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Biomedical subjects

Iu N Belenkov

Publications and source records attributed to Iu N Belenkov.

At least 19 recordsLinked to original sources
PubMed2006

[Comparative analysis of efficacy of endovascular interventions in native vascular bed and grafts in patients with ischemic heart disease after coronary artery bypass surgery].

AIM: Investigation of efficacy of endovascular interventions in native vascular bed and grafts, elucidation of factors, affecting immediate and remote prognosis after endovascular treatment. MATERIAL AND METHODS Coronary stenting was carried out in 212 patients who had previously undergone coronary bypass surgery. Stents were implanted into native vessels and grafts in 116 (native vessels group) and 96 (grafts group) patients, respectively. Frequency of angina recurrence and development of complications were assessed during hospitalization and after 1 year. Coronary angiography was repeated after 1 year in 47 and 36 patients in native vessels and grafts groups, respectively. Multifactorial analysis of predictors of complications and angina recurrence was performed with the use of logistic regression. RESULTS AND CONCLUSION: In grafts group signs of distal embolism were observed in 9 patients (9.4%), shunt thrombosis occurred in 2 of these patients. Risk factors of embolism in grafts group were complicated lesions (type C) and length of stenosis >20 mm. There was 1 non-Q wave myocardial infarction after stenting of native vascular bed (0.8%). Angina recurrence was observed after 1 year in 9 (7.8%) and 26 (27.1%), myocardial infarction developed during 1 year in 2 (1.7%) and 3 (3.1%) patients of native vessels and grafts groups, respectively. Risk factors of recurrence of clinic of ischemic heart disease (IHD) after stenting of grafts were time interval between stenting and bypass surgery >5 years and the use of stents without drug coating. More frequent recurrence of clinic of IHD in patients of grafts group was a consequence of higher level of restenosis in stented segments and more frequent progression of atherosclerosis in previously unaffected segments.

Adult↗
PubMed2006

[Effects of long term therapy with angiotensin converting enzyme inhibitor quinapril, antagonist of receptors to angiotensin II valsartan, and combination of quinapril and valsartan in patients with moderate chronic heart failure. Main results of the SADKO-CHF study].

AIM: To compare effects of therapy with angiotensin converting enzyme inhibitor quinapril (Q), angiotensin II receptor antagonist valsartan (V), and their combination in patients with stable moderate chronic heart failure (CHF). MATERIAL AND METHODS: Patients (n=80) with NYHA class II-III CHF due to ischemic heart disease, dilated cardiomyopathy or decompensated hypertensive heart and ejection fraction <40% were randomized into 3 groups. Patients of group Q, V and Q+V received Q (average dose 13 mg/day, n=28), V (121 mg/day, n=26), and combination of Q and V (12 and 78 mg/day, n=26), respectively. Methods included assessment of clinical state and quality of life, echocardiography, 6 min walk test, Holter ECG monitoring with measurements of parameters of heart rate variability (HRV), and determination of neurohormones in peripheral blood. Examinations and measurements were made at baseline, in 3 and 6 months. RESULTS AND CONCLUSIONS: Six months therapy with Q, V and their combination resulted in improvement of clinical and functional state of patients. More pronounced augmentation of exercise tolerance and lowering of CHF functional class were observed in group Q. Combined use of Q and V had no significant advantages over monotherapy with Q and V when effect on parameters of left ventricular remodeling were concerned. Therapy with Q was associated with "escape" of blockade of aldosterone synthesis and "reactivation" of angiotensin II formation after 6 months. The use of V and combination of V+Q allowed to achieve more stable but incomplete control of aldosterone activity. The use of Q appears to be the preferential regimen to influence activity of sympathoadrenal system and parameters of 24 hour HRV compared with V and Q+V. Long term therapy with V does not improve main parameters of 24 hour HRV.

Adult↗
PubMed2006

[Pilot experience in Russia with external contrapulsation in patients with coronary heart disease].

