Экспериментальная оценка биосовместимости различных типов сетчатых эндопротезов, используемых в реконструктивной хирургии брюшной стенки

Course of Surgery of the Faculty of Dentistry, Department of Morphopathology, Nicolae Testemitanu State Medical and Pharmaceutical University, Chisinau, Republic of MoldovaThe purpose of this study was to compare biological tissue response to three types of surgical mesh. In the present study a low-weight macroporous polypropylene mesh (PPLW) was compared to heavy-weight microporous polypropylene mesh (PPHW) and polyethylene terephthalate (PET) mesh. All three types of surgical non-absorbable mesh with different pore size were implanted in an preperitoneal position in the abdominal wall of 60 rats. Five animals per group were sequentially sacrificed at 7, 14, 30 and 90 days after implantation. The mesh samples were investigated by light microscopy. The morphometric parameters of the mesh area and surrounding host tissue were examined in regard to the inflammatory infiltrate, the number of granulocytes, macrofages, giant cells, fibroblasts, collagen deposition and neo-angiogenesis. Conclusions: the experimental data confirmed the development of the chronic inflammatory foreign body reaction at the interface to all three types of implanted meshes. Polypropylene meshes tended to induce higher acute inflammatory reaction and connective tissue formation, while polyethylene terephthalate mesh tended to induce the giant cell type of foreign body reaction. The experimental data confirmed an improved biocompatibility and superior integration in recipient tissue for the „low weight” polypropylene mesh with large pores.Целью данного исследования является сравнение биосовместимости сетчатых протезов различных по структуре полимера и его текстильным свойствам. В статье были проанализированы сравнительные результаты имплантации 3 типов сетчатых протезов: «легкого» макропористого эндопротеза-сетки из полипропилена, «тяжелого» полипропиленового эндопротеза-сетки с малым диаметром пор и полиэфирного полифиламентного сетчатого эндопротеза. Все три вида сетчатого эндопротеза были имплантированы преперитонеально в брюшную стенку лабораторных крыс (n = 60). Животные выводились из эксперимента на сроках 7, 14, 30 и 90 суток с момента операции. Полученные гистологические срезы были исследованы посредством световой микроскопии. Посредством морфометрического анализа проводилась сравнительная оценка степени выраженности воспалительного инфильтрата, числа полиморфоядерных лейкоцитов, макрофагов, гигантских клеток инородных тел, фибробластов, синтеза коллагена и ангиогенеза. Выводы: экспериментальные данные подтверждают развитие хронической воспалительной реакции типа «реакции инородного тела» в ответ на имплантацию всех трех типов сетчатых протезов. В то же время, воспалительная реакция, в ответ на имплантацию каждого из протезов, имеет свои характерные особенности. Монофиламентные эндопротезы-сетки из полипропилена способны на начальном этапе индуцировать развитие острой воспалительной реакции по полиморфоядерному типу с последующим формированием соединительной ткани. Эндопротезы-сетки из полиэфирного волокна провоцируют умеренную воспалительную реакцию гигантоклеточного типа. Вместе с тем, фиброгистиоцитарная реакция и накопление волокон коллагена менее выражены. Данные экспериментального исследования позволяют сделать вывод о том, что «легкие» макропористые полипропиленовые сетчатые протезы обладают рядом преимуществ с точки зрения их биосовместимости и степени интеграции в ткани реципиента

Внебольничные пневмонии с неблагоприятным течением: клинико-морфологические аспекты

