Pulmonary hypertension and right ventricular failure. Part X. Prostanoids in the treatment of primary pulmonary arterial hypertension

In a series of articles the authors discuss literature data concerning epidemiology of pulmonary arterial hypertension (PAH), its modern classification; peculiarities of its pathogenesis and treatment in various diseases and conditions. The tenth communication contains consideration of results of controlled trials of prostacyclin and its synthetic analogues in patients with primary (idiopathic) PAH, and PAH associated with diffuse diseases of connective tissue, congenital heart disease, HIV-infection. Continuous intravenous infusion of prostacyclin (epoprostenol) has made a revolution in the treatment of patient with severe PAH because its long-term use is associated with improvement of survival of patients refractory to high doses of calcium antagonists. Subcutaneous administration of treprostinil and especially inhaled iloprost substantially widen possibilities of prolonged use of prostanoids in patients with various forms of PAH. Literature data on application of different prostanoids for long term treatment of patients with PAH, their side effects, indications and counterindications for their administration are analyzed in this communication.     

Pulmonary hypertension and right ventricular failure. Part VIII. Diagnosis, course, and prognosis of primary (idiopathic) pulmonary arterial hypertension

In a series of articles the authors discuss literature data concerning epidemiology of pulmonary hypertension (PH), its modern classification; peculiarities of its pathogenesis and treatment in various diseases and conditions. In the eight communication they describe presentations of PH and methods of its instrumental diagnostics. This part also contains discussion of problems of differential diagnosis of diseases which can be complicated by PH, contemplation of natural course of primary (idiopathic) PH and factors determining its prognosis.     

Interaction of angiotensin converting enzyme inhibitors with nonsteroidal antiinflammatory drugs

Analysis of results of randomized controlled studies revealed pronounced attenuation of vasodilating, natriuretic, and cardioprotective effects of angiotensin converting enzyme inhibitors (ACEI) by concomitant use with of indomethacin and aspirin in patients with hypertension, chronic heart failure, and acute myocardial infarction. In some studies beneficial effects of ACEI were shown to be weakened by concomitant use with of other nonsteroidal antiinflammatory drugs, including selective inhibitors of cyclooxygenase-2.     

Invasive cardiology: focus on restenosis. Part II

In-stent restenosis represents a pathological process which histology is different from that of restenosis after balloon angioplasty. In-stent restenosis is mainly caused by neointima proliferation. This part of review deals with technologies of prevention of in-stent restenosis including novel stent designs and coatings aimed at suppression of neointima proliferation.     

Single coronary artery arising from the left sinus of valsalva

A single coronary artery is a rare congenital anomaly of the coronary arteries where only one coronary artery arises from the aortic trunk by a single coronary ostium, supplying the entire heart. We report a case of a 57-year-old woman with atypical chest pain, in whom coronary angiography showed a L-I subtype single coronary artery (arising from a single ostium in the left sinus of valsalva) without associated cardiovascular disease. The clinical significance and subtype of the single coronary artery are discussed.     

Comparison of effects of nebivolol and atenolol on P-wave dispersion in patients with hypertension

BACKGROUND: P-wave dispersion has been shown to be a noninvasive electrocardiographic predictor for development of atrial fibrillation . Thus it may be possible to attenuate atrial fibrillation risk through normalization of P-wave variables and improvement in P-wave dispersion may be an important goal in treatment of hypertension. OBJECTIVE: To compare the effects of nebivolol, a new b-blocker that have additional vasodilating activity via acting on endothelium and nitric oxide release, and atenolol on P-wave duration and dispersion in patients with mild-to-moderate hypertension. METHODS: A total of 34 newly-diagnosed hypertensive patients were enrolled in the study. The patients were randomly assigned to receive treatment with either nebivolol (5 mg) or atenolol (50 mg). P-wave durations (Pmin and Pmax) and P-wave dispersion were measured before and one month after treatment. RESULTS: While Pmin increased (50,6 +/- 11,2 ms to 54,7 +/- 9,1 ms, p=0,05), Pmax decreased (111,9 +/- 9,1 ms to 104,0 +/- 12,4 ms, p=0,003) and P-wave dispersion decreased (62,5 +/- 10,6 ms to 51,3 +/- 8,9 ms, p < 0,001) with nebivolol, Pmin increased (44,4 +/- 9,8 ms to 58,0 +/- 15,5 ms, p=0,02), Pmax didn t change (106,1 +/- 13,8 ms to 107,0 +/- 11,6 ms, p=NS) and P-wave dispersion decreased (61,7 +/- 15,0 ms to 49,0 +/- 13,7 ms, p < 0.001) with atenolol. However, there was no statistical difference between pre- and post-treatment values of two groups. CONCLUSIONS: Both nebivolol and atenolol are effective in improvement of P-wave dispersion in patients with hypertension and there s no significant difference between them.     

Relationship between components of heart rate variability and Doppler echocardiographic indices of left ventricular systolic performance in patients with coronary artery disease

Decreased heart rate variability (HRV) has been reported as prognostic predictor in coronary artery disease population. The aim of the study was to assess the relationship between cardiac autonomic tone disturbances and the degree of left ventricular dysfunction, estimated by 2-dimensional and Doppler echocardiography, in patients with coronary artery disease. Forty patients with angiographically proven coronary artery disease and 15 age-and sexmatched healthy subjects were included into the study (Group I and II, respectively). Routine clinical examinations, electrocardiography, coronary angiography, and 2-dimensional and Doppler echocardiography with assessment of LV systolic performance were done in all the patients and control subjects. Cardiac autonomic function was assessed by means of frequency-domain analysis of heart rate variability. The powers of LF and HF bands (P1 and P2), their ratio (P1/P2), and the logarithmic expression of powers were measured. The patients (Group I) had lower values of parasympathetic band of HRV and higher sympathetic activity than the healthy population (Group II) (p<0.0002 for P2 andp<0.04 for P1/P2 ratio). A positive significant correlation was seen between parasympathetic band of HRV and ejection fraction (r=0.61,p<0.0001), and mean acceleration of aortal flow (r=0.56,p<0.0001), whereas P1/P2 ratio inversely and significantly correlated with the same parameters (r=–0.46,p<0.002 and r=–0.41,p<0.008).     

Stroke and Other Thromboembolic Complications of Atrial Fibrillation. Part III. Prevention With Aspirin

In part III of a series of papers on epidemiology and drug prevention of stroke and other thromboembolic complications of atrial fibrillation the authors present data on clinical pharmacology of aspirin as well as discussion of results of randomized trials in which cerebroprotective efficacy and safety of the use of aspirin for primary and secondary prevention of thromboembolism was studied in comparison with placebo and warfarin. According to cumulative data of 6 randomized studies average stroke risk lowering caused by aspirin was 22%. In primary prevention of stroke aspirin did not increase substantially frequency of serious bleedings. However in secondary prevention trials its use was associated with significant increase of serious bleeding rates. Thus in patients with atrial fibrillation aspirin compared with warfarin less effectively prevents stroke but causes fewer serious bleedings.