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Ischemic heart disease and acute myocardial infarction (AMI) in particular remain widely spread and contribute seriously in total mortality of population. This literature review is devoted to the right ventricular (RV) AMI as the least studied problem of contemporary cardiology. We present here description of specific characteristics of blood supply to ventricles of the heart, clinical picture, diagnostic criteria and prognosis of RV infarction. We also present current strategy of management of patients with RV AMI including early revascularization with the help of percutaneous coronary intervention.

Aim of the study was assessment of prognostic value of exercise myocardial perfusion scintigraphy in patients with stable and unstable angina in whom revascularization by percutaneous coronary intervention (PCI) was incomplete and at least one chronic total coronary artery occlusion (CTO) remained after PCI. Between March 2002 and December 2007 569 consecutive patients with multivessel lesions were subjected to SPECT imaging of myocardial perfusion after incomplete revascularization of the myocardium by PCI. At least 1 residual CTO was found in 129 patients (79% men, mean age 64+/-8 years). Primary outcomes were defined as cardiac death or myocardial infarction. Secondary outcomes were registered in 10 (7.9%) and 15 (11.9%) patients, respectively, with moderate and large transitory disturbances of perfusion. Logarithimic range criterion was statistically significant in patients distributed to groups by total estimation of rest in relation to cardiac complications. Univariate and multivariate Cox proportional hazards regression analysis gave additional important information for prediction of severe and nonsignificant cardiac complications when scintigraphic data were added to angiographic and clinical data, left ventricular ejection fraction, and results of treadmill test. Early monitoring with the use of myocardial scintigraphy by SPECT method is associated with increasing prognostic value relative to severe cardiac complications in patients subjected to incomplete revascularization by PCI, and having at least one residual chronic total occlusion.

Aim of this multicenter retrospective study was assessment of effect of intracoronary administration of tirofiban loading dose in troponin positive patients with acute coronary syndrome (ACS). We analyzed multicenter data base of patients subjected to percutaneous coronary interventions (PCI) because of ST-elevation or non-ST elevation ACS from October 2010 to October 2011. Patients who received loading doses of aspirin (300 mg) and clopidogrel (600 mg) before PCI and tirofiban (10 mg/kg bolus with subsequent infusion 0.15 mg/kg/min for 24 h) were selected for the study (n=133, 89 with intravenous and 44 - intracoronary administration of tirofiban loading dose). We assessed hospital mortality, myocardial reinfarctions (reMI), necessity of target vessel revascularization (TVR) and pronounced bleedings. There were no significant differences in mortality, reMI, and TVR between two groups. However major adverse cardiac events was significantly less in patients who received intracoronary tirofiban (6.8 vs. 21.3% in i.v. group; p=0.046). Hospital stay was significantly shorter in intracoronary compared with i.v. group (3.84+/-0.96 vs. 4.55+/-1.11 days; p=0.001). Rates of bleedings did not differ significantly between groups. Thus compared with i.v. intracoronary administration of tirofiban loading dose allows lower rate of major adverse cardiac events as well as to shorten length of hospital stay of patients with ACS.

Percutaneous coronary interventions (PCI) for chronic total occlusions (CTO) remain one of most difficult parts of interventional cardiology. Introduction of novel devices and methods of recanalization of CTO have facilitated fulfillment of these interventions and increased number of successful procedures. Howere a number of cases it is impossible to position a balloon in the site of occlusion even after its successful crossing with a guidewere. Penetration catheter Tornus was specifically created for such cases. It allows to form a channel in CTO for subsequent dilation and stent implantation. We present a review of available clinical studies assessing efficacy of the use of Tornus catheter during PCI for CTO, as well as results of its comparison with efficacy of rotational atherectomy. Authors of these studies concluded that Tornus catheter was highly effective in cases when it was not possible to pass a catheter for changing usual "RotaWire" guide with the aim of conducting rotational atherectomy, or in cases of impossibility to pass a balloon along a guidewere for predilation of the occlusion site. At the same time the use of penetration catheter had no advantages over rotational atherectomy.

