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We studied dynamics of content of subpopulation of lymphocytes including regulatory and effector T-lymphocytes as well as concentration of soluble form of interleukine-2 receptor (sCD25) in peripheral blood of patients after coronary stenting (CS) with implantation of stents with rapamycin covering (SRC). We included into the study 62 patients with stable effort II-III functional class angina. Coronary angiography (CA) was carried out in all, CS with implantation of 1 - 2 SRC - in 42 patients. Blood samples were taken before CA/CS, in 24, 48 hours, 7 days, 1 and 3 months after intervention. Content of T-, helper and cytotoxic T-cells, -, NK-, NKT-cells, activated effector T-lymphocytes (CD4+CD251owCD127high) and regulatory T-lymphocytes (CD4+CD25highCD1271ow) were measured by direct immunofluorescence and flow cytometry. CD4+ lymphocytes were isolated from mononuclear cell fraction of donor blood by magnetic separation. Content of regulatory T-lymphocytes in culture were determined by expression of a specific marker FOXP3+. Concentration of sCD25 was measured by chemiluminescent method. It was shown that content of main subpopulations of lymphocytes in blood changed after CS or CF. Blood content of regulatory T-lymphocytes and sCD25 significantly increased after 7 days and 1 month after CS but not after CA. Plasma sCD25 concentration correlated with content of regulatory T-lymphocytes in 1 month after SRC implantation. During cultivation of CD4+ lymphocytes in the presence of rapamycin we noted antiproliferative effect relative to FOXP3-cells and accumulation of regulatory +-lymphocytes. Thus implantation of SRC in coronary arteries leads to increase of number of circulating regulatory T-lymphocytes and blood concentration of sCD25. Changes of these parameters after CS can reflect peculiarities of local and systemic reaction arising in response to introduction of stent with drug covering and be significant for assessment of prognosis of the disease.

Aim of the study was to assess activation of eosinophils as well as allergic and inflammatory reactions of the body in development of restenosis after implantation of stents with drug covering. We included into the study 32 patients with ischemic heart disease (IHD) and stable angina subjected to repeat coronary angiography during first year after endovascular myocardial revascularization with the help of stents with drug covering, and 11 healthy persons. Levels of eosinophilic cation protein (ECP), immunoglobulin E (IgE), and C-reactive protein (CRP) in blood plasma of patients and healthy persons was determined by immunoenzyme assay. According to results of angiographic study patients were divided into 2 groups: the first comprised 19 patients in whom no instent restenosis was found, the second comprised 13 patients in whom formation of restenosis at least in one stent was noted. Patients in these groups did not differ by age, sex, smokers and nonsmokers ratio, presence of hyperlipidemia, and angiographical characteristics of involved arteries. In patients with restenosis of stents blood plasma ECP level was 17.7 (11.2-24.0) g/ml and significantly higher than in patients without restenosis [9.0 (6.4-12.9) g/ml; p=0.017]. Blood level of IgE in these groups of patients did not differ [58.8 (42.1-164.0) and 52.9 (12.8-76.1) mg/ml, respectively; p=0.40] and did not differ from IgE level in blood of healthy volunteers [32.0 (21.2-80.8) mg/ml; p=0.91]. CRP level in patients with IHD was higher than in healthy volunteers [0.36 (0.1-0.75) mg/ml; p=0.0008)], but did not differ significantly in groups of patients with and without restenosis [2.38 (0.30-4.08) and 1.63 (0.61-2.47) mg/ml, respectively; p=0.52]. It was found that in the group of patients with low blood level of ECP (<11 g/ml) restenoses were revealed in 19% while in the group with higher blood level of ECP (>11 g/ml) - in 62% of cases (p=0,019). In patients subjected to coronary stenting with higher level of ECP in blood we noted more frequent development of restenoses than in patients with low level of this protein. The data obtained allow to suggest presence of relationship between development of restenosis and elevated activity of eosinophilic granulocytes in patients with IHD after revascularization.

The article is devoted to results of randomized clinical trails BEAUTIFUL and SHIFT. Position of If-inhibitor ivabradine in current guidelines on management of patients with stable angina and heart failure is discussed.

In this work analysis of results of a prospective populational cohort study "Stress and health in Russia" is presented. We included in the study inhabitants of Moscow randomly sampled from the population of men and women aged > or =55 years. Aim of the present work consisted in the study of relationship of activity of fibrinolysis and main parameters of the system of lipoproteines providing transport of lipids in blood serum and system controlling utilization of glucose by tissues. In dependence on fibrinolytic activity all examined persons were divided into 3 groups: with hypofibrinolysis (group 1, n=41.5%), with normofybrinolysis (group 2, n=41.9%), and hyperfibrinolysis (group 3, n=16.6%). In persons of group 1 low fibrinolytic activity and high level of fibrinogen were combined with atherogenic spectrum of blood serum lipids and elevated level of insulin at normal level of glucose. In patients of group 3 elevated fibrinolytic activity was combined with more favorable composition of blood lipids, lower levels of insulin and glucose and absence of obesity. At study of relation between fibrinoltic activity and a row of clinical states by the method of logistic regression a tendency to elevation of prevalence of myocardial infarction in persons with hypofibrinolysis was found while in persons with hyperfibrinolysis a significant lowering of prevalence of arterial hypertension, ischemic heart disease, and angina pectoris was observed.

