Method for selecting chronic cardiac insufficiency patients treatable with nebivolol |
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IPC classes for russian patent Method for selecting chronic cardiac insufficiency patients treatable with nebivolol (RU 2305498):
Method for differential diagnostics of purulent meningitis / 2305287
In spinal fluid (SF) one should detect the concentration of C-reactive protein (C-RP) and at its value being >2.9 mg/l it is possible to diagnose meningococcal meningitis, at SF C-RP value being ≤2.9 mg/l - nonmeningococcal meningitis. Application of the present method provides the chance to increase accuracy, specificity and information value of differential diagnostics of purulent meningococcal and non-meningococcal meningitis that enables to carry out earlier specific treatment. The method in question, moreover, is very quick and simple in implementation.
Method for evaluating the severity of tuberculosis infection / 2305286
In the experiment upon guinea pigs in blood plasma one should detect the concentration of taurine and glutamic acid and at taurine concentration being below 68 mcM/l and glutamic acid being below 76 mcM/l it is necessary to evaluate the state as severe, at taurine concentration ranged 68-89 mcM/l and that of glutamic acid ranged 125-227 mcM/l - as average severity degree, and at taurine and glutamic acid concentrations being above 89 and 227 mcM/l, correspondingly - as light severity degree. Application of the present method enables to increase information value and significance of the method in question and, also, detect body reactivity according to the state of its different systems.
 Method for predicting diabetic retinopathy / 2304786
Due to biochemical testing lacrimal fluid (LF0 it is necessary to detect the concentration of cholesterol, activity of superoxide dismutase (SOD) and catalase, in blood one should detect the concentration of nitrites and based upon the values obtained calculate Function 1 and Function 2. Function 1 = -3.4+0.29(NO2)+32.5(cholesterol)-0.97(catalase)-17.28(SOD) - corresponds to Y-axis values and Function 2 = -7.14+0.17(NO2)+37.2(cholesterol)+2.1(catalase)-17.28(SOD) - corresponds to X-axis values on the scheme to detect lesion type. If the point obtained is on the field of the 1st scheme one should detect the presence of nonproliferative DR form in a patient at no risk of proliferation; if it is on the field of the 2nd scheme - nonproliferative DR form with the risk of proliferation; if it is on the field of the 3d scheme - proliferative form of retinopathy in the phase of neovascularization. Application of the present method enables to carry out diagnostics in due time, differentiation in doubtful cases directed towards adequate treatment and decreasing the risk for DR progressing.
Method for predicting the development of postgastroresectional peptic ulcers / 2304785
The present innovation deals with predicting the development of postgastroresectional peptic ulcers in patients due to detecting the level of gastrin after stimulation, pepsinogen, prostaglandins PGE2 and PG F2α, correspondingly, in mucosa of gastric stump and in mucosa of gastroenteroanastomosis. At increasing gastrin level up to 12.5 pM/l and higher, that of pepsinogen up to 10.0 mcg/l and higher and decreasing the level of prostaglandin PGE2 up to 570 and lower and at the decrease of prostaglandin PG F2α level up to 652 ng/g and lower one should predict the development of postgastroresectional peptic ulcer. Application of the present innovation enables to increase the accuracy in predicting the development of postgastroresectional peptic ulcers.
Method for predicting the chance for osteomyelitis chronization in children / 2304784
During the moment of exacerbation and on ending the disease in question one should detect the content of alpha-1 proteinase inhibitor and alpha-1 acid glycoprotein in blood due to immunoturbidimetric technique. At decreased content of alpha-1 proteinase inhibitor from 2.3-2.6 g/l up to 1-1.2 g/l, and alpha-1 acid glycoprotein from 2.4-2.6 g/l up to 0.7-0.8 g/l one should predict the absence of osteomyelitis chronization. At decreased content of alpha-1 proteinase inhibitor from 2.9-3.1 g/l up to 1.8-1.6 g/l, and that of alpha-1 acid glycoprotein from 3-3.2 g/l up to 1.2-1.3 g/l one should predict osteomyelitis chronization. Application of the present method enables to predict the disease flow in shorter terms at high significance that provides the chance to prescribe the complex of efficient measures in due time which vary depending upon the disease flow.
