Left ventricular hypertrophy in hypertension. Part I. Criteria of diagnosis and prevalence

Possibilities of electrocardiography, echocardiography and magnetic resonance tomography for diagnosis of left ventricular hypertrophy are reviewed and various criteria of left ventricular hypertrophy compared. Literature data concerning prevalence of left ventricular hypertrophy in different populations are presented and dependence of reported prevalences of left ventricular hypertrophy on diagnostic technique and criteria is demonstrated. Criteria of dynamic changes of left ventricular mass are also discussed.     

Immediate and long-term outcomes after "Ephesos" coronary stent implantation in patients with stable or unstable angina

AIM: An open non-randomized trial was initiated to assess clinical and angiographic results of using the coronary stent "Ephesos" in 457 patients with stable or unstable angina pectoris and native coronary affections. MATERIAL AND METHODS: 268 stents have been implanted in 231 patients with stable angina (SA) and 271 stents--in 226 patients with unstable angina (UA). 46% lesions were complicated. The length of stenosis was 12.9 +/- 6.7 mm in the group SA and 14.1 +/- 7.4 mm in the group UA, 30% stenoses were long. RESULTS: Successful stenting was stated in 99% without cases of acute thrombosis. Non-fatal myocardial infarction took place in hospital in 1.3% of SA patients and in 2.6% of UA patients. Incidence of cardiac complications (death, recurrent angina pectoris, myocardial infarction, restenosis, repeated revascularization) for 6-month follow-up was 15.6% in SA group and 18.1% in UA group. At angiographic control, the index of vascular diameter loss made up 0.22 +/- 0.2 in SA group and 0.3 +/- 0.27 in UA group. Incidence of restenosis was 12 and 14%, respectively. 18-month follow-up found no differences in frequency of complications: 21.6 and 22.6% in groups SA and UA, respectively. CONCLUSION: Implantation of the stent "Ephesos" is effective in prevention of thrombosis and restenosis in patients with stable or unstable angina pectoris at high risk of intervention.     

Coronary angioplasty: view through 30 years

Andreas Gruentzig executed the first successful percutaneous transluminal coronary angioplasty (PTCA) in 1977. Percutaneous coronary interventions (PCI) have considerably changed since this time. The changes have touched the technical equipment for PCI, the pharmacological and mechanical support of PTCA also. The serious revision was in recommendations for PCI too. New catheter technologies have allowed to perform successful PCI in patients with an acute myocardial infarction, with multivessel coronary disease and in many others. PCI became the most often method of a coronary revascularization for ischemic heart disease in the nineties. Percutaneous interventions pass ahead of coronary artery bypass graft operations in many countries of Europe and America. The coronary angioplasty is carried out more than in 2 million patients in the world annually, and 1 million patients is exposed to the PCI annually in the USA. Coronary stenting became most frequently used technology of PCI from the middle of the nineties. The implantation of drug-eluting stents has been the dominating catheter-based method in world clinical practice during last three years. Nevertheless, both these technologies are not deprived of restrictions and disadvantages. The coronary restenosis has become the main limitation for standard (bare-metal) stents, and late thrombosis has become the most terrible complication for the drug-eluting stents. The big success of a method and huge increase of quantity of coronary interventions would be impossible without sequence of openings, innovations and other important events which are surveyed in this review.     

Drug-eluting stent thrombosis and its pharmacological prevention

The problem of drug eluting stents (DES) safety has been actively discussed throughout 2006 because of increase of frequency of development of late stent thromboses which were noted during almost 2 years after stenting. In December 2006 US Food and Drug Administration (FDA) advisory panel acknowledged increase of development of late stent thrombosis. At the same time FDA accepted new definition of stent-thrombosis suggested by the Academic Research Consortium. According to this definition thrombosis can be definite, probable and possible. Any unexplained death before end of follow-up in a trial should be considered thrombosis related. Recalculation of thrombosis rate using this definition caused pronounced increase of this parameter in previously conducted trials. Thrombosis rate rose from 0,6 to 3,3% for bare metal stents, from 0,8 to 3,6% for sirolimus eluting stents and from 1,3 to 3,5% for paclitaxel eluting stents. Professional cardiological and angiographical societies (ACC, AHA, SCAI) responding to FDA advisory panel published their proofs and vision of the problem of stent thrombosis. In February 2007 ACC, AHA, SCAI, American College of Surgeons and Association of Dentists published scientific bulletin in which described preventive measures aimed at lowering of risk of thrombosis development. This document contains strict recommendation to continue double antithrombotic therapy with aspirin and clopidogrel for 12 months after implantation of DES or abandonment of the use of this type of stents when long term double antithrombotic therapy is not possible.     

Pulmonary hypertension and right ventricular failure. Part IX. Traditional therapy of primary 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 nine 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.     

