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The polymorphic markers Ala455Val of the THBD gene and Arg353Gln of the F7 gene were tested for association with the frequency of unfavorable outcomes in patients with a history of acute ischemic heart disease. The study involved 1145 patients hospitalized in cardiology clinics of Moscow, St. Petersburg, Kazan, Chelyabinsk, Perm, Stavropol, and Rostov-on-Don because of acute ischemic heart disease. The patients were followed up for up to 62.5 months. None of the markers displayed a significant association with the time to an endpoint. The patients were then grouped by sex. In females, the frequency of unfavorable outcomes (fatal or nonfatal myocardial infarction and fatal or nonfatal stroke) was higher in carriers of allele Val of the Ala344Val polymorphic marker of the THBD gene and carriers of genotype Arg/Arg of the Arg353Gln polymorphic marker of the F7 gene, but the difference was not statistically significant. Such an increase in frequency was not observed in males. To study the combined effect of the polymorphic markers of the THBD and F7 genes, the course of ischemic heart disease was compared for two female subgroups. One included carriers of allele Val of the Ala344Val polymorphic marker of the THBD gene and genotype Arg/Arg of the Arg353Gln polymorphic marker of the F7 gene; the other subgroup included carriers ofgenotype Ala/Ala of the Ala455Val polymorphic marker of the THBD gene and allele Gln of the Arg353Gln polymorphic marker of the F7 gene. The frequency of unfavorable outcomes in the first subgroup was higher than in the second one. The time to an endpoin was 40.5 months (95% confidence interval (CI) 33.5-47.6) in the first subgroup and 51.6 months (95% CI 45.0-58.1) in the second subgroup (chi2 = 4.15, P = 0.042). The results made it possible to assume that the F7 and THBD genes play an important role in genetic predisposition to unfavorable outcomes in patients with a history of acute ischemic heart disease.

Aim: Effects of levosimendan treatment compared to dopamine treatment on a clinical course, central hemodynamics and prognosis in patients with resistant cardiac failure (RCF)., Material and Methods: A total of 30 RCF patients (16 females and 14 males aged 50-80 years) were divided into two groups. Patients of group 1 received inotropic drug levosimendan intravenously in the initial dose 12-24 mcg/kgfor 10 min with subsequent 24-hour infusion in a dose 0.1 mcg/kg/min. Patients of group 2 received dopamine intravenously for 24 hours in a mean dose 2.2 mcg/kg/min. The patients were followed up for 6 months., Results: In group 1 cardiac failure regressed earlier than in group 2. Left ventricular performance index after infusion hour 1 increased from 2.9 to 3.3 (kg.m)/m2, in group 2 it decreased from 2.6 to 2.3 (kg.m)/m2; p = 0.028). To infusion hour 24 this index in group 1 was 3.2 (kg.m)/m2, in group 2--2.6 (kg.m)/m2. Cardiac index (CI) in group 1 increased from 23 l/min/m2 at infusion min 1 to 2.7 l/min/ m2 after 10 min of infusion and 29 l/min/m2 after 24 hours, i.e. there was a 26% rise (p = 0.025). In group 2 the CI rise was insignificant--from 2.4 to 2.5 l/min/m2. To the end of levosimendan injection, systemic vascular resistance fell from 1520.9 to 1174.6 dyne.s.cm(-5) (p = 0.031), in group 2 no significant changes were seen. Hospital mortality in group 1 was 1 patient, in group 2--6 patients., Conclusion: Inotropic treatment in RCF patients with levosimendan vs dopamine produces earlier regress of cardiacfailure symptoms, better improvement of myocardial contractivity, is associated with a good prognosis.

