The role of viruses, inflammation and myocardial macrophages in the development of idiopathic arrhythmia

We studied viral antigens, inflammation, and macrophages in the endomyocardial biopsies of patients with idiopathic arrhythmias. Immunohistological study was performed to identify the antigens of cardiotropic viruses and the types of lymphocytes and macrophages. We observed the presence of viral antigens in the myocardium of patients with and without histological criteria of myocarditis. Heart failure and ventricular arrhythmias were associated with small focal infiltration of the myocardium with macrophages. The presence of viral antigens in the myocardium was associated with fewer number of myocardial M2 macrophages. Severity of myocardial interstitial fibrosis correlated with small-focal infiltration of M2 macrophages

Macrophage activation and polarization in post-infarction cardiac remodeling

Adverse cardiac remodeling leads to impaired ventricular function and heart failure, remaining a major cause of mortality and morbidity in patients with acute myocardial infarction. It have been shown that, even if all the recommended therapies for ST-segment elevation myocardial infarction are performed, one third of patients undergoes progressive cardiac remodeling that represents morphological basis for following heart failure. The need to extend our knowledge about factors leading to different clinical scenarios of myocardial infarction and following complications has resulted in a research of immuno-inflammatory pathways and molecular activities as the basis for post-infarction remodeling. Recently, macrophages (cells of the innate immune system) have become a subject of scientific interest under both normal and pathological conditions. Macrophages, besides their role in host protection and tissue homeostasis, play an important role in pathophysiological processes induced by myocardial infarction. In this article we summarize data about the function of monocytes and macrophages plasticity in myocardial infarction and outline potential role of these cells as effective targets to control processes of inflammation, cardiac remodeling and healing following acute coronary event

Клинический случай амилоидоза сердца, ассоциированного с миеломной болезнью

This clinical case demonstrates the difficulty of timely intravital diagnosis of cardiac amyloidosis and the prescription of adequate drug therapy which is associated not only with the limited possibilities of  establishing a correct diagnosis and the absence of specific treatment in most cases, but also with a delay in seeking medical care. Thus, development and improvement of non-invasive screening methods of examination will allow to identify this pathology at earlier stages with a possibility of prescribing effective drugs and performing heart transplantation in some cases.Данный клинический случай демонстрирует сложность своевременной прижизненной диагностики амилоидоза сердца и подбора адекватной медикаментозной терапии, что связано не только с ограниченными возможностями установления точного диагноза и отсутствия в большинстве случаев специфического лечения, но и с поздним обращением пациентов за медицинской помощью. Таким образом, разработка и усовершенствование  неинвазивных скрининговых методов обследования позволят выявлять патологию на более ранних этапах с  возможностью подбора эффективных препаратов, а в ряде случаев – трансплантации сердца

МАГНИТНО-РЕЗОНАНСНАЯ ТОМОГРАФИЯ С КОНТРАСТНЫМ УСИЛЕНИЕМ КАК МЕТОД ВИЗУАЛИЗАЦИИ АТЕРОСКЛЕРОТИЧЕСКОГО ПОРАЖЕНИЯ СТЕНКИ АОРТЫ

The article describes patterns of paramagnetic contrast enhanced MR tomographic imaging of atherosclerotic lesions of aorta in patients with extensive atherosclerosis and previous acute myocardial infarction.The purpose. We have analyzed MR tomographic imaging features of atherosclerotic lesions of the aorta, with a paramagnetic contrast enhancement, in patients with extensive atherosclerosis and old acute myocardial infarction (AMI).Materials and methods. The patients population comprised 24 patients with multiple atherosclerosis and old transmural AMI of the left ventricle. As control group eight patients with tumor pathology of the thorax were employed, without evidence of clinically significant atherosclerosis, of the same age range. All patients underwent contrast-enhanced study (paramagnetic in standard dose of 0,1 mmol / kg BW) and index of enhancement (IE) of T1-weighted images was calculated as the ratio of intensities over the aortic wall on contrast and initial MRI studies.Results and discussion. In patients with extensive atherosclerosis and old AMI IE of the atherosclerotic lesions in the aortic wall in all cases was over 1,14 (mean 1,19±0,06), far more than increasing of intensity in the control group. Types of accumulation of contrast paramagnetic was assigned as a local or diffuse accumulation syndrome, depending on the length and circularity of the lesions. In the control group no significant accumulation of contrast paramagnetic material in the aortic wall was observed, IE did not exceed 1.04 (mean 1,01±0,02).Conclusion. Contrast-enhanced MRI allows to visually and quantitatively assess pathology of aortic wall in atherosclerosis.В статье представлена картина МР-томографической визуализации атеросклеротических изменений аорты у пациентов с распространенным атеросклерозом и перенесенным острым инфарктом миокарда при контрастировании парамагнетиком.Цель. Изучить картину МР-томографической визуализации атеросклеротических поражений аорты при парамагнитном контрастировании у пациентов с распространенным атеросклерозом и перенесенным острым инфарктом миокарда (ОИМ).Материалы и методы. В исследование были включены 24 пациента с распространенным атеросклерозом и перенесенным трансмуральным ОИМ левого желудочка. В качестве контрольных обследованных в исследование включены восемь пациентов с опухолевой патологией органов грудной клетки (ОГК) без признаков клинически значимого атеросклероза того же возрастного диапазона. Всем пациентам проведено контрастированое исследование с введением парамагнетика в стандартной дозе 0,1 ммоль/1 кг массы тела и рассчитан индекс усиления Т1-взв. изображения как отношение интенсивности области стенки аорты на контрастированном и исходном МРТ-исследовании.Результаты. У пациентов с распространенным атеросклерозом и перенесенным ОИМ наблюдалось достоверно превосходящее показатели контрольных лиц усиление интенсивности сигнала в атеросклеротически измененной стенке аорты при введении контраста-парамагнетика, значение ИУ во всех случаях было больше 1,14 (среднее значение – 1,19±0,06). Характер накопления контраста-парамагнетика в зависимости от протяженности и циркулярности поражения визуализируется как локально-очаговый либо диффузно-распространенный тип аккумуляции. В контрольной группе было отмечено отсутствие значимого накопления контраста парамагнетика в стенке аорты, ИУ не превышал 1,04 (среднее значение – 1,01±0,02).Заключение. Контрастированная МРТ позволяет визуально и количественно оценить патологическое поражение аортальной стенки при атеросклерозе

