Anti Heart Research Articles

Diagnosis and treatment of arrhythmogenic cardiomyopathy in children

Objective: To summarize the clinical manifestations, experiences in diagnosis and treatment of arrhythmogenic cardiomyopathy (ACM) in children. Methods: A retrospective analysis of the clinical manifestations, laboratory tests, radiological features, treatment and follow-up results was conducted in 11 children diagnosed with ACM at the center of congenital heart disease, Beijing anzhen hospital from May 2010 to March 2022. Results: A total of 11 patients aged 2 to 16 years, including 5 males and 6 females were diagnosed with ACM. The clinical manifestations included decreased activity tolerance (7 patients), heart failure (4 patients), syncope or sudden death (3 patients), palpitation (3 patients), and chest tightness and pain (3 patients). Electrocardiogram showed right bundle branch block in 9 cases, paroxysmal ventricular tachycardia in 4 cases, frequent premature ventricular contraction in 4 cases, ventricular pre-excitation in 1 case, left bundle branch block in 1 case, and first degree atrioventricular block in 2 cases. Echocardiography showed enlargement of the right heart, widening of the right ventricular outflow tract, and thinning and bulging of the local wall of the right ventricle with reduced pulsation. Ventricular thrombosis was found in 2 cases. Six children underwent cardiac magnetic resonance imaging, which mainly showed severe enlargement of the right heart, thin free wall of the right ventricle, decreased right heart function, enhanced right ventricular myocardium, and formation of right ventricular aneurysm. Two children underwent myocardial biopsy examination and presented with typical pathological changes of ACM. Genetic tests in five patients revealed DSG2 gene mutation in 2 cases, PKP2 gene mutation in 2 cases, and MYH6 gene mutation in 1 case. All patients received anti heart failure treatment and antiarrhythmic drugs. Two children received anticoagulant treatment due to ventricular thrombosis. Radiofrequency ablation was performed in 2 patients. Glenn procedure was performed in 4 patients, and heart transplantation was performed in 1 patient due to progressive heart failure. The follow-up period ranged from 6 months to 12 years. Two cases died of right heart failure, 6 cases had different degrees of heart failure, 1 case had intermittent chest tightness and pain, and 2 cases were stable. Conclusions: ACM is a progressive genetic cardiomyopathy characterized by decreased activity tolerance, cardiac failure and arrhythmia in pediatric patients. The diagnosis is mainly based on clinical manifestations, electrocardiogram, cardiac imaging changes, and genetic testing. Early detection, diagnosis, and personalized treatment can improve the prognosis.

P369 AUTOIMMUNE LYMPHOCYTIC MYOCARDITIS: ONE SIZE DOES NOT FIT ALL

Abstract Fulminant myocarditis (MF) is an acute onset, rapidly progressive and potentially fatal inflammatory cardiomyopathy which could manifests with cardiogenic shock and incessant arrhythmias. There is often a need for aminic or mechanical support to the circulation in the acute phase, waiting to obtain a histological diagnosis as quickly as possible to establish a specific therapy. Mortality in the acute phases is high, with a worse prognosis than in other forms of presentation of myocarditis, even in the long term. We report the case of a 45–year–old Asian woman suffering from autoimmune hypothyroidism, who had been reporting atypical chest pain for about 3 days, associated with fever, asthenia, and vomiting. On admission, the patient was in cardiogenic shock; an echocardiogram revealed biventricular dysfunction. Pulmonary embolism and acute coronary syndrome were excluded. Blood tests showed a significant troponin rise, neutrophilic leukocytosis, and hypertransaminasemia. Anti heart antibodies (AHA) were negative. Amine support with dobutamine and norepinephrine was then started. The first EKG showed an advanced atrioventricular block with a ventricular escape with the need for emergency temporary PM placement. Right heart catheterization showed pressures in the pulmonary circulation at the upper limits with average resistance and reduced cardiac index. An endomyocardial biopsy (EMB) was performed, subsequently complicated by cardiac tamponade due to lead displacement, treated with urgent pericardiocentesis. At the end of the procedure, the appearance of incoming episodes of complete BAV was highlighted, for which ICD implantation was performed. The biopsy showed virus–negative diffuse acute lymphocytic myocarditis. Cortisone therapy was therefore started, with immediate benefit, until the aminic support was suspended. A follow–up echocardiogram showed a complete recovery of normal biventricular function. In MF, early diagnosis, and the possibility of establishing specific therapy are crucial to reduce mortality. EMB is the only method that allows you to make an etiological diagnosis and exclude a possible infectious genesis. The patient‘s prognosis, in fact, in addition to supportive therapy, depends on the possibility of establishing a targeted treatment as soon as possible, which in virus–negative autoimmune forms consists of an immunosuppressive therapy modulated on the patient‘s histological type and clinic.

