The aim of this work was to evaluate anti-ischemic and angiographic efficiency of endovascular revascularization of ischemic myocardium by implantation of Sirolimus-eluting stents from the results of a 18 moth-long prospective study of patients with coronary heart disease and/or type 2 diabetes mellitus (DM). The study included 108 patients with angina of effort randomized into two groups: CHD with DM (n = 51) and CHD without DM (n = 57). All of them received anti-ischemic and antihypertensive therapy and two desaggregants; DM patients also used oral hypoglycemic preparations. The patients underwent implantation of Sirolimus-eluting stents. The frequency of restenosis of the target arteries, development of serious cardio-vascular events (death, MI, cerebral stroke, and the need in repeat revascularization) were compared within 18 months after primary endovascular revascularization. Although Sirolimus-eluting stents markedly improved long-term prognosis in DM patients, results of their implantation were worse than in patients with CHD without DM.

Aim. To evaluate effects of 6-month therapy with losartan in combination with indapamide on a clinical course, immunological, metabolic parameters, left ventricular function, exercise tolerance and quality of life in patients with coronary heart disease (CHD) associated with metabolic syndrome (MS). Material and methods. Forty six CHD patients with postinfarction cardiac dysfunction in MS were randomized into two groups. Group 1 consisted of 22 patients with impaired glucose tolerance, group 2 - of 24 type 2 diabetics. Treatment included combination of losartan (50 mg/day) with indapamide (1.5 mg/day), on demand nitrates, nebivolol. Basic therapy in diabetes included sugar-reducing drugs. Clinical condition, findings of echocardiography, parameters of lipid and carbohydrate metabolisms, immunoglobulins, circulating immune complexes, autoantibodies to cardiolipin (AB to CL), spectrum of proinflammatory cytokines were studied before and 3 months after course treatment. Results. Overactivation of cytokines (primarily IL-2, IL-1, TNFalpha) with high expression of IgA, IgG, CIC, AB to CL was found in CHD patients with type 2 diabetes mellitus and less evident in impaired glucose tolerance. Losartan in both groups had an antihypertensive effect, stabilized LV hypertrophy, improved clinical symptoms leading to cytokines expression decline: TNFalpha by 9.8%, IL-1 - by 6.1%, IL-6 - by 6.7%. Losartan was well tolerated, caused no negative metabolic effects. Conclusion. New original facts of cytokine overactivation and humoral immunity disturbances were discovered which play an essential role in pathogenesis of postinfarction dysfunction and LV remodeling developing in type 2 diabetes mellitus. Losartan 6-month treatment in the fixed combination has a positive effect on clinicohemodynamic and immunometabolic indices. This gives grounds for wider use of losartan in CHD combined with type 2 diabetes mellitus.

Aim. To evaluate clinico-immunological disorders in patients with ischemic heart disease (IHD) and metabolic syndrome (MS), to study an immunocorrective action of nebivolol during 6-month treatment. Material and methods. A total of 54 patients with postinfarction left ventricular dysfunction and chronic cardiac failure of NYHA functional class II-III were divided into two groups: group 1 (n = 24) comprised patients with effort angina FC II-III and impaired glucose tolerance, group 2 (n = 30) consisted of anginal patients associated with type 2 diabetes mellitus (DM). Clinical, laboratory and functional indices were registered before therapy with nebivolol and 6 months after it. Immunological control included determination of the subpopulation composition of lymphocytes, immunoglobulins, circulating immune complexes (CIC), antibodies to cardiolipin (CL), proinflammatory cytokines: IL-1alpha, IL-2, IL-6, IL-8, alpha-interferon, tumor necrosis factor alpha (TNFa). Results. Nebivolol demonstrated good antihypertensive and anti-ischemic cardioprotective efficacy in IHD patients with MS, it did not deteriorate atherogenic dyslipidemia and impaired carbohydrate metabolism. As a good immunocorrector, nebivolol significantly inhibited cytokine overactivation, had a weak effect on dysimmunoglobulinemia, CIC level and expression to CL antibodies. Side effects were not recorded. Conclusion. IHD patients with MS (especially patients with type 2 DM) have manifest immune disorders presenting with overactivation of proinflammatory cytokines with high levels of IgA, IgG, CIC and antibodies to CL in the presence of low immunoregulatory index. Nebivolol provided good control of arterial hypertension, myocardial ischemia, positive changes in immunological indices, improved intracardiac hemodynamics.