Method for predicting the development of gestosis / 2304783
Starting from 22nd wk of pregnancy it is necessary to detect the concentration of neurospecific enolase and glyofibrous acid protein in blood serum. The development of gestosis in pregnant women should be predicted by the value of neurospecific enolase being above 12.4 ng/ml and glyofibrous acid protein being above 4 ng/ml. Moreover, severe gestosis should be predicted at the value of neurospecific enolase being 19 ng/ml and higher and glyofibrous acid protein being 10 ng/ml and higher. Application of the method enables to increase the accuracy of prediction.
Method for evaluating the results of surgical sanitation of inflammation focus in patients with chronic osteomyelitis / 2304781
The present innovation deals with laboratory investigations in case of traumatological pathology. One should simultaneously carry out microscopic investigation of material sample out of inflammation focus and blood from cubital vein to study the growth of microorganisms in the focus and in case of its absence and at registering positive index of digestion in blood with test culture S.aureus 209 P inside neutrophil after incubation, the value of IgM being 0.5-1.3 against the norm, the value of C-reactive protein being up to 12.0 mg/l it is possible to conclude upon satisfactory result of therapy conducted. Application of the present method enables to evaluate the degree of inflammatory process in bony tissue and, also, the state of phagocytic function of neutrophils as the first line of protection against microbial invasion.
Method for predicting the frequency of acute respiratory-viral infections due to evaluating the state of local immunity in children of primary-school age / 2303784
One should detect gamma-glutamyl transferase (GGT) in saliva sampled in the morning to an empty stomach. At GGT values being under 0.85 IU/l or above 3.4 IU/l it is possible to diagnose the decrease of local immunity in children and predict the risk for transferring a healthy child into the group of frequently sick patients. Application of the present method enables to predict the frequency of acute respiratory-viral infections (ARVI) before the procedure of prophylactic vaccinations, provides the chance for carrying out corresponding correction measures. The innovation is simple in application being noninvasive and could be applied in any age group.
 Method for quantitative determination of antibodies concentration specific to human endometrial tissue stromal cells antigen and in human biological fluid containing specific antibodies / 2303267
Method involves using the usual solid-phase enzyme immunoassay based on chemical binding antigen with microplate surface followed by placing antibodies-containing biological fluid on microplate, incubation, carrying out the color reaction and spectrophotometric evaluation of the color reaction indices. The end antigen is prepared by enzymatic hydrolysis of human normal tissue samples containing stromal cells of endometrial tissue. The enzymatic hydrolysis reaction is terminated by addition of chelating agent. Prepared mixed suspension of cells is centrifuged in continuous density gradient resulting isolation of stromal cells. Microsomal fraction of stromal cells is used as the end antigen that is diluted and bound covalently with microplate well surface. Then calibrating material prepared on basis of standard preparation antibodies specific to the end antigen is added into wells set, and biological fluid samples for analysis are added into another wells set. After carrying out the usual solid-phase enzyme immunoassay and using spectophotometry data a calibrating curve is plotted and the concentration of specific antibodies is determined using this curve. Invention provides the development of method for assay of antibodies amount specific to endometrial tissue stromal cells exceptionally that gives possibility for clinical diagnosis of autoimmune syndrome. Invention can be used in gynecology and obstetrics for diagnosis of autoimmune syndrome accompanying to clinical picture of endometriosis and other diseases in female reproductive system.
Method for predicting atrial fibrillation in cardiac ischemia patients / 2303266
Method involves applying immunoenzyme assay approach for analyzing blood for Chlamydia pneumoniae presence. Levels of inflammatory markers like C-reactive protein and tumor necrosis factor alpha are quantitatively determined. Seropositive result being the case with CRP level above 1.8 mg/l and TNF-α level above 2.4 pg/dl, atrial fibrillation occurrence is to be predicted.
Method for treating colon carcinoma cases / 2305497
Method involves making colon resection together with the tumor. Cytological study of lavage and smear samples is carried out after having accomplished basic surgical intervention stage. Intra-abdominal tumor dissemination signs being observed, intra-abdominal chemotherapy is administered with Mytomycin C dialysate at a dose of 12 mg/m2 during 40 min. Systemic chemotherapy with 5-fluorouracyl is administered at a dose of 425 mg/m2 combined with Leukovarin 20 mg/m2.