Clinical Efficacy of Tapazole Integrated with Anti Heart Failure Drugs in the Remedy of Hyperthyroidism Merged with Heart Failure

Clinical Efficacy of Tapazole Integrated with Anti Heart Failure Drugs in the Remedy of Hyperthyroidism Merged with Heart Failure

Predictors of relapse, death or heart transplantation in myocarditis before the introduction of immunosuppression: negative prognostic impact of female gender, fulminant onset, lower ejection fraction and serum autoantibodies.

Outcome predictors in myocarditis are not well defined; we aimed at identifying predictors of death, heart transplantation (HTx) and relapse before the introduction of immunosuppression. From 1992 to 2012, 466 consecutive patients (68% male, mean age 37 ± 17 years, single centre recruitment, median follow-up 50 months) were included, of whom 216 had clinically suspected and 250 biopsy-proven myocarditis. Serum anti-heart (AHA) and anti-intercalated disk (AIDA) autoantibodies were measured by indirect immunofluorescence. Univariable and multivariable analyses of clinical and diagnostic features at diagnosis were performed. Survival free from death or HTx at 10 years was 83% in the whole study population and was lower in biopsy-proven versus clinically suspected myocarditis (76% vs. 94%, p < 0.001). Female gender (hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.1-6.5), fulminant presentation (HR 13.77, 95% CI 9.7-261.73), high-titre organ-specific AHA (HR 4.2, 95% CI 1.2-14.7) and anti-nuclear antibodies (ANA) (HR 5.2, 95% CI 2.1-12.8) were independent predictors of death or HTx; higher echocardiographic left ventricular ejection fraction (LVEF) at diagnosis was protective, with a 0.93-fold risk reduction for each 1% LVEF increase (95% CI 0.89-0.96). History of myocarditis at diagnosis (HR 8.5, 95% CI 3.5-20.7) was an independent predictor of myocarditis relapse at follow-up; older age was protective (HR 0.95, 95% CI 0.91-0.99). Predictors of death, HTx and relapse did not differ in biopsy-proven versus clinically suspected myocarditis. Young age and a previous myocarditis were independent relapse predictors; female gender, fulminant onset, lower LVEF at presentation and high-titre organ-specific AHA and ANA were independent predictors of death and HTx, suggesting that autoimmune features predict worse prognosis.

Serum Organ-Specific Anti-Heart and Anti-Intercalated Disk Autoantibodies as New Autoimmune Markers of Cardiac Involvement in Systemic Sclerosis: Frequency, Clinical and Prognostic Correlates.