We consider in this review traditional and novel approaches to drug prevention of pulmonary embolism (PE) which in predominant number of cases is related to deep vein thrombosis of lower extremities. Risk of PE development is especially high in patients after orthopedic hip or knee surgery. Modern recommendations contemplate use of unfractionated and low molecular weight heparins, vitamin K antagonists (warfarin in the first place), fondaparinux. Oral direct anticoagulants related to selective inhibitors of blood coagulation factors IIa (thrombin) and Xa have appeared recently and proved their preventive efficacy and safety in randomized controlled studies. Preventive efficacy and safety of dabigatran among direct selective factor IIa (thrombin) inhibitors and of rivaroxaban, apixaban, and edoxaban among direct selective factor IIa inhibitors have been studied best.

Effect on left ventricular (LV) contractility of percutaneous coronary interventions (PCI) with implantation of bare-metal stents in patients with chronic total occlusions (CTO) of coronary arteries (CA) has not been completely studied. Aim of this study was to assess effect of PCI with implantation of bare-metal stents ("L+", Relisys, U) on LV ejection fraction (EF) and to investigate clinical and angiographical factors capable to affect restoration of LVEF.We included in this study 154 patients after successful implantation of bare-metal stents in CTO of main epicardial CA. For assessment of LV function we performed echocardiographical examination before and in 6 months after PCI.Significant increase of LV EF (from 50.4 +/- 10.7 to 56.1+/-11.3%, p0.0001), decreases of LV end diastolic (from 86.2+/-17.9 to 80,8+/-18,1 ml/m2, p0.001) and end systolic (from 41.4+/-14.9 t 34.7+/-13.8 ml/m2 (p0,001) volumes took place after implantation of stents. Multivariate analysis showed that initial LVEF50%, duration of occlusion2 months and absence of diabetes mellitus were independent predictors of improvement of LVEF.Implantation of bare-metal stents in patients with CTO CA affects positively LVEF during first 6 months after PCI especially in patients with lowered LVEF, in patients without diabetes mellitus, and duration of occlusion less or equal 2 months.

The review is devoted to different aspects of pulmonary arterial hypertension (PAH); new classification of PAH is published in 2010. There are idiopathic PAH and PAH associated with other diseases. Current guidelines recommend to treat PAH only after the verification of diagnosis with right heart catheterization and acute tests with vasodilators. Patients-reactors should be treated with calcium antagonists. The following drugs related to one of three categories should be used in PAH: (1) prostanoids (epoprostenol, iloprost et al.); (2) blockers of endothelin receptors (bosentan, ambrisentan, sitaxsentan); (3) phosphodiesterase 5 type inhibitors (sildenafil, tadalafil et al.) In majority of cases the combined treatment is used, usually the combination of bosentan and sildenafil is used.

In a series of articles the authors consider clinical pharmacology and experience of clinical application of blockers of platelet P2Y12 receptors, most well known representatives of which ticlopidine and clopidogrel according to chemical structure belong to thienopyridine derivatives. In the fifth communication we consider data of two randomized studies in which efficacy and safety of clopidogrel in combination with acetylsalicylic acid (ASA) has been assessed in comparison with ASA in stable patients with atherothrombotic cardiovascular disease. It has been shown in both studies that in stable patients with atherothrombotic cardiovascular disease long-term therapy with combination of clopidogrel and ASA was no more effective than monotherapy with ASA or clopidogrel but was associated with high risk of hemorrhagic complications. Thus contrary to acute coronary syndromes and percutaneous interventions with stenting combinations of clopidogrel and ASA is not indicated to patients with stable course cardiovascular diseases.

Percutaneous coronary interventions (PCI) on chronic total occlusions have been always associated with worse immediate results compared with interventions on nonoccluded arteries. From initial stage of development of interventional cardiology up to present time intervention on chronic occlusions has remained one of most technically sophisticated procedures. This is related to difficulties which arise during passage of chronic occlusions with guide wires and balloons. Therefore large proportion of patients with occlusions of coronary arteries were directly sent to coronary bypass surgery. However in recent decade interventional cardiologists have created special wires and other tools for penetration of chronic occlusions. At the same time technique of revascularization of this type of coronary lesions has also improved. All this resulted in increased success rate of interventions. Moreover a number of trials have proven clinical advantages of revascularization of chronic coronary artery occlusions what serves as an extra stimulus for implementation of PCI. In this review we present results of clinical studies which might be of interest both for interventionalists and noninvasive cardiologists.

