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Biomedical subjects

D V Preobrazhenskiĭ

Publications and source records attributed to D V Preobrazhenskiĭ.

At least 19 recordsLinked to original sources
PubMed2006

[Restenosis after bare-metal stents implantation in small coronary arteries.].

Potential of bare uncoated metal stents in prevention of restenosis in coronary arteries with diameter of 2.2-3.0 mm in comparison with balloon angioplasty (BA) was studied in 426 patients with ischemic heart disease (mean age 58+/-11 years, 16% women, 8% with diabetes, total cholesterol 211+/-44 mg/dl, all received aspirin and clopidogrel). BA was carried out in 214 patients (mean artery diameter 2.45+/-0.25 mm) and coronary stenting (CS) - in 212 patients (mean artery diameter 2.43+/-0.27 mm). Immediate success rate was 85.5 and 96.2% in BA and CS groups, respectively (p<0.001). When complementary methods of revascularization were taken into account success rate of the whole intervention was 100% in both groups. Inhospital cardiovascular complications developed in 3.7 and 2.8% of patients in BA and CS groups, respectively (p=ns). During 6 months of follow-up rates of target vessel restenosis and repeat percutaneous interventions were 24.3 and 15.6% (p=0.034) while total rate of complications related to target vessel was 36.9 and 26.9% in BA and CS groups, respectively (p=0.035). Thus CS compared with BA in patients with low risk of restenosis development in small coronary arteria provides better immediate, inhospital and remote results.

Angioplasty, Balloon, Coronary↗
PubMed2006

[Pulmonary hypertension and right ventricular failure. Part I. Classification, anatomy, patophysiology.].

In a series of articles authors discuss the literature data concerning epidemiology of pulmonary hypertension, its modern classification, peculiarities of pathogenesis and treatment in various diseases. In first communication they examine questions of terminology and classification of pulmonary hypertension and also discuss peculiarities of anatomy, physiology and pathophysiology of pulmonary circulation and right ventricle of the heart.

Heart Failure↗
PubMed2006

[Pulmonary hypertension and right ventricular failure. Part III. Patients with congenital heart disease].

In a series of articles the authors discuss literature data concerning epidemiology of pulmonary hypertension, its modern classification, peculiarities of its pathogenesis and treatment in various diseases and conditions. In the third lecture they consider peculiarities of pathogenesis of pulmonary hypertension and right ventricular failure in patients with congenital heart defects, and present literature data on drug treatment and other curative interventions in pulmonary hypertension in patients with Eisenmenger syndrome.

Heart Defects, Congenital↗
PubMed2006

[Contemporary approaches to the treatment of chronic heart failure in adults (after materials of recommendations of American College of Cardiology and American Heart Association, 2005)].

Detailed and critical analysis of a novel version of the "Updated Guideline for the Diagnosis and Management of Chronic Heart Failure (CHF) in the Adult" prepared by experts of American College of Cardiology and American Heart Association is given. The novel version contains somewhat modified recommendations on the management of patients with CHF. In particular this relates to the place of various classes of drugs in the treatment of CHF due to systolic left ventricular dysfunction. For the first time recommendations on the treatment of patients with CHF and normal left ventricular ejection fraction are presented in detail. Among statements of the updated guideline the following are considered controversial or deserving special discussion. Perindopril is mentioned among recommended ACE inhibitors despite the fact that it has never been studied in long term trials. Results of SENIORS trial are ignored and nebivolol is not included in the number of beta-blockers with proven efficacy. Despite multiple proofs of beneficial effects of aldosterone receptor blockers on clinical course of CHF wide use of spironolactone and eplerenone is not recommended because of multiple communications about life threatening hyperkalemia. Inherent dangers of digoxin therapy are disregarded and the use of cardiac glycosides in patients with sinus rhythm is not prohibited.

Aged↗
PubMed2006

[Antiatherogenic effects of angiotensin converting enzyme inhibitors from positions (point of view) of evidence based medicine. Part I].

