REPERFUSION THERAPY IN ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION

Aim. To compare effect of percutaneous balloon angioplasty (PCA) and a systemic thrombolysis (STL) on the central and intracardiac hemodynamics in patients with acute coronary syndrome (ACS) with ST segment elevation.Material and methods. 80 patients with ACS with ST segment elevation were included in the study. Patients were split into 2 groups depending on reperfusion strategy. PCA was performed in 55 patients (first group). 25 patients of the second group had STL with Streptokinase, i/v, 1 500 000 units per hour. Echocardiography was performed in all patients at admission and after 3 and 7 days of treatment to evaluate intracardiac hemodynamics.Results. Both reperfusion methods significantly increase of ejection fraction (EF) and maximal output speed of left ventricle (LV). Increase of LV EF in patients after PCA was higher than this in patients after STL. PCA improved LV diastolic function; STL did not change this characteristic. After PCA working diagnosis of ACS was transformed to the following final diagnosis: acute myocardial infarction (AMI) with Q, AMI without Q and unstable angina in 37,5, 30,4 and 32,1% of patients, respectively. After STL diagnosis of AMI with Q was defined in all patients.Conclusion. PCA in patients with ACS with ST segment elevation results in fast improvement of global systolic and diastolic LV function. Besides, PCA prevents AMI with Q in a half of these patients.</p

EFFECTS OF ACETYLSALICYLIC ACID AND CLOPIDOGREL ON MORPHOFUNCTIONAL STATUS OF ERYTHROCYTES IN PATIENTS WITH ACUTE CORONARY SYNDROME

Aim. In patients with acute coronary syndrome (ACS) to study an aggregation activity and morphology of erythrocytes and to assess their changes during therapy with acetylsalicylic acid, clopidogrel and combined antiplatelet therapy (acetylsalicylic acid and clopidogrel).Material and methods. 98 patients (67 men and 31 women, aged 59,6±10,8 y.o.) with ACS were included in the study. Patients were split in 3 groups depending on prescribed antiplatelets (acetylsalicylic acid; clopidogrel; acetylsalicylic acid+clopidogrel). Aggregation activity and morphofunctional status of erythrocytes were evaluated at baseline, after 3 and 7 days of treatment.Results. The highest efficacy of antiaggregant therapy was observed in patients receiving antiplatelet combination. In this group there was a maximal reduction of erythrocyte aggregation and a number of pathological erythrocytes in peripheral blood by the 3rd day of therapy. This effect was increasing by the 7th day.Conclusion. The effect of all antiplatelet drugs was significant. The antiaggregant effect of clopidogrel was more significant than this for acetylsalicylic acid. Efficacy of combined therapy was higher than these for each drug alone. </p

PREVENTION OF LEFT VENTRICLE SYSTOLIC DYSFUNCTION IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION AFTER CARDIAC REVASCULARIZATION

Aim. To study effects of bioflavonoid quercetin (corvitin) on left ventricle (LV) systolic dysfunction in patients with acute coronary syndrome with ST segment elevation (ACS+ST) after cardiac revascularization.Material and methods. 60 patients with ACS+ST (44,2±1,3 y.o.) were examined. Patients were admitted to hospital within 6 hours after complaints beginning. Patients were randomized in two groups. 30 patients of group A had standard therapy and cardiac revascularization. 30 patients of group B received corvitin additionally to standard therapy before cardiac revascularization. Echocardiography initially and stress-echocardiography with dobutamine after status stabilization (at 8-10 days of disease) were performed.Results. Dobutamine test (with low and high doses) showed myocardial viability in patients of group B. Patients of group A had irreversible LV systolic dysfunction in 32 % of segments. Corvitin slowed down LV dilatation progression in patients with ACS+ST. It resulted in the end-diastolic and end-systolic indexes did not change within 10 days. The LV ejection fraction was more increased in patients of group B in comparison with patients of group A.Conclusion. The early corvitin prescribing has positive effects on LV systolic function and prevents post-reperfusion complications. </p

THE ROLE OF ECHOCARDIOGRAPHY IN THE DIAGNOSIS OF CORONARY HEART DISEASE AND MONITORING OF TRIMETAZIDIN THERAPY IN PATIENTS WITH CORONARY HEART DISEASE

&lt;p&gt;Coronary heart disease (CHD) is one of the most common diseases with high mortality worldwide. Therefore, in order to improve the quality and increase the life expectancy of mankind, it is important to improve the methods of diagnosis, treatment and prevention of coronary heart disease. The purpose of our study is to conduct a diagnostic analysis of the heart of patients who have suffered a myocardial infarction using EchoCG and to identify the structural and functional features of coronary heart disease. In addition, using these features to analyze the therapeutic efficacy of trimetazidin after treatment of these patients. We found that after treatment of patients with coronary artery disease with trimetazidin, the results of EchoCG showed mainly positive changes in markers associated with functional features of the heart, and to a lesser extent we found structural changes.&lt;/p&gt