 Method for cytological diagnostics of puerperal pathology in cows / 2304773
The present innovation deals with sampling a cow's vaginal smear followed by its staining and microscopic testing the cells. During microscopic testing one should count the cells of vaginal epithelium (surface, parabasal and basal) . In case of prevailing quantity of surface cells (49-60%) one should diagnose normal flow of puerperal period, in case of prevailing parabasal epithelial cells one should diagnose complicated puerperal period, moreover, if the quantity of surface and basal cells is similar or he difference is insignificant (15-20% against 15%, correspondingly) it is possible to diagnose uterine subinvolution, and at considerable difference in the quantity of surface and basal cells (0.5-11% against 20-22%) one should diagnose acute puerperal endometritis. The innovation enables to analyze and detect puerperal pathology in earlier terms.
Method for detecting the composition of urinary calculi in vivo / 2304425
The present innovation deals with detecting the composition of non-disintegrated (in vivo) urinary calculi. According to density value H determined due to the method of spiral roentgen computed tomography one should establish potential composition of single-phase or mixed urinary calculi. Then it is important to calculate the calculus' density value ρ (g/cu. cm) by the following formula: ρ=1.539+0.000485H, where H - the density determined due to the method of spiral roentgen computed tomography (rel. U) to be compared with known density values for separate components of urinary calculi. Then, one should choose the most probable combinations of components, calculate potential compositions of urinary calculi in weight% and taking into account the results of urinary analysis and roentgenoscopy it is possible to determine the single variant of urinary calculus composition in vivo that provides the chance to prescribe corresponding therapy.
Method for predicting efficiency in treating fetal development delay syndrome / 2303958
The present innovation deals with predicting efficiency of conventional therapy of fetal development delay syndrome (FDDS) in the 3d trimester of pregnancy due to detecting the value of relative content of AnnexinV+PI+ lymphocytes in female peripheral venous blood in case of FDDS and at its value being under 10% one should predict the efficiency of conventional therapy of the syndrome in question. The innovation provides higher accuracy, sensitivity and specificity of the method suggested and enables to choose another tactics of therapy.
Method for predicting the development of chronic obstructive pulmonary disease in smoking persons / 2303957
The present innovation deals with predicting the development chronic obstructive pulmonary disease (COPD) in smoking persons. It is necessary to detect clinical symptoms and risk factors out of life anamnesis: the index of packs/yr - A1; smoking intensity degree - A2; the number of cigarettes smoked out daily - A3; what cigarette are smoked out - A4; the experience of smoking in years - A5; the availability of dyspnea or crepitation - A6; how much has been smoked out against the cigarette's length - A7; whether the quantity of smoked out cigarettes has been changed during the last years - A8; inhalation of cigarette smoke - A9; the availability of sputum - A10; how often sputum is separated - A11; the degree of nicotinic addiction in points by Fagerstrem's test - A12 to establish their digital values and determine prognostic coefficients F1, F2, F3 by the following formulas: F1=-3.04-0.23*A1-2.11*A2-2.57*A3-0.60*A4-0.97*A5+0.44*A6-0.37*A7+0.19*A8+0.28*A9+0.16*A10-0.08*A11+0.29*A12; F2=-1.82-2.03*A1+1.45*A2+2.61*A3-0.17*A4+1.64*A5-0.29*A6+0.29*A7-0.19*A8-0.20*A9-0.16*A10-0.06*A11-0.49*A12; F3=-13.99+8.30*A1+3.08*A2+0.75*A3+3.04*A4-2.09*A5-0.71*A6+0.40*A7-0.08*A8-0.37*A9-0.02*A10+0.56*A11+0.64*A12. At F3 or F2 being above F1 one should predict high risk of COPD development, at F1 being above F2 or F3 one should predict low risk for COPD development. The innovation enables to evaluate the risk of COPD development more efficiently among smoking persons and simplify the method for its prediction.
Method for predicting the development of chronic obstructive pulmonary disease in patients at no signs of bronchial obstruction / 2303956
The present innovation deals with predicting the development of chronic obstructive pulmonary disease (COPD), determining clinical symptoms and risk factors out of life anamnesis: dyspnea, passive smoking, sputum production, cough, crepitation in lungs, episodes of cough with sputum being more than 3 wk, sex, snore. It is necessary to establish their gradations and digital values. Then one should estimate prognostic coefficients F1, F2, F3 by the following formulas: F1=-4.10-3.35*A1-2.68*A2-1.74*A3-1.22*A4-0.48*A5-0.10*A6-0.20*A7-0.32*A8; F2=-5.69-3.32*A1+4.62*A2-1.21*A3-0.08*A4-0.79*A5-0.08*A6-0.25*A7+0.01*A8; F3=-8.14+7.47*A1-1.79*A2-1.16*A3-0.95*A4-0.19*A5-0.76*A6+0.69*A7+0.38*A8; F4=-12.4+3.90*A1-0.05*A2+5.87*A3+3.17*A4+2.14*A5+0.98*A6+0.09*A7+0.20*A8. At F4 being above F1 or F2 or F3 or F4 one should predict high risk for COPD development. At F2 being above F1, or F3, or F4 - low risk for COPD development. The innovation enables to carry out early onset of prophylactic measures.