Background: Heart involvement (HInv) in systemic sclerosis (SSc) may relate to myocarditis and is associated with poor prognosis. Serum anti-heart (AHA) and anti-intercalated disk autoantibodies (AIDA) are organ and disease-specific markers of isolated autoimmune myocarditis. We assessed frequencies, clinical correlates, and prognostic impacts of AHA and AIDA in SSc. Methods: The study included consecutive SSc patients (n = 116, aged 53 ± 13 years, 83.6% females, median disease duration 7 years) with clinically suspected heart involvement (symptoms, abnormal ECG, abnormal troponin I or natriuretic peptides, and abnormal echocardiography). All SSc patients underwent CMR. Serum AHA and AIDA were measured by indirect immunofluorescence in SSc and in control groups of non-inflammatory cardiac disease (NICD) (n = 160), ischemic heart failure (IHF) (n = 141), and normal blood donors (NBD) (n = 270). AHA and AIDA status in SSc was correlated with baseline clinical, diagnostic features, and outcome. Results: The frequency of AHA was higher in SSc (57/116, 49%, p < 0.00001) than in NICD (2/160, 1%), IHF (2/141, 1%), or NBD (7/270, 2.5%). The frequency of AIDA was higher (65/116, 56%, p < 0.00001) in SSc than in NICD (6/160, 3.75%), IHF (3/141, 2%), or NBD (1/270, 0.37%). AHAs were associated with interstitial lung disease (p = 0.04), history of chest pain (p = 0.026), abnormal troponin (p = 0.006), AIDA (p = 0.000), and current immunosuppression (p = 0.01). AHAs were associated with death (p = 0.02) and overall cardiac events during follow-up (p = 0.017). Conclusions: The high frequencies of AHA and AIDA suggest a high burden of underdiagnosed autoimmune HInv in SSc. In keeping with the negative prognostic impact of HInv in SSc, AHAs were associated with dismal prognosis.

Immunosuppression and outcomes of myocarditis patients presenting with ventricular arrhythmias

Abstract Background Effects of immunosuppressive therapy (IST) on ventricular arrhythmias (VA) have not been reported in immune-mediated biopsy-proven myocarditis patients. Furthermore, myocarditis arrhythmic risk is still unpredictable. The aim of our study was to evaluate effectiveness of IST on VA in myocarditis patients, and stratify their arrhythmic risk, using clinical and diagnostic features, including serum organ-specific anti-heart (AHA) and antiintercalated-disk autoantibodies (AIDA). Methods From a cohort of 498 consecutive patients, we enrolled 255 cases with biopsy-proven virus-negative myocarditis and evidence of VA (VF, VT, NSVT, and Lown's grade ≥2 PVC) at index hospitalization. Serum AHA and AIDA were detected by a standardised indirect immunofluorescence technique. Whenever accepted and non-contraindicated, IST was started. Controls (IST-) were chosen after 1:1 matching to IST+ cases by age, gender, ethnicity, left ventricular ejection fraction, VA type, and treatment. Prospective follow-up (FU), occurred at defined timepoints. Results 58 matched patient couples (42±13 y, 67% males, 50% IST+) were analyzed in the main study cohort. Overall, 28 (24%) had VT, and 62 (53%) were discharged with ICD. IST duration was 12±1 months. No patients died and no serious complications from IST occurred. By 24-month FU, major VA occurred in 6 IST+ vs. 10 IST- patients (p=0.420), with no cases of VT following IST termination. As compared to IST- ones, IST+ patients showed a significant reduction in NSVT and PVC burden, as well as an improvement in clinical, laboratory and imaging findings (all p&amp;lt;0.05). Major VA onset and positive AIDA status were independently associated with major VA at FU (HR 14.2, 95% CI 2.9–68.7, and 8.0, 95% CI 2.6–25.2, respectively, both p&amp;lt;0.001). Furthermore, in the whole study population (N=255), IST played as an independent protective factor from major VA (HR 0.3, 95% CI 0.2–0.7, p=0.005) at 38±21 months FU. Conclusions In immune-mediated virus-negative myocarditis patients presenting with VA, IST is feasible and effective on NSVT and PVC burden, as well as on structural, laboratory and imaging endpoints. Short-term effects are limited on major VA, which were independently associated with major arrhythmic onset and positive AIDA, in keeping with the proposed etiopathogenetic involvement of autoimmunity in virus-negative myocarditis. Funding Acknowledgement Type of funding source: None