AIM: To examine effects of programmed external contrapulsation (ECP) on the clinico-functional status, quality of life (QOL) in patients with coronary heart disease (CHD), stable angina of FC II-IV resistant to medication. MATERIAL AND METHODS: Eighteen patients with CHD, stable angina of FC III-IV (2 females and 16 males, mean age 63.6 +/- 7.4 years) have completed a course of ECP including 35 one-hour procedures 5-6 times a week for 7 weeks. Ten patients had cardiac failure (NYHA FC II-III). Before and after ECP course the patients were examined using QOL assessment by Minnesota questionnaire, complex echo-cardiography, bicycle exercise test, perfusion myocardial scintigraphy with 99m-Tc-4,2-methoxy-isobutilisonitril, 24-h Holter ECG monitoring, enzyme immunoassay for plasma natriuretic propeptides. RESULTS: Significant subjective QOL improvement (p < 0.01) was noticed by all the patients. Anginal attacks and nitrates doses reduced at least 2-fold. Exercise tolerance rose significantly (p < 0.01), bicycle exercise test was positive in 5 patients, the rest stopped the test after achievement of submaximal heart rate (HR) and fatigue. Most of the patients exhibited improvement of myocardial perfusion. Patients with abnormal myocardial contractility showed a moderate trend (p < 0.03) to an increase in left ventricular ejection fraction. By 24-h ECG, mean HR diminished significantly (p < 0.02). CONCLUSION: ECP is highly effective and safe in combined therapy of CHD, stable angina resistant to drug therapy, in impossibility of myocardial revascularization, including patients with cardiac failure. This manifests in a significant abatement of angina, lower doses of nitrates, improvement of exercise tolerance, quality of life, myocardial perfusion and hemodynamic indices.

Coronary Angiography↗
PubMed2006

[Is triple combination of different neurohormonal modulators recommended for treatment of mild-to-moderate congestive heart failure patients? (Results of SADKO-CHF study). Part 2].

AIM: To assess different variants of neurohormonal (NH) modulation with angiotensin converting enzyme (ACE-I) quinapril (Q), angiotensin-receptor blocker (ARB) valsartan (V) and their combination in addition to beta-adrenergic blocker bisoprolol (B) on functional status, quality of life (QL), parameters of left ventricular (LP) remodeling, main indices of 24-h heart rate variability (HRV) and NH profile in patients with stable mild-to-moderate CHF. MATERIAL AND METHODS: 63 patients with CHF (NYHA class II-III) as a result of ischemic heart disease and dilated cardiomyopathy with LV EF < 40% were randomly assigned to one of the treatment variants on 1:1:1 basis: B+Q (n = 22; mean daily dose of B-5.5 mg; Q-15.4 mg), B+V (n = 23; mean daily dose of B = 4.8 mg; V = 128 mg) and combination of B+Q+V (n = 18; mean daily dose of B = 4.1 mg; Q = 12 mg; V = 82 mg). At baseline, all the patients in this study were on background B treatment and according to the study design Q or V were then added to B at randomization. NYHA FC, 6-min walking test (6MT), QL, 2D-echocardiography, plasma rennin activity (PRA), angiotensin II (AT-II), aldosterone (Ald), norepinephrine (NE), epinephrine (E), brain natriuretic peptide (BNP) concentrations and 24-hour HRV parameters were investigated at baseline, 3 and 6 months after randomization. RESULTS: During the study NYHA FC improvement was revealed in all 3 treatment groups with comparative significant changes in 6MT distance by 20.4%, 19.1% and 19.4% in B+Q, B+V and B+Q+V groups. QL maximally decreased in B+V combination (from 45 to 21 points). LV volumes significantly decreased and LV ejection fraction (EF) increased in all groups to the end of the study. Triple combination had no additional effect on LV volumes and LVEF changes compared to B+Q and B+V groups. Maximally plasma NE concentrations decreased in B+Q group (from 650 to 430 pg/ml, p = 0.007). A worse effect was observed in the combination of B+Q+V, with any NE changes in B+V group. The E concentration increased significantly (from 215 to 295 pg/ml, p = 0.024) in the B+Q+V group at the end of the study. Plasma A-H concentration did not differ from the baseline during the study in B+Q group, but significantly increased in B+V group and maximally in B+Q+V group (from 11.4 to 23.5 pg/ml, p = 0.009). To the end of the study plasma Ald concentrations remain reduced significantly only in B+V group. The level of BNP significantly decreased in all 3 treatment groups. Significant changes in HRV indices, both in time and frequency domain, were revealed in the B+Q group at 3-month follow-up and SDNN increased on month 24 (p = 0.039). These changes became insignificant at the end of the study. The lesser effect was revealed in B+Q+V group, with insignificant trend toward an increase of SDNN to the end of the study. HRV indices did not improve in the B+V group. CONCLUSION: During long-term treatment the triple combination of B+Q+V has no significant advantages over B+Q and B+V by the functional status, QL and parameters of LV remodeling in patients with mild-to-moderate CHF. The combination of B+Q has more potent effect on 24-hour HRV parameters, sympatho-adrenal activity and renal function compared to B+V and B+Q+V groups in CHF patients in our study. The combination B+Q+V may have a negative effect on NH profile (excessive activation of ATII and E) in CHF patients. The triple combination is not recommended for therapy of stable mild-to-moderate CHF patients.