Catedra Medicină internă nr. 5, Catedra Morfopatologie, USMF „Nicolae Testemiţanu”, Curs Morfopatologie, Universitatea Agrară de Stat din Moldova, Conferinţa naţională ştiinţifico-practică în domeniul otorinolaringologiei pediatrice, 30 octombrie 2009, Chişinău, Republica MoldovaThe aim of the study of 250 patients under 60 years of age was to determine prognostic factors of the unfavorable evolution of community-acquired pneumonia and to observe histopathological changes in the lungs. The fatal outcome of community-acquired pneumonia was influenced by alcoholism, malnutrition, chronic liver disease, chronic renal failure, extended pulmonary infiltrate, arterial hypotension, lack of febrile reaction and an altered mental state. Alveolar exsudate, oedema and thickening of interalveolar septa, focci of destruction, infiltration with leucocytes and fibrin deposition on visceral pleura were among the most frequently seen histopathological changes.Целью настоящего исследования, включившего 250 пациентов в возрасте до 60 лет, было определить факторы прогноза неблагоприятного течения внебольничных пневмоний и выявить гистопатологические изменения в легких в случаях с летальным исходом. Установлено, что на неблагоприятное течение пневмоний у пациентов молодого и среднего возраста влияют алкоголизм, дефицит массы тела, хроническое заболевание печени, хроническая почечная недостаточность, протяженность легочного инфильтрата, артериальная гипотензия, отсутствие температурной реакции, нарушение сознания. Среди наиболее частых изменений легочной ткани были отмечены альвеолярный экссудат, отек и утолщение межальвеолярных перегородок, очаги деструкции, лейкоцитарная инфильтрация висцеральной плевры с наложениями фибрина

Морфопатологические особенности плаценты у пациенток с приобретенными митральными валвулопатиями

Institutul de Cercetări Ştiinţifice în Domeniul Ocrotirii Sănătăţii Mamei şi Copilului, Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”Relevance. Cardiovascular diseases are observed in 1% of pregnant women and are the major cause of maternal and perinatal mortality. Acquired valvulopathy makes up about 80% out of the cardiovascular system diseases. Morphopathologic examination of placenta is one of the informational sources on the causes of fetal hypoxia, premature birth, intrauterine growth retardation, etc. At the same time, morphopathologic changes in placenta of pregnant women with circulatory insufficiency due to an acquired valvulopathy remain almost unresolved. The aim of the study. Comparative analysis of morphopathologic changes in placentas of pregnant women with circulatory insufficiency due to an acquired valvulopathy. Materials and methods. The study included 35 placentas, which were divided into groups depending on the degree of circulatory failure and without it. Placentas were examined macroscopically and hystopathologically using routine methods of staining with hematoxylin-eosin and pikrofuksin according to van Gieson. The changes revealed were treated with different statistical methods using STATISTICA 7.0. 61.0 EN of the StatSoft. Inc company (USA) (2006). Results. Macroscopically, in placentas of pregnant women with circulatory failure there have been identified disorders of the form, placenta circumvallate, the cysts of chorionic plate in place of the umbilical cord attachment, additional cotyledons, heart attacks, focal calcification. It was also revealed the disorder of the umbilical cord attachment, sometimes with the presence of amniotic folds. Hystopathologically there it was identified a number of structural changes that have been grouped into several categories: inflammation processes, dyscirculatory changes, disorders in maturation of chorionic villi and compensatory-adaptive changes. Along with these changes, there were identified dysplastic changes in the chorionic villi and vessels. Statistical analysis revealed a strong correlation between the disorders of chorionic villi maturation and dyscirculatory changes (r = 0,79), and a moderate correlation between the disorders of chorionic villi maturation and inflammatory processes (r = 0,65). A high level of differences in changes in placentas from women with circulatory failure and without was found during the clustered analysis at Euclid distances. Conclusions. Cardiovascular disorders in pregnant women lead to different structural changes in placenta, the most pronounced of which are dyscirculatory changes and disorders in chorionic villi maturation, which are increasing with a more pronounced degree of circulatory disorders in pregnant women (p <0b05). The revealed strong correlation between the disorder in the maturation of chorionic villi and dyscirculatory changes indicate the important role of the latter for fetal development and is one of the links in the pathogenesis of intrauterine growth retardation. In groups of patients with circulatory disorders the cases of perinatal mortality were not registered, which is apparently related to a high level of compensatory-adaptive processes, which in this study made up 77%.Актульность. Сердечно-сосудистые заболевения наблюдаются у 1% беременных женщин и являются одной из главных причин материнской и перинатальной смертности. Приобретенные валвулопатии составляют около 80% из заболеваний сердечно-сосудистой системы. Морфопатологическое исследование плаценты является одним из источников информации о причинах гипоксии плода, преждевременных родов, внутриутробной задержки развития плода и др. В то же время морфопатологические изменения в плацентах беременных с циркуляторной недостаточностью обусловленной приобретенными валвулопатиями остаются практически нераскратыми. Цель исследования. Сравнительный анализ морфопатологических изменений в плацентах беременных с циркуляторной недостаточностью обусловленной приобретенными валвулопатиями. Материл и методы. Настоящее исследование включило 35 плацент, которые были разделены на группы в зависимости от степени циркуляторной недостаточности и без таковой. Плаценты были исследованы макроскопически и гистопатологически с использованием рутинных методов окрашивания гематоксилин- эозином и пикрофуксином по ван Гизону. Выявленные изменения были обработаны разными статистическими методами с использованием STATISTICA 7.0. 61.0 EN компании StatSoft. Inc (США) (2006). Результаты. Макроскопически, в плацентах от беременных с циркуляторной недостаточностью были выявлены нарушения формы, placentа circumvallate, кисты хориальной пластинки в месте прикрепления пуповины, добавочные котиледоны, инфаркты, очаговая кальцификация. Также были выявлены нарушения прикрепления пуповины, иногда с наличием амниотической складки. Гистопатологически был выявлен ряд структурных изменений, которые были группированны в несколько категорий: воспалительные процессы, дисциркуляторные изменения, нарушение созревания ворсин хориона и компенсаторно-приспособительные изменения. Наряду с зтами изменениями были выявлены диспластические изменения в ворсинах и сосудах хориона. Статистический анализ выявил сильную корелляцию между нарушением созревания ворсин хориона и дисциркуляторными изменениями (r=0,79), и умеренную кореляцию между нарушением созревания ворсин хориона и воспалительными процесами (r=0,65). При кластреном анализе на эвлидовых расстояниях был выявлен высокий уровень различия изменений в плацентах от беременных с циркуляторной недостаточностью и без таковой. Выводы. Сердечно-сосудистые нарушения у беременных приводят к различным структурным изменениям в плаценте, самые выраженные из которых являются дисциркуляторные изменения и нарушение созревания ворсин хориона, которые усиливаются при более выраженной степени цируляторных нарушений у беременных (р<0б05). Выявленная сильная корелляция между нарушением созревания ворсин хориона и дисциркуляторными изменениями указывает на важную роль последних для внутриутробного развития плода и является одним из зеньев в патогенезе внутриутробной задержки развития плода. В группах пациенток с циркуляторными нарушениями не были зарегистрированныи случаи перинатальной смертности, что по-видимому связано с высоким уровнем компенсаторно-приспособительных процессов, которые в данном исследовании составили 77%

