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Aim: To study effect of trimetazidine on restoration of hibernating myocardium after myocardial revascularization on beating heart., Material: Patients with ischemic heart disease subjected to direct myocardial revascularization on beating heart: 25 patients received trimetazidine (60 mg/day) in pre and postoperative periods and 30 patients did not., Methods: Echocardiography, veloergometry, 6 minute walk test, myocardial scintigraphy with Tl-199., Results: Course (35 days) treatment with trimetazidine provided significant decrease of frequency and severity of episodes of angina, reduction of nitrate consumption, enhancement of tolerance to physical exercise, improvement of myocardial perfusion manifested as significant decrease of mean size of transient perfusion defects., Conclusion: These results demonstrate efficacy and expediency of trimetazidine use in therapy of reversible myocardial dysfunction in patients with ischemic heart disease subjected to direct myocardial revascularization.

Possibilities of secondary prevention of reperfusion syndrome with amlodipine was assessed in 46 patients (39 with class III-IV angina after myocardial infarction and 7 with non ST elevation acute coronary syndrome). Twenty six patients received basic therapy, in 20 patients this therapy was supplemented with amlodipine (5-10 mg/day). In all patients complete direct arterial myocardial revascularization on beating heart was carried out. Methods of dynamic control included echocardiography, paired bicycle exercise tests, 6 minute walk test, myocardial scintigraphy with thallium-199. The results evidence for efficacy and feasibility of secondary prevention of reversible myocardial dysfunction with amlodipine.

Aim: To assess effect of calcium antagonists amlodipine and verapamil on the risk of development of atrial fibrillation after coronary artery bypass surgery., Material: Of 74 patients subjected to mammary artery and venous coronary bypass grafting with the use of cardiopulmonary bypass 19 received amlodipine and 21 - verapamil., Results and Conclusion: Attacks of atrial fibrillation during 24 hour ECG monitoring were registered in 22.9% of patients mostly on days 2 and 3 after surgery. In verapamil treated patients atrial fibrillation occurred 1.5-2 times more often than in amlodipine treated patients or in patients receiving no calcium antagonists. This could possibly be explained by pronounced slowing of atrio-ventricular conduction by verapamil at the background of postoperative general "irritation" of the atrial myocardium.

Aim: To assess efficacy of dihydropyridine calcium antagonists nifedipine and amlodipine for prevention of spasm of internal mammary artery after mammary-coronary bypass grafting., Material and Methods: Eighty eight men (age 56,5-/+7.2 years) subjected to mammary-coronary grafting were randomized to 3 groups. Patients of group 1 (n=35) received nifedipine (10 mg t.i.d.), patients of group 2 (n=30) received amlodipine (5 mg o.d.) and patients of group 3 (n=23) did not receive calcium antagonists. The following parameters were studied: mean linear and volume velocity of blood flow, graft lumen diameter, systolic-diastolic index. Dynamics of flow was assessed during 2 weeks after surgery., Results: In nifedipine treated patients blood flow through grafts to posterior interventricular, anterior interventricular, anterior interventricular and diagonal branches rose by 61.2, 37.4, and 102.9%, respectively. In amlodipine treated patients these figures were 103.4, 113.1 and 147.1%, respectively. Treatment with nifedipine was associated with decrease of graft systolic-diastolic index by 20.2, 20.7, 19.9%, respectively, treatment with amlodipine--by 27.3, 20.6, 32.9%, respectively. Lumen diameter of grafts to posterior interventricular, anterior interventricular, anterior interventricular and diagonal branches in nifedipine treated patients increased by 9.5, 17.6, and 7.7%, respectively, in amlodipine treated patients--by 20, 22.7, and 25.9%, respectively. Moreover amlodipine was better tolerated., Conclusion: The first dose of nifedipine and amlodipine increased diameter of mammary-coronary grafts and blood flow through them. Augmentation of these effects which occurred during further use of nifedipine and amlodipine for 2 weeks was milder and more gradual in amlodipine treated patients.