Predictors of death and heart transplantation in biopsy-proven myocarditis: a machine-learning approach

Abstract Background Risk stratification for death and heart transplantation (HTx) in myocarditis is complex. A random forest (RF) is a tree-based machine learning technique (MLT) which is being increasingly used for clinical data analysis; it allows the detection of complex relationships between the outcome of interest and the covariates, overcoming the limits of traditional statistical analysis (i.e. regression approaches). Purpose To assess the potential role of clinical and diagnostic features at presentation as predictors of death and HTx in biopsy (Bx)-proven myocarditis using RF. Methods From January 1993 to August 2019, we consecutively enrolled 357 patients with Bx-proven myocarditis (65% male, median age 39 years, interquartile range (IQR) 26–51). An RF approach for survival data was used. Variables included in the analysis were: histology type by Bx, NYHA, type of presentation (infarct-like, arrhythmia, heart failure), viral genome detection on Bx, serum antiheart (AHA), antiintercalated disk (AIDA), anticardiac endothelial cells (AECA), antinuclear (ANA) autoantibodies, immunosuppressive therapy, cardiac catheterisation (left ventricular enddiastolic volume (LVEDV), mean capillary wedge pressure, right and left ventricular enddiastolic pressure) and 2-D echocardiographic measures (LVEDV, left ventricular ejection fraction (LVEF) at presentation and at follow-up, right ventricular fractional area change (FAC%), right ventricular diastolic area). Results The median follow-up time was of 1352 days (IQR 423.25–2535.75). At the end of follow-up, 42 patients were dead or transplanted. The 1-year, 5-year, and 10-year survival probabilities were of 0.928, 0.854, and 0.817, respectively. The most relevant predictors of death or HTx identified by the RF algorithm (according to the variable importance measure) were histological type, NYHA, clinical presentation, LVEF, and FAC%. Among the circulating auto-antibodies AECA were found to be the most important. Histological type was the strongest predictor of death/HT (100% relative importance, (RI)), giant cell myocarditis having a lower survival probability compared to other types. The next stronger predictors were advanced (III-IV) NYHA and heart failure presentation with lower survival probabilities (90% and 84% RI respectively). AECA-positive patients had lower survival probability compared to AECA negative ones (20% RI). The RF algorithm revealed an excellent predictive performance in the correct identification of all alive patients, with only 5 dead patients being misclassified (balanced accuracy 94%). Conclusions Autoimmune features, i.e Giant cell myocarditis and AECA, as well as severity of heart failure and of left ventricular disfunction at presentation were the strongest predictors of dismal prognosis. Our RF approach provides a new automated powerful tool for accurate risk stratification for death/HTx in Bx-proven myocarditis. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Budget Integrato per la Ricerca dei Dipartimenti (BIRD, year 2019), Padova University, Padova, Italy (project Title: Myocarditis: genetic background, predictors of dismal prognosis and of response to immunosuppressive therapy.)

Diagnostic Usefulness of Histological Examination of the Left Ventricular “Core” Excised to Insert a Left Ventricular Assist Device in Patients With Severe Heart Failure

The left ventricular assist device (LVAD) has proven to be beneficial for patients with severe heart failure poorly responsive to anti heart failure medicine. To examine both grossly and histologically the portion of left ventricular (LV) free wall excised ("the left ventricular core") to insert a LVAD in 337 patients with severe heart failure from a variety of causes. We collected together all photographs of LV "cores" and the histologic sections prepared from them and reexamined both. Despite the fact that these LV cores usually weighed >100 times the quantity of myocardium available to examine compared with that available by biotome inserted via a transvenous catheter, the number in which histologic study allowed an unequivocal diagnosis was limited. Examination of the clinical records usually was required to establish the definitive diagnosis. Although the presence of a scarred myocardial wall usually suggested ischemic cardiomyopathy (IC), the scarring may not have involved the LV apex resulting in a nonscarred portion of myocardium simulating idiopathic dilated cardiomyopathy (IDC). Moreover, about 10% of the patients with IDC have myocardial scars thus simulating IC. Involvement of the LV core by amyloid, sarcoid, myocarditis, and acute infarction, of course, allowed a specific anatomic diagnosis. Despite the presence of ample tissue to secure a definitive diagnosis, the combination of clinical input and morphologic assessment was required to arrive at a definite diagnosis in most patients.