 Method of predicting effectiveness of methods of cure of diseases / 2303955
Prediction is fulfilled due to analyzing 1-th particular diagnostic factors Xi(tj), where I=1, 2, 3..., n; tj=t0, t1, t2 - moments of time of getting of particular diagnostic factors during diagnostic procedures and of calculated generalized factors of predicted effectiveness before treatment at t0 time moment and after first and second procedures of treatment at time moments of t1 and t2. Analysis of particular diagnostic factors and of generalized factors of predicted effectiveness is performed at any selected time moment t as outside t0-t2 time interval and inside it while taking priorities of criticality of their values into account. Method allows predicting effectiveness of treatment at any random time moment as within t0 to t2 interval and outside it due to representation of functional dependence of relative particular diagnostic factors. Method also allows representing particular diagnostic factors in form of obvious and convenient order of priority for usage in mathematical computer programs for degree of criticality of their values by means of supplied mathematical conversion formula from form with physical dimensions to relatively dimensionless form. Method allows precise measuring of degree of disease for any chosen time moment by calculated generalized coefficient of effectiveness of treatment. Method can be used for prediction of effectiveness of any methods of treatment for any diseases and for any number particular diagnostic factors due to universal approach used for derivation of mathematical formulas used for described method.
Method for predicting brucellosis in small-size cattle / 2303458
The method deals with studying animal's blood serum with antigen in reaction of immunodiffusion. Moreover, as an antigen one should apply O-PS M-antigen prepared out of vaccinic strain B.melitensis Rev.-1. The innovation enables to increase considerably the sensitivity of the technique applied.
 Device for retaining biopsy material in biopsy hollow needle-cannula / 2303402
Device holds biopsy material in biopsy needle-cannula provided with fixing mechanism. Fixing mechanism is introduced into proximal end of biopsy needle-cannula, which end is pushed through between internal wall of biopsy cannula and cylindrical fragment of biopsy material. Distal end of fixing mechanism is provided with wire having cut. Wire has angle of preliminary shift, length, which length corresponds to biopsy cannula and ends up directly at its end. Device can be successfully used for performing through-skin biopsy of tissues, especially of solid tissue and marrow tissue.
Method for evaluating peritonitis severity degree in scores in perforated gastroduodenal peptic ulcercases / 2303401
Method involves evaluating the following clinical course signs with scores. Time passed since disease onset, nature and amount of exudate into he abdominal cavity, available abdominal sepsis are evaluated as the clinical course signs by scoring. Each sign receives score value. Each hour of time passed since disease onset receives +1 score; peritonitis generalization degree is assessed with +1 score per each 100 ml of exudate; peritonitis evaluation with exudate nature is made with +0 in gastric content and serous exudate cases, +5 scores in serofibrinous exudate cases, +10 scores in pyofibrinous exudate cases; peritonitis evaluation with clinical manifestation severity is carried out by giving +0 scores in cases with no abdominal sepsis phenomena, +10 scores are given in cases with abdominal sepsis phenomena being available. Score sum being equal to or less than 11, mini-laparotomic access operation is considered to be advisable.
 Method for predicting the result of acute peroral intoxication with cauterizing liquids / 2244930
At patient's hospitalization one should gather the data of clinical and laboratory values: on the type of chemical substance, patient's age, data of clinical survey and laboratory values: body temperature, the presence or absence of dysphonia, oliguria being below 30 ml/h, hemoglobinuria, erythrocytic hemolysis, exotoxic shock, glucose level in blood, fibrinogen and creatinine concentration in blood serum, general bilirubin, prothrombin index (PTI), Ph-plasma, the state of blood clotting system. The state of every sign should be evaluated in points to be then summed up and at exceeding the sum of points being above "+20" one should predict unfavorable result. At the sum of "-13" prediction should be stated upon as favorable and at "-13" up to "+20" - prediction is considered to be doubtful.