THE MORPHOLOGY OF ELECTROPHYSIOLOGICAL DISORDERS OF MYOCARDIUM IN POSTINFARCTION ANEURYSM AND VENTRICULAR TACHICARDIA

Aim. To study morphology of the left ventricle (LV) myocardium in zones with disordered conduction of electrical potential in patients with post infarction aneurysm of the heart and ventricular tachycardia.Material and methods. The microscopic and morphometric investigations performed of 78 fragments of LV myocardium, obtained during LV reconstruction from zones with different electrical conductivity, from 19 patients with post infarction LV remodeling and chronic heart failure. For electrical conductivity all patients underwent electrophysiological study of the heart. In the zones with normal conduction (1 group) the value of electrical potential was more than 1,5 mV, in transient zone (2 group) — 0,5-1,5 mV, in “electrical scar” zone — less than 0,5 mV (3 group). The zone with zero value of electrical potential got to the 4th group.Results. In transient zone of myocardium pieces and “electrical scar” zone, comparing to those from normal electrical potential, there were more significant sclerosis of endocardium and myocardium, atrophy and degeneration of cardiomyocytes. In “electrical scar” zone there was more significant value of these changes than in transitory zone. Areas of myocardium with zero value of the potential differed from the zones with normal and low values of electrical potential by more significant replacement of myocardium by fat tissue.Conclusion. Transition from normal electrical potential to electrical scar do determine the severity of endocardial fibrosis, and myocardial lipomathosis, degeneration of cardiomyocyte

CD68 AND STABILIN-1 POSITIVE MACROPHAGES IN POSTINFARCTION MYOCARDIAL REGENERATION

Aim. Translation of experimental data on cardiac macrophages populations in postinfarction cardiac regeneration, into clinical practice.Material and methods. In the study, 41 patients included, with fatal myocardial infarction (MI) type 1. All patients were selected to 4 groups according to fatal outcome timing. Together with routine pathohistology, immune histochemistry was done, on macrophageal infiltration. As the markers of macrophagal line we used CD68; stabilin-1 was used for M2 macrophages.Results. The amount of CD68+ and stabilin-1+ macrophages in infarction zone increased and reached the peak in regeneratory phase, and did not decline at later stage. In peri-infarction area the amount of CD68+ macrophages increased during inflammatory phase, reached peak at reparation phase and did not change anymore either. By the results of multiple regression, the model was proposed, showing interrelations between the grade of macrophage infiltration and clinical markers of MI course.Conclusion. Our study translates experimental results on cardiac macrophages subpopulations in postinfarction cardiac regeneration into clinical area. We observed a biphasic response of cardiac macrophages on acute ischemia, similar of that in mice. The grade stabilin-1+ macrophagal infiltration intensity increased at regeneration phase. There was significant strong positive correlation of the numbers of stabilin1+ macrophages and MI course phase, that underlies potential application of stabilin-1 as diagnostic biomarker of M2 macrophages in MI patients

Determination of the efficiency of single-photon emission computed tomography with 99mTc-HMPAO-labelled leukocytes in the diagnosis of myocarditis: Comparison of scintigraphic and histological data

Objective: to determine the efficiency of single-photon emission computed tomography (SPECT) with 99mTc-HMPAOlabelled leukocytes in diagnosing myocarditis, by comparing scintigraphic and histological data.Material and methods. The investigation enrolled 35 patients with suspected myocarditis, who were planned to undergo coronaroventriculography or intervention with endomyocardial biopsy. Prior to endomyocardial biopsy, all the patients underwent myocardial scintigraphy using 99mTC-exametazime-labelled leukocytes. The results of myocardial scintigraphic and histological examinations were compared.Results. Abnormal myocardial 99mTc-HMPAO-labelled leukocyte accumulation was detected in 7 (20%) examinees. Myocarditis was histologically verified in 9 (25.7%) persons. Our findings showed that the sensitivity of 99mTc-HMPAO-labelled leukocyte SPECT in diagnosing myocardial inflammatory changes was 62%; its specificity and diagnostic accuracy were 92% and 85%, respectively.Conclusion. 99mTc-HMPAO-labelled leukocyte scintigraphy is today one of a few procedures for the primary noninvasive diagnosis of myocardial inflammation. However, in view of its  sufficiently low sensitivity and laboriousness and the high cost of consumables, the technique is irrationally used in routine clinical practice

The role of viruses, inflammation and myocardial macrophages in the development of idiopathic arrhythmia

We studied viral antigens, inflammation, and macrophages in the endomyocardial biopsies of patients with idiopathic arrhythmias. Immunohistological study was performed to identify the antigens of cardiotropic viruses and the types of lymphocytes and macrophages. We observed the presence of viral antigens in the myocardium of patients with and without histological criteria of myocarditis. Heart failure and ventricular arrhythmias were associated with small focal infiltration of the myocardium with macrophages. The presence of viral antigens in the myocardium was associated with fewer number of myocardial M2 macrophages. Severity of myocardial interstitial fibrosis correlated with small-focal infiltration of M2 macrophages