Aim. To characterize clinical and immune disorders in patients with ischemic heart disease (IHD), postinfarction left ventricular remodeling (PLVR), clinical manifestations of chronic cardiac failure (CCF).Material and methods. A comparative clinical controlled trial of immune system was made. The immune system was assessed by diagnostic and prognostic significance of changes in population composition of T- and B-lymphocytes, by activation of proinflammatory cytokines (IL-1alpha, IL-2, IL-6, IL-8, Inf-alpha, TNF-alpha); high expression of circulating immune complexes (CIC), autoimmune complexes to cardiolipin (CL) in 94 CCF patients with PLVR. The patients were divided into 3 groups according to severity of CCF. Group I consisted of 32 patients with CCF (FCII by NYHA) and normal ejection fraction (EF) of the left ventricle (52.0 +/- 2.8%). Group 2 - 31 CCF (FCIII) patients with decreased EF (by 43.8%) (36 +/- 4.3%). Group 3 - 31 CCF (FCIV) patients with low (25 +/- 3.8%) EF of the left ventricle. The protocol required conduction of echocardiographic parameters, paired bicycle exercise tests, 6-min walk tests, 24-h ECG monitoring, population cell composition of T- and B-lymphocytes, concentrations of cytokines, IgG and IgG autoantibodies to CL.Results. A dominating hyperactivation of cytokines TNFalpha, IL-1alpha, IL-2, IL-6 with high expression of CIC and autoAB to CL was associated with moderate or severe CCF (FCII-IV by NYHA), declined inotropic function of the left ventricle (EF 38-23%), low exercise tolerance and remodeling of the left ventricle.Conclusion. Immune disorders in the form of hyperactivation of proinflammatory cytokines (most of all TNFalpha, IL-]alpha, IL-2, IL-6), enhanced expression of CIC and autoAB to CL growing with severity of CCF and abnormal heart pump function play an important role in CCF pathogenesis in IHD patients with LCPR and can be markers of the disease progression.

The aim of research was comparison of prognostic importance of various indexs non-homogeneousness of processes repolari-zations of heart ventricles registered in acute and subacute periods of myocardial infarction (MI). The retrospective analysis of med-ical histories has allowed to determine dynamics of dispersion of intervals Q-T, Q-Ta and R-Tm in groups of patients with fa-vourable (n = 125) and lethal (n = 250) outcome. The best prognostic importance concerning fatal cardial events have indexs cor-rected on frequency of cardiac rhythm. Most important and independent predictor of intrahospital cardial deaths of the patients with MI is a dispersion of the corrected interval R-Tm, exceeding 80 мс1/2 in the first 6 hours after hospitalization.

The aim of research was comparison of prognostic importance of various indexs non-homogeneousness of processes repolari-zations of heart ventricles registered in acute and subacute periods of myocardial infarction (MI). The retrospective analysis of med-ical histories has allowed to determine dynamics of dispersion of intervals Q-T, Q-Ta and R-Tm in groups of patients with fa-vourable (n = 125) and lethal (n = 250) outcome. The best prognostic importance concerning fatal cardial events have indexs cor-rected on frequency of cardiac rhythm. Most important and independent predictor of intrahospital cardial deaths of the patients with MI is a dispersion of the corrected interval R-Tm, exceeding 80 мс1/2 in the first 6 hours after hospitalization.

A three-year follow-up of patients with coronary heart disease (CHD) and type II diabetes after coronary artery bypass grafting, shows that the following pathologic conditions are significantly more frequent: arterial hypertension, visceral obesity, marked disturbances of blood lipid spectrum, an increases CHD duration, and an increased rate of myocardial reinfarction and revascularizations. The study shows that the presence of diabetes mellitus in CHD patients undergoing coronary artery bypass grafting, is associated with pronounced disturbances in blood lipid spectrum, and is an important risk factor of coronary event progression.