An alarm signal for the medical world addressed from the pathological anatomy service in the Republic of Moldova

Department of Morphopathology, Nicolae Testemitsanu State University of Medicine and Pharmacy Chisinau, the Republic of Moldova, Department of Microscopic Morphology/Histology, Angiogenesis Research Center, Victor Babes University of Medicine and Pharmacy, Timisoara, RomaniaBackground: Maintaining the quality and safety of pathology services is crucial for the efficient delivery of health care. However, pathology is, perhaps, the least understood of the medical specialties. In particular, the scope of pathology and the integral role it plays in all areas of medicine are not well recognized even by some of those working in health care environments. Strategic partnerships have as the main goal the enlargement of collaborative research and partnership on national and international level, mainly, but not exclusively in European Research Area. There is a perceived need for improved management practices, use of new technologies, and increased use of some categories of the personnel. Issues with the employment program were mentioned, including tracking, matching people to jobs, training, and finding more opportunities. There was a call for greater visibility in the community (both medical and scientific). The problems facing pathology teaching and pathology teachers mirror those of most other medical disciplines, namely a lack of time and money, and competing pressures from many other sources. Conclusion: There is the danger of producing doctors who cannot explain disease to their patients, who abuse laboratories and who have no interest in pursuing pathology as a career, leading to a slow and possibly irreversible decline in pathology as a medical profession

Distinct cortical and subcortical structural alterations mirroring daytime‐related seizure occurrence [Abstract]