In a series of articles the authors consider clinical pharmacology and experience of clinical application of blockers of platelet P2Y12 receptors, most well known representatives of which ticlopidine and clopidogrel according to chemical structure belong to thienopyridine derivatives. In the forth communication we consider data of randomized studies in which efficacy and safety of clopidogrel in combination with has acetylsalicylic acid (ASA) been assessed in comparison with (ASA) in various acute coronary syndromes (ACS), as well as before, during, and after percutaneous coronary interventions (PCI). In ACS it is recommended to start therapy with clopidogrel with 300 mg loading dose with subsequent transition to maintenance dose 75 mg/day. Preliminary therapy with clopidogrel (in combination with ASA) before emergent or elective PCI significantly decreases risk of development of unfavorable clinical outcomes. In PCI loading dose of clopidogrel is 300-600 mg while duration of maintenance therapy (75 mg/day) depends on the type of used coronary stent. After implantation of bare stent duration of therapy with clopidogrel should be not less than 1 month (ideally no less that 12 months) and after implantation of drug-eluting stent - not less than 12 months.

In a series of articles the authors consider clinical pharmacology and experience of clinical application of blockers of platelet P2Y12 receptors, most well known representatives of which ticlopidine and clopidogrel according to chemical structure belong to thienopyridine derivatives. In the third communication we consider data of randomized studies in which efficacy and safety of clopidogrel monotherapy has been assessed in comparison with acetylsalicylic acid (ASA), ticlopidine, warfarin, as well as ASA in combination with extended release form of dipyridamole in various cardio-vascular diseases. Results of these studies indicate that efficacy of monotherapy with clopidogrel is comparable with that of ASA, ticlopidine, warfarin, and ASA in combination with extended release form of dipyridamole. Clopidogrel significantly more rarely causes ulcerogenic and other hemorrhagic complications than ticlopidine, but is substantially more expensive. Therefore prescribing of clopidogrel as monotherapy is justified only in those cases when ASA and ticlopidine are contraindicated or induce pronounced side effects.

Relatively little time has passed since elaboration and introduction of coronary angioplasty however interventional cardiology in these years has made a swift leap in its development. Initially coronary interventions were carried out only on isolated proximal stenoses but later interventions became to be performed on more complex lesions of coronary arteries and then on multivessel disease intruding into area which previously had belonged exclusively to coronary bypass surgery. Although both methods of revascularization rapidly developed the researchers were interested in assessment and comparison of results of two strategies. Thus studies appeared in which patients were randomized for coronary bypass surgery or percutaneous coronary angioplasty. Below we present data of the largest and most interesting studies in which these strategies of revascularization in patients with multivessel involvement have been compared. We also separately consider results of revascularization in a subgroup of patients with diabetes mellitus.

In a series of articles the authors consider clinical pharmacology and experience of clinical application of blockers of platelet P2Y12 receptors, most well known representatives of which ticlopidine and clopidogrel according to chemical structure belong to thienopyridine derivatives. In the second communication we describe in detail clinical pharmacokinetics and pharmacodynamics of the most often used thienopyridine derivative - clopidogrel. We discuss results of randomized studies and clinical observations which have shown that pharmacokinetics of clopidogrel might vary substantially in dependence of polymorphisms of genes responsible for synthesis of P2Y12 receptors of platelets or cytochromic isoenzymes P-450 CYP of liver with participation of which formation of active metabolite of clopidogrel occurs. Contrary to practically healthy people in patients with various forms of ischemic heart disease (IHD) concomitant therapy, for instance some statins and calcium antagonists, can affect clopidogrel pharmacokinetics. Pharmacodynamics of clopidogrel in patients with IHD with acute coronary syndrome or diabetes mellitus or before percutaneous coronary interventions (PCI) also differs from that in healthy people, because in these patients hyperaggregation of platelets takes place initially and antiaggregatory action of clopidogrel is less expressed. In 10-30% of patients with IHD partial or complete resistance to antiaggregation action of clopidogrel is detected, which according to some observations is combined with elevated risk of thrombotic cardiac complications after PCI. Possible causes of resistance to clopidogrel and ways of its overcoming are discussed.

