THE PLACE FOR SYSTEMIC THROMBOLYSIS IN MODERN REPERFUSION METHODS FOR MYOCARDIAL INFARCTION

The analytic article provides a brief history of thrombolytic therapy in myocardial infarction and discusses benefits and restrictions of contemporary reperfusion methods of treatment. Albeit dominating position of primary transcutaneous interventions, thrombolytic therapy remains the main part for primary stage of treatment, especially in hard acessible and remote areas. Its usage especcialy important for Russia where such territories and cities with out of date infrastructure make impossible to follow optimal standards of care during permitted time window. The attention spotted on the improvement of thrombolytic therapy by pre-hospital thrombolysis and broad usage of pharmacoinvasive approach

Clinical value of complex ambulatory monitoring of blood pressure and arterial rigidity in elderly patients

Aim. To study the clinical and diagnostic role of pulse wave time (PWT) in 24-hour blood pressure monitoring (BPM) and its link to elasticity of larger arteries and aorta (carotid-femoral pulse wave velocity, PWVcf; cardioankle vascular index, CAVI) in patients aged over 75 years.Material and methods. The study included 52 patients (20 men) aged over 75 years (mean age 79,1±3,5 years) with arterial hypertension (AH). Fifteen participants had cardiovascular events (CVE) in anamnesis: myocardial infarction, MI (n=11) or stroke (n=4). Sixteen patients had Functional Class II-III angina (n=16), and 32 received antihypertensive therapy. 24-hour BMP and PWT parameters were measured. Corrected PWT100-60 was calculated for systolic BP (SBP) 100 mm Hg and heart rate (HR) 60 bpm. PWVcf and CAVI were assessed with a screening device VS 1000 VaSera, Fukuda Denshi, Japan.Results. In all participants, clinical BP level was 147,5+6,9/76,5+5,1 mm Hg; 24-hour BPM BP level - 139,6+6,7/70,7+4,6 mm Hg; PWT100-60 - 161,7+6,2 ms; PWVcf - 17,3+4,6 m/s, and CAVI - 10,6+3,1. A sig­nificant negative correlation between PWT100-60 and 24-hour BPM SBP (r=-0,36, p<0,05), 24-hour BPM PBP (r=-0,43, p<0,01), PWVcf (r=-0,54, p<0,01) and CAVI (r=-0,34, p<0,05) was observed. Patients with and without CVE were comparable by age. CVE-free participants were characterised by lower frequency of antihypertensive therapy, higher levels of clinical BP (153,5+6,9/82,5+6,3 vs. 136,5+3,4/71,1+3,9 mm Hg), higher 24-hour BPM BP (144,0+6,9/73,2+5,3 vs. 132,6+4,2/69,3+3,8 mm Hg), lower PVWcf (15,8+4 vs. 18,7+4,4 m/s), lower CAVI (9,7+2,4 vs. 11,5+3,8), and higher PWT100-60 (167+5,4 vs. 156,2+6,9 ms; p<0,05).Conclusion. In AH patients aged over 75 years, PWT100-60 correlated with traditional indices of arterial rigidity. Lower PWT100-60 and higher PWV were observed among individuals with CVE in anamnesis

Carotid artery elasticity in young men with arterial hypertension

Aim. To compare the wall rigidity of common carotid artery (CCA), assessed by ultrasound (US), in young men with arterial hypertension (AH).Material and methods. The study included young men aged 18-25 years (mean age 22 years): 25 with normal blood pressure (BP) during office visits and 24-hour BP monitoring (BPM), 11 with white coat AH (WCAH), and 23 with AH. Intima-media thickness (IMT) was examined by B-mode US, maximal systolic and minimal diastolic diameters — by M-mode US. Elasticity and dispensability coefficients, Peterson’s elasticity module, Young module, and flow deformation index were calculated.Results. In AH patients, IMT levels and CCA wall rigidity were higher than in young men with normal BP or WCAH.Conclusion. In young men aged 18-25 years, AH, confirmed by office measurement and 24-hour BPM, was asso­ciated with carotid artery remodelling and reduced elasticity

MODERN METHODS OF INTRACARDIAC HEMODYNAMICS AND CARDIAC DEFORMABILITY ASSESSMENT IN PREGNANT WOMEN WITH DILATION CARDIOMYOPATHY SYNDROME

Aim. The search for plausible additional criteria of diagnosis in patients with the syndrome of dilation cardiomyopathy (SDCMP) on the basement of deformity of myocardium (MD) assessment results in lifemode.Material and methods. Totally, 28 pregnant with SDCMP studied, of those 10 at the age 29±5,8 y. with postmyocarditis cardiosclerosis and SDCMP, and 18 — without anamnestic data of myocarditis or SDCMP. Controls consisted of 30 pregnant women with normal systolic and pumping heart function, and non-changed geometry of the left ventricle (LV). All patients underwent 24-hour ECG and blood pressure monitoring. USE of the heart was done by the common protocol in B-regimen, impulse and continuous Doppler, color Doppler with chambers size measurement, intracardiac hemodynamics, pressure in pulmonary artery stem, and longitudinal, radial and circular global systolic MD and velocity of the shift of respective LV myocardial fibers.Results. In the pregnant of 1st and 2nd groups there were significant disorders of the force and velocity of myocardium, together with negative remodeling of LV chamber, comparing to the controls. While comparing the parameters of 1 and 2 groups, there was significant decrease of longitudinal and circular global systolic MD in patients of the 1 group.Conclusion. Except the assessment of anatomy, intracardiac hemodynamics, systolic and pumping function of the heart of the pregnant with SDCMP, it is expedient to apply additional diagnostic criteria as the values of longitudinal, radial, circular global systolic MD