Purpose: Investigating the daytime‐related patterns of sei-zure presentation might provide important insights into theinvolved epileptogenic networks. However, the alterationsof brain structural integrity linked to different profiles ofseizure occurrence are still not clear. In this study weaddressed the structural magnetic resonance imaging(MRI)‐derived features of the involved cortical and subcor-tical substrates. Method: In 13 patients (mean age ± standard deviation:28±9 years; 9 male) with nocturnal seizures (NS), 12patients (26±9; 3 male) with diurnal seizures (DS) and 10healthy controls (HC) (28±4; 6 male) 3D 3T MRI was per-formed. Cortical and subcortical volumes (hippocampus,amygdala, thalamus) were extracted with the FreeSurferprocessing stream and the between‐group differencesassessed with analysis of variance (ANOVA) and Bonfer-roni post hoc tests. There was no difference between thegroups regarding age (F2,32= 0.26, p = 0.77) and gender(χ†= 5.103, df = 2, p = 0.08). Results: NS group in contrast to DS group showed largervolumes of bilateral insula, superior temporal and orbito-frontal cortices (p = 0.05, corrected). In patients with NScortical volumes of left postcentral and right middle tempo-ral cortices were smaller in comparison to HC. Patientswith DS in comparison to HC displayed reduced corticalvolumes mainly in frontal, temporal and parietal lobes ofthe right hemisphere. Hippocampus analysis showed a sig-nificant group difference (F2,32= 3.643, p = 0.03) withpost hoc test indicating larger volumes in NS group(8208.6±1006.1) vs DS group (3859.1±508.1 mm‡,p = 0.02). For amygdala, ANOVA showed a similar signif-icant group difference (F2,32= 4.341, p = 0.02) with largervolumes in NS group (1797.3±323.2 mm‡) vs DS group(1500.5±246.2 mm‡, p = 0.03). There were no differencesin thalamic volumes between the studied groups. Conclusion: Despite epileptogenesis daytime‐related sei-zures have distinct structural correlates. These alterationscan assign protective or susceptibility properties linked tovigilance or sleep states that could be useful for therapeuticdecisions

The pathomorphological changes of the biliary tract in liver cirrhosis

Clinica 2 chirurgie “Constantin Tîbîrnă”, Catedra Chirurgie nr. 2, Catedra Morfopatologie, USMF „N. Testemiţanu”, Chişinău, Republica Moldova, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Scopul lucrării a constituit studierea leziunilor morfopatologice ale segmentelor intra- şi extrahepatice ale arborelui biliar în ciroză hepatică. Material şi metode: Studiul a inclus 11 cazuri necroptice de ciroză hepatică. În calitate de control s-au studiat 3 cazuri necroptice fără patologii hepato-biliarepancreatice. În toate cazurile, conform datelor clinice, ciroza a avut etiologie virală (în 5 cazuri – HVC şi în 6 – HVB), stadiul 2-3 după clasificarea Child. Vîrsta pacienţilor: de la 32 până la 64 ani, 7 pacienţi de sex masculin şi 4 – de sex feminin. După aspectul macroscopic în 7 cazuri a fost ciroză hepatică micronodulară, iar în 4 – ciroză mixtă. În toate observaţiile studiate în colecist s-au depistat calculi veziculari până la 1 cm în diametru. Rezultate: La nivel intrahepatic s-a constatat o reacţie ductulară intensă – proliferarea epiteliului ductulilor biliari, localizată în special în zonele periferice ale lobulilor hepatici, la nivelul plăcii limitante. În canaliculele intralobulare s-au observat semne de colestază (trombi biliari), precum şi acumulări de pigmenţi biliari în citoplasma hepatocitelor. Ducturile biliare interlobulare au fost deformate, comprimate de fascicule inelare fibroconjunctive, cu aspect tortuos, neregulat. În peretele vezicii biliare şi a coledocului s-a atestat atrofia peretelui, în special a mucoasei, atrofia, scleroza şi hialinoza stratului fibromuscular, îngroşarea membranei seroase. Concluzii: Leziunile morfologice ale arborelui biliar intra- şi extrahepatic în ciroză favorizează dereglări ale fluxului biliar, apariţia colestazei, modificări în compoziţia şi proprietăţile fizico-chimice ale bilei, ce conduc la scăderea tonusului, motilităţii şi capacităţii de evacuare a vezicii biliare, creînd un fundal favorabil pentru dezvoltarea colelitiazei.Aim: The goal of this research was to study the morpho-pathological injuries in intra- and extrahepatic segments of the biliary tree in liver cirrhosis. Methods and materials: This study included 11 cases of liver cirrhosis necroptic. As controls were studied 3 cases of the necroptic without hepatobilliary-pancreatic diseases. In all cases, according to clinical cirrhosis was viral etiology (in 5 cases - HVC and 6 - HVB), Child classification after stage 2-3. Patient age: from 32 to 64 years, 7 male patients and 4 - female. After macroscopic appearance in 7 cases, cirrhosis was micronodularis, and 4 - mixed cirrhosis. In all cases studied in gallbladder stones were detected up to 1 cm in diameter. Rezults: At the level of intrahepatic structures, there was noticed an intense ductular reaction – proliferation of the biliary ductular epithelium, particularly in the peripheral areas of hepatic lobules, and at the level of limiting plate. There were seen signs of cholestasis in the intralobular canaliculi (biliary thrombi), as well as deposits of biliary pigments in hepatocytes’ cytoplasm. The interlobular biliary ducts were deformed, compressed by annular fibrous connective fascicles, having a tortuous and unregulated appearance. Both the wall of the gallbladder and the choledochus displayed atrophy, particularly of the mucous stratum, as well as atrophy, sclerosis and hyalinosis of the fibro-muscular stratum, and thickening of the serous membrane. Conclussions: The morphological injuries of the intra- and extrahepatic billiary system in cirrhosis favor the abnormalities of biliary low, progress of cholestasis, and changes in the composition and physical-chemical features of bile, leading to a decreased tonus, motility and evacuation capacity of gallbladder, altogether constituting a favorable foundation for the development of cholelithiasis

