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Objective To study clinically the feasibility of early diagnosis of cardiac allograft vascularopathy (CAV) and chronic rejection. Methods A 13 year old female patient with dilated cardiomyopathy received orthotopic heart transplantation for advanced heart failure, and subsequent immunosuppressive therapy including cyclosporine, prednisone and mofetil, and a monthly close follow up. Coronary angiography and left ventricular endomyocardial biopsy (EMB) was performed 9 months after the operation. Results The clinical and follow up data of the case showed that cardiac or systemic nonspecific symptoms such as exertional chest discomfort, palpitation, fatigue or fever of unknown reasons were the first and ignorable clinical symptoms, and found disappeared after dosage addition of cyclinsporine, which indicated a early clinical manifestations of rejection or vasculopathy. While persistent sinus tachycardia on electrocardiogram, decreased left ventricular ejection fraction (from 64?% ～68?% down to 47?%～50?%), enlarged right atrial (from 32～ 41?mm up to 44?mm in diameter), thickened intraventricular septal ( 13?mm ), repetitive tricuspid regurgitation on echocardiography, increased white blood cells without infection were observed respectively. Coronary angiography showed a typical (type B) vasculopathy with diffuse concentric stenosis of mid and distal left anterior descending artery and its small braches, the distal diagonal, circumflex, and right coronary artery were also involved to some extent. Furthermore, early mild chronic rejection of grade I A was proved by pathologic study. Conclusion Close clinical observation and follow up, serial echocardiography and electrocardiogram, reaction to enhanced anti rejection, and other related laboratory methods could be analyzed and colligated for early noninvasive diagnosis of cardiac allograft vasculopathy and chronic rejection, while EMB and coronary angiography are still the precise diagnostic ways.
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PurposeTo observe the effects of blocking the renin-Angiotensin-Aldosterone system at different sites in experimental congestive heart failure (CHF)rats. Methods Six weeks after coronary ligation, rats( n = 66)were randomized to benalapril, losartan, spironolactone, placebo, and treated for 6 weeks. Sham-operated rats( n = 18) served as controls. Six weeks later left ventricular hemodynamics were measured. Results In the hemodynamic variables, HR was not significantly different between groups. Compared four treatment groups with sham-operated group, LVEDP increased, LVPSP and ± dp/dtmax decreased (P＜0.05). Compared with placebo group,all data in spironolactone group were not significantly different, LVEDP, mortality in benalapril group and in losartan group decreased, LVPSP and ± dp/dtmax in benalapril group and in losartan group increased(P ＜ 0.05). ConclusionsAdministration of ACEI and Ag Ⅱ-AT1 antagonist are effective in preventing from cardiac function deterioration, while spironolactone treatments are not. Spironolactone has tendency in decreasing LVEDP.
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AIM: To investigate the dynamic alteration of cardiac collagen metabolism in mice with acute,chronic myocarditis and dilated cardiomyopathy(DCM).METHODS: BALB/c mice infected with coxsackievirus B_3 were used to establish animal models of acute,chronic myocarditis and dilated cardiomyopathy,while uninfected animals were also prepared and served as controls.After verification of models by histopathological methods and echocardiography,serum concentration of aminoterminal propeptide of type Ⅲ procollagen(PIIINP),aminoterminal propeptide of type Ⅰ procollagen(PINP) and carboxyterminal propeptide of type I procollagen(PICP) in each group of mice were detected by enzyme linked immunosorbent assay(ELISA).The expression of matrix metalloproteinase 1(MMP1) and its tissue inhibitor(TIMP-1) were determined by Western blotting analysis.The MMP-1 activity was also detected.RESULTS: Marked myocardial fibrosis was observed in all groups of CVB_3-infected mice.Reparative fibrosis,promotion of synthesis and degradation of cardiac collagens were presented in heart tissue of acute myocarditis mice. Both reparative and reactive fibrosis,enhanced synthesis and lightened degradation of collagen were present in chronic myocarditis,while reactive fibrosis and excess collagen synthesis were confirmed in DCM.Expression and activity of(MMP-1) was progressively decreased.TIMP-1 showed unchanged.The ratio of MMP-1/TIMP-1 was progressively descended.CONCLUSION: Collagen metabolism was special in different phase of viral heart diseases,which may play different roles in the progression and prognosis of these kinds of disease.