March 1997 to May 2003 were analyzed. Group 1 comprised 35 patients with a stent implanted at the site of coronary restenosis; Group 2 included 42 patients undergone repeated TBAP. These groups did not significantly differ in main clinical and functional characteristics, the extent coronary bed lesion, the number of diseased arteries and the morphological type of a coronary lesion (p < 0.05). The angiographic success of secondary TBAP, as well as coronary stenting was 100%. Survival was 100% in the late period. A control examination revealed the clinical picture of angina on exertion in 57.1% and 76.2% of the patients in Groups 1 and 2, respectively (p = 0.039). In the late period, a satisfactory angiographic result of coronary stenting was revealed in most cases (74.3 and 35.7% in Groups 1 and 2, respectively); restenosis was detected in 20 and 59.5% of cases, respectively (p < 0.01); occlusion in 5.7 and 4.8% (p > 0.05). Need for repeated interventional and surgical (aortocoronary bypass surgery) procedures was significantly less after coronary stenting than that after repeated TBAP (20 and 40.5%, respectively). In the late period, the factors significantly increasing a risk for in-stent restenosis were hypercholesterolemia (cholesterol > or = 5.5 mmol/l); the length of restenosis of an operated segment was > or = 18 mm and that of a stent > or = 20 mm. It is expedient to use coronary endroprosthesis to reduce the incidence of repeated restenosis and needs for repeated procedures for myocardial revascularization in the late period.     

Spirapril - a new long-acting ACE inhibitor: efficacy and safety in patients with arterial hypertension in combination with diabetes mellitus and impaired kidney function

AIM: To examine effectiveness and safety of quadropril. MATERIAL AND METHODS: Changes in blood pressure (BP), heart rate (HR), levels of glucose, potassium and creatinine, creatinine clearance were studied in 120 patients (48 males and 72 females, mean age 60.6 +/- 0.7 years) with mild to moderate arterial hypertension (AH) with average duration 13.8 +/- 0.7 years. The patients were divided into 3 groups: with AH (n = 40), AH + noninsulindependent diabetes mellitus (DM) (n = 43), AH and nephropathy (n = 37). 8-week treatment was performed with a standard dose of 6 mg/day (1 tablet of quadropril). Control examinations were made 2, 4 and 8 weeks after the treatment. RESULTS: After 8 weeks of treatment a decrease in systolic blood pressure in AH group was 24.0 +/- 3.0 mm Hg and in diastolic blood pressure 16.3 +/- 1.3 mm Hg (P < 0.001). In the group with DM this decrease was 22.4 +/- 2.8 mm Hg and 15.7 +/- 1.4 mm Hg (p < 0.001), respectively. In the group with nephropathy this decrease was 26.4 +/- 2.4 and 16.5 +/- 1.3 mm Hg (p < 0.001), respectively. Heart rate changed significantly only in diabetics: from 75.1 +/- 1.7 to 72.9 +/- 1.3 beats/min. Biochemical parameters in the hypertensive and diabetic patients did not change significantly. In the nephropathy group there was a significant decrease in creatinine and increase in creatinine clearance. Their level of glucose and potassium changed insignificantly. CONCLUSION: The treatment with quadropril results in a significant decrease in blood pressure, does not influence parameters of carbohydrate metabolism, improves nitrogen eliminating function of the kidneys.     

Prostaglandin E1 during angioplasty as preventative therapy for coronary restenosis.

The effect of intravenous prostaglandin E ( 1 ) (PGE ( 1 ) ) on the incidence of restenosis after elective percutaneous transluminal coronary angioplasty (PTCA) was studied in a prospective, single-blind, randomized trial of 30 patients. Group I (12 patients) received only the conventional medications before and after protocol, and group II (18 patients) received intravenous PGE ( 1 ) infusion for 24 hours starting at least 2 hours before angiography after hemodynamically based titration to a mean dosage of 16 +/- 3 ng/kg/min (range, 10-20 ng/kg/min). All patients received aspirin orally, beginning 24 hours before PTCA and continuing for 6 months, and intravenous heparin at 1000 U/h for 24 hours commencing with the beginning of catheterization before PTCA. Recatheterization was performed routinely at 6 months after PTCA, or earlier when clinically indicated. Angiographic evaluations were made by both visual and quantitative assessment. No significant side effects of PGE ( 1 ) treatment were observed. Only 17% of patients treated by PGE ( 1 ) experienced angina pectoris during 6-month follow-up period, as compared with 42% of patients who received conventional treatment (p = 0.13). Re-PTCA was more frequent in patients receiving conventional therapy than in those receiving PGE ( 1 ) (42% versus 11%; p = 0.06). The use of PGE ( 1 ) during PTCA was associated with 17% restenosis (both by computer and by visual evaluation) 6 months post-PTCA as compared with 33% and 50% restenosis (by computer and by visual evaluations, respectively) in the conventional group (p < 0.05). In conclusion, PGE ( 1 ) appears to decrease coronary restenosis 6 months after PTCA.     