Clopidogrel therapy effects on cell hemostasis in acute coronary syndrome

The study was aimed at investigating cell hemostasis parameters in acute coronary syndrome (ACS), and comparing the effects of various antiaggregant medications (clopidogrel, aspirin, or their combination) on platelet (PL) and red blood cell (RBC) aggregation activity. In total, 98 ACS patients were divided into groups, according to the antiaggregant therapy received. At Days 3-4 and 6-7, PL aggregation activity and RBC morphology and function were assessed. Antiaggregant therapy was highly effective among those receiving combined treatment, with minimal PL aggregation and maximal RBC morphology improvement (high prevalence of discocytes and reversibly deformed RBC) observed as early as Day 3 and further increasing by Day 7. All three variants of antiaggregant therapy were significantly effective, but Clopidogrel, especially in combination with aspirin, demonstrated the best effect. Combined therapy (clopidogrel and aspirin) improved cell hemostasis parameters, which could be linked to better aggregation inhibition due to different therapeutic targets for these two agents

Клінічний випадок ендоваскулярного лікування хронічної артеріальної недостатності головного мозку у пацієнтів з критичною ішемією нижніх кінцівок

The article describes the case of one-stage stenting of the internal carotid artery and balloon angioplasty of the tibial arteries in a patient with multifocal atherosclerosis.В статье приводится описание случая одномоментного стентирования внутренней сонной артерии и баллонной ангиопластики берцовых артерий у пациента с мультифокальным атеросклерозом.У статті наведено опис випадку одномоментного стентування внутрішньої сонної артерії та балонної ангіопластики гомілкових артерій у пацієнта з мультифокальним атеросклерозом

Phospholipid metabolism and effectiveness of a glycoprotein IIb/IIIa receptor blocker tirofiban in patients with acute coronary syndrome without ST segment elevation

Aim. To study the effects of tirofiban, a glycoprotein IIb/IIIa receptor blocker, on platelet (PL) phospholipids (PhL) in patients with acute coronary syndrome (ACS).Material and methods. The study included 55 ACS patients without ST segment elevation (↓ST), receiving standard therapy; 26 participants were administered tirofiban. The control group included 23 healthy volunteers, with­out any cardiovascular disease. In all participants, PL PhL characteristics were assessed at baseline, at Day 3 and Days 7-10.Results. In ACS patients, both qualitative and quantitative changes in PL PhL metabolism were observed, which could result in disturbed PL hemostasis. The main manifestation of these disturbances was increased lysophosphatidyl choline (LFS) level in PL membranes. Disturbed PL PhL metabolism was observed in all ACS patients, being maximally manifested at baseline.Conclusion. Tirofiban therapy, as a part of standard ACS↓ST treatment, improved PhL composition of PL membranes and beneficially affected PL hemostasis

Клінічна ефективність бісопрололу у пацієнтів з ішемічною хворобою серця залежно від типу поліморфного маркера гена ADRB-1

At present, in order to influence the indices of the global contractions of the left ventricles in patients with coronary heart disease effectively, genetic characteristics in receptor structure and particularly adrenoreceptors responsible for sympathoadrenal activity should be considered. Patients division depending on the type of polymorphism gives prerequisites for new efficient algorithms for individual selection of medicines, including β-blockers. Taking into consideration the type of polymorphous marker of ADRB- 1 receptor, it is possible to maximize the effect of β-adrenoceptor, thereby to influence effectively the pathogenic mechanism of the disease.На сегодняшний день для эффективного воздействия на показатели глобальной сократимости левого желудочка у пациентов с ишемической болезнью сердца (ИБС) необходимо учитывать генетические особенности строения рецепторов, в частности адренорецепторов, отвечающих за симпатоадреналовую активность. Разделение пациентов в зависимости от типа полиморфизма дает предпосылки к созданию новых эффективных алгоритмов по индивидуальному подбору медикаментов, в том числе и β-адреноблокаторов. Учитывая тип полиморфного маркера рецептора ADRB-1, появляется возможность максимизации β-адреноблокирующего эффекта, тем самым эффективно воздействовать на патогенетический механизм заболевания.На сьогоднішній день для ефективного впливу на показники глобального скорочення лівого шлуночка в пацієнтів з ішемічною хворобою серця (ІХС) необхідно враховувати генетичні особливості будови рецепторів, зокрема адренорецепторів, які відповідають за симпатоадреналову активність. Розподіл пацієнтів залежно від типу поліморфізму є передумовою для створення нових ефективних алгоритмів щодо індивідуального підбору медикаментів, у тому числі й β-адреноблокаторів. Враховуючи тип поліморфного маркера рецептора ADRB-1, виникає можливість максимізації β-адреноблокуючого ефекту, тим самим ефективно впливати на патогенетичний механізм захворювання