Исследование психометрических качеств опросников Minnesota LHF Q, MacNew Heart Disease HRQL и MOS SF-36 у больных с хронической сердечной недостаточностью ишемического происхождения

Department of Chronic Heart Failure, Institute of Cardiology, State University of Medicine and Pharmacy „Nicolae Testemitanu”, Chisinau, Republic of MoldovaUntil now there have not been validated instruments that assess the quality of life in patients with cardiovascular disease in the Republic of Moldova. The 6 stages of Minnesota LHF Q, MacNew Heart Disease HRQL and MOS SF-36 questionnaires were validated, followed by a pilot study – 337 patients with ischemic chronic heart failure in II-III NYHA functional classes. To determine the psychometric qualities of the questionnaires we performed a test-retest method looking at correlations between the components of the questionnaires and quality of life indices, which were analyzed according to the age, sex, living environment, and studies. Our results demonstrated the questionnaires’ reliability and validity through the indication of linguistic validation that had been carried out successfully. Thus, it can be a methodological basis for future clinical trials in the Republic of Moldova.В настоящее время в Республике Молдова инструменты для оценки качества жизни пациентов с сердечно-сосудистой патологией не валидированы. Нами были выполнены все 6 этапов валидации трёх опросников (Minnesota LHF Q, MacNew Heart Disease HRQL и MOS SF36), с последующим проведением пилотного исследования – 337 пациентов с сердечной недостаточностью (ФК II-III NYHA) ишемического происхождения. Чтобы определить психометрические качества опросников было проведено двойное тестирование пациентов, корреляции между компонентами опросников, были проанализированы параметры качества жизни в зависимости от возраста, пола, условий жизни, наличия высшего образования. Полученные результаты продемонстрировали надежность и валидность опросников. Таким образом, проведение данной валидации составит методологическую основу для последующего проведения в нашей стране сравнимых клинических исследований в области кардиологии

Периоперационная эволюция фенотипа хронической сердечной недостаточности у кардиохи- рургических больных.

