Objective. Submaximal myocardial hyperemia is known not to be achieved in 16–18% of cases during cardiac stress tests and monotonic intracubital administration of adenosine triphosphate (ATP) at a dose of 140–160 μg/kg/min. The authors set a task to elaborate a new algorithm for stress echocardiography (SEchoCG) with ATP, providing for the possibility of a stepwise increase in the dosage of the drug, as well as to test it in healthy individuals and patients with coronary heart disease (CHD). Material and methods. The authors elaborated a new algorithm for SEchoCG on the basis of an analysis of the main science databases and their first own experience in using ATP during SEchoCG. The key provisions of the new algorithm were: (a) the exercise test consisted of 3 stages (EchoCG data should be recorded before, during, and 5 minutes after ATP infusion); (b) the criterion for achieving submaximal myocardial hyperemia during ATP administration is a systolic blood pressure (SBP) reduction of 5 and more mm Hg; (c) EchoCG was usually recorded at Stage 2 of the test 3 minutes after the start of ATP administration and with a decline in SBP; (d) the initial dose of ATP administration was 140 μg/kg/min; if SBP did not decrease at 3 minutes of the drug administration, the dosage should be first increased up to 175 μg/kg/ min at 1 minute; if there was no effect, the dosage should be increased up to 210 μg/kg/min at another 2–3 minutes. The algorithm was tested in 9 healthy volunteers, and in 26 patients with CHD. Results. Testing the new algorithm showed that all cases achieved submaximal myocardial hyperemia. SBP decreased below 90 mm Hg in 2 patients; 1 patient developed second-degree atrioventricular block; however, a simple decrease in the ATP infusion rate within 30 sec leveled this symptomatology. The SEchoCG data acceptable for the subsequent analysis of myocardial contractility and deformation could be recorded in all the examinees. Conclusion. The new algorithm for SEchoCG with ATP is effective in recording EchoCG findings. To have a final decision on the safety and information value of a new stress test protocol, it may be recommended to further test those in larger groups of patients during SEchoCG and in the use of other imaging procedures to assess myocardial contractility and perfusion.

PURPOSETo: 1) optimize algorithm of stress echocardiography (s-Echo) with intravenous adenosine triphosphate (ATP) infusion taking into account pharmacokinetics and pharmacodynamics of ATP in human body, 2) test new algorithm in patients with coronary and other heart diseases.MATERIALS AND METHODSIn order to determine spectrum of factors influencing the results of stress test with ATP we inspected main scientific data bases and found 48 publications on ATP application for diagnostic purposes. Analysis of these publications allowed us to optimize algorithm of ATP s-Echo. Optimized algorithm was tested on 26 subjects, who underwent ATP 4D strain-stress-echocardiography of the left ventricle.RESULTS AND DISCUSSIONOptimized algorithm has three stages: registration of Echo data sets before, at the time of ATP infusion, and after 5 min of ATP infusion termination. Registration of Echo parameters at the second stage must begin not earlier than 3 min after the onset of ATP infusion and only in the presence of signs of coronary vasodilation. We think that the main indirect criterion of submaximal coronary vasodilation is 5 mm Hg or more decrease in systolic blood pressure (SBP), but not below SBP level of 90 mm Hg. Initial dose of ATP is 140 µg/kg/min. If after 2 min of infusion SBP do not diminish we increase the infusion rate at first to 175 and then to 210 µg/kg/min. While testing new algorithm in all cases we have achieved criteria of effective vasodilation. Mean SBP decrease was 16.4±13.7 mm Hg, heart rate increase - 12.7±8.1 bpm. In all patients we obtained interpretable 4D LV Echo data sets for visual analysis of local contractility and automatic strain analysis.CONCLUSIONOptimization of ATP s-Echo algorithm was performed. Safety and efficacy of optimized algorythm for registration of echo data was demonstrated. New ATP infusion algorithm can also be recommended for testing with other cardiac imaging modalities in evaluation of myocardial perfusion and contractility (SPECT, CT, MRI, PET).

76 patients with coronary artery disease who underwent aortocoronary bypass surgery were examined to study the role of paraoxonase, myeloperoxidase, arginase, asymmetric dimethylarginine and nitric oxide in the mechanisms of the pathogenesis of post-pericardiotomy syndrome (PPCS). Patients were divided into two groups: the 1st - patients with coronary artery disease, who did not have PPCS as a result of clinical studies; the 2nd- patients with ischemic heart disease (IHD who were diagnosed with PPCS. The results showed that the postoperative period after coronary artery bypass grafting is associated with inhibition of paraoxonase, activation of myeloperoxidase, increased activity of arginase, nitrite/nitrate level and asymmetric dimethylarginine, and may be accompanied by the development of endothelial dysfunction and increased systemic inflammatory response. In the present work, inverse correlation relationships between the arylesterase activity of paraoxonase and myeloperoxidase activity in plasma, as well as between the aryl esterase activity of paraoxonase in the blood plasma and the activity of arginase in erythrocytes of the patients of the two studied groups were established. tests were developed on basis of ratio of the enzymes activities to predict the development of post-pericardicotomy syndrome.

To study the role of paraoxonase, myeloperoxidase, arginase, asymmetric dimethylarginine, and nitric oxide in the mechanisms of the pathogenesis of postpericardiotomy syndrome (PPCS), 76 patients with ischemic heart disease (IHD) who underwent coronary artery bypass grafting were examined. Patients were divided into two groups: Group 1, IHD patients who were not diagnosed with PPCS as a result of clinical studies, and Group 2, IHD patients who were diagnosed with PPCS. The results indicate that the postoperative period after coronary artery bypass grafting is associated with the inhibition of paraoxonase, the activation of myeloperoxidase, enhanced arginase activity, increased nitrite/nitrate and asymmetric dimethylarginine levels; it may also be accompanied by the development of endothelial dysfunction and increased systemic inflammatory response. In the present work, inverse correlations were found between the paraoxonase aryl esterase activity and myeloperoxidase activity in plasma, as well as the paraoxonase aryl esterase activity in blood plasma and arginase activity in erythrocytes in patients of both groups. Tests to predict the development of postpericardiotomy syndrome were developed based on the ratio of activity of the studied enzymes.

Purpose: to study the effect of application of intraluminal coronary bypass grafts on the intra- and early postoperative periods in patients with coronary artery disease, who underwent a direct myocardial revascularization under conditions of a parallel cardiopulmonary bypass.Material and methods: the study included patients with multiple lesions of coronary arteries with an ejection fraction 51,2% ± 5,3. The patients were randomised into 2 groups: in the first group (n = 41) the cardiopulmonary bypass operation was accompanied by using intraluminal coronary grafts; in the second group (n = 52) - without this procedure. The superior effectiveness of the graft procedure was assessed by lesser changes in ST-segment of ECG during and after the operation, fluctuations in cardiac index, the value of the plasma fraction of cardiac creatine phosphokinase, and a number of complications during the intra-and postoperative periods.Summary: based on these data it was concluded the advantage of application of intraluminal coronary bypass grafts with direct revascularization in parallel artificial circulation.