Aim of investigation was to study complications during 3 years follow up of patients after implantation of standard metal stents (SMS) in unprotected left main coronary artery (LMCA). Patients with high risk of surgery (n=124) with stenting of unprotected LMCA performed between August 2002 and November 2004 were included in this investigation. Study end points were death, myocardial infarction, repeat vessel revascularization. Success of intervention was achieved in 96.7% of cases. Mean duration of follow up was 38.1 +/- 1.8 months. Death due to cardiac causes was registered in 6.5% of cases, 3 of these deaths were sudden. Noncardiac mortality was 3.2% (4 patients died). Peripheral complications were noted in 1 case: in one patient pseudoaneurism of femoral artery developed and was successfully resolved by compression under ultrasound control. Restenosis in stented segment during follow up was noted in 25 patients (20.2%). Repeat percutaneous coronary intervention (PCI) was carried out in 18 patients. In other cases patients were referred to coronary bypass surgery. Total survival of patients in the investigation was 95.2, 91.9, 90.3% in 1, 2, an 3 years, respectively. Despite high success of PCI of unprotected LMCA with the use of SMS and relatively low percent of restenosis it is necessary to use this method carefully in the treatment of patients with lesions in unprotected LMCA. We consider PCI in unprotected LMCA justified only in patients with high risk of surgical intervention who are not suitable candidates for coronary bypass surgery.

It has been noted in recommendations of the European Society of Hypertension (ESH) and of the European Society of Cardiology (2007) that there are no data on effects of antihypertensive therapy on risk of development of cardiovascular complications in patients older than 80 years. In the recently completed study HYVET on 3845 patients aged80 years (mean age 83 years) with arterial pressure (AP)160 mm Hg as criterion of inclusion, and target AP below 150/80 mm Hg at the background of 1.5 mg of indapamide retard with or without addition of 2-4 mg of perindopril, 30% lowering of risk of development of fatal and nonfatal stroke (95% confidence interval [CI] -1 to 51, p=0.06), 21% lowering of risk of all-cause death (95%CI 4 to 35, p=0.02), 23% lowering o f risk of cardiovascular death (95%CI -1 to 40, p=0.06), and 64% lowering of risk of development of heart failure (95%CI 42 to 78, p0.001) were observed. Thus lowering of elevated AP in persons older than 80 years leads to substantial decrease of total mortality, rate of development of fatal stroke and heart failure, improvement of prognosis of life.

P wave dispersion (PWD) has been accepted as a predictor for atrial fibrillation (AF) in hypertension and some other cardiac diseases. The aim of this study was to compare the P wave parameters between patients with mild-moderate hypertension and those with hypertensive crises.A total of 48 patients, 24 of who presented to the emergency department with hypertensive urgency and 24 patients who were followed in the cardiology clinic with mild-moderate essential hypertension were included in this study. P wave durations were measured manually by two investigators blinded to data of patients.The maximal duration of P wave (P max) and the PWD were found to be significantly different between groups, being longer in patients with hypertensive urgency (p=0,05 and 0,02; respectively).PWD increases in hypertensive urgency states. Clinical implication of this finding should be addressed with further, prospective studies conducted on larger samples.

