Drug and Alcohol Rehabilitation: [Possibilities of Using Levosimendan in Patients With Idiopathic Pulmonary Hypertension].
[Possibilities of using levosimendan in patients with idiopathic pulmonary hypertension].
Filed under: Drug and Alcohol Rehabilitation
Ter Arkh. 2012; 84(9): 83-8
To evaluate the efficiency and safety of intravenous infusion of levosimendan in patients with idiopathic pulmonary hypertension (IPH) and its clinical, hemodynamic, and neurohumoral effects.The study included 9 patients (mean age 31.8 +/- 8.7 years) with Functional Class III and IV IPH and severe right ventricular failure (RVF). Levosimendan was administered as dropwise intravenous infusion. The patients’ general condition, blood pressure, heart rate, and 6-minute walk test results were assessed at baseline and 24 hours after levosimendan infusion, and then following 12 weeks. The time course of changes in blood neurohumoral mediators was determined and transthoracic echocardiography performed.At 24 hours after initiation of levosimendan infusion, there were substantial reductions in pulmonary artery systolic pressure, mean pulmonary artery pressure, mean right atrial pressure, and pulmonary vascular resistance. There was a significant increase in exercise tolerance. The blood exhibited lower norepinephrine and NT-proBNP and higher epinephrine concentrations. At 12 weeks after termination of levosimendan infusion, the improved functional status was preserved in the patients with IPH. There were no noticeable changes in the achieved key hemodynamic parameters. Only one patient needed re-administration of the drug 12 weeks later. The achieved changes in vasoactive mediators were retained 12 weeks following levosimendan infusion. Levosimendan treatment was not followed by clinically relevant adverse reactions requiring infusion termination and therapy discontinuation.24-hour intravenous levosimendan infusion in patents with FC III-IV IPH and severe RVF causes positive changes in the key hemodynamic parameters and neurohumoral status of the patients and promotes stabilization in those with IPH at 12-week follow-up.
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[Radionuclide evaluation of renal function in essential hypertensive patients with chronic kidney disease].
Filed under: Drug and Alcohol Rehabilitation
Ter Arkh. 2012; 84(9): 80-2
To carry out radionuclide evaluation of renal function in patients with arterial hypertension (AH) and chronic kidney disease (CKD).Thirty-one AH patients with CKD were examined using dynamic nephroscintigraphy. A control group consisted of 8 CKD patients without AH.The scintigraphic findings reflected statistically significant differences in renal secretory and excretory functions depending on the level of glomerular filtration rate (GFR) decrease in AH patients with CKD. If GFR was 30-59 ml/min, there was a deceleration in the secretory phase in the histogram; but when it was lower than 30 ml/min, the secretory function tended to accelerate, which appeared as a 3-fold reduction in achieving the peak radio tracer concentration (p < 0.001).Dynamic nephroscintigraphy can detect early renal secretory and excretory dysfunctions and it is of prognostic value in assessing renal dysfunction, which necessitates early drug correction of revealed disorders. HubMed – drug
[Aspects of risk stratification in acute coronary syndrome: prognostic value of evaluation of left ventricular myocardial viability according to the data of pharmacological stress echocardiography].
Filed under: Drug and Alcohol Rehabilitation
Ter Arkh. 2012; 84(9): 22-9
To define the prognostic value of the indicators of left ventricular myocardial viability according to the data of pharmacological stress echocardiography in patients with acute coronary syndrome (ACS).The results of examinations were analyzed in a total of 91 patients with ACS; 71 of them were found to have areas of asynergy (these cases formed the key basis for statistical processing). An analysis of the outcomes registered in the established follow-up period (mean 14.3 +/- 0.7 months) took into consideration death from cardiac diseases, a recurrent acute coronary episode (nonfatal myocardial infarction (MI), unstable angina (UA)).Risk stratification for cardiac events in patients with ACS requires both the assessment of a myocardial viability testing result and the detection of stress-induced ischemia. An analysis of the impact of the indicators of myocardial viability on prognosis in the ACS group showed that the most important predictors of cardiac death were impaired segmental contractility index (ISCI), number of asynergic segments, and total ejection fraction (TEF) at rest; TEF, ISCI, number of segments with a negative response to low-dose drug infusion; TEF, deltaTEF (as compared to the baseline data), and a positive or negative peak stress testing result. The most important predictors of major cardiac events (death MI, UA) were ascertained to be ISCI, number of asynergic segments, resting TEF; TEF, ISCI, number of segments with a negative response to low-dose drug infusion; a positive or negative testing result, TEF, deltaTEF (as compared to the baseline data), and ISCI during the peak stress test.The low myocardial/coronary reserve increases mortality rates; the high one worsens the prognosis of major cardiac events, particularly when the test is positive, which tacitly transfers these patients to a very high risk group.
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