The purpose of the study was to evaluate anti-ischemic and metabolic effects of the cardioselective beta-adrenoblockers nebivolol and retarded metoprolol-metaprolol CR/XL (betalok ZOK) in patients with postinfarction heart dysfunction, associated with type II diabetes mellitus (DM). 40 patients with coronary heart disease (CHD), functional class (FC) II-III exertional angina, postinfarction left ventricular (LV) dysfunction, and NYHA FC II heart failure, associated with type II DM, were randomized into 2 groups. The 20 patients of the 1st group were administered nebivolol in a dose of 1.25 to 5 mg per day, the 20 patients of the 2nd group - betalok ZOK in a dose of 12.5 to 100 mg per day. The course therapy lasted 8 weeks. The effects of the treatment were evaluated using paired veloergometry, echoCG, and lipid spectrum analysis. The study found that nebivolol in a mean dose of 4.2 +/- 0.3 mg per day and betalok ZOK in a dose of 46.5 +/- 6.2 mg per day reduced the frequency and severety of angina attacks (by 73.8% and 67.8%, respectively) and daily nitroglycerine uptake (by 78.6% and 69.1%, respectively), and increased activity tolerance (by 7.9% and 25.3%, respectively). None of the preparations displayed any adverse effects on carbohydrate exchange and blood lipid spectrum. Nebivolol, unlike betalok ZOK, significantly (p = 0.02) reduced triglyceride blood level by 29%. Thus, the new generation cardioselective beta1-adrenoblockers nebivolol and metoprolol CR/XL (betalok ZOK) provide anti-ischemic and metabolic effects in patients with CHD and postinfarction LV dysfunction, associated with type 2 diabetes mellitus. Nebivolol is preferable as far as blood lipid spectrum is concerned.

A randomized blind cross-over study with placebo lead-in compared efficacy of calcium antagonists diltiazem and verapamil in 71 patients with stable angina concurrent with arterial hypotension (group 1) and 38 normotensive patients with ischemic heart disease (group 2). By acute bicycle exercise test evidence, verapamil was effective in 80% and 82% patients of group 1 and 2, respectively, dilitiazem--in 67 and 77%, respectively. Cumulation of the effect (p < 0.01) to the third month of verapamil course was comparable in both groups. Tolerance to an antianginal effect of dilitazem developed in 53% patients of group 1 (against 30% in group 2, p < 001) in 2-4 weeks of therapy (against 4-12 weeks in group 2, p < 0.05). By stress 199-T1 scintigraphy of the myocardium, administration of effective doses of diltiazem reduced the number of hypoperfused segments by at least 30%.

A comparative randomized clinical study was conducted to evaluate the diagnostic and prognostic value of the activation of proinflammatory cytokines [tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1alpha, IL-2, IL-6, IL-8)] and the increased production of autoimmune complexes in the pathogenesis of chronic heart failure (CHF) in patients with coronary heart disease (CHD). The study included 47 patients with CHD who had a more than 6-month history of Q-forming myocardial infarction. The patients were randomized into 3 groups: 1) 21 patients with NYHA Functional Class (FC) II heart failure (HF); 2) 16 patients with FC III HF; and 3) 10 with FC IV HF. Basic therapy involved angiotensin-converting enzyme (ACE) inhibitors, nitrates, diuretics, beta-adrenoblockers; 27.6% received digoxin, disaggregatory agents. A study protocol involved the estimation of the parameters of EchCG, paired bicycle ergometric tests, 6-min walking test, ECG daily monitoring, the levels of proinflammatory cytokines in the serum and IgG autoantibodies to cardiolipin. The findings suggest that with the higher expression of autoimmune complexes, the activation of cytokines (primarily TNF-alpha, IL-1alpha, IL-2) plays an important role in the pathogenesis of CHF in patients with postinfarct cardiac dysfunction: the high activation of cytokines and the elevated level of autoimmune complexes are associated with moderate or severe NYHA FC II-IV HF, depressed left ventricular contractility (ejection fraction, 23-38%), low exercise tolerance, and cardiac remodeling.