Metabolic effects of berlipril-5 in patients with non-insulin dependent diabetes mellitus and arterial hypertension

AIM: To study metabolic effects of berlipril-5 (enalapril) in patients with non-insulin-dependent diabetes mellitus (NIDDM) and arterial hypertension (AH). MATERIALS AND METHODS: 24 patients with NIDDM and AH were divided into three groups by the level of basal C-peptide: > 2 ng/ml (group 1), 2-4 ng/ml (group 2) and < 4 ng/ml (group 3). RESULTS: A correlation was found between the level of basal C-peptide and duration of AH (r = 0.7) and NIDDM (r = -0.47), between the level of triglycerides (TG) and glycolized hemoglobin Hb A1c (r = 0.48). Berlipril treatment reduced basal C-peptide level in groups 2 and 3 by 20.65 +/- 1.95% and elevated it in group 1 by 16.4 +/- 1.5%. Fasting glucose levels lowered by 9.2 +/- 1.95% indicating better sensitivity of the liver to insulin. Blood glucose levels 2 hours after meal fell by 8.3 +/- 0.95% (p < 0.05) and Hb A1c by 8.14 +/- 1.25% showing indirectly diminishing insulin-resistance at the level of peripheral tissues. TG and VLDLP significantly declined. CONCLUSION: Inhibitors of angiotensin converting enzyme (enalapril, in particular) produce a positive effect on carbohydrate and lipid metabolism in patients with NIDDM and AH.     

Early and late (during 3 years) results of coronary bypass operation in patients with ischemic heart disease with moderate dyslipoproteinemia

AIM: The study of efficacy of rehabilitation and clinical-instrumental characteristics of coronary failure in patients with ischemic heart disease (IHD) of high functional classes and moderate dyslipoproteinemia early (1.6 months) and late (1 and 3 years) after coronary by-pass operation. MATERIALS AND METHODS: The examination covered 119 males with IHD (mean age 51.8 +/- 6.9 years) 1.6 months and 3 years after coronary by-pass operation. Lipid spectrum of blood plasma, frequency of anginal attacks, 24-h nitroglycerin requirement, results of bicycle exercise and loading myocardial scintigraphy were assessed. The patients were divided into two groups. In 82 patients of group 1 total cholesterol ranged within 3 years after the surgery from 5.2 to 6.5 mmol/l, 37 patients of group 2 had no lipid disorders. RESULTS: Within 12 months after direct myocardial revascularization, the groups had similar clinical-instrumental characteristics. 3 years after the operation, patients of group 1 exhibited a rise in anginal attacks frequency, nitroglycerin requirement, size of unstable perfusion defects by 84.6, 88.8 and 26.4%, respectively. Exercise tolerance diminished by 18.7%. CONCLUSION: Moderate defects in lipid metabolism influence progression of coronary failure. This becomes especially pronounced within 3 years after coronary by-pass operation.     

药物洗脱支架内再狭窄的危险因素分析

目的 探讨冠状动脉药物洗脱支架内再狭窄的危险因素.方法 对157例行冠状动脉药物洗脱支架植入术患者的临床资料进行回顾性分析,按照冠状动脉造影结果分为再狭窄组33例和无再狭窄组124例,采用单因素及Logistic多因素回归分析其临床及冠状动脉造影特征与药物洗脱支架内再狭窄的相关性.结果 再狭窄组33例,糖尿病18例(54.5%),术后反复心绞痛26例(78.8%);无再狭窄组124例,糖尿病31例(25.0%),术后反复心绞痛72例(58.1%),组间差异有统计学意义(χ2=10.60,P＜0.01;χ2=4.77,P=0.03).2组慢性完全闭塞分别为11例(19.3%)、12例(7.6%),分叉病变12例(21.1%)、16例(10.2%),弥漫病变15例(26.3%)、19例(12.1%),组间差异有统计学意义(χ2值分别为5.92、4.34、6.32,P均＜0.05).再狭窄组植入支架57枚,无再狭窄组植入157枚.Logistic多因素分析显示糖尿病、术后反复心绞痛、慢性完全闭塞、分叉病变、弥漫病变和支架长度与支架内再狭窄相关(OR分别为3.52、2.59、3.05、3.14、3.08、0.93,95%CI分别为1.56～7.90,1.02～6.59,1.11～8.36,1.30～7.59,1.34～7.05,0.88～0.98,P均＜0.05).结论 冠状动脉药物洗脱支架植入术后,糖尿病史、术后反复发生心绞痛、慢性完全闭塞、分叉病变、弥漫病变及支架长度为支架内再狭窄的危险因素.

