Russian Heart Failure Journal 2008year Peculiarities of transplanted heart regional mechanics during episodes of acute humoral rejection in relation with the condition of local hemostasis system

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Peculiarities of transplanted heart regional mechanics during episodes of acute humoral rejection in relation with the condition of local hemostasis system

Naydich A.M., Shumakov D.V., Kupriyanova A.G., Beletskaya L.V., Babushkina N.A.., Chestukhin V.V., Mironkov B.L., Blyakhman F.A.



Urgency. Episodes of acute humoral rejection (AHR) in the postoperative period are known to provoke coronary disease and represent the major factor limiting long-term functioning of a transplanted heart (TH). Aim. Studying the function of TH LV wall during AHR episodes in relation to the presence of fibrin in myocardial microcirculation and interstitium. Materials and methods. Study included 10 patients who were evaluated using angiographic and echoCG methods in different time after TH (overall 38 evaluations). Based on results of immunohistochemical analysis of endomyocardial biopsy (EMB) samples the cohort was divided into 2 groups. Group I (without fibrin in microcirculation) included 20 cases; group II (with fibrin) – 18 cases. All 38 cases were similar with respect of AHR severity (I–II degree), time after TH and the condition of coronary arteries. Intracardiac hemodynamics was evaluated using heart chamber and blood vessel manometry. Functional condition of LV walls was evaluated by movements of 12 regions in the course of entire cardiac cycle. Based on these results variation coefficients (VC) were calculated for the following parameters: 1) 12 regional ejection fractions as a dissimilarity parameter for contribution of a region to the overall LV ejection fraction, and 2) asynchronous region movement parameters for the entire cardiac cycle (D) and its systolic (Ds) and diastolic parts (Dd). Results. Of all intracardiac hemodynamic parameters, only right atrial pressure and lung artery pressure appeared significantly higher in group II than in group I. At the same time all used parameters of LV wall function had significantly lower values in group I than in group II: CV 20.5 ± 2.5 and 34.3 ± 5.7 %, р<0.05; D 0.33 ± 0.03 and 0.60 ± 0.04; Ds 0.33 ± 0.03 and 0.61 ± 0.05; Dd 0.38 ± 0.03 and 0.65 ± 0.05 conv. units, respectively, p<0.001. It was concluded that the impaired prothrombotic endothelial activity during AHR is associated with increased mechanical asynchronicity of the myocardium evident as increased dissimilarity of region contributions to the overall LV ejection fraction.
Study supported by the RF President grant.
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