Aim: To compare efficacy and safety of cardioselective beta-adrenoblockers nebivolol and metoprolol in patients with hypertension and ischemic heart disease (IHD) combined with type 2 diabetes., Material and Methods: Patients with IHD, class II-III angina and moderately severe compensated or subcompensated type II diabetes (n=35, 29 with grade 1-2 hypertension according to WHO 1999 classification) were divided into 2 groups with similar clinical and laboratory characteristics. Patients of group 1 received metoprolol (50-100 mg/day), of group 2--nebivolol (5-7.5 mg/day) for 8 weeks. Data of physical investigation, exercise tests, 24-hour blood pressure and heart rate monitoring, analysis of lipid spectrum and glycemic profile were used for assessment of treatment efficacy., Results: Decrease of number of anginal attacks and nitroglycerine requirement was more pronounced in nebivolol treated patients. The use of both drugs was associated with lowering of blood pressure and heart rate. There were no unfavorable changes of parameters of carbohydrate and lipid metabolism. Pronounced (by 19.2%) lowering of triglycerides was observed in nebivolol treated patients. Both drugs were well tolerated., Conclusion: Nebivolol and metoprolol are effective and safe antianginal agents in patients with IHD and hypertension combined with type 2 diabetes. However in doses used nebivolol produced more favorable metabolic and hemodynamic effects.

The study was undertaken to examine 20 healthy individuals and 60 IHD patients with stable angina of various functional classes. All the examinees were males. By the random sampling method, all the patients were divided into 2 groups: (1) 30 were on erinit and (2) 30 on erinit and allopurinol in conventional therapeutical doses. The level of uric acid in the serum and daily urine, lipid peroxidation, the antioxidative system and central hemodynamics were examined in all the examinees. The examination was performed on admission and every 10-14 days of their hospital stay. A combined therapy with erinit and allopurinol led to a significant decrease in serum and daily urinary levels of uric acid and lipid peroxidation antioxidative system and an improvement of central hemodynamics. It is concluded that it is useful to include allopurinol into the combined therapy for IHD patients with stable angina.

The sympathetic-adrenal and kallikrein-kinin systems were studied in 225 patients with various coronary heart diseases before and after therapy with lipoic acid (150 mg/day), tocopherol (100 mg/day), anaprilin (40 mg/day), prodectin (750 mg/day) or their combination. Myocardial and adrenal catecholamine levels were measured in experiments on animals exposed to emotional pain stress. Their levels were found to be affected by lipoic acid, tocopherol, obsidan or their combinations in the same doses, taking into account species specificity. Lipoic acid therapy for patients with coronary heart disease decreased epinephrine excretion, enhanced the elimination of vanillylmandelic acid and norepinephrine. Tocopherol lowered daily urinary epinephrine levels and increased the release of vanillylmandelic acid, without changing epinephrine excretion. Emotional pain stress resulted in myocardial epinephrine accumulation and adrenal norepinephrine in the animals. Lipoic acid prevented this accumulation, whereas tocopherol did not possess this effect.

The paper shows the high therapeutical efficiency of combined He-Ne laser therapy in patients with coronary heart disease. Its effect on the thromboxane-prostacyclin system is one of the mechanisms of laser impact. The combined He-Ne laser therapy promotes normalization of the level of thromboxane B2 and its ratio to the metabolite prostacyclin.

The time course of serum levels of malonic dialdehyde and red blood cell activity of antioxidative enzymes, such as superoxide dismutase and glutathione peroxidase, was assessed from the outcomes of hyperbaric oxygenation combined with antianginal therapy in 38 patients with functional classes II-III stable angina on effort without clinical manifestations of circulatory failure. Hyperbaric oxygenation involved 10-12 sessions at 1.5 ata during 40 min each. The antianginal agents (long-acting nitrates, beta-adrenoblockers, nifedipine) were given in median therapeutical doses. The control group included 26 patients who had hyperbaric oxygenation in the same fashion without taking antianginal drugs. The criteria for beneficial therapy were a reduction in the number of anginal episodes and the nitroglycerin tablets used, an increase in exercise tolerance, as evidenced by repeated bicycle ergometric test. The positive clinical effect of a hyperbaric oxygenation course was shown to be accompanied by higher activity of superoxide dismutase in the red blood cells. The use of nifedipine in the multimodality anginal therapy prevents the hyperbaric oxygenation-induced increase in serum malonic dialdehyde levels.