P5557Cardiac autoantibodies and ventricular arrhythmias in patients with biopsy-proved myocarditis

Abstract Background Cardiac autoandibodies have been associated with dilatative cardiomyopathy in subjects with inflammatory heart disease. However, their association with ventricular arrhythmias (VA) in patients with autoimmune myocardits has never been investigated so far. Purpose To evaluate the association between cardiac autoantibodies and both baseline and FU VA in patients with a de novo diagnosis of biopsy-proved autoimmune myocarditis. Methods We enrolled 44 consecutive patients (59% males, mean age 44±13y, mean LVEF 50±10%) presenting with symptomatic VA (VF, VT, NSVT, &gt;1ehz746.0501 PVC/24h) and a de novo diagnosis of biopsy-proved autoimmune myocarditis according to the ESC criteria. Serum anti-heart (AHA) and anti-intercalated disk (AIDA) autoantibodies were assessed at a referral center at the time of the index hospitalization. Complete baseline data, including ECG, arrhythmia telemonitoring, echocardiogram, cardiac magnetic resonance (CMR) and blood biomarkers (T-troponin, NT-proBNP) were collected. The endpoint of the study was the occurrence of major VA (VT, VF, appropriate ICD shocks) at 5y FU, as assessed by 2/y Holter ECG monitoring and (when applicable) ICD interrogation. Results At baseline evaluation, 24 (55%) and 23 patients (52%) were AHA+ and AIDA+, respectively. Clinical onset with major VA was documented in 24 patients (55%): 9 AHA+ vs. 15 AHA- (p=0.017) and 13 AIDA+ vs. 11 AIDA- (p=0.547). At presentation, no significant differences were found between AHA+ vs. AHA- and AIDA+ vs. AIDA- patients in LVEDV, LVEF, T-troponin and NT-proBNP values (all p=n.s.). Positive (2/3) Lake Louise criteria at CMR were found in 33 patients (75%; p=n.s. among different subgroups). Before discharge, 27 subjects (61%) underwent ICD implant. Optimal medical treatment was started in all of the cases, with no significant differences in betablockers, antiarrhythmic drugs and immunsuppressive therapy, among different subgroups (all p=n.s.). Overall, 10 patients (23%) experienced major VA by 5y FU: 3 AHA+ vs. 7 AHA- (p=0.147) and 9 AIDA+ vs. 1 AIDA- (p=0.013). In particular, 18 events were documented (range 1–3 episodes per patient at 2.2±1.7 y mean FU), including 3 VT episodes and 15 appropriate ICD shocks. Taking together baseline and FU data, multiple (&gt;1) major VA episodes occurred in 8 patients: 3 AHA+ vs. 5 AHA- (p=0.436) and 8 AIDA+ vs. 0 AIDA- (p=0.005). Of note, 3/3 AHA+ patients with multiple major VA espisodes were also AIDA+ (double positivity). Conclusion In biopsy-proved autoimmune myocarditis presenting with VA, major VA occurrence by 5y FU, as well as arrhythmias recurrences, are more common among AIDA+ patients. By converse, none of the isolated AHA+ cases experienced multiple episodes of major VA. These findings may suggest distinct pathophysiological mechanisms involving the different molecular targets of cardiac autoimmunity. Acknowledgement/Funding None

Prediction of Xanton Derivatives as Anti Heart Cancer using In Silico Quantitative Structure-Property Relationships