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FIELD: medicine. SUBSTANCE: method involves determining endothelin-1 concentration in blood plasma. Its value being equal to 1.5-5 fmole/ml, treatment with Nebivolol is administered. EFFECT: enhanced effectiveness in selecting patients for applying treatment with Nebivolol. 1 dwg, 3 tbl
The present invention relates to medicine, in particular to therapy, and may find application in the treatment of patients with chronic heart failure (CHF). In CKD patients the increased pressure of filling of the left ventricle accompanied by the passive pressure increase in the venous part of the pulmonary vascular bed and an increased pulmonary vascular resistance [1]. Further it leads to remodeling of the vessels of the pulmonary circulation and the development of secondary pulmonary hypertension, which worsens the clinical picture, increases the risk of death and is regarded as a predictor of poor prognosis [2]. The impact on the hemodynamics of the pulmonary circulation and the degree of pulmonary hypertension is an important component of therapy for chronic heart failure. The selection of CKD patients for treatment with nebivolol is based on a comprehensive assessment of the clinical symptoms and echocardiographic data [3]. However, the positive effect of treatment with nebivolol in relation to hemodynamics of the pulmonary circulation is observed not in all patients [4, 5]. The main method of measuring pulmonary hemodynamics is the definition of pressure in the pulmonary artery [6]. The disadvantage of this method is the inability to predict the effectiveness of treatment, to assess the contribution of different pathogenetic mechanisms in the occurrence of pulmonary hypertension and steinernematidae vascular bed, which undoubtedly affect the effectiveness of therapeutic effects and the possibility of regression of the pathological process. The objective of the invention is to increase the accuracy of selection of patients with chronic heart failure, complicated by the development of pulmonary hypertension, for the treatment with nebivolol. The problem is solved by the method lies in the fact that patients determine the level of endothelin-1 (ET-1) in plasma and at the level of 1.5-5 fmol/ml prescribed therapy with nebivolol. ET-1 is biologically active peptide secreted by the endothelium, which has a powerful vasoconstrictor, proaggregatory and mitogenic effects, stimulates the production of cytokines, growth factors, collagen formation, proliferation of vascular smooth-muscle cells, thereby potentsiruya vascular remodeling, including the pulmonary circulation [1, 7]. The following examples illustrate the method of the invention. Clinical example 1. Patient H., 54 years, is observed in SHR MMA. Sechenov with a diagnosis of ischemic heart disease: angina FC. Diffuse atherosclerotic and postinfarction cardiosclerosis. The constant form of atrial fibrillation. Ventricular premature beats. HSN IIB century, FK according to NYHA. Syndrome small release. The patient in 2002 first registered atrial fibrillation, in the same year suffered a myocardial infarction without Q wave anterior wall of LV. When ECHO IS G revealed dilatation of all cardiac chambers with reduced EF of 35%, signs of pulmonary hypertension. Since that time progresses the symptoms of biventricular heart failure, about what was in constant therapy ACEI, diuretics. During the survey: shortness of breath with little exertion (test 6-minute walk - 175 m), was determined by clinical and radiographic signs of stagnation in a small circle of blood circulation. When the ECHO-KG heart revealed: dilatation of all cardiac chambers, diffuse decrease in contractile function (EF 30%), signs of pulmonary hypertension: mean pulmonary artery pressure (P cf. LA) - 22 mm Hg, systolic pulmonary artery pressure (R Syst. LA) 35 mm Hg Concentration of ET-1 in plasma was 0,95 fmol/ml Patient continued therapy chosen therapy with nitrates, ACE inhibitors, verospiron, furosemide. Additionally, he was appointed nebivolol (with dose titration to 5 mg/day). When you study after 10 weeks, the concentration of ET-1 was 1 fmol/ml Clinical and echocardiographic data remained essentially unchanged - systolic pulmonary artery pressure of 35 mm Hg, the results of test 6-minute walk - 180 m, LV EF 32%. In the absence of the effect from the additional purpose of nebivolol was enhanced vasodilating therapy. Clinical example 2. Patient P., 69, was observed in SHR