Prevalence and prognostic relevance of myocardial inflammation and cardiotropic viruses in non-ischemic dilated cardiomyopathy

Background: Non-ischemic dilated cardiomyopathy (DCM) is a heterogeneous disease with a spectrum of etiological factors. However, subsets of the disease are not well-characterized with respect to these factors. The aim of this study was to evaluate the prevalence of myocardial inflammation and cardiotropic viruses in DCM patients and their impact on clinical outcome. Methods: Fifty-seven patients with DCM underwent endomyocardial biopsy between 2010 and 2013. Biopsies were analyzed by polymerase chain reaction (PCR) for the presence of cardiotropic viruses, and inflammatory cell infiltration was assessed by immunohistochemistry. During a 5-year follow-up, 27 (47%) patients reached the primary composite outcome measure: heart transplantation, left ventricle assist device implantation or cardiovascular-related death. Results: rvovirus B19 and human herpesvirus type-6. Four specific sub-groups were distinguished by PCR and immunohistochemistry: virus-positive (chronic) myocarditis, autoreactive inflammatory DCM, viral DCM, non-inflammatory DCM. The presence of a viral genome in myocardium or diagnosis of inflammatory DCM did not predict the outcome of composite outcome measures (p > 0.05). However, univariate Cox regression and survival function estimation revealed an association between inflammation by a high number of T-cells and poor prognosis. Conclusions: This study has shown that two markers — cardiotropic viruses and myocardial inflammation — are prevalent among DCM patients. They are also helpful in identifying sub-groups of DCM. An increased number of T-lymphocytes in the myocardium is a predictor of poor mid-term and long‐term prognosis

Prognostic value of myocardial fibrosis in severe aortic stenosis:Study protocol for a prospective observational multi-center study (FIB-AS)

BACKGROUND: Adverse cardiac remodeling with a myocardial fibrosis as a key pathophysiologic component may be associated to worse survival in aortic stenosis (AS) patients. Therefore, with the application of advanced cardiac imaging we aim to investigate left ventricular myocardial fibrosis in severe AS patients undergoing aortic valve replacement (AVR) and determine its impact with post-intervention clinical outcomes. METHODS: In a prospective, observational, cohort study patients with severe AS scheduled either for surgical or transcatheter AVR will be recruited from two tertiary heart centers in Denmark and Lithuania. All patients will receive standard of care in accordance with the current guidelines and will undergo additional imaging testing before and after AVR: echocardiography with deformation analysis and cardiovascular magnetic resonance (CMR) with T1 parametric mapping. Those undergoing surgical AVR will also have a myocardial biopsy sampled at the time of a surgery for histological validation. Patients will be recruited over a 2-year period and followed up to 2 years to ascertain clinical outcomes. Follow-up CMR will be performed 12 months following AVR, and echocardiography with deformation analysis will be performed 3, 12, and 24 months following AVR. The study primary outcome is a composite of all-cause mortality and major adverse cardiovascular events. DISCUSSION: Despite continuous effort of research community there is still a lack of early predictors of left ventricular decompensation in AS, which could improve patient risk stratification and guide the optimal timing for aortic valve intervention, before irreversible left ventricular damage occurs. Advanced cardiac imaging and CMR derived markers of diffuse myocardial fibrosis could be utilized for this purpose. FIB-AS study is intended to invasively and non-invasively assess diffuse myocardial fibrosis in AS patients and investigate its prognostic significance in post-interventional outcomes. The results of the study will expand the current knowledge of cardiac remodeling in AS and will bring additional data on myocardial fibrosis and its clinical implications following AVR. ETHICS/DISSEMINATION: The study has full ethical approval and is actively recruiting patients. The results will be disseminated through scientific journals and conference presentations. TRIAL REGISTRATION: ClinicalTrials.govNCT03585933. Registered on 02 July 2018

Evaluation of the human heart conduction system visualization possibilities based on morphospectral and proteomic investigations

The theme covered in the dissertation is about investigation of the morphological differences of the conduction system of the human heart and those of other heart tissues, applying spectroscopic, histochemical and proteomic methods. The described spectroscopical and proteomic investigations of the human heart conduction system and other heart tissues in the dissertation indicate clear structural differences between these tissues. Electrophoresis shows protein groups which may be detected only in a conduction system tissue. The dissertation concludes that estimated fluorescence and proteomic differences between His bundle and myocardium tissues may allow us to suggest that distinction of the bioelectrical impulse velocity in these tissues is determined by the specific morphological odds. According to these differences it is possible to create the visualization method of the conduction system

Žmogaus širdies laidžiosios sistemos vaizdinimo galimybių įvertinimas pagal morfospektrinius ir proteominius tyrimus

The theme covered in the dissertation is about investigation of the morphological differences of the conduction system of the human heart and those of other heart tissues, applying spectroscopic, histochemical and proteomic methods. The described spectroscopical and proteomic investigations of the human heart conduction system and other heart tissues in the dissertation indicate clear structural differences between these tissues. Electrophoresis shows protein groups which may be detected only in a conduction system tissue. The dissertation concludes that estimated fluorescence and proteomic differences between His bundle and myocardium tissues may allow us to suggest that distinction of the bioelectrical impulse velocity in these tissues is determined by the specific morphological odds. According to these differences it is possible to create the visualization method of the conduction system