Antiatherogenic effects of angiotensin converting enzyme inhibitors from the point of view of evidence based medicine

In a series of articles the authors analyze literature data concerning controlled studies in which cardio-, cerebro-, and vasoprotective effects of angiotensin converting enzyme inhibitors (ACEI) have been assessed. In the second communication they discuss the results of three recently completed major randomized placebo controlled trials assessing effect of ACEI on the risk of cardiovascular events in patients with chronic ischemic heart disease (IHD) and preserved left ventricular systolic function. In PROGRESS and PEACE trials ACEI perindopril and trandolapril as monotherapy turned out incapable to prevent development of myocardial infarctions and strokes in patients with cardiovascular diseases without left ventricular systolic dysfunction. In EUROPA positive results were achieved at the account of special selection of patients, post hoc replacement of end points, and the use of high dose of perindopril (8 mg/day). Therefore results of this trial can not be applied to majority of patients with IHD. Biochemical studies have shown that ACEI are unable to suppress angiotensin II formation in human heart and vessels and thus in principle are not capable to cause cardio- and vasoprotective effects independent of their antihypertensive action. The fact is that contrary to rats in human heart and vessels angiotensin converting enzyme is responsible for just a portion (2-20% and 40%, respectively), of entire angiotensin II production. The remaining part of angiotensin II is formed under influence of chymase, activity of which is not altered during treatment with ACEI.     

Immediate and long-term results of implantation of the coronary stent "BioDiamond"

AIM: To assess immediate and long-term outcomes after BioDiamond-stent implantation in patients with native coronary artery disease. MATERIALS AND METHODS: The BioDiamond stent was implanted in 112 patients with 132 de novo lesions. Most patients (54%) had unstable angina, 33% of the lesions were of type B2-C. RESULTS: No stent deployment failure occurred as well as acute or subacute stent thrombosis. The 6-month angiographic follow-up was obtained in 108 patients (98%) (125 lesions). The loss index was 0.40 +/- 0.27. Angiographic restenosis rate occurred in 14%. Repeat target lesion revascularization was successful in 16 patients with restenosis. CONCLUSION: The results of this study indicate a potential benefit of BioDiamond for prevention of stent thrombosis and restenosis in these relatively high-risk patients.     

Effects of acute hypoxia on left and right ventricular contractility in chronic obstructive pulmonary disease

The purpose of this investigation was to assess the effects of acute hypoxia on left (LV) and right ventricular (RV) contractility in clinically stable chronic obstructive pulmonary disease (COPD) patients. Eleven male patients (mean age 52.4 ± 12.6 years) who were diagnosed to have COPD were included into the study. All of the patients underwent left and right heart catheterization. RV contractility was measured according to the method of Ferlinz and LV contractility according to the method of Kennedy and colleagues using indirect digital substraction angiography. Mean pulmonary artery pressures (Mean P_PA) and oxygen saturation of the pulmonary artery (S_aO₂) were measured before and at each stage of graded hypoxic exposure 14%, 12%, and 10% of O₂. Right atrial pressures (P_RA,syst, P_RA,diast, P_RA,mean), RV pressures (P_RV,syst, P_RV,diast, P_RV,mean, P_RV,end-diast), RV and LV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume index (SVI), cardiac index (CI), ejection fraction (EF), and heart rate (HR) were calculated before and after breathing a hypoxic mixture of 10% of O₂ for 30 minutes. Acute hypoxia induced significant elevation of mean P_PA, P_RA,syst, P_RA,diast, P_RA,mean, P_RV,syst, P_RV,mean, P_RV,end-diast, RV EDVI, RV ESVI, LV EDVI, LV ESVI, decreased significantly after acute hypoxia confidence interval, and HR (p < 0.05). Whereas S_aO₂ (p < 0.05). These findings suggest that the systolic performance of the right and left ventricles were well-maintained during acute hypoxia in patients with COPD.     

The problem of complications of percutaneous coronary interventions. Part I. Character and frequency of complications

In recent years interventions in cardiology became routine procedure in many clinics. This could not to affect frequency of complications. From the very beginning of development of interventional cardiology specialists have been showing great interest to monitoring of complications and to possibilities of lowering of their rate. Data of several studies which consider complications at various stages of development of interventional cardiology are given in this review. It also covers studies in which analysis of cardiac as well as local complications after different types of procedures - percutaneous coronary interventions, catherization of chambers of the heart, valvuloplasties - was carried out.     

Frequency in the anomalous origin of the right coronary artery with angiography in a Turkish population

OBJECTIVE: The estimate frequency of anatomic variations in origin of the right coronary artery in a Turkish population. MATERIAL AND METHOD: The angiographic data of 5253 consecutive adults patients undergoing coronary angiography were analysed retrospectively for the diagnosis of anomalous origin of the right coronary artery. RESULTS: Among 5253 adults patients, five (0.09%) patients had anomalous origin of the right coronary. They had an isolated anomalous origin of the right coronary artery. The right coronary arose from the left coronary sinus of Valsalva (there was separate orificium for the right coronary artery and the left coronary artery) in two (0.03%) patients, from above the left coronary sinus of Valsalva in three (0.05%) patients. In all patients, the anomalous origin of right coronary artery from the left sinus of Valsalva and from above the left coronary sinus of Valsalva coursed between the aorta and the pulmonary artery. CONCLUSION: The anomalous origin of the right coronary artery is a rare congenital cardiac malformation. Most patients remain asymptomatic. However, there are cases of sudden cardiac death described in the literature, indicating a potentially malign course of the disease. The angiographic recognition of this vessel may be useful for physicians dealing with diagnosis and treatment of the anomaly of the right coronary artery.