Abstract：

Objective To investigate the risk factors of in-stent restenosis (ISR) after coronary implantation of drug-eluting stent Methods One hundred and fifty-seven patients including 118 males and 39 females,who underwent successful implantation of drug-eluting stent, were recruited in the study. The patients were divided into the restenosis group (33 patients) and non-restenosis group ( 124 patients) according to the angiographic results. The associations of ISR with clinical and coronary angiographic characteristics were analyzed using univiriate analysis and logistic regression. Results In the restenosis group,there were 18 cases of diabetes mellitus ( 54. 5% ), 26 cases of frequency angina ( 78. 8% ), which were significantly higher than those of 31 cases of diabetes (25.0%) and 72 case of frequent angina (58. 1% ) in the non-restenosis group (χ2 = 10. 60, P ＜ 0. 01, χ2 = 4. 77, P = 0. 03 for diabetes mellitus and frequent angina, respectively). Compared to non-restenosis group, the occurrence rates of chronic total occasion, bifurcatus lesions, diffuse lesions were significandy higher in the restenosis group ( 19. 3% vs 7. 6% χ2 =5.92,21.1% vs 10. 2% χ2 =4. 34,26. 3%vs 12. 1% χ2 =6. 32,Ps ＜0. 05). Fifty-seven stents were implanted into the restenosis group,and one hundred and fifty-seven into the non-restenosis group. Logistic regression analysis showed that diabetes, frequent angina,chronic total occlusion lesions, bifurcatus lesions, diffuse lesions, stent length and diameter were significantly associated with restenosis ( OR value were 3.52,2. 59,3.05,3. 14,3.08,0. 93,95% CI were 1.56 - 7.90,1.02 - 6. 59,1.11 - 8. 36,1.30 - 7.59,1.34 - 7.05,0. 88 - 0. 98 respectively, Ps ＜ 0. 05 ). Conclusion After implantation of drug-eluting stent, diabetes mellitus, chronic total occasion lesions, frequent angina, diffuse lesions, bifurcatus lesions and stent length and diameter are associated with follow-up restenosis.     

One-year prospective health-related quality-of-life outcomes in patients treated with conservative method, endovascular treatment or open surgery for symptomatic lower limb atherosclerotic disease.

BACKGROUND: There are no many reports on the long-term impacts of different treatments of lower limb atherosclerotic disease (LLAD) on patients' health behaviour, clinical outcome and health-related quality of life (HRQoL). AIMS: The purpose of this study was to follow up the HRQoL of LLAD patients before and after the conservative, endovascular or surgical treatment. METHODS: Patients who were treated conservatively (64 patients), scheduled for endovascular treatment (85 patients), or for elective surgery (31 patients) filled in the Nottingham Health Profile (NHP) questionnaire before treatment and 12 months after. The patients' background data were recorded, and their resting ankle-brachial pressure (ABI) was measured at baseline and 12 months later. RESULTS: Smoking increased statistically significantly (p=0.031) in the group of conservatively treated patients. The ABI and asymptomatic walking distance scores of the patients treated with endovascular (p=0.000/p=0.000) and surgical (p=0.000/p=0.000) procedures improved statistically significantly. Conservatively treated patients reported improvement of sleep (p=0.047) and emotional reactions (p=0.032). The patients with endovascular treatment reported improved emotional reactions (p=0.016), energy (p=0.027) and less social isolation (p=0.050). The surgically treated patients reported improvement of pain (p=0.001), mobility (p=0.048), sleep (p=0.030) and emotional reactions (p=0.007). CONCLUSION: Deterioration of any clinical characteristics or HRQoL was not observed after any of the treatment modalities. Surgery gave LLAD patients a good clinical outcome and HRQoL for at least a year, whereas patients who were treated with endovascular and especially conservative treatment gained limited benefits.     