Models of intracranial aneurysms for angiographic imaging modalities. A technical note

Objective. To delineate technical aspects of vascular models with intracranial aneurysm in vitro production, suitable for angiographic imaging. Material and methods. Wax (K2 exact, S-U-CERAMO-CAPS-WAX), Girtl’s mass, gelatin, and silicone (Silicone 10015 Den Braven, Elastosil 7683/25, Elite Double 32 Shore-A, Rema-Sil) were used for model production. Construction of models was based on T-shaped plastic tube connections and lost core techniques. Images of rotational angiography, glass tubes with aneurysm, and casts obtained in human specimen were used as samples of cerebral arteries. Results. Technical aspects of vascular models production were delineated in experience of eight silicone models produced. M1 was hand made with basilar tip aneurysm; M2 was obtained according to angiography images with internal carotid artery supraclinoid part bifurcation to anterior and middle cerebral artery aneurysm. BM1 and BM2 casts were made using glass tubes with lateral aneurysm, M3 – from T-shaped plastic tubes with lateral aneurysms. M4, M5, and M6 were formed using casts obtained in human specimen with basilar tip aneurysm. Conclusions. Silicone of two components is practical for casts of cerebral arteries in human specimen production. Gelatinous solution 50°C diluted 1:1 with water can be used for copies of arterial casts production. Wax materials are unsuitable for making casts in a human specimen

Gydymui atsparios kriptogeninės organizuojančios pneumonijos atvejis

Cryptogenic organizing pneumonia is a rare interstitial lung disease with different onset of symptoms, which responds rapidly to glucocorticoid treatment. We present a case of cryptogenic organizing pneumonia which manifested as a progressive 3-year dyspnea that ultimately has led to acute respiratory failure. Moreover, treatment with prednisone for this patient exhibited slow onset of the effect

Žmogaus širdies nervinių mazgų sandaros pokyčiai, susiję su amžiumi

The present study was performed in order to determine morphological agerelated changes of the human intracardiac ganglia. Paraffin sections of 40 ganglia from infants, adult and aged human hearts were stained with Picro-Mallory method. The ganglia area, nerve cell (with clearly visible nucleolus) area, neuron soma long axis length, perimeter, area of neuronal nuclei and neuron soma form factor were measured with the aid of computer images analyzing program “Sigma Scan Pro 5.0”. Also, the neuronal density and the area occupied by nerve cells per ganglion section were calculated. The relative frequency of satellite cells, in close contact with nerve cell soma, was estimated. Based on the data of this study, we concluded that the area of ganglia, neurons and their nuclei increased with age. Neuronal packing density significantly decreased, but the area occupied by nerve cells within the ganglia decreased non-significantly. Satellite cells were more numerous nearby ganglion neurons from infant hearts. Shape factor of neurons was stable between the groups. In conclusion, the present study confirms significant differences in the morphology of the intrinsic cardiac ganglia with age

Širdies audinių ekstraktų tyrimas spektroskopijos metodais

The conduction system of the heart (HCS) is a type of muscular tissue which generates and transmits bioelectrical impulses. During surgical operations it is possible to harm HCS, since the common origin makes it hardly discernible for an unaided eye in the surroundings of ordinary myocardium (MC) or endocardium. The aim of this study was to reveal the protein composition differences between His bundle (HB) and MC tissues and to determine the distribution of fluorophores in these tissues. This in turn would help to visualize HCS by means of optical-fluorescence biopsy. It has been shown that fluorescence of the soluble fractions of heart tissues is mainly determined by tryptophan (W) and tyrosine (Y) residue emission, while fluorophores, responsible for the fluorescence in the visible region, were found to be hardly extractable from tissues and precipitated out as the insoluble fraction. According to SDS-PAGE, some protein groups specific to MC and HB were revealed. Some SDS-PAGE gel sections containing certain proteins of heart tissue fractions were investigated by spectroscopic methods. The results indicated that proteins of the same weight extracted from different heart tissues exhibit different fluorescence spectra

Models of intracranial aneurysms for angiographic imaging modalities. A technical note

Objective. To delineate technical aspects of vascular models with intracranial aneurysm in vitro production, suitable for angiographic imaging. Material and methods. Wax (K2 exact, S-U-CERAMO-CAPS-WAX), Girtl’s mass, gelatin, and silicone (Silicone 10015 Den Braven, Elastosil 7683/25, Elite Double 32 Shore-A, Rema-Sil) were used for model production. Construction of models was based on T-shaped plastic tube connections and lost core techniques. Images of rotational angiography, glass tubes with aneurysm, and casts obtained in human specimen were used as samples of cerebral arteries. Results. Technical aspects of vascular models production were delineated in experience of eight silicone models produced. M1 was hand made with basilar tip aneurysm; M2 was obtained according to angiography images with internal carotid artery supraclinoid part bifurcation to anterior and middle cerebral artery aneurysm. BM1 and BM2 casts were made using glass tubes with lateral aneurysm, M3 – from T-shaped plastic tubes with lateral aneurysms. M4, M5, and M6 were formed using casts obtained in human specimen with basilar tip aneurysm. Conclusions. Silicone of two components is practical for casts of cerebral arteries in human specimen production. Gelatinous solution 50°C diluted 1:1 with water can be used for copies of arterial casts production. Wax materials are unsuitable for making casts in a human specimen