Adrenergic beta-Antagonists↗
PubMed2006

[Is triple combination of different neurohormonal modulators recommended for treatment of mild-to-moderate congestive heart failure patients? (Results of Sadko-CHF study)].

AIM: To assess effects of different variants of neurohormonal (NH) modulation with angiotensin converting enzyme (ACE-I) quinapril (Q), angiotensin-receptor blocker (ARB) valsartan (V) and their combination in addition to beta-adrenergic blocker bisoprolol (B) on functional status, quality of life (QOL), parameters of left ventricular (LV) remodeling, main indices of 24-h heart rate variability (HRV) and NH profile in patients with stable mild-to-moderate congestive heart failure (CHF). MATERIAL AND METHODS: Sixty three patients with CHF (NYHA class II-III) as a result of ischemic heart disease and dilated cardiomyopathy with LV EF < 40% were randomly assigned to one of the treatment variants on 1:1:1 basis: B+Q (n = 22), B+V (n = 23) and combination of B+Q + V (n = 18). At baseline, all the patients in this study were on background B treatment and according to the study design Q or V were then added to B at randomization. NYHA FC, 6-min walking test (6MT), QOL, 2D-echocardiography, plasma renin activity (PRA), angiotensin II (AT-II), aldosterone (Ald), norepinephrine (NE), epinephrine (E), brain natriuretic peptide (BNP) concentrations and 24-hour HRV parameters were investigated at baseline, 3 and 6 months after randomization. RESULTS: During the study NYHA FC improvement was revealed in all three treatment groups with comparative significant changes in 6MT distance by 20.4%, 19.1% and 19.4% in B+Q, B+V and B+Q+V groups, respectively. QOL maximally decreased in B+V combination (from 45 to 21 points). LV volumes significantly decreased and LV ejection fraction (EF) increased in all groups to the end of the study. Triple combination had no additional effect on LV volumes and LVEF changes compared to B+Q and B+V groups. Plasma NE concentrations decreased maximally in B+Q group (from 650 to 430 pg/ml, p = 0.007). The lesser effect was observed in the combination of B+Q+V, with any NE changes in B+ V group. The E concentration increased significantly (from 215 to 295 pg/ml, p = 0.024) in the B+Q+V group at the end of the study. Plasma A-II concentration did not differ from the baseline during the study in B+Q group, but significantly increased in B+V group and maximally in B+Q+V group (from 11.4 to 23.5 pg/ml, p = 0.009). To the end of the study plasma Ald concentrations remain reduced significantly only in B+V group. The level of BNP significantly decreased in all 3 treatment groups. Significant changes in HRV indices, both in time and frequency domain, were revealed in the B+Q group at 3-month follow-up and SDNN increased on month 24 (p = 0.039). These changes became insignificant at the end of the study. The lesser effect was revealed in B+Q+V group, with insignificant trend toward an increase of SDNN to the end of the study. HRV indices did not improve in the B+V group. CONCLUSION: During long-term treatment the triple combination of B+Q+ V has no significant advantages over B+Q and B+V by the functional status, QOL and parameters of LV remodeling in patients with mild-to-moderate CHF. The combination of B+Q has more potent effect on 24-hour HRV parameters, sympatho-adrenal activity and renal function compared to B+V and B+Q+V groups in CHF patients in our study. The combination B+Q+V may have a negative effect on NH profile (excessive activation of ATII and E) in CHF patients. The triple combination is not recommended for therapy of stable mild-to-moderate CHF patients.