ACE基因多态性与PTCA合并支架植入术后再狭窄的相关性研究

目的:探讨血管紧张素Ⅱ转换酶(ACE)基因的多态性与PTCA合并支架植入术后发生支架内再狭窄(ISR)的相关性。方法:选取2001-2003年入我院治疗,成功实施PTCA合并支架植入手术的华东地区冠心病患者共197例,并作为期半年的追踪随访,按照二次冠状动脉造影结果分为术后再狭窄组和未狭窄组,然后运用PCR技术对这197例患者样本进行ACE基因分型,最后采用统计学方法判断ACE基因多态性是否与支架内再狭窄具有相关性。结果:197例患者中再狭窄组为58例,ACE基因型DD、DⅠ、Ⅱ的频率分别为25.9%、39.6%、34.5%;未狭窄组为139例,ACE基因型DD、DⅠ、Ⅱ的频率分别为33.8%、43.9%、22.3%,两组间无显著差异(x2=3.2N).P>0.05)。再狭窄组和未狭窄组的D等位基因的频率分别为52.6%和55.8%,亦无显著差异(x2=3.326.P>0.05)。结论:ACE基因1/D多态性与支架术后再狭窄无相关性。     

Predictive value of C-reactive protein in patients with unstable angina pectoris undergoing coronary artery stent implantation

In-stent restenosis is a major problem following coronary stent implantation, and inflammation plays an active role. We evaluated the effectiveness of the inflammatory marker C-reactive protein (CRP) as a predictor of in-stent restenosis after successful stent implantation, in 86 patients with unstable angina pectoris. Plasma CRP was measured in all patients before the procedure, and at 48 - 72 h and 1, 2 and 3 months post-procedure. An angiographic loss of 50% at follow-up was accepted as in-stent restenosis. We found negative and positive predictive values of the pre-procedural plasma CRP for determining 6-month in-stent restenosis of 34% and 61%, respectively. We also found a strong correlation between the 3-month post-procedural CRP value and 6-month in-stent restenosis; the negative and positive predictive values being 8% and 76%, respectively. In conclusion, we showed that a plasma CRP value > 3 mg/l in the third month after coronary stent implantation was a strong predictor of angiographic in-stent restenosis.     

锁骨下动脉支架置入术后再狭窄的发生率及其影响因素分析

目的应用彩色多普勒超声分析锁骨下动脉重度狭窄或闭塞性病变患者支架置入术后再狭窄的发生率及其影响因素。 方法回顾性纳入2016年1月至2018年4月于首都医科大学宣武医院经彩色多普勒血流显像（CDFI）筛查及数字减影血管造影（DSA）证实的锁骨下动脉重度狭窄或闭塞患者共172例,所有患者均行锁骨下动脉支架（SAS）介入治疗。根据SAS术后随访检查结果将172例患者分为再狭窄组（31例）与无再狭窄组（141例）。于术前、术后1周、3、6、12个月采用CDFI检测记录狭窄病变的内径、长度,狭窄段及狭窄以远段的收缩期峰值流速（PSV₁、PSV₂）、舒张期末流速（EDV）。分析SAS术后再狭窄发生率,比较2组患者术前与术后各随访时间段血流动力学参数变化,应用单因素及多因素Logistic回归方法分析SAS术后再狭窄的影响因素。 结果172例患者支架置入成功率为95.3%（164/172）,术后12个月再狭窄检出率为18.0%（31/172）。与术前相比,术后锁骨下动脉内径明显增宽［（1.5±0.7）mm vs（5.9±1.0）mm,t=49.384,P<0.001］,狭窄段PSV₁较术前明显改善［（437.7±169.5）cm/s vs（178.5±56.0）cm/s,t=19.905,P<0.001］,狭窄以远段PSV₂明显升高［（72.5±31.3）cm/s vs（124.3±34.8）cm/s,t=-15.267,P<0.001］。再狭窄组PSV₁在术后3、6、12个月逐渐升高,在术后12个月时PSV₁平均值达最高（363.7±141.4）cm/s,与术前比较无显著性差异（P>0.05）;无再狭窄组的PSV₁术后3、6、12个月与术后1周比较,差异均无统计学意义（P均>0.05）。狭窄病变长度≥2 cm（OR=3.640,95%CI：1.413~9.379,P<0.01）、支架内残余狭窄（OR=21.860,95%CI：2.218~215.479,P<0.01）是SAS术后再狭窄的独立危险因素。 结论锁骨下动脉长段病变、术后残余狭窄是影响支架术后再狭窄的重要因素。CDFI能够客观、准确评价SAS术前、术后血流动力学变化,并早期发现再狭窄,对提高支架远期疗效具有重要的临床价值。     

