The purpose of this study was to present results of special examination and prospective observation of patients with coronary artery disease (CAD) and angina pectoris (AP) in practical cardiology. Except standard cardiological methods, we used high-resolution rhythmocardiography and apparatus-program complex for registration and analysis of the heart rate variability. There was an evaluation of the autonomic and humoral-metabolic regulative influences on pacemaker activity of the heart sinus node in 273 patients selected by criteria of including-excluding patients with CAD and AP. It was determined by high-resolution HRV-analysis that ischemic heart disease is accompanied by the sinus node autonomic and humoral disregulation. Angina pectoris was correlated to HRV-stabilization on the rhythmocardiogram during ischemic episodes. Duration and frequency of these HRV-stabilization episodes permit to describe different peculiarities of the angina pectoris in every case, to predict the complication, for example, acute coronary syndrome, to define risk of lethal outcome, to study autonomic efficacy of the same drug (nitroglycerin). Prospective observations of patients with CAD permitted to create ischemic cascade in HRV-symptoms. The following conclusion can be made. High-resolution HRV analysis is an informative and perspective method in the diagnosis and management of CAD and AP. Recent patents have also disclosed methods and apparatus to reduce heart rate variability and assessment of cardiovascular risks.
Aim. To study the effect of nitroglycerin on the heart rate and its variability in patients with stable angina pectoris class 1 and 2. Methods. 85 men with stable angina pectoris class 1 and 2 pathologies were examined between 2007 and 2012 in the City Clinical Hospital No. 8 of Chelyabinsk (mean age 53.15.66 years). In addition to common methods, a rhythmocardiographic study was performed, which allows you to calculate heart rate variability. An electrocardiogram was recorded simultaneously with the rhythmocardiogram. Results. After sublingual nitroglycerin, the number of ventricular extrasystoles decreased in the background test and during Valsalva maneuver, increased in the Ashner's test and an exercise stress tests and did not change in the orthostatic test. An increase in supraventricular extrasystoles after nitroglycerin administration occurred in 10.6% of patients. Nitroglycerin administration resulted in a decrease in the inter-systolic intervals, an increased in the proportion of slow low-frequency waves statistically significant in the background and an exercise stress test. Spectral indicators of cardiac sympathetic modulation significantly increased in the Ashners test and decreased in the background test, while spectral indicators of cardiac parasympathetic modulation decreased in all samples except in exercise stress tests. Conclusion. Under the influence of nitroglycerin, supraventricular arrhythmias increased in all vegetative tests except for orthostatic, the number/severity of ventricular extrasystoles ambiguously changed: decreased in Valsalva manoeuvre the background test, did not change in orthostatic and increased in Aschner's and an exercise stress tests; after nitroglycerin, the proportions of sympathetic influence (in Ashner's test) and slow low-frequency waves in the spectrum of the vegetative modulation increased with a decrease in parasympathetic.
The 2019 coronavirus disease (COVID-19) pandemic has had an unprecedented impact on health and economies around the world. Direct myocardial injury and cytokine storm, leading to destabilization of preexisting plaques and accelerated formation of new plaques, are two mechanisms that trigger the acute coronary syndrome in COVID-19. There is insufficient data on the immune status of patients with acute coronary syndrome who have undergone COVID-19. The aim of the study was to study T and B cell, humoral immunity depending on the number of cytotoxic T lymphocytes (CD8+) in patients with acute coronary syndrome who underwent COVID-19. Materials and methods of research: 65 men with unstable angina pectoris and acute myocardial infarction (acute coronary syndrome) from 40 to 65 years old, who had previously had COVID-19, were examined. A study of peripheral blood was carried out: complete blood count (Medonic device, Sweden), general and specific IgM, IgG, IgA, compliment fragments (Vector Best, Russia). Subpopulations of T and B lymphocytes were determined by flow cytometry. In persons with acute coronary syndrome who underwent COVID-19 with predominantly normal and elevated levels of cytotoxic T cells, a more severe course of the disease was observed: patients with acute myocardial infarction prevailed, they had longer mortality, longer treatment duration, and stent thrombosis was more common. In patients with elevated cytotoxic T cells, there was a maximum increase in erythrocytes, hemoglobin, hematocrit, lymphocytes of both the total number and subpopulations – T helpers, T-NK lymphocytes, NK lymphocytes, T lymphocytes of early and late activation, B1 and B2 lymphocytes, index of NBT-induced test. In patients with normal levels of NK cells, compared with other groups, there was an increase in spontaneous NBT activity and index, a significant decrease in C3a and C5a complement fragments. Prevalence of stent thrombosis and mortality in the group of patients with normal levels of cytotoxic T cells may indicate torpidity of the immune system in these patients with poor outcomes.