Adrenergic beta-Antagonists↗
PubMed2005

[Long-term results of the use of TAIS coronary stent. Data of prospective follow-up for 18 months].

The stent was placed in 528 coronary artery segments (39% complicated lesions) in 448 patients with coronary artery disease and no previous invasive interventions. Immediate angiographic success was 99.8% with no case of acute thrombosis. Six months survival without restenosis, angina, and reintervention was 83%. Repeat angiography was carried out in 432 patients with 502 stented stenoses. Index of vessel diameter loss and level of restenosis were 0.32+/-0.26, and 15,6%, respectively. Fifty four patients with in-stent restenosis were subjected to successful repeat revascularization. Eighteen months survival without myocardial infarction and reintervention was 70%. The study demonstrated favorable effect of TAIS on 18 month rate of thrombosis and restenosis in patients with native atherosclerotic lesions.

Adult↗
PubMed2005

[Combined therapy with quinapril, an ACE inhibitor, and valsartan, a type 1 angiotensin II receptors blocker, for moderate chronic cardiac failure may raise the degree of neurohormonal block and improve 24-h heart rate variability compared to the effect of monotherapy (data from the trial SADKO-CHF)].

AIM: To compare effects of various regimens of long-term monotherapy with quinapril (an ACE inhibitor) and valsartan (a type 1 angiotensin II receptors blocker) and combined therapy with these drugs on the activity of heurohormonal systems and 24-h heart rate variability (HRV) in patients with stable moderate chronic cardiac failure (CCF). MATERIAL AND METHODS: A total of 80 patients with FC II-III CCF secondary to coronary heart disease (CHD), delated cardiomyopathy (DCMP) and decompensated hypertensive heart (49%/47%/4%) were randomized into 3 groups. Group 1 patients (n = 28) received quinapril, group 2 (n = 26)--valsartan, group 3 (n = 26)--quinapril + valsartan. The levels of norepinephrine (NE), angiotensin II (AT II), activity of plasmic renin (PR), aldosteron (AS), plasmic cerebral sodiumuretic peptide (CSUP) were measured and ECG with determination of HRV and heart rate disturbances was made before and 3, 6 months after the treatment. RESULTS: NE concentration lowered most significantly in group 1 (from 630 to 405 pg/ml) vs groups 2 and 3 (from 525 to 490 pg/ml and from 525 to 480 pg/ml, respectively). A 6-month treatment induced significant changes neither in concentrations of AT II nor AC. ATII concentrations rose 2-fold in group III (from 11.9 to 24.3 pg/ml) under a parallel rise of PR activity from 0.7 to 2.5 ng/ml/h and a fall in AS level from 132 to 83 pg/ml. In group 2 AS diminished also (from 165 to 126 pg/ml). CSUP decreased in all the groups, but significantly only in groups II and III (from 350 to 237 and 322 to 204 pg/ml after 6 months of treatment, respectively). Significant changes of 24-h HRV (both spectral and temporary) were observed in group 1 after 3 months of treatment. These changes lost significance to the end of the treatment. In groups 2 and 3 the changes were less pronounced. CONCLUSION: Quinapril is more potent than valsartan and quinapril + valsartan combination in relation to activity of sympathico-adrenal system and HRV in patients with moderate stable CCF. Long-term therapy with valsartan does not improve parameters of HRV in moderate CCF. If CCF patients take quinapril for a long time, they develop the effect of disappearing block of AS synthesis and reactivation of A TII production. The best mechanism of long-term control over the activity of renin-angiotensin-aldosteron system in patients with moderate CCF is combination of quinapril with valsartan.

Adult↗
PubMed2005

[Two-year results after implantation of a metallic stent EPHESOS in patients with coronary heart disease].

AIM: To evaluate two-year results of using a metallic stent EPHESOS in patients with native atherosclerotic lesion of coronary arteries (without prior interventions). MATERIAL AND METHODS: The stent was implanted to 731 patients. 53% had manifestations of unstable angina. 42% of the lesions were complicated. The length of the stenosis was 15.5 +/- 6.8 mm, 44% stenoses were long. RESULTS: The success of stenting was 99.6%. Cases of acute and subacute thrombosis were absent. Non-Q wave myocardial infarction in primary hospitalization developed in 4 patients. For 6 months, cardiovascular complications (death, angina, restenosis, repeated revascularization) occurred in 21%. Angiographic control follow-up of 6 months maximum covered 329 (45%) patients. Hemodynamically significant restenosis was detected in 18% patients. Cardiovascular complications for 24 months occurred in 39%. CONCLUSION: The EPHESOS stent has demonstrated a stable long-term effect on prevention of thrombosis and restenosis in the majority of patients with a relatively high risk of intervention.