连续性肾脏替代疗法在治疗伴急性肾衰竭的多器官功能障碍综合征中的应用

目的 :探讨连续性肾脏替代疗法 (CRRT)治疗伴急性肾衰竭 (ARF)的多器官功能障碍综合征(MODS)患者的临床疗效和影响预后的因素。方法 :应用 CRRT治疗 2 2例伴 ARF的 MODS患者 ,所有患者CRRT治疗前后均记录液体摄入量 ,每日检查血肌酐 (SCr)、尿素氮 (BUN )、血钾、血碳酸氢根浓度、动脉血p H;对 10例存活患者 (存活组 )和 12例死亡组患者 (死亡组 )的临床资料进行统计学分析。回顾分析应用间歇性血液透析 (IHD)治疗 17例伴 ARF的 MODS患者的液体摄入量 ,每日晨 SCr、BU N、血钾。结果 :CRRT组和IHD组每日液体摄入量分别为 (5 2 37± 10 6 ) m l和 (2 319± 87) ml(P<0 .0 5 )。 IHD组透析间期出现透析相关性低血压 13例次 ,发生容量依赖性心功能衰竭 8例次 ;而 CRRT组分别为 3例次及 1例次 (P均 <0 .0 1)。IHD组每日晨平均 SCr、BU N均高于 CRRT组 (P均 <0 .0 5 )。 IHD组和 CRRT组存活率分别为 35 .3% (6 / 17)和4 5 .5 % (10 / 2 2 ,P>0 .0 5 )。死亡组患者年龄更大 ,病情更重 ,需要机械通气患者数更多。结论 :CRRT控制伴ARF的 MODS患者酸碱平衡、液体平衡及氮质血症优于 IHD;伴 ARF的 MODS患者的预后与原发病、衰竭器官数、年龄等因素有关 ;CRRT可以改善危重 MODS患者的预后。     

Brain natriuretic peptide in patients with ST segment elevation myocardial infarction. Prognostic significance

AIM: To study changes in the level of brain natriuretic peptide (BNP) in patients with ST segment elevation myocardial infarction (MI) to assess prognostic value of this marker and validity of its use as a criterion of therapy effects. MATERIAL AND METHODS: The trial enrolled 217 patients (102 males and 15 females, mean age 63.96 +/- 0.73 years) admitted to hospital on MI day 1. Plasmic level of BNP (Nt-proBNP) was measured 1, 7, 21 days, 8 weeks and 6 months after MI. RESULTS: The severity of chronic cardiac failure (CCF) correlated with peptide content in the blood: it was by 46.6% higher in patients with chronic heart failure (CHF) functional class (FC) IV than in those with CHF FC I (p = 0.047), in FC III by 27.5% higher (p = 0.003) and in FCII--by 13.1% (p = 0.485). Initially high levels of BNP correlated with early development of CHF (R2 = 0.9058), with hospital lethality (in the deceased--1040.0 +/- 65.8 fmol/ml, in the survivors--461.4 +/- 26.2 fmol/ml, r = 0.35, p < 0.001) and overall lethality. A more pronounced decrease in the peptide level was seen in patients after 3 week intake of beta-adrenoblocker esmolol than in those who did not take it (by 125.2 vs 74.1 fmol/ml, respectively, p < 0.05). By BNP level, efficacy of perindopril vs captopris was studied (group 1 and group 2, respectively), in patients with ejection fraction under 40%. Initially, BNP levels were elevated and did not differ among the groups. On MI week 8 there was a decrease in the level of BNP by 25.4% (p = 0.004), 19.1% (p = 0.06) in groups 1 and 2, respectively. Six months after MI patients of group 1 had normal levels of BNP (up to 269.6 +/- 18.3 fmol/l). CONCLUSION: Measurements of BNP levels are useful for prediction of poor prognosis in MI patients and evaluating efficacy of the treatment.     