Quantitative Structure-Activity Relationship (QSAR) study have been performed on Xanthone derivatives as anti-cancer activity. The objectives of this research is to design a new Xanthone derivatives from the best QSAR equation model. The data set were taken from the previous study, involving 41 Xanthone derivatives and their biology activities in Inhibitor Concentration 50 % (IC50). The parameters (descriptors) were calculated by semiempirical PM3 method. The selection of the best QSAR equation models was determined by multilinear regression analysis. The best linear equation resulted from that analysis is: Log 1/IC50 = 13,099 + 2,837 qC1 + 0,098 qC2 + 11,214 qC10 + 2,065 qC13 – 1,236 qC14 + 35,356 qO15 + 0,001 (vol) – 0,025 (log P) + 0,283 (dipole) n = 41; r = 0.735; adjusted r2 = 0.360; Fhit/Ftab = 1.2911; PRESS = 5.0089. Based on that model, a new Xanthon derivatives has been design which show better predicted biology activity (log 1/IC50= 15,0863), new derivatives have the log 1/IC50 higher than the old one (log 1/IC50= 9). This result indicated that new Xanthone derivatives has potential to developed as new anti-cancer drug

Influence of erythropoietin therapy with oral iron supplementation on red blood cell distribution width in chronic heart failure patients with anemia

Objective To analyze the effect of erythropoietin therapy with oral iron supplementation on red blood cell distribution width(RDW)in chronic heart failure patients with anemia. Methods 148 patients of chronic heart failure with anemia from September 2014 to March 2015 in our hospital were included and randomly divided into two groups with the random number table, with 74 cases in each group. The control group were treated with conventional anti heart failure therapy, the treatment group were treated with erythropoietin and oral iron supplementation on the basis of routine treatment for four weeks. RDW was tested by automatic five classification blood analyzer. The correlation between RDW and other detection indexes was analyzed. Results The levels of RDW in the treatment group were significantly lower than those of the control group［(13.08±0.792)vs(14.32±0.864),t＝-8.974,P＜0.01］. Before treatment, bivariate analysis in the treatment group showed that RDW had positive correlation with NT -proBNP and high-sensitivity C-relative protein(hs-CRP)(r＝0.783,P＜0.01;r＝0.870,P＜0.01), but negative correlation with serum creatinine(Cr)and hemoglobin(r＝-0.338,P＜0.01;r＝-0.743,P＜0.01). After treatment, bivariate correlations analysis in the treatment group showed that the difference of RDW was positive correlation with the difference of NT-proBNP, high-sensitivity C-relative protein(hs-CRP)(r＝0.783,P＜0.01;r＝0.680,P＜0.01), but negative correlation with the difference of hemoglobin(r＝-0.459,P＜0.01), and no correlation with the others(Cr,UA,LDL,TC,TG and LVEF). Conclusion On the basis of conventional anti heart failure treatment, erythropoietin therapy with oral iron supplementation against anemia could improve heart function of CHF and decrease the levels of RDW.RDW may be served as one of observing indexes of the worsening and effect judgment in chronic heart failure patients with anemia. Key words: Erythropoietin production; Iron; Heart failure, Congestive; Anemia; Red blood cell distribution width

Effect of non finasteride on elderly male patients with chronic heart failure combined with benign prostatic hyperplasia