Coronary Disease↗
PubMed2005

[Possibility of coronary angiography without hospitalization].

Coronary angiography is the necessary investigation in the diagnostic complex of patients with ischemic heart disease (IHD). The use of trans-radial access makes it possible to do the angiography without hospitalization. The algorithm of coronary angiography in day-time clinic was proposed. Non-hospital angiography in 15 patients was successful. It is the first time this method has been used in this country.

Ambulatory Care↗
PubMed2004

[Antioxidants in complex therapy of atherosclerosis: pro et contra].

The review contains current insights into the role of free radical processes in formation of oxidative stress in atherosclerosis and its relevance to therapy and prevention. Data of epidemiological studies evidence for existence of correlations between blood plasma content of antioxidant vitamins and presence of signs of atherosclerosis. However mostly positive data on the use of antioxidants in various animal experimental models of atherosclerosis contrast with equivocal results of therapeutic application of antioxidant vitamins in humans. Possible causes for this controversy have been choice of suboptimal combinations of components, extremely high concentrations of consumed substances, lack of biochemical testing of baseline antioxidant status and its changes in the process of therapy. The authors of the review suggest novel approaches to planning of clinical trials of antioxidant vitamins.

Animals↗
PubMed2004

[Results of nonmedical interventions in multicenter randomized open study of efficacy of lifestyle modification and therapy with quinapril in patients with obesity and hypertension].

There is a pathogenetic interrelationship between obesity and hypertension. Moreover it has become evident that the use of most modern and active antihypertensive drugs can not be effective without concomitant treatment of obesity. This study was conducted in 18 cities of Russian Federation in order to demonstrate influences of lifestyle changes on hypertension and levels of cardiovascular risk factors. The objective was to attract attention of physicians and patients to the problem of obesity and hypertension and to their inherent dangers.

Antihypertensive Agents↗
PubMed2004

[First experience with "live" three-dimensional echocardiography in Russia].

Revival of interest to three-dimensional echocardiography during recent years was invoked by introduction of essentially novel ultrasound technology of "live" three-dimensional imaging. We introduce here the first experience of the use of < > three-dimensional echocardiography in Russia comprising examination of 74 patients with various pathology of the heart. Positions and sections are described allowing best visualization of pathology of cardiac valves and other intracardiac structures. Our experience shows that at present < > three-dimensional echocardiography should be considered to be an important supplement to standard echocardiography. However in some < > cases it can be the only non-invasive technique able to provide complete information on the size of ventricular and atrial septal defects, valvular and other cardiac pathology.

Echocardiography↗
PubMed2004

[First results of stenting of bifurcation stenoses of the coronary arteries].

AIM: To study effectiveness of various types of coronary stenting in bifurcation stenoses. MATERIAL AND METHODS: Fifty six patients with bifurcation stenoses were divided into 2 groups: stenting of the basic and side branch of the coronary artery (CA) was made in group 1 patients (n = 27), stenting of the basic branch and balloon angioplasty of the side branch were made in group 2 (n = 29). Primary clinical and angiographic response reached 96 and 90% in groups 1 and 2, respectively. Complications were absent in group 1, occurred in 13.7% cases in group 2 (the difference was insignificant). One year after the procedure lethal outcomes were absent. The number of unfavourable clinical outcomes was higher in group 1 (25.9 and 13.7%, respectively, p = 0.4). The rate of restenoses detected angiographically was not significantly different in group 1 and 2 (33 and 26%, respectively). CONCLUSION: Stenting of bifurcation stenoses brings about good short-term and satisfactory long-term results in most of the patients. The rate of the complications was low. Two stents implantation (in basic and side branches) has no significant advantages over stenting of the basic CA and balloon angioplasty of its side branch.

Angioplasty, Balloon, Coronary↗