with di is the prognosis: IHD: angina FC. Diffuse atherosclerotic and postinfarction cardiosclerosis. Ekstrasystolichniy arrhythmia. Paroxysmal form of atrial fibrillation. Chronic aneurysm of the anterolateral wall of the left ventricle. Parietal thrombus in the LV cavity. HSN IIB Art. FC according to NYHA. Syndrome small release. Pulmonary hypertension 1 tbsp. Of history: in 1994, without previous history of angina underwent krupnooptovyj myocardial infarction of the anterior wall of the left ventricle. Since 2004 - the growing signs of biventricular heart failure with a gradual worsening of edema-ascites syndrome and shortness of breath, increased cardiac asthma. Radiographically determined venous congestion and pulmonary hypertension, as well as increasing all heart chambers. Conducted therapy with diuretics, ACEI, nitrates, verospiron. When the ECHO-KG revealed severe systolic dysfunction (with akinesis of almost all departments of the myocardium of the left ventricle with the exception of basal segments and a decrease in PV to 31%), mitral, tricuspid regurgitation 2 article, pulmonary hypertension (P Syst. LA 40 mm Hg, P cf. LA - 26 mm Hg). Test 6-minute walk - 160 m Concentration of ET-1 in plasma - 3.1 fmol/ml Continued previously selected therapy with nitrates, ACE inhibitors, digoxin, verospiron, furosemide. In addition to therapy added nebivolol (5 mg/day). After 10 weeks of observations noted), the significant decrease in the concentration of ET-1 (up to 1.1 fmol/ml) and positive clinical dynamics (decrease shortness of breath, expansion mode motor activity - the increase of the test, 6-minute walk up to 220 m). Rest. LA decreased to 30 mm Hg, PCP. LA to 22 mm Hg, which allowed to talk about the positive effect of a 10-week therapy with nebivolol. Clinical example 3. Patient S., aged 52, is observed in SHR MMA. Sechenov with a diagnosis of coronary heart disease, angina equivalents, painless myocardial ischemia. Post-infarction and diffuse atherosclerotic cardiosclerosis. The constant form of atrial fibrillation. HSN IIB Art. In 1999 accidentally revealed atrial fibrillation, not treated. Since 2000, he became concerned about the palpitations and shortness of breath, was chosen therapy with digoxin, ACE, nitrates, diuretics. In a further marked increase in shortness of breath during exercise, heart attacks, there are signs of progressive right ventricular failure (presumably associated with recurrent myocardial infarction and distribution zone on the right ventricle). At the time of inclusion in the study the result of the test 6-minute walk was 180 m), the ECHO-KG showed dilatation of all cardiac chambers, diffuse decrease in contractile function with akinesia back wall and apex of the left ventricle and distribution of hypokinesis of the right ventricle, PE 34%. The valve of the pulmonary artery lazerette bad, signs of pulmonary hypertension,R. stat. LA 45 mm Hg Concentration of ET-1 in plasma of 1.8 fmol/ml In the background included in therapy nebivolol marked improvement in exercise tolerance test (6-minute walk away at the end of the observation period 240 m), the disappearance of signs of pulmonary hypertension: systolic flow in the pulmonary artery is not modified, R. stat. LA 27 mm Hg decreased the concentration of ET-1 to 0.85 fmol/ml, indicating a positive effect of additional prescription nebivolol. Clinical example 4. Patient K., 72 years, observed in SHR MMA. Sechenov diagnosed with coronary heart disease, angina FC. Post-infarction and diffuse atherosclerotic cardiosclerosis. Chronic aneurysm of the anterolateral wall of the left ventricle. Paroxysmal form of atrial fibrillation. HSN 2A Art., FK according to NYHA. The patient for many years suffered from arterial hypertension. In 1968 he moved uncomplicated krupnooptovyj myocardial infarction paradisevalley area, and then significantly decreased tolerance to exercise. Since 1990, developing paroxysmal atrial fibrillation. In 1996, he moved again zadnemotorny myocardial infarction, acute LV failure. Since that time growing phenomenon of left ventricular heart failure, regularly receives nitrates, ACEI, antiplatelet agents. In 2000 revealed the formation of chronic aneurysm of the left ventricle. N is the moment of inclusion in the study was determined radiographically venous congestion in the root zones. When the ECHO-KG dilatation of the left chambers of the heart, akinesia the top and rear walls throughout, hypokinesia of the anterior and peregrinating