P-wave dispersion has been shown to be a noninvasive electrocardiographic predictor for development of atrial fibrillation . Thus it may be possible to attenuate atrial fibrillation risk through normalization of P-wave variables and improvement in P-wave dispersion may be an important goal in treatment of hypertension.To compare the effects of nebivolol, a new b-blocker that have additional vasodilating activity via acting on endothelium and nitric oxide release, and atenolol on P-wave duration and dispersion in patients with mild-to-moderate hypertension.A total of 34 newly-diagnosed hypertensive patients were enrolled in the study. The patients were randomly assigned to receive treatment with either nebivolol (5 mg) or atenolol (50 mg). P-wave durations (Pmin and Pmax) and P-wave dispersion were measured before and one month after treatment.While Pmin increased (50,6 +/- 11,2 ms to 54,7 +/- 9,1 ms, p=0,05), Pmax decreased (111,9 +/- 9,1 ms to 104,0 +/- 12,4 ms, p=0,003) and P-wave dispersion decreased (62,5 +/- 10,6 ms to 51,3 +/- 8,9 ms, p0,001) with nebivolol, Pmin increased (44,4 +/- 9,8 ms to 58,0 +/- 15,5 ms, p=0,02), Pmax didn t change (106,1 +/- 13,8 ms to 107,0 +/- 11,6 ms, p=NS) and P-wave dispersion decreased (61,7 +/- 15,0 ms to 49,0 +/- 13,7 ms, p0.001) with atenolol. However, there was no statistical difference between pre- and post-treatment values of two groups.Both nebivolol and atenolol are effective in improvement of P-wave dispersion in patients with hypertension and there s no significant difference between them.

In recent years interventions in cardiology became routine procedure in many clinics. This could not to affect frequency of complications. From the very beginning of development of interventional cardiology specialists have been showing great interest to monitoring of complications and to possibilities of lowering of their rate. Data of several studies which consider complications at various stages of development of interventional cardiology are given in this review. It also covers studies in which analysis of cardiac as well as local complications after different types of procedures - percutaneous coronary interventions, catherization of chambers of the heart, valvuloplasties - was carried out.

Peripheral complications related to diagnostic and curative catheterizations remain to be serious problem in invasive cardiology. As annual number of interventional procedures only increases questions of tactics and treatment of peripheral vascular complications appear extremely actual. In recent decades clear tendency in treatment of complications by less invasive methods is noted. In the second part of the review contemporary methods of nonsurgical correction of iatrogenic injuries of vessels, situations in which those methods are most effective are described, and data on long term results are given.

Andreas Gruentzig executed the first successful percutaneous transluminal coronary angioplasty (PTCA) in 1977. Percutaneous coronary interventions (PCI) have considerably changed since this time. The changes have touched the technical equipment for PCI, the pharmacological and mechanical support of PTCA also. The serious revision was in recommendations for PCI too. New catheter technologies have allowed to perform successful PCI in patients with an acute myocardial infarction, with multivessel coronary disease and in many others. PCI became the most often method of a coronary revascularization for ischemic heart disease in the nineties. Percutaneous interventions pass ahead of coronary artery bypass graft operations in many countries of Europe and America. The coronary angioplasty is carried out more than in 2 million patients in the world annually, and 1 million patients is exposed to the PCI annually in the USA. Coronary stenting became most frequently used technology of PCI from the middle of the nineties. The implantation of drug-eluting stents has been the dominating catheter-based method in world clinical practice during last three years. Nevertheless, both these technologies are not deprived of restrictions and disadvantages. The coronary restenosis has become the main limitation for standard (bare-metal) stents, and late thrombosis has become the most terrible complication for the drug-eluting stents. The big success of a method and huge increase of quantity of coronary interventions would be impossible without sequence of openings, innovations and other important events which are surveyed in this review.

