Annual rate of progression of aortic-jet velocity and survival in cases of severe asymptomatic aortic stenosis.

(Full text is available at http://www.manu.edu.mk/prilozi). The aim of the study was to establish the predictive role of maximal aortic-jet velocity, i.e. its annual rate of progression, in the decision in favour of aortic valve replacement (AVR), as well as in the event appearance and/or patients' survival with severe asymptomatic aortic stenosis. 49 patients were analysed who belonged to the clinical and echocardiography group with severe asymptomatic valve aortic stenosis, with an average of 22 +/- 10 months follow-up period. The echocardiography parameters were: ejection fraction, maximal aortic-jet velocity (AV_Vmax), trans-valve maximal gradient and aortic valve area, as well as calcification rate, all of which were included in the predictive model. The progression rate of the aortic-jet velocity was established, reduced to an annual level. The variable ECHO status worsening was defined as worsening when the progression rate of the AV_Vmax at the annual level was > or = 0.3 mps per year. The results show that in 20% of the patients an annual rate of progression of the aortic-jet velocity over > or = 0.3 mps per year was registered. For the follow-up period, event appearance was registeredin 20% of the patients , where the risk of event appearance is 4.3 times higher in patients with ECHO worsening status, in relation to those without ECHO worsening status. It was established the that the probability of survival of the asymptomatic patients with severe AS over a period of 3 years was 0.57 +/- 0.11. The average length of survival in patients without ECHO worsening status was 32.8 +/- 1 months, while in patients with ECHO worsening status it was 23.5 +/- 4 months. It can be conclude that the maximal trans-valve aortic-jet velocity, especially the rate of its annual progression, is a significant predictor of the rapid progression of the disease, which contributes to the risk stratification in the risk group of patients with severe asymptomatic aortic stenosis while referring for AVR. Key words: severe asymptomatic valve aortic stenosis, echocardiography, annual rate of progression of the maximal aortic-jet velocity, survival.

HLA-DRB and -DQB1 polymorphism in the Macedonian population.

HLA-DRB1, DRB3/4/5 and DQB1 polymorphism has been studied in a population of 80 unrelated healthy Macedonians using molecular methods. Twenty-five different DRB1 alleles were identified of which DRB1*1104, *1501, *1601, and *1101 were found most frequently. Among the 15 identified DQB1 alleles, two were predominant: DQB1*0301 and *0502. The most frequent three-locus haplotypes were DRB1*1104-DRB3*02-DQB1*0301 (18%/), DRB1*1101-DRB3*02-DQB1*0301 (9%) and DRB1*1601-DRB5*02-DQB1*0502 (10%). Polymorphism for DRB1*04, *13 and *15 haplotypes was extensive. Eleven different DR2-related haplotypes were found, some of which were unusual for European populations: DRB1*1501-DRB5*0102-DQB1*0502, DRB1*1501-DRB5*02-DQB1*0502, DRB1*1501-DRB5*0102-DQB1*0601.

[Epidemiology of the major histocompatibility complex-human leukocyte antigen in the Madeconian population]. / Epidémiologie du complexe majeur d'histocompatibilité "human leucocyte antigens" dans la population macédonienne.

Human leukocyte antigens (HLA) at loci A (14 antigens) and loci B (29 antigens) were determined in 2,385 healthy Macedonians, using the microlymphocytotoxicity test. Results were compared with those obtained in Caucasians. The most common HLA antigens in the Macedonian population are: A2 (51.65%), A1 (25.87%), A3 (17.14%) and A24 (20.41%) for loci A and B51 (32.03%), B35 (23.98%), B8 (12.11%), B44 (12.11%), B7 (11.48%) and B18 (10.23%) for loci B. These frequencies are similar to those found in Caucasians. However, antigens B12, B44, B7, B8 and especially B15 are more common in Caucasians, while B51 and B35 antigens are more common in the Macedonian population. The most common haplotypes in the Macedonian population are: A2/B51 (15.68%), A2/B35 (10.35%), A2/B12 (7.79%), A9/B51 (7.50%) and A1/B8 (7.50%). The frequencies of HLA antigens were also determined in 348 patients with chronic renal disease and compared with those observed in the healthy population (2,385 subjects). No significant differences was observed between HLA frequencies depicted in patients and those described in healthy individuals. Results should therefore make easier the finding of compatible kidney transplants in the Macedonian population.

[Living donors: immunologic factors]. / Donneurs vivants: aspects immunologiques.

Transplantations using grafts from living donors were performed on 70 patients with chronic kidney failure, 66 of them involved matching recipients-donors and four involved non-matching recipients-donors. Immunological data were analyzed in 56 pairs of recipients and patients. Of these pairs, one was identical, seven had three identical antigens, 46 were haploidentical at A and B loci, one pair was identical in one antigen and one pair was completely incompatible. The survival of transplanted kidneys largely depended on the degree of histocompatibility. In 33 (59%) transplantations kidneys are functioning from more than 36 months. In the group of seven transplanted pairs with three identical antigens kidneys are functioning in six cases, with four of them functioning from more than 72 months. In the remaining patients (41 patients [73%]) kidneys are functioning, with 8 of them functioning from more than 10 years. The existence of HLA antibodies was investigated. Preimmunization was found in 18 (32%) patients and correlated with the number of blood transfusions. Rejection crises were observed in 12 (21%) patients. As the number of blood transfusions per patient increased the number of rejection crises decreased. Rejection crises were also observed in haploidentical pairs, with a relative risk > 30%. They occurred in the first 2 weeks following transplantation.