With the aim to assess prevalence of aortic stenosis (AS) and prognostic value of its detection among survivors of acute coronary syndrome (ACS) we examined 851 patients included into multicenter prospective study of risk factors of serious vascular events and death after acute coronary syndrome. The patients were enrolled into the study in stable condition on 10th day after onset of myocardial infarction (MI) or unstable angina (UA). Examination involved medical history, laboratory tests and echocardiography. Afterwards all cases of death and serious vascular events were registered. Severity of AS was specified by maximal aortic flow rate: 1st degree > 2.5, 2nd degree 3.0-4.0, 3rd degree > 4.0 m/s. AS was detected in 16 patients (1.9%). AS severity was 1st, 2nd and 3rd degree in 9, 4 and 3 patients, respectively. Patients with AS were significantly older (77.4 vs. 61.3 years, p < 0.001), more often had history of chronic heart failure (CHF) (81.3 vs. 53.2%, p = 0.021) and lowered renal function (66.7 vs. 34.0%, p < 0.041). At multifactorial analysis independent prognostic value in relation to development of serious events showed age > 75 years (OR 1,395 [1.023-1.902], p = 0.036), history of CHF (1.319 [1.015-1.713], p = 0.038), history of MI (1.692 [1.320-2.170], p < 0.001), left ventricular diastolic dimention (1.023 [1.005-1.041], p = 0.012), left atrial diameter (1.024 [1.001-1.047], p = 0.037) and presence of AS (3.211 [1.742-.,916], p < 0.001). Prevalence of preexisting AS among patients who have had MI/UA is 1.9% what is similar to data of European Heart Survey ACS-II (1.8%). Presence of AS of any severity in a survivor of ACS worsens prognosis independently of other known risk factors.

We investigated the association of gene IL6 G(-174)C polymorphism and gene IL10 G(-1082)A polymorphism with coronary artery disease (CAD) in the Russian population. A total of 1145 patients with CAD diagnose on the basis of clinical studies in cardiological hospitals of Moscow, St -Petersburg, Kazan, Chelyabinsk, Perm, Stavropol and Rostov-on-Don. Supervision term was 9.10 +/- 5.03 months (the maximum term 18 months). In case of gene IL10 G(-1082)A polymorphism we determined that patients with CAD diagnose and A alleles gene IL10 had unfavorable outcome more often than patients with homozygous G alleles. Survival time from end point from carrier genotype GA and AA is 11.68 +/- 0.67 months against 12.69 +/- 0.65 months from carrier phenotype GG gene IL10 (chi2 = 4.13, p = 0.042). The group studied do not differ significantly with respect to the distributions of gene IL6 G(-174)C alleles and genotypes. However in case combined group studies of gene IL10 G(-1082)A polymorphism and IL6 G(-174)C polymorphism we determined that patients with CAD diagnose and carrier genotype GG gene IL6 and genotype GA and AA gene IL10 had unfavorable outcome more often (survival time 11.01 +/- 1.24 months) than patients with genotype CC and CG gene IL6 and genotype GG gene IL10 (survival time 13.28 +/- 0.83 months) chi2 = 10.23, p = 0.017. The obtained data allows assuming the important role of the IL6 and IL10 genes which are responsible for functioning of inflammation system, in the accelerated formation of failures at the patients who had a coronary syndrome.

We investigated the association of polymorphisms of genes FGB G(-455)A and PROCC(-1654)T with coronary artery disease (CAD) in the Russian population. A total of 1145 patients with CAD diagnose on the basis of clinical studies in cardiological hospitals of Moscow, St. Petersburg, Kazan, Chelyabinsk, Perm, Stavropol and Rostov-on-Don. Supervision term was 1.14 +/- +/- 0.33 years (the maximum term 3.2 years). The group studied do not differ significantly with respect to the distributions of G(-455)A alleles and genotypes. However in case of gene PROC C(-1654)T polymorphism we determined that patients with CAD diagnose and Talleles of PROC gene had unfavorable outcome more often than patients with homozygous C alleles. Survival time from end point from carrier phenotype TT and CTis 2.19 +/- 0.18 r. years against 2.46 +/- 0.16 from carrier phenotype CCgene PROC. The obtained data allows to assume the important role of the genes which are responsible for functioning of system of a hemostasis, in the accelerated formation of failures at the patients who had a coronary syndrome.