Predictive value of plasma plasminogen activator inhibitor-1 for coronary restenosis: dependence on stent implantation and antithrombotic medication.

BACKGROUND: The plasmin activation system is involved in the development of restenosis after percutaneous coronary interventions (PCI). Conflicting data exist concerning the role of plasminogen activator inhibitor-1 (PAI-1) and its predictive value for restenosis. OBJECTIVES: To evaluate the fibrinolytic response to injury after PCI with or without stent implantation on different antithrombotic medications and its relation to late restenosis. PATIENTS AND METHODS: Eighty consecutive patients with successful PCI without (balloon only; n = 37) or with stent implantation (stent; n = 43) on different antithrombotic regimes (balloon only, aspirin; stent, aspirin/coumadin/dipyridamole vs. aspirin/ticlopidine). Blood samples were taken at baseline and up to 7 days after PCI and PAI-1 active antigen and tissue plasminogen activator (t-PA) antigen were determined. Restenosis was angiographically determined after 6 months. RESULTS: PCI increased both t-PA and PAI-1 levels (P < 0.001), with a significant prolonged and pronounced increase in stent vs. balloon-only patients (P < 0.05). Restenosis (stent 26%; balloon 38%) was significantly correlated to an attenuated PAI-1 increase after 24 h in the ticlopidine group (P = 0.007; restenosis, relative Delta PAI-1 + 50 +/- 28%; non-restenosis, + 139 +/- 50%), but not in the coumadin group. In the balloon-only group late restenosis (ISR) was associated with a trend for an augmented PAI-1 increase after 24 h. CONCLUSIONS: Coronary stent implantation significantly increases t-PA and PAI-1 plasma levels up to 1 week compared with balloon angioplasty alone. ISR in ticlopidine-treated patients was associated with an attenuated early PAI-1 active antigen increase. A less than 50% increase 24 h after stent implantation under ticlopidine treatment may identify patients at risk for the development of ISR.     

Levels of anti-inflammatory cytokines interleukin-2, interleukin-8, and soluble interleukin-2 receptor in blood of patients with various forms of ischemic heart disease

AIM: To quantify interleukin-8 (IL-8), interleukin-2 (IL-2) and soluble receptor of IL-2 (sIL-2r) in blood serum of patients with various forms of ischemic heart disease (IHD). MATERIAL AND METHODS: Levels of IL-8, IL-2 and sIL-2r were measured with enzyme immunoassay (EIA) in the serum of 75 patients with IHD: angina of effort (group 1), progressive angina (group 2) and acute myocardial infarction (group 3). The EIAs were performed at admission and 2 weeks later. RESULTS: Baseline levels of IL-2 in group 1 and 2 patients were close (9.1 +/- 1.6 and 10.1 +/- 3.8 pg/ml) being significantly lower in group 3 (0.81 +/- 0.57 pg/ml, p < 0.01). 14 days of therapy did not change the values noticeably. IL-8 level was the highest in group 1 (94.2 +/- 27.6, 20.03 +/- 7.4, 22.47 +/- 4.8 pg/ml, respectively). sIL-2r in the three groups did not vary greatly (73.95 +/- 12.23, 89.46 +/- 18.17, 89.2 +/- 14.17 pg/ml, respectively). SIL-2r levels rose in 2 weeks in group 3 (to 147.67 +/- 18.17 pg/ml). CONCLUSION: It is confirmed that IL-2, IL-8 and sIL-2r take part in pathogenesis of IHD. IL-2 and IL-8 levels are persistently high in anginal patients while in patients with acute myocardial infarction they are low. Low concentrations of IL-2 in the latter may be attributed to high levels of its soluble receptor.     

Exercise in outpatient complex rehabilitation and secondary prophylaxis in patients with ischemic heart disease after acute coronary events (a cooperative trial in Russia)

