ABSTRACT
In 22 patients with heart failure and/or ventricular arrhythmias presumably of inflammatory etiology the results of clinical and instrumental investigation were analyzed and compared to the endomyocardial biopsy data. In the subgroup of patients with left bundle branch block (LBBB) we revealed features indicative of lesser contribution of inflammatory destruction in pathogenesis of cardiomyopathy. The only virus, detected in biopsy samples, was parvovirus B19. Its persistence in myocardium was not related to activity of inflammation and severity of clinical course. Increased expression of Coxsackie adenovirus receptor (CAR) was found in 20 patients. It was not related to inflammatory cells infiltration and virus persistence in myocardium. Patients with most prominent CAR expression were characteried by right heart dilatation, more severe heart failure and absence of LBBB. Enhancement of CAR expression could reflect the attempt of organism to repair intercellular communications between cardiomyocites and to protect cells from the products of necrotic lysis during long standing inflammation.
Subject(s)
Arrhythmias, Cardiac , Coxsackie and Adenovirus Receptor-Like Membrane Protein/immunology , Heart Conduction System/abnormalities , Heart Failure , Heart Ventricles , Myocarditis , Adult , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/immunology , Arrhythmias, Cardiac/physiopathology , Biopsy , Brugada Syndrome , Bundle-Branch Block/immunology , Bundle-Branch Block/physiopathology , Cardiac Conduction System Disease , Female , Heart Conduction System/immunology , Heart Conduction System/physiopathology , Heart Failure/diagnosis , Heart Failure/etiology , Heart Failure/physiopathology , Heart Function Tests/methods , Heart Ventricles/pathology , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Monitoring, Immunologic , Myocarditis/complications , Myocarditis/immunology , Myocarditis/pathology , Prognosis , Risk Assessment , Severity of Illness Index , Statistics as TopicABSTRACT
UNLABELLED: Allapinin, class 1C antiarrhythmic drug, is highly effective in treatment of patients with ventricular premature beats (VPB). The purpose of work was retrospective assessment of efficacy and safety of allapinin in patients with benign ventricular arrhythmias. 73 patients with VPB and no structural heart disease were selected from a database. In short course allapininin in dose of 75-150 mg per os daily decreased the number of VPB for more than 90% in 46,6% of patients. In 34,4% cases tolerable drug side effects were observed. Among patients with VPB burden of 10% and higher allapinin reduced this quantity below the indicated value in 76% of cases with tolerable drug side effects in 38,6% of cases. In long treatment study antiarrhythmic effect of allapinin persisted and no other side effects of the drug were documented. CONCLUSION: Allapinin is highly effective in treatment of patients with VPB without structural heart disease.
Subject(s)
Aconitine/analogs & derivatives , Anti-Arrhythmia Agents/therapeutic use , Ventricular Premature Complexes/drug therapy , Aconitine/administration & dosage , Aconitine/therapeutic use , Adolescent , Adult , Anti-Arrhythmia Agents/administration & dosage , Drug Administration Schedule , Electrocardiography , Female , Humans , Male , Middle Aged , Ventricular Premature Complexes/physiopathology , Young AdultABSTRACT
AIM: To study the specific features of an immune response and the role of infectious pathogens in the occurrence, development, and maintenance of ventricular ectopic activity in patients without signs of organic disease of the cardiovascular system (CVS). SUBJECTS AND METHODS: The investigation enrolled 91 patients (27 men and 64 women with a mean age of 36.5 +/- 11.5 years) with premature ventricular contractions (PVC) without signs of organic CVS pathology. A control group comprised 31 healthy volunteers. In addition to standard physical examination, a study of N-terminal pro-brain natriuretic peptide (NT-proBNP) and cellular and humoral immune parameters was performed and the serological and molecular genetic markers of infections were determined in all the patients. RESULTS: The persons with PVC, as compared to the control group, were recorded to have a higher NT-proBNP level (49.2 pg/ml versus 25.4 pg/ml; p = 0.001) accompanied by an increase in both the total number of PVC and the number of coupled PVC and the episodes of ventricular tachycardia. They were also found to have elevated CD3(+)HLA-DR+ (2.4% versus 1.56%) and CD3(+)CD95+ (27.6% versus 18.8%) counts (p = 0.001). In patients with a C-reactive protein level of more than 2 mg/l, the total number of PVC was larger than that in the other patients (p = 0.065). The patients with PVC did not show a statistically significant difference from the controls in the levels of antiviral and antibacterial antibodies. The people with PVC displayed a number of relationships between the infectious pathogen antibody titers and the ECG Holter monitoring and echocardiography readings. CONCLUSION: In the patients with PVC without signs of organic CVS pathology, the parameters of an immune response were not different from those obtained in the control group, which was likely to be associated with the involvement of the immune system in the development and maintenance of ventricular arrhythmias.
Subject(s)
Antibodies/immunology , C-Reactive Protein/metabolism , Electrocardiography , Immunity, Cellular , Natriuretic Peptide, Brain/metabolism , Peptide Fragments/metabolism , Ventricular Premature Complexes/immunology , Adult , Female , Humans , Male , Severity of Illness Index , Ventricular Premature Complexes/metabolism , Ventricular Premature Complexes/physiopathologyABSTRACT
By means of computer simulation has been built polypeptide antigen conformational structure that imitates the immunodominant epitope of the 2nd extracellular loop of ß1-adrenoreceptor. A linear 25-membered peptide corresponding to calculated sequence was synthesized by means of solid-phase methoyd using Fmoc-technology, then directed by the closure ofdisulfide bridges was obtained original bicyclic polypeptide corresponding to the proposed structure of the conformational antigen. With the help of high-resolution NMR spectroscopy 3D structure of synthetic conformational antigen was investigated. It was shown that the structure of the bicyclic polypeptide similar to that of building computer model. Bicyclic conformational antigen was suitable for the detection of autoantibodies in the blood serum of patients with rhythm and conductivity violation without evidence of organic disease of the cardiovascular system.
Subject(s)
Immunodominant Epitopes/immunology , Peptides/chemistry , Protein Conformation , Receptors, Adrenergic, beta-1/immunology , Antigens/immunology , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/immunology , Computer Simulation , Humans , Immunodominant Epitopes/chemistry , Magnetic Resonance Spectroscopy , Peptides/immunology , Receptors, Adrenergic, beta-1/chemistryABSTRACT
Linear peptides corresponding to fragment 83-98 of the first loop and fragments 168-192 and 171-182 of the second extracellular loops of M2-muscarinic receptor (marker of early cardiac disorders and arrhythmias) were synthesized by Fmoc-SPPS method. A new conformational antigen was synthesized by method of selective ligation of linear peptides by disulfide bond with native localization. Peptides were studied in reaction with sera from patients with idiopathic arrhythmias. A new conformational antigen was recognized by sera from patients with idiopathic arrhythmias with high reactivity.