Objective To investigate clinical efficacy of finasteride on chronic heart failure(CHF)complicated with benign prostatic hyperplasia(BPH)in elderly patients. Methods 100 cases of elderly patients with CHF complicated with BPH were chosen,according to the number table method,they were divided into the observation group and control group,50 cases in each group,all patients were treated according to their cardiac function to regulate anti-CHF therapy.The patients in the observation group were added with finasteride treatment,the control group placebo treated patients,the measurement indexes were compared between the two groups after treatment,including prostate volume,N terminal pro brain natriuretic peptide concentration,creatinine,international prostate symptom score and symptom score,need operation treatment intervention,incidence acute urinary retention rate. Results After treatment, the prostate volume,N terminal pro brain natriuretic peptide concentration,creatinine,international prostate symptom score of symptom scores of the observation group were(23.86±10.27)m L,(352.63±72.55)g/L,(84.0±11.6)mol/ L,(9.3±4.9),those in the control group were(39.11±12.53)mL,(483.46±76.47)g/L,(99.0±12.8)mol/L,(13.9 ±5.6).The difference was statistically significant(t=9.47,17.56,12.33,8.48,all P<0.05);the observation group need operation treatment intervention was 16.0%,obviously less than 52.0%in the control group,there was significant difference between two groups(χ2=21.85,P<0.05);acute urinary retention in patients with the observation group the incidence rate of 14.0%,significantly lower than 38.0%in the control group,there was significant difference between two groups(χ2=12.83,P<0.05). Conclusion Patients with CHF complicated with BPH aged at the same time standard anti heart failure treatment using finasteride,significantly reduce the prostate volume,reduce the measurement indexes,and significantly reduce the rate of operation intervention patients,safe and reliable,which is worthy of clinical application. Key words: Heart failure; Hyperplasia of prostate; Finasteride; Aged

Effect of trimetazidine in treatment of ischemic cardiomyopathy heart failure and its influence on cardiac function and heart rate variability

Objective To investigate the clinical efficacy of trimetazidine in treatment of ischemic cardiomyopathy heart failure and its influence on cardiac function and heart rate variability. Methods 160 cases of patients with ischemic cardiomyopathy heart failure were randomly divided into the two groups with 80 cases in each group.The two groups were given conventional treatment of anti heart failure,the observation group used trimetazidine on basis of that,clinical effect and the influence on the index of heart rate variability and cardiac function of two groups were observed. Results The total effective rate of the observation group was 91.25%,significantly higher than 73.75% of the control group(χ2= 9.57,P< 0.05);LVEDD and LVESD of the observation group after treatment were(49.88±4.60)mm and(37.10±3.15)mm,significantly reduced than before treatment(t= 7.44,7.83,all P<0.05)and the control group(t= 6.60,6.85,all P< 0.05); while the LVEF was(48.04±4.20)%,increased significantly than before treatment(t= 6.51,P<0.05)and the control group(t= 7.11,P< 0.05); SDNN,SDANN,r MSSD and PNN50 of the observation group after treatment were(124.72±7.02)ms,(111.20±5.89)ms,(46.74±4.22)ms and(17.72±2.08)%,increased significantly than before treatment(t= 7.43,7.83,7.06,8.17,all P<0.05)and the control group(t = 6.66,6.90,6.15,7.21,all P<0.05). Conclusion Trimetazidine has an exact effect in treatment of ischemic cardiomyopathy heart failure,which can improve heart function and heart rate variability which has an important value in clinical application. Key words: Cardiomyopathy,ischemic; Heart failure,congestive; Heart rate variability; Trimetazidine

GW24-e3539 The research about the levels of serum N-terminal pro-brain natriuretic peptide, growth differentiation factor 15and troponin T in preoperative and postoperative cardiac resynchronisation therapy

ObjectivesTo study the feasibility to observe and evaluate the curative effect about the heart failure patients with Cardiac Resynchronisation Therapy (CRT), using the concentration changes of serum N-terminal brain natriuretic...

Anti-heart and anti-intercalated disk autoantibodies: evidence for autoimmunity in idiopathic recurrent acute pericarditis

BackgroundIdiopathic recurrent acute pericarditis (IRAP) is a rare disease of suspected, yet unproved, immune-mediated origin. The finding of serum heart-specific autoantibodies in IRAP would strengthen the autoimmune hypothesis and provide...