AIM: To assess efficacy of early and long-term exercise in patients with ischemic heart disease (IHD) after acute coronary events (acute myocardial infarction--AMI, unstable angina--UA, coronary artery bypass grafting--CABG) in wide outpatient medical practice of Russia. MATERIAL AND METHODS: Three to eight weeks after the acute coronary event (ACE) 373 patients from different clinics of RF regions were randomized into two groups: the study group (n = 188) and a control one (n = 185). Both groups received standard therapy, the study group performed also a special exercise program (moderate exercise for maximum 1 hour 3 times a week for a year). The efficacy of the treatment was assessed by clinical, device and biochemical findings during 6-month follow-up. RESULTS: Physical work capacity, total amount of performed work (PW) in stress test rose in the study group by 26.5% (p < 0.01) and 59.4% (p < 0.01), respectively; HRmax and BPSmax x HRmax increased by 6.4 and 9.8%, respectively, p < 0.01); PW/Hrpeak rose by 48.6% (p < 0.01), PW/DP peak--by 45.9% (p < 0.01). Left ventricular ejection fraction increased by 5.6% (p < 0.05), LV stroke volume--by 3.4% (p < 0.05). In 6 months, controls demonstrated a 4.7% (p < 0.05) rise in HDLP cholesterol, total cholesterol lowered in the study group by 6.4% (p < 0.01), body mass index--by 1.9%, number of anginal attacks--by 0.9%. CONCLUSION: The proposed exercise program is effective and can be applied in outpatients after acute coronary events. The program can be also used as a method of secondary prophylaxis as it lowers total cholesterol, atherogenic index and body mass index.     

Main risk factors of psychosomatic diseases

AIM: To reveal main risk factors (RF) of psychosomatic diseases and to design models of prediction of each nosological entity. MATERIAL AND METHODS: For design of a model of predicting the risk of different nosological entities of psychosomatic diseases, a standard linear regression model was used. The study included 482 patients with arterial hypertension (AH, n = 96), ischemic heart disease (IHD, n = 99), duodenal ulcer (DU, n = 60), bronchial asthma (BA, n = 52), diabetes mellitus type 1 (DM-1, n = 84) and 2 (DM-2, n = 91). RESULTS: The stress factor was essential in the onset of all the diseases and was registered in more than 90% cases. The other leading prognostic RF in AH were the following: heredity, age, hypodynamics, history of craniocerebral traumas. In IHD--AH, age over 50, dislipidemia, behavior pattern 1. In DU--alcoholism, malnutrition, Helicobacter pylori infection. In BA--reaction to atopic and infection allergens, physical and meteorological factors, allergic diseases. In DM-1--heredity and prior virus infections. In DM-2--obesity, IHD, AH, dislipidemia. CONCLUSION: A stress factor plays an important role in development of all the diseases studied. This confirms a psychosomatic nature of these diseases and point to necessity of rendering psychotherapeutic and psychological aid to such patients at early stages of the disease. The models proposed for prognosis of the risk to develop psychosomatic diseases can predict probability of the disease onset.     

Intermittent versus continuous renal replacement therapy in the ICU: impact on electrolyte and acid-base balance

OBJECTIVES: The maintenance of normal serum sodium, potassium and bicarbonate concentrations is a therapeutic goal of renal replacement therapy (RRT) in acute renal failure (ARF). The aim of this study was to determine whether this goal is best achieved with intermittent hemodialysis (IHD) or continuous venovenous hemodiafiltration (CVVHDF). DESIGN: Retrospective controlled study. SETTING: Tertiary intensive care unit. PATIENTS: Consecutive patients with ARF treated with IHD (n = 47) or CVVHDF (n = 49). INTERVENTIONS: Measurement of daily morning sodium, potassium and bicarbonate concentrations after the initiation of RRT for up to 2 weeks of treatment. MEASUREMENTS AND RESULTS: Before RRT, abnormal (high or low) values were frequently observed for sodium (42.6% vs 39.6%; NS) potassium (23.4% vs 45.8%; NS) and bicarbonate (63.2 % vs 54.3 %; NS). After treatment, however, CVVHDF, but not IHD, significantly increased mean sodium concentrations (p = 0.0001). CVVHDF was also more likely to normalize the serum sodium than IHD (76.2 % vs 47.8% p = 0.0001). The mean potassium concentrations of both groups significantly decreased (p = 0.019 vs p = 0.0075, difference: NS). However, CVVHDF more frequently reduced the incidence of hypokalemia (1.9 % vs 7.1%, p = 0.0006). CVVHDF but not IHD significantly increased mean bicarbonate concentrations (p = 0.016) in the first 48 h, and more frequently normalized them (71.5% vs 59.2, p = 0.0073). CONCLUSIONS: Serum sodium and potassium, and arterial bicarbonate, concentrations are frequently abnormal in ARF patients before and during renal replacement. Normalization of these values, however, is achieved more frequently with CVVHDF than with IHD.