In a series of two articles the authors present data from controlled trials in which cardio-, cerebro-, and vasoprotective effects of angiotensin converting enzyme inhibitors (ACEI) were assessed. The first communication deals with results of randomized studies in most of which no objective proof of antiischemic (antianginal) effects of ACEI was obtained. In seven placebo controlled studies effects of ACEI were evaluated by means of quantitative angiography (or intravascular ultrasound) and in none of them favorable effect of long-term therapy with ACEI on progression of coronary atherosclerosis and restenosis rate after balloon coronary angioplasty was revealed. Retardation of progression of carotid artery atherosclerosis under influence of ACEI was noted in 2 of 4 trials. But diagnostic value of noninvasive methods which were used in these trials is considerably lower than that of angiography or intravascular ultrasound.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2006

[Pulmonary hypertension and right ventricular failure. Part II. Patients with left ventricular involvement].

In a series of articles the authors discuss literature data concerning epidemiology of pulmonary hypertension, modern classification; peculiarities of its pathogenesis and treatment in various diseases and conditions. In the second part they consider peculiarities of pathogenesis of pulmonary hypertension and right ventricular failure in patients with predominant involvement of left cardiac chambers. Effects of various classes of drugs used in the treatment of left ventricular heart failure including their influence on pulmonary circulation and functional state of the right ventricle are also discussed.

Comorbidity↗
PubMed2006

[Pulmonary hypertension and right ventricular failure. Part IV. Chronic lung disease].

In a series of articles the authors discuss literature data concerning epidemiology of pulmonary hypertension, its modern classification; peculiarities of its pathogenesis and treatment in various diseases and conditions. In the forth lecture they present literature data on prevalence of chronic cor pulmonale among patients with congestive heart failure and its value for prognosis. The authors consider peculiarities of pathogenesis of pulmonary hypertension in patients with chronic obstructive pulmonary disease (COPD) and interstitial lung diseases. Attention is paid to the fact that chronic cor pulmonale develops mainly in bronchitic type of COPD and rarely is met in patients with emphysematous type of COPD. Pathogenetic mechanisms of right ventricular failure in COPD and the role of interaction of hemodynamic, renal, and neuro-humoral factors in pathogenesis of edematous syndrome in patients with chronic cor pulmonal are presented. The article also contains discussion of possibilities and limitations of clinical and instrumental diagnostics of pulmonary hypertension and right ventricular failure in patients with COPD.

Disease Progression↗
PubMed2006

[Angiotensin converting enzyme inhibitors in acute period of myocardial infarction: the place of zofenopril].

Acute myocardial infarction (MI) is one of main predecessors of chronic heart failure (CHF), for the treatment of which angiotensin converting enzyme inhibitors (ACEI) are recommended at present. It seems logical to prescribe ACEI in early period of MI in order to prevent development of CHF in postinfarction period. For assessment of benefit and risk related to prescription of ACEI early after onset of acute MI multiple placebo controlled trials have been carried out. Data obtained in these trials evidence for inexpediency of wide use of ACEI in acute period of MI. Several categories of patients with acute MI with stable hemodynamics have been established in whom benefit of early prescription of ACEI noticeably outweighs possible risk. Those are patients with clinical manifestations of CHF or echocardiographical signs of systolic left ventricular dysfunction as well as patients with high risk of development of CHF in postinfarction period. The latter group comprises patients with transmural MI of the anterior left ventricular wall in whom thrombolytic therapy either have not been carried out or have been ineffective, patients with diabetes mellitus or hypertension in anamnesis. In all other cases prescription of ACEI in early period of acute MI might be dangerous because hypotension induced by them can worsen blood flow and aggravate ischemic injury of the myocardium and increase dimensions of MI.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2006

[Pulmonary hypertension and right ventricular failure. Part V. Therapy in the patients with chronic obstructive pulmonary disease].