Background. Heart failure (HF) is a well-defined risk factor for early mortality and morbidity after cardiac surgery.We aimed to analyze the evolution of the clinical phenotype of HF at an early stage after heart surgery.Methods. The study included 126 consecutive patients with established chronic HF who fulfilled the cardiac rehabilitation program after undergoing heart surgery (62.23±8.59 years, 67.5% - men). Subjects were divided into 3 groups according to the clinical phenotype of HF: group 1 - HF with reduced left ventricular (LV) ejection fraction (EF) (HFrEF), group 2 - HF with mildly reduced LV EF (HFmrEF) and group 3 - HF with preserved LV EF (HFpEF). All patients were investigated by electrocardiography, transthoracic echocardiography, 6 minutes walk test and assessment of serum NT-proBNP level. Results. Preoperatively, 23.9% of patients had HFrEF, 24.8% - HFmrEF and 51.3% - HFpEF. Analyzing the evolution of the HF phenotype in the early postoperative period, we found that most patients remained in the same group. However, among patients with preoperative HFmrEF, in 22.2% of patients there was an increase in LV EF over 50% and in 22.2% of patients was determined a reduced LV EF, p&amp;lt;0.001. The most obvious positive dynamic of the HF phenotype was attested in patients with HFrEF, where 37% of them presented a mildly reduced LV EF postoperatively, p &amp;lt;0.001. 78.9% of individuals with HFpEF remained in the same group, but 21% showed a decrease in LV EF, p&amp;lt;0.001. Conclusions. At the early stage after cardiac surgery, the most positive evolution of HF phenotype was noticed in the group of patients with HFrEF. Of the 44.4% of patients with HFmrEF who switched to another HF phenotype, only a half reported an increase in LV EF over 50%. The vast majority of patients with HFpEF had the same HF phenotype postoperatively.Introducere. Insuficiența cardiacă (IC) este un factor de risc bine determinat pentru mortalitate și morbiditate în perioada precoce după intervenție chirurgicală cardiacă. Ne-am propus să analizăm evoluția fenotipului clinic al IC la etapa precoce după suportarea unei operații pe cord. Materiale și metode. Studiul a inclus 126 pacienți consecutivi cu IC cronică stabilită, care au urmat programul de reabilitare cardiacă după suportarea unei intervenții chirurgicale pe cord (62,23±8,59 ani, 67,5% bărbați). Subiecții au fost divizați în 3 grupuri în funcție de fenotipul clinic de IC: grupul 1 - IC cu fracția de ejecție (FE) a ventriculului stâng (VS) redusă (IC-FErVS), grupul 2 - IC cu FE VS ușor redusă (IC-FEurVS) și grupul 3 - IC cu FE VS prezervată (IC-FEpVS). Toți pacienții au fost investigați complex prin electrocardiografie, ecocardiografie transtoracică, test de mers plat 6 minute și evaluarea nivelului seric al NT-proBNP. Rezultate. Preoperator, 23,9% de pacienți au avut IC-FErVS, 24,8% - IC-FEurVS și 51,3% - IC-FEpVS. Analizând evoluția fenotipului de IC în perioada postoperatorie precoce, s-a observat că majoritatea pacienților au rămas în cadrul aceluiași grup. Totuși, dintre pacienții cu IC-FEurVS preoperator, la 22,2% bolnavi s-a atestat IC-FEpVS la etapa postoperatorie precoce, iar la 22,2% dintre bolnavi s-a determinat IC-FErVS, p&amp;lt;0,001. Cea mai evidentă dinamică pozitivă a fenotipului de IC s-a atestat la pacienții cu IC-FErVS, unde 37% dintre aceștia au prezentat postoperator o FE VS ușor redusă, p&amp;lt;0,001. 78,9% dintre indivizii cu IC-FEpVS au rămas în același grup, iar 21% au manifestat o diminuare a fracției de ejecție a VS, p&amp;lt;0,001. Concluzii. În grupul de pacienți cu IC-FErVS s-a remarcat o dinamică pozitivă mai importantă a fenotipului IC la etapa precoce după intervenția chirurgicală cardiacă. Dintre cei 44,4% de pacienții cu IC-FEurVS care au manifestat tranziția spre un alt fenotip de IC, doar jumătate a atestat majorarea FE VS peste 50%. La majoritatea covârșitoare a pacienților cu IC-FEpVS s-a stabilit același fenotip al IC postoperator.Вступление. Сердечная недостаточность (СН) является установленным фактором риска смертности и заболеваемости в раннем периоде после кардиохирургического вмешательства. Целью исследования было проанализировать эволюцию клинического фенотипа СН на ранней стадии после операции на сердце. Методы. В исследовании были включены 126 последовательных пациентов с признаками и симптомами хронической СН, госпитализированных для кардиологической реабилитации после операции на сердце (62,23±8,59 года, 67,5% - мужского пола). Пациенты были разделены на 3 группы в соответствии с клиническим фенотипом СН: 1 группа - СН со сниженной фракцией выброса (ФВ) левого желудочка (ЛЖ) (СНснФВ), 2 группа - СН с промежуточной ФВ ЛЖ (СНпФВ) и 3 группа - СН с сохраненной ФВ ЛЖ (СНсохрФВ). Все пациенты были обследованы с помощью электрокардиографии, трансторакальной эхокардиографии, теста 6-минутной ходьбы и определения уровня мозгового натрийуретического пептида. Результаты. До операции, 23,9% пациентов имели СНснФВ, 24,8% - СНпФВ и 51,3% - СНсохрФВ. Анализируя эволюцию фенотипа СН в раннем послеоперационном периоде, можно отметить, что большинство пациентов остались в той же группе. Однако среди пациентов с СНпФВ в предоперационном периоде, у 22,2% больных отмечалось увеличение ФВ ЛЖ выше 50% на раннем послеоперационном этапе, а у 22,2% пациентов определялась сниженная ФВ ЛЖ, p&amp;lt;0,001. Наиболее очевидная положительная динамика фенотипа СН отмечена у пациентов с СНснФВ, так как у 37% из них после операции ФВ ЛЖ стала выше 40%, p&amp;lt;0,001. 78,9% больных с СНсохрФВ осталось в той же группе, но 21% показали снижение ФВ ЛЖ, p&amp;lt;0,001. Выводы. В группе пациентов с СНснФВ отмечена наиболее очевидная положительная динамика фенотипа СН на раннем этапе после кардиохирургического вмешательства. Из 44,4% пациентов с СНпФВ у которых отмечен переход к другому фенотипу СН, только у половины больных ФВ ЛЖ превысила уровень 50%. Среди пациентов с СНсохрФВ перед операцией на сердце ФВ ЛЖ сохранялась выше 50% в подавляющем большинстве случаев и после кардиохирургического вмешательства