The capillary electrokinetics method (measurements of streaming potential and current in origi nal and hydrophobized fused quartz capillaries with radii of 5-7 μm) is employed to study the formation of adsorption layers upon contact with solutions containing a cationic polyelectrolyte, poly(diallyldimethylam monium chloride). It is shown that polyelectrolyte adsorption causes the charge reversal of both hydrophilic and hydrophobic surfaces, with a smaller amount of the substance being adsorbed on the hydrophobic than on the hydrophilic surface. The adsorption on both surfaces increases with the polymer solution concentra tion. The cationic polyelectrolyte adsorption on the pure quartz surface occurs mainly due to the electrostatic attraction, while, in the case of the hydrophobic surface, the contribution of hydrophobic interactions increases. The study of the layer deformability shows that, on the hydrophilic surfaces, the layer ages and its structure depends on the polymer solution concentration. On the modified surface, the deformation of even freshly formed layers is slight, which suggests that a denser layer is formed on the hydrophobic surface. In con trast to the hydrophilic surface, the polyelectrolyte is partly desorbed from the hydrophobic surface.
We examined 23 patients aged 40 to 65 years (mean age 54.526.72) with a diagnosis of acute coronary syndrome (ACS) at admission, who underwent emergency or delayed coronary stenting a day later. All patients had arterial hypertension as a concomitant disease. Upon additional examination, blood troponin levels were determined, ECG was performed in the time dynamics. Acute myocardial infarction with ST elevation was diagnosed in 7 patients, infarction without ST elevation, in 6 patients, the unstable angina rest, in the rest of this group (Grace risk from 75 to 150 points, on average, 107.727.16 points). To assess the immune status, especially, lymphocyte populations and subsets we used standardized techniques, i.e., flow cytometric assays with Navios cytofluorimeter (Beckman Coulter, USA). The following subpopulations were determined: CD45+ (panleukocyte marker for gating lymphocytes), CD45+, CD3+ (T cells), CD45+, CD3+, CD4+ (helper inducers), CD45+, CD3+, CD8+ (cytotoxic T cells), CD45+, CD3+CD16+, CD56+ (TNK cells) CD45+, CD3-, CD16+, CD56+ (natural killer cells), CD45+, CD3-, CD19+CD5+ (B cells), CD45+, CD3+, CD4+, CD25+ (activated helpers, early activation phase), CD45+, CD3+, HLA-DR (activated T lymphocytes late activation phase). The data obtained indicate that the relative indices of T helper subpopulations, T cells at early and late activation step, and B lymphocytes were increased in the patients with acute coronary syndrome, compared with control group. At the same time, there is a trend for increasing absolute values of these indexes. The subpopulation of TNK lymphocytes proved to be significantly increased both in relative and absolute values, whereas percentages of CD45+CD3+CD19- (p 0.01) and T cytotoxic lymphocytes (p 0.001) were decreased and showed the same trend in absolute terms. The ratio of CD4/CD8 lymphocytes was almost doubled (p 0.001), due to increased content of T-helpers and decrease in cytotoxic T lymphocytes. In clinical blood analyses of ACS patients a tendency for leukocytosis was shown, (10.155.22), with a shift to the band forms.
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