segments, PE-39%, pulmonary hypertension (cf. P LA 24.6 mm Hg, Rest. LA was not determined). Test 6-minute walk - 170 m In the background add to the selected therapy (nitrates, ACE inhibitors, diuretics) nebivolol (5 mg/day) at the end of the observation period has been an increase in ejection fraction (43%), however, the dynamics of pressure in the pulmonary artery is not revealed (cf. P LA 24.6 mm Hg), retains the same level of dyspnea on exertion and exercise tolerance. All patients at the beginning and after 10 weeks of observations were carried out test 6-minute walk for the evaluation of exercise tolerance and functional class of CHF, the Doppler - ECHO-KG) determination of the size of the heart chambers, PV, mean pressure in the pulmonary artery by the method Kitabataki and in the presence of tricuspid regurgitation systolic pressure in pulmonary artery (based on the Bernoulli equation). In addition, we determined the level of endothelin-1 (ET-1) in plasma with EDTA ELISA (Biomedica group). All patients by the time of inclusion in the study were taking ACE inhibitors, loop diuretics, verospiron, nitrates in a selected dose, 33% with digoxin. To this therapy was added nebivolol in max is th a dose of 5 mg/day, the control group consisted of patients who continued receiving the same treatment. Statistical analysis was performed using Statistica-5 was used nonparametric methods of analysis (criterion of Wilcoxon signed for paired samples, the correlation Coefficient). Was found a significant correlation between the absolute dynamics of ET-1 and the absolute dynamics of R. cf. LA (r Spearmen = 0,56, p = 0.008) (see drawing). When ET-1 levels less than 1.5 fmol/ml was observed a significant decrease of this indicator in the background of a 10-week therapy with nebivolol and was only misleading tendency to decrease in pulmonary artery pressure increasing. In the group of patients with the concentration of ET-1 to 1.5-5 fmol/ml showed a significant decrease in the level of ET-1 on the background of the 10-week treatment with nebivolol (table 1), there was an improvement in clinical indicators of pulmonary hemodynamics (dyspnea reduction, improvement of the test, 6-minute walk), as well as the reduction of pressure in the pulmonary artery when the ECHO-KG study (table 2, 3). A control group of patients with the concentration of ET-1 in the range from 1.5 to 5 fmol/ml was observed only misleading tendency to decrease the level of ET-1 and tended to decrease in pulmonary artery pressure and increased results of test 6-minute walk away, which has not reached the level of confidence. At high values of ET-1 is turning into therapy nebivolol did not lead to significant changes of ET-1 levels and indices of pulmonary hemodynamics. Thus, the concentration of ET-1 in plasma of 1.5-5.0 fmol/ml is a prognostic indicator for destination therapy with nebivolol for correction of pulmonary hemodynamics in patients with chronic heart failure.
Sources of information 1. Moraes DL., Colucci WS., Givertz MM. Secondary Pulmonary Hypertension in Chronic Heart Failure The Role of The Endothelium in Pathophysiology and Management. Circulation. 2000; 102: 1718. 2. Abramson SV, Burke JF, Kelly JJ Jr, et al. Pulmonary hypertension predicts mortality and morbidity in patients with dilated cardiomyopathy. Ann Intern Med. 1992; 116: 888-895. 3. Expert consensus document on b-adrenergic receptor blockers. The Task Force on Beta-Blockers of the European Society of Cardiology European Heart Journal (2004) 25, 1341-1362. 4. Gurevich, M.A.; Sanin, NP; Khokhlova TF; Byvaltsev VI Evaluation of clinical and hemodynamic action of nebivolol in patients with chronic heart failure. Grew up with. Cardiol. journal, 2001; No. 2, p.38-41. 5. Brune S, Schmidt T, Tebbe U, Kreuzer H. Hemodynamic effects of nebivolol at rest and on exertion in patients with heart failure. Angiology. 1990 Sep; 41 (9 Pt 1): 696-701. 6. Nauser T.D., Stites S.W. Diagnosis and Treatment of Pulmonary Hypertension. Am. Fam. Physician 2001; 63: 1789-98, 1800. 7. Luscher TF., Barton M. Endothelins and Endothelin Receptor Antagonists. Therapeutic Considerations for a Novel Class of Cardiovascular Drugs Circulation. 2000; 102: 2434. The method of selection of patients with chronic heart failure for the treatment with nebivolol, namely, that determine the level of ET-1 in plasma and the amount of 1.5 to 5 fmol/ml prescribed therapy with nebivolol.
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