Thirty males with prior myocardial infarction concurrent with arterial hypertension (AH) were examined to study the antihypertensive and antiischemic effects of the AT1-receptor blocker irbesartran. Group 1 comprised 12 (40%) patients with mild AH; Group 2 included 18 (60%) with moderate AH. In Group 2, the standard therapy with irbesartan in a single dose of 150 mg in the morning was supplemented by the beta1-adrenoblocker atenolol in the average daily dose of 31.25 mg. In Group 1 patients there were decreases in systolic blood pressure (SBP) by 28% and diastolic blood pressure (DBA) by 19% while in Group 2 receiving combined therapy with atenolol, SBP lowered on the average of 38.3 mm Hg of the baseline values and DBA became normal in 66.7% of the patients (p < 0.00). Thus, irbesartan provides good antihypertensive and antiischemic effects in patients with grade 1 AH; the combined therapy enhances the efficiency of treatment by 92% in patients with moderate AH.

Effect of 6 months treatment with carvedilol (25 mg/day) on blood levels of cytokines (interleukins 1alpha, 2, 6, 8, tumor necrosis factor alpha) and clinical symptoms of heart failure was studied in patients with cardiac dysfunction after myocardial infarction. Patients with NYHA class II heart failure, ejection fraction 50% and moderately lowered tolerance to physical exercise (n=21) initially had enhanced cytokine expression: blood content of interleukin (IL) 2 was 2.8 times, tumor necrosis factor (TNFalpha) 78%, IL-1alpha 60% above normal level. Therapy with carvedilol in this group was associated with decreases of Il-2 (-23.8%), TNFalpha (-16.7%), IL-1alpha (-12.5%) (p<0.05-0.01). This was accompanied by alleviation of clinical symptoms and improved exercise tolerance. Patients with NYHA class III heart failure (n=16) with low left ventricular ejection fraction (30+/-2.7%) and low exercise tolerance had high levels of all studied cytokines. Levels of IL-2, TNFalpha and IL-1alpha were most elevated (3.1, 2.8 and 2 times higher than normal values, respectively). Therapy with carvedilol was associated with improvement of clinical symptoms and exercise tolerance (+35%, p<0.05)), increase of ejection fraction (+15%, p<0.05), decrease of left ventricular end systolic volume (-17.5%, p<0.05), and lowering of blood levels of TNFalpha (-31%), IL-2 (-17.4%), IL-1alpha (-15.6%). However cytokine levels remained substantially elevated compared with normal values. Carvedilol was well tolerated, and did not cause negative metabolic effects or other complications.

The antiishemic efficiency of course monotherapy with trimethazidine and its impact on myocardial perfusion were studied in patients with postinfarct dysfunction of the left ventricle (LV), which was associated with moderate heart failure (HF). This prospective controlled clinical study included 47 patients who had experienced myocardial infarction. The patients had also angina pectoris on exertion and NYHA Functional Classes (FC) II-III HF. The patients were randomized into 2 groups: Group 1 comprised patients with more than 50-W exercise tolerance (ET), FC II angina, and FC II HF; Group 2 consisted of those with 50-W or less ET, FC II-III angina, and FC II-III HF. Four-week course therapy with trimethazidine in a dose of 60 mg/day was found to exert a pronounced antiischemic effect in patients with reversible LV ischemia associated with HF. The tolerance of the drug during its 4-week course therapy was good and the drug caused no adverse reactions.

: Antianginal efficacy of atenolol (A) and isosorbide dinitrate (ID) was compared in a long-term randomized, single-blind, crossover, placebo controlled trial in 71 patients with combined stable angina pectoris and chronic hypotension (Hpts) and in 38 normotensive patients with angina of effort (Npts). Paired bicycle tests showed anti-ischemic activity of drugs: A in 75% and ID in 49% of Hpts, A in 83% and ID in 82% of Npts. Antianginal effect of 25 mg A was observed in 49% of Hpts (vs 6% of Npts; p < 0.01). Secondary resistance to A effect was developed on the treatment week 2-4 in 13% of Hpts (vs 0 in Npts) tolerance to ID effect--on week 1-2 in 71% of Hpts (vs 15% of Npts; p < 0.01) as evidenced by T1-199 exercise myocardial scintigraphy. Hpts needed individual ID therapy with a long-term ID-free period during 8-16 days (vs 3-5 in Npts; p < 0.05) to avoid tolerance. Stable antianginal ID effect manifested with a decrease of myocardial perfusion defect size by 43.1 +/- 1.3% (p < 0.05).