Aim: To study changes in the level of brain natriuretic peptide (BNP) in patients with ST segment elevation myocardial infarction (MI) to assess prognostic value of this marker and validity of its use as a criterion of therapy effects., Material and Methods: The trial enrolled 217 patients (102 males and 15 females, mean age 63.96 +/- 0.73 years) admitted to hospital on MI day 1. Plasmic level of BNP (Nt-proBNP) was measured 1, 7, 21 days, 8 weeks and 6 months after MI., Results: The severity of chronic cardiac failure (CCF) correlated with peptide content in the blood: it was by 46.6% higher in patients with chronic heart failure (CHF) functional class (FC) IV than in those with CHF FC I (p = 0.047), in FC III by 27.5% higher (p = 0.003) and in FCII--by 13.1% (p = 0.485). Initially high levels of BNP correlated with early development of CHF (R2 = 0.9058), with hospital lethality (in the deceased--1040.0 +/- 65.8 fmol/ml, in the survivors--461.4 +/- 26.2 fmol/ml, r = 0.35, p < 0.001) and overall lethality. A more pronounced decrease in the peptide level was seen in patients after 3 week intake of beta-adrenoblocker esmolol than in those who did not take it (by 125.2 vs 74.1 fmol/ml, respectively, p < 0.05). By BNP level, efficacy of perindopril vs captopris was studied (group 1 and group 2, respectively), in patients with ejection fraction under 40%. Initially, BNP levels were elevated and did not differ among the groups. On MI week 8 there was a decrease in the level of BNP by 25.4% (p = 0.004), 19.1% (p = 0.06) in groups 1 and 2, respectively. Six months after MI patients of group 1 had normal levels of BNP (up to 269.6 +/- 18.3 fmol/l)., Conclusion: Measurements of BNP levels are useful for prediction of poor prognosis in MI patients and evaluating efficacy of the treatment.

Aim: Efficacy and tolerability of carvedilol vs captopril were studied at 24-h monitoring of blood pressure (BP) in hypertensive patients with an uncompletated hypertensive crisis (HC)., Material and Methods: The trial included 43 patients (23 males and 20 females aged 58 +/- 4.1 years) with an uncomplicated HC (duration of hypertension 9.4 +/- 1.1 years). Twenty patients of group 1 received oral carvedilol (25 mg), 23 patients of group 2--oral captopril (25 mg). The criterion of efficacy was a 15-25% decrease of BP within 60-120 min., Results: Attenuation of HC symptoms and tolerability was the same in both groups. Forty five minutes after the drug intake systolic pressure lowered by 11.1% (p = 0.039) and 10.9% (p = 0.042) in group 1 and 2, respectively; diastolic pressure--by 14.9% (p = 0.037) and 17.9% (p = 0.018), respectively. Heart rate diminished significantly only in group 1 (by 10.9%, p = 0.043) 30 min after carvedilol intake. A maximal BP fall in group 1 occurred 180 min after the drug intake: systolic by 23.5% (p = 0.0001), diastolic by 26.9% (p < 0.0001). In group 2 the BP fall was 23.3% (p < 0.0001) and 29.1% (p < 0.0001) on min 165 and 150, respectively. Systolic and diastolic pressures lowered faster in group 1. The effect of carvedilol lasted longer--372.6 +/- 19.3 min and 245.1 +/- 13.7 min, respectively, p = 0. 0001., Conclusion: A hypotensive effect of carvedilol and captopril in hypertensive patients with an uncomplicated HC was the same. Carvedilol produced a longer and a more stable effect.

Patients (n=52) with acute myocardial infarction (MI) and diabetes mellitus type 2 older than 18 years were distributed within first 24 hours of MI into 2 groups. In patients of group 1 (n=28) standard therapy was supplemented with trimetazidine (70 mg/day) for 30 days, patients of group 2 received only standard therapy. The following parameters were assessed: rate of recurrent MIs, inhospital mortality, dynamics of MB CR, rate of development and progression of heart failure, dynamics of brain natriuretic peptide, parameters of echocardiogram. Mortality in group 1 at the background of thrombolytic therapy (TLT) was 5.9% (n=1) what was significantly lower than in group 2 where this parameter was equal to 35.7% (n=5), p=0.006. A tendency was noted to lowering of rate of recurrent MIs (17.6 and 21.4% in groups 1 and 2, respectively). Analogous parameters did not differ significantly between subgroups of patients not treated with TLT. In group 1 significant 31% lowering of MB CK level was noted in TLT treated patients. In group 2 level of MB CK after 27-30 hours significantly increased by 30.16% compared with initial level (p=0.001). At analysis of analogous parameters in subgroups not treated with TLT significant differences were not obtained. There were no significant differences between groups according to echocardiography data, however ejection fraction in group 1 was 12.6% higher than in group 2 (p>0.05).

Forty patients with acute Q-wave myocardial infarction and Killip class I-II heart failure were randomized to treatment with esmolol (n=22) or just to standard therapy (n=18) and followed up for 30 days. Esmolol treated patients had significantly lower in-hospital mortality (p<0.02), less frequently had postinfarction angina (p<0.05) and heart failure progression (p<0.01) and demonstrated significant decrease of brain natriuretic peptide level (by 25%, p<0.05). Incidence of heart rhythm disturbances and values of parameters of echocardiogram were similar in both groups.