In a series of articles the authors discuss literature data concerning epidemiology of pulmonary hypertension, its modern classification; peculiarities of its pathogenesis and treatment in various diseases and conditions. In the fifth lecture they present literature data on nondrug interventions and drug therapy of patients with chronic obstructive pulmonary disease (COPD), complicated with development of chronic cor pulmonale. Contemporary views of the role of oxygen therapy and bronchodilators of various type in treatment of COPD are discussed in detail. Beneficial effect of dihydropyridine calcium antagonists on pulmonary circulation in patients with COPD, possibilities and limitations of their long term use in treatment of pulmonary arterial hypertension including that in patients with COPD are considered. The authors also consider in detail beneficial and harmful properties of drugs, which may be used in treatment of patients with COPD, in particular of digoxin, diuretics, spironolactone, angiotensin converting enzyme inhibitors. Discussion of indications to phlebotomy in patients with COPD and chronic cor pulmonale is presented as well.

Antihypertensive Agents↗
PubMed2006

[Torasemide--new generation loop diuretic: clinical pharmacology and therapeutic application].

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.

Heart Failure↗
PubMed2005

[Stroke and other thromboembolic complications of atrial fibrillation. Part VI. Choice of optimal approach and drugs for prevention of stroke].

In part VI of a series of papers on epidemiology and drug prevention of stroke and other thromboembolic complications of atrial fibrillation the authors analyze data of randomized trials comparing various approaches to the treatment of atrial fibrillation: cardioversion with subsequent use of antiarrhythmic drugs for maintenance of sinus rhythm and control of rate of ventricular rhythm with obligatory concomitant use of anticoagulants. Approach aimed at sinus rhythm maintenance by means of repetitive cardioversions and long term antiarrhythmic therapy has not been associated with lowering of mortality, rates of stroke or other thromboembolic complications. The use of antithrombotic drugs represent a sole reliable method of stroke prevention in patients with persistent and chronic AF. The paper contains consideration of indications for prescription of warfarin and aspirin to these patients.

Anti-Arrhythmia Agents↗
PubMed2005

[Atrial fibrillation: choice of the method of pharmacological cardioversion].

The paper considers circumstances under which it is expedient or not expedient to perform cardioversion in patients with paroxysmal or persistent atrial fibrillation. It contains discussion of benefits, limitations and drawbacks of electrical and pharmacological methods of cardioversion. American College of Cardiology/American Heart Association/European Society of Cardiology Guidelines for the Management of Patients With Atrial Fibrillation are presented. These guidelines suggest amiodarone, dofetilide, ibutilide, propafenone, flecainide, and quinidine as first line therapy because of their proven efficacy. Efficacy of intravenous disopyramide and procainamide in some patients with recent onset atrial fibrillation is recognized with certain reservations. The use of azimilide and dronedarone is considered promising. In Russia nibentan and ethacizine can be also used. Special emphasis is made on the possibility of wide use (including self-administration) of loading doses of oral propafenone for cardioversion in some categories of patients with atrial fibrillation of recent onset.

Anti-Arrhythmia Agents↗
PubMed2005

[The place of cardiac glycosides in the treatment of chronic heart failure].

In a series of papers the authors analyze literature data on the use of cardiac glycosides for long term treatment of chronic heart failure. Part 1 is devoted to clinical pharmacology of glycosides with special emphasis on digoxin. In low doses digoxin produces no substantial effect on contractility of left ventricular myocardium but can cause worsening of its diastolic function. Favorable action of digoxin on clinical course and outcomes of chronic heart failure is most probably related to modulation of neuro-humoral systems. Data on factors influencing sensitivity to glycosides in various categories of patients with heart failure, their interaction with other drugs, and contraindications for digoxin are also presented.

Cardiac Glycosides↗
PubMed2005

[The place of cardiac glycosides in the treatment of chronic heart failure. Part III. The DIG trial].

In a series of papers the authors analyze literature data on the use of cardiac glycosides for long term treatment of chronic heart failure. Data obtained in prospective placebo controlled trial DIG show that digoxin significantly increases mortality of all patients with sinus rhythm and intact left ventricular systolic function (ejection fraction > 45%) and of women with left ventricular systolic dysfunction (ejection fraction < or = 45%). Men with left ventricular systolic dysfunction represent the only category of patients with chronic heart failure in sinus rhythm in whom long term administration of digoxin is justified. Digoxin does not affect mortality of these patients however it reduces requirements in hospitalizations due to worsening of heart failure.

Cardiac Glycosides↗