Peculiarities of clinical pharmacology of new generation loop diuretic torasemide and its possible place in the treatment of arterial hypertension, chronic heart failure (CHF) and liver cirrhosis are considered. Main advantage of torasemide over loop diuretics of furosemide and bumetamide type is that in addiction to powerful diuretic and natriuretic actions it produces potassium sparing effect that is explainded by ability its of to tosasimide to block aldosterone receptors in renal tubules. Moreover torasemide exerts longer action than furosemide and bumetamide what allows to take it once a day. In low doses torasemide produces pronounced antihypertensive effect without augmentation of excretion of potassium and water with urine. Because of this it can be used as antihypertensive drug for monotherapy or in combination with other drugs. Contrary to thiazide and loop diuretics prescription of subdiuretic doses of torasemide usually does not require control of potassium content in the blood or addition of potassium preparations. In higher doses (10 mg/day or more) torasemide acts as typical loop diuretic and can be used in the treatment of CHF and liver cirrhosis with ascites. Due to potassium sparing action it more rarely than furosemide and bumetamide causes hypokalemia. Comparative studies have shown than in CHF torasemide exerts more favorable effect on clinical signs of disease and functional status of patients than furosemide. Total mortality, cardiovascular mortality and requirements in hospitalization of patients receiving torasemide is substantially less than of patients receiving furosemide.

Bicycle exercise tests were carried out in 2 weeks -- 9 months after successful stent implantation in 1463 patients. Result of exercise test was positive in 472 and negative -- in 991 patients. At control angiography which was performed within 1 week after exercise test binary in-stent restenosis50% was found in 326 of 1463 patients. Sensitivity, specificity, predictive value of positive and negative results of exercise test for the presence of restenosis were 85, 83, 59 and 5%, respectively.

Results of prospective trials of effects of various antihypertensive drugs on left ventricular hypertrophy in patients with hypertensive disease are reviewed. According to 2 meta-analyses angiotensin converting enzyme inhibitors are most effective inducers of regression of left ventricular hypertrophy. However in comparative randomized trials in patients with hypertension ability of diuretics, lipophilic beta-adrenoblockers, long-acting calcium antagonists, and angiotensin receptor blockers to cause regression of left ventricular hypertrophy was not inferior to that of angiotensin converting enzyme inhibitors.

This part of review is based on results of prospective studies of prognostic value of left ventricular hypertrophy defined by electro- or echocardiographical criteria. Increased risk of cardiovascular complications has been found to be associated with left ventricular hypertrophy detected not only by voltage ECG criteria but also by ST-segment and T-wave changes in left precordial leads. Left ventricular myocardial mass is an independent factor of prognosis too. Prognostic significance of left ventricular hypertrophy depends on echocardiographical criteria used and on age, sex, race of patients and presence of coronary heart disease. Unfavorable prognostic significance of left ventricular hypertrophy becomes evident after several years of follow-up. Concentric left ventricular remodeling is also associated with increased risk of cardiovascular complications, however its value for prognosis is inferior to that of left ventricular hypertrophy.

Possibilities of electrocardiography, echocardiography and magnetic resonance tomography for diagnosis of left ventricular hypertrophy are reviewed and various criteria of left ventricular hypertrophy compared. Literature data concerning prevalence of left ventricular hypertrophy in different populations are presented and dependence of reported prevalences of left ventricular hypertrophy on diagnostic technique and criteria is demonstrated. Criteria of dynamic changes of left ventricular mass are also discussed.

In-stent restenosis is mainly caused by neointima proliferation and represents a pathological process which histology is different from that of restenosis after balloon angioplasty. Frequency of in-stent restenoses increases parallel with progressively increasing number of procedures of coronary stenting. The review summarizes results of research devoted to restenosis pathology and pathogenesis including animal studies, presents methods of mechanical treatment of in-stent restenoses (balloon inflation, direct and rotational atherectomy), as well as techniques of beta and gamma irradiation aimed at prevention of restenosis development.

ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult are summarized in detail. According to statements of these Guidelines most patients with chronic heart failure as a rule should receive combination of representatives of 4 different drug classes - diuretic, angiotensin converting enzyme inhibitor, beta-adrenoblocker and usually digoxin. Special indications have been formulated for inclusion in complex therapy of aldosterone receptor blockers (first of all spironolactone), angiotensin1 receptor blockers and direct vasodilators (hydralazine, isosorbide dinitrate).

An analysis of data of contrast ventriculography before and after volume load tests in 19 males suffering of chronic alcoholism with disorders of intraventricular conduction revealed signs of alcohol involvement of the heart with signs of "latent" insufficiency of the right and left ventricles manifested in an increased rate of circular shortening of myocardial fibers, terminal diastolic and terminal systolic volumes, terminal diastolic pressure.