Introduction of Metoprolol Increases Plasma B-Type Cardiac Natriuretic Peptides in Mild, Stable Heart Failure

The effect of beta-blockade on the cardiac natriuretic peptides is poorly understood but could contribute to their beneficial treatment effect and may be relevant to clinical use of plasma brain natriuretic peptide (BNP)/N-terminal pro brain natriuretic peptide (NTproBNP) measurements in risk stratification and in titration of anti-heart failure therapy. Sixteen men with mild, stable heart failure (NYHA class II to III; left ventricular ejection fraction <40%) underwent serial blood sampling for plasma natriuretic peptide levels and received infusions of atrial natriuretic peptide (ANP) and BNP before and 6 weeks after the introduction and uptitration of metoprolol or 6 weeks unchanged therapy in a randomized, parallel-group design. Plasma natriuretic peptides (BNP, NTproBNP, ANP, and NTproANP) were increased by metoprolol (P<0.01 for all). The natriuretic responses to ANP and BNP infusions were sustained with the introduction of metoprolol despite reduced renal perfusion pressure. The levels of the noninfused natriuretic peptide were increased by both ANP and BNP infusions, and this effect was enhanced by metoprolol. The early plasma half-life (t(1/2)alpha) of BNP was prolonged by metoprolol (5.6+/-0.45 to 11+/-1.3 versus 5.7+/-0.8 to 6.6+/-1.3 minutes in control subjects; P=0.019). Plasma cardiac natriuretic peptide levels increase significantly with the introduction of metoprolol in heart failure as a result of effects on secretion and clearance. Natriuretic responses to NP infusions are sustained with beta-blockade despite reduced renal perfusion pressure. Clinicians should be aware that the introduction of metoprolol causes a rise in plasma BNP/NTproBNP that is unrelated to deterioration in clinical status and must be considered when measurements are undertaken for risk stratification or titration of treatment.

Humoral immune response in post-cardiac injury syndrome

To better understand the pathogenesis of the post-cardiac injury syndrome (PCIS), we studied humoral immune response against heart tissue and the major contractile proteins in 129 patients who underwent cardiac surgery (CS) and 80 patients with acute myocardial infarction (AMI). Serial determinations of anti-heart (AHA), anti-actin (AAA), anti-myosin (AMA), anti-viral antibodies (AVA) and circulating immune complexes (CIC) were made. PCIS was found significantly more frequently after CS than after AMI. In correlation with these clinical results, immune response was significantly more important after CS than after AMI. Furthermore, a significant correlation between PCIS, AHA, AAA, AMA and CIC after cardiac injury could be demonstrated. No correlation was found between PCIS and AVA, nor between humoral immune response and AVA after cardiac injury.

Experimental autoimmune myocarditis in the guinea pig

Male and female guinea pigs underwent immunisation with heterologous heart protein (rat heart), complete Freund's adjuvant and pertussis vaccine (immunised) or normal saline (control) at weekly intervals for 6 weeks, and were subsequently studied. In vivo intracardiac pressures, cardiac outputs, blood volumes, in vitro pressure-volume relations, left ventricular collagen contents, light microscopy, direct immunofluorescence, lymphocyte stimulation studies, and serology for circulating anti heart antibody (haemagglutination and radioimmunoassay) were performed. Immunised guinea pigs studied between 5 and 8 weeks following the immunisation protocol demonstrated a 44% increase in LVEDP (p less than 0.005), an increase in right atrial pressure (p less than 0.001), although no change in aortic pressure or cardiac output when compared with controls. Left ventricular weight was increased 20% (p less than 0.001), and in vitro left ventricular volume by 34% (at 8 mmHg distending pressure, p less than 0.001). Lung wet weight was increased 44% (p less than 0.005), and left ventricular collagen content increased 60% (p less than 0.001). Cultured lymphocytes from treated guinea pigs demonstrated a 1.5- to 4.5-fold (dependent upon proximity to last immunisation) increase in radiolabelled thymidine uptake when incubated with guinea pig heart protein compared to controls (p less than 0.001), and circulating anti guinea pig heart antibodies were detected by haemagglutination and radioimmunoassay. Histological examination of the left ventricles revealed inflammatory cell infiltration and myocyte increase to varying degrees in 15 of the 18 treated animals. We conclude that inflammatory, probably immune-mediated, chronic myocarditis can be produced in the guinea pig.