The likely mechanisms responsible for the occurrence of angina pectoris, which were revealed by 24-hour ECG monitoring, were correlated with abnormalities in hemostasis and blood lipid spectrum. Changes in the blood lipid spectrum were demonstrated to play the leading role in the development of angina due to higher myocardial oxygen demand. Those in platelet hemostasis are mostly pronounced in impaired myocardial oxygen supply due to vessel spasm and/or formation of platelet aggregates.

The paper presents the changes found in the lipid spectrum in 48, platelet aggregation in 23 and microcirculation in 35 patients with coronary heart disease after plasmapheresis. In patients with Functional Classes III and IV angina, repeated procedures of plasmapheresis were found to result in a clinical improvement of its course in 92% of the patients and in conversion to a lower functional class of angina in 71%. Massive plasmapheresis performed by the developed methods caused a significant improvement in the lipid spectrum, blood rheology, and microcirculation, which persisted for 1 to 6 months after plasmapheresis in relation to the type of hyperlipoproteinemia.

In 9 patients with stable angina pectoris of effort the authors studied the relation between the effect of verapamil in single and regular administration and concentration of invariable preparation and its primary metabolites in the blood serum. Antiischemic effect of verapamil was assessed with use of repeated identical and individual loads on treadmill in combination with ECG monitoring before and at the end of treatment. Linear correlation was established between the effect and concentration of verapamil in the blood serum under the conditions of single and regular administration. In long-term use of verapamil the authors noted a significant increase in the action of a single dose caused by verapamil cumulation in the blood serum. During long-term treatment by verapamil a marked effect was recorded in significantly more high concentrations of the preparation in the blood as compared to a single administration. The main primary metabolites of verapamil failed to affect on antianginal effect both in single and regular administration.

In 16 patients with unchanged coronary arteries during coronaroangiography, where ischaemic heart disease was suspected, the use of bicycle ergometry and studies of the myocardium metabolism with the atrial stimulation test it was possible to diagnose myocardial ischaemia during the pain attack. It must be noted that atypical forms of angina pectoris are frequent. Patients with unchanged coronaroangiogram must have myocardium metabolism examined during the pain attack in order to exclude finally ischaemic heart disease.

Venous blood acid-soluble fraction was investigated by means of high-efficiency liquid chromatography in patients with myocardial infarction and angina pectoris. Myocardial ischemia is shown to result in marked changes of purine and pyrimidine metabolism. A rise in intermediate and end products of purine metabolism (inosine, hypoxanthine, xanthine, uric acid), and the emergence of thymin and thymidine were demonstrated in venous blood of patients with myocardial infarction and angina pectoris.

A study of the causes of tolerance to antianginal effect of nifedipine++, conducted in 12 patients with angina of effort, examined serum pharmacokinetics of nifedipine++ and its primary metabolite (puridine analogue of nifedipine++), after a single 20 or 30 mg dose and at the end of a treatment course (20-40 mg 3-4 times daily for 2 to 6 months). In addition, the effect of nifedipin treatment on nonspecific microsomal hepatic oxidase activity was assessed by means of the antipyrin test. Pharmacokinetics of both unchanged nifedipin and its primary metabolite showed no change through the nifedipin course, suggesting that tolerance to the antianginal effect of nifedipin may be based on altered systemic pharmacologic response rather than altered pharmacokinetics of nifedipin. Nifedipin treatment caused no induction or inhibition of nonspecific microsomal hepatic oxidase activity in the patients so the drug may be expected to have no substantial effect on pharmacokinetics, and hence, efficacy, of combined drugs that are eliminated by oxidation inside the liver.

Parameters determining and restricting physical aerobic working capacity were examined in 35 patients with angina of effort. Aerobic potentiality in angina of effort is not only measured by power or cardio-respiratory productivity, but also by oxygen economy of energy supply and the fulfilment of aerobic potentials whose parameters are unrelated to one another. It is proposed that anaerobic metabolic parameters be measured in order to choose optimum exercise intensity expanding aerobic potentialities of patients with angina of effort.

Sustak pharmacodynamics was studied in 32 patients with stable angina pectoris of effort during acute tests with dosaged physical exercises repeated a tone-hour intervals. The results were compared with those in placebo. It is shown that the duration and pronounced character of the antianginal sustak effect varies widely in different patients. The maximum effect of the drug in a dose of 6.4 mg was encountered one hour after medication and was characterized by reduced depression of the ST segment by 54% during physical exercise and alleviation of the pain syndrome. The drug caused a statistically significant reduction of arterial pressure, an increase in the pulse rate at rest and a decrease of this value during exercise. The antianginal effect of sustak was particularly manifest in patients with low tolerance of physical exertion and in patients in whom the attack of angina pectoris was attended by marked dyspnea.