A combined study of patients with second- or third-stage chronic alcoholism, prone to drinking bouts or regular alcohol consumption, was carried out to evaluate the clinical course of an early stage of alcoholic heart damage (AHD). The AHD patients with second- or third-stage chronic alcoholism and periodic alcohol consumption typically exhibited recurrent chest pains, heart rhythm disorders, signs of heart failure after an alcoholic bout, and those given to regular drinking had somato-vegetative complaints.

Coronaroventriculographic data are presented for 32 patients with alcoholic heart damage (AHD). Volumetric load (400-450 ml polyglucin administration) was used to detect preclinical heart failure. Coronarography demonstrated atherosclerotic coronary arterial lesions in 7 of 32 patients. A comparative assessment of central hemodynamic and right-ventricular myocardial contractility parameters in the patients and control subjects showed that the ejection fraction was reduced in AHD patients because of a significant increment of end diastolic and end systolic volumes as well as significantly reduced right-ventricular stroke index. Repeated ventriculography after volumetric stress showed significantly increased volumes and reduced ejection fraction that were indicative of latent right-ventricular heart failure.

The authors presented the results of right contrast ventriculography with a volumetric exercise test in patients with alcoholic heart affection. An increase in right ventricular end-systolic and diastolic volumes (most of the former), a decrease in the ejection fraction in response to an increase in the right ventricular end-diastolic pressure were noted during the test. A diffuse decrease in right ventricular regional (segmental) contractility in the absence of zones of akinesia or local contractility disorder was also revealed.

Distribution of I, III, IV and V-type collagen, fibronectin, vimentin, filamin, and desmin in myocardial biopsy specimens of 8 patients with alcoholic cardiomyopathy was studied by indirect immunofluorescence. It is found that all types of collagen and fibronectin participate in formation of diffuse cardiosclerosis while small cardiosclerosis is formed by interstitial types of collagen and to a lower extent of fibronectin. Filamin and desmin distribution in cardiomyocytes proves deformation and destruction of Z-lines and intercalated discs.

Sixty chronic alcoholic patients, aged 35.6 +/- 0.7 years and an average alcoholic history of 9.3 +/- 0.5 years were examined. Atrial fibrillation was detected at 24 h ECG monitoring in 2 (3.45%) patients, and paroxysms of atrial fibrillation or flutter were detected by intracardiac electrophysiologic investigation in 6 (22.2%). Fourteen (44.8%) patients with alcoholic heart damage demonstrated atrial vulnerability, indicative of a predisposition to atrial fibrillation even at earlier stages of alcoholic heart damage.

Forty patients aged 33 to 66 years suffering from chronic alcoholism, stages II-III, were examined. All the patients were subjected to contrast ventriculography before and after exercise test to identify the latent forms of heart failure. According to the coronarography findings, 9 out of the 40 patients demonstrated the signs of atherosclerotic injury to the coronary arteries. The data of endomyocardial biopsy of the left ventricle have shown morphologic changes characteristic of alcohol-induced heart injury, namely atrophy of cardiomyocytes, fat deposition in the interstitium, lysis of myofibrils, appearance of large vacuoles in cardiomyocytes, and mitochondriosis.

33 patients with alcoholic heart damage (AHD) were studied. The diagnosis was based on clinical symptoms of chronic alcoholism, roentgenocontrast coronaroangiography and ventriculography (in some cases with endomyocardial biopsy), echocardiography, bicycle exercise test and on exclusion of other cardiovascular diseases. In all the patients intracardiac electrophysiological study was performed. Younger persons systematically abusing alcohol and having no pronounced clinical picture of cardiovascular damage exhibited symptoms of functional conduction disturbances located mainly in ventricular conduction pathways and AV-node and more rarely in the sinus node and His-Purkinje's system. AHD in younger persons could have 2 different clinical courses. 1) with prevailing damage in conductive structures; 2) with prevailing damage of contractile myocardium.