Hyponatraemia and changes in natraemia during hospitalization for acute heart failure and associations with in-hospital and long-term outcomes – from the ESC-HFA EORP Heart Failure Long-Term Registry

Aims To comprehensively assess hyponatraemia in acute heart failure (AHF) regarding prevalence, associations, hospital course, and post-discharge outcomes.Methods and results Of 8298 patients in the European Society of Cardiology Heart Failure Long-Term Registry hospitalized for AHF with any ejection fraction, 20% presented with hyponatraemia (serum sodium &lt;135 mmol/L). Independent predictors included lower systolic blood pressure, estimated glomerular filtration rate (eGFR) and haemoglobin, along with diabetes, hepatic disease, use of thiazide diuretics, mineralocorticoid receptor antagonists, digoxin, higher doses of loop diuretics, and non-use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and beta-blockers. In-hospital death occurred in 3.3%. The prevalence of hyponatraemia and in-hospital mortality with different combinations were: 9% hyponatraemia both at admission and discharge (hyponatraemia Yes/Yes, in-hospital mortality 6.9%), 11% Yes/No (in-hospital mortality 4.9%), 8% No/Yes (in-hospital mortality 4.7%), and 72% No/No (in-hospital mortality 2.4%). Correction of hyponatraemia was associated with improvement in eGFR. In-hospital development of hyponatraemia was associated with greater diuretic use and worsening eGFR but also more effective decongestion. Among hospital survivors, 12-month mortality was 19% and adjusted hazard ratios (95% confidence intervals) were for hyponatraemia Yes/Yes 1.60 (1.35- 1.89), Yes/No 1.35 (1.14-1.59), and No/Yes 1.18 (0.96-1.45). For death or heart failure hospitalization they were 1.38 (1.21- 1.58), 1.17 (1.02- 1.33), and 1.09 (0.93-1.27), respectively.Conclusion Among patients with AHF, 20% had hyponatraemia at admission, which was associated with more advanced heart failure and normalized in half of patients during hospitalization. Admission hyponatraemia (possibly dilutional), especially if it did not resolve, was associated with worse in-hospital and post-discharge outcomes. Hyponatraemia developing during hospitalization (possibly depletional) was associated with lower risk

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC

2016 ESC on Acute and Chronic H