[Microflora of peripheral blood obtained from patients with infective endocarditis.]

Infective endocarditis is a serious inflammatory disease associated with damage of heart valves and other parts of endocardium. This study included 91 patients with a confirmed diagnosis of «infectious endocarditis¼ and hospitalized at the Research Institute of Complex Problems of Cardiovascular Disease (Kemerovo, Russia) from 2010 to 2015. The determination of the spectrum of microorganisms in the samples of patients' peripheral blood was carried out using the PCR method using reagents produced by Lyteh Ltd. (Moscow, Russia) allowing detect Staphylococcus spp., Staphylococcus aureus, Streptococcus pyogenes, Streptococcus agalacticae, Enterobacter spp., Klebsiella spp., Proteus spp., Haemophilus influenza, Enterococcus faecalis, Enterococcus faecium in the samples of biological material. Statistical analysis was performed in the StatSoft STATISTICA 10 software. 83.5% of patients were characterized by presence Staphylococcus spp. in the peripheral blood; the other pathogens were detected much less often (from six cases of enterococci detection to one case of Streptococcus agalacticae and Proteus spp.). In nine patients, none of the analyzed pathogens was detected, and a number of patients were characterized by the simultaneous presence of several pathogens. There was no reliable data on the difference in microflora structure depending on sex, drug addiction, the type of infective endocarditis and the damaged valve. It was established that the results of PCR of peripheral blood samples and microbiological examination of the tissues of damaged valves that were removed during cardiac surgery, differ significantly. The obtained results testify to the need for more in-depth studies including PCR analysis of peripheral blood samples, flushing from damaged valves, and also homogenized valve tissue samples, which will allow us to obtain more detailed data and conclude that PCR can be used as a diagnostic test for early detection microbiological agent as causative.

[The Integrated Approach to Improving Efficiency and Safety of Anticoagulation Therapy in Patients With Prosthetic Mitral Valve].

AIM: To assess advantages of integrated approach to improvement of efficiency and safety of warfarin therapy after heart valve replacement. MATERIALS AND METHODS: We included in this study 118 patients who had undergone simultaneous mitral valve replacement and maze procedure. Group 1 patients (n=37) underwent just sinus rhythm restoration, group 2 patients (n=54) underwent sinus rhythm restoration and participated in a patient education program, group 3 patients (n=27) underwent sinus rhythm restoration, participated in a patient education program, and were subjected to pharmacogenetic testing for warfarin sensitivity. In examination of patients we used clinical, demographic, and instrumental methods. Estimation of the time in the therapeutic range (TTR) of an international normalized ratio (INR) was used as a measure of warfarin therapy quality, and the Kaplan-Meier method was applied for analysis of hemorrhagic and thrombotic complications. RESULTS: TTR was 42 % in group 1, 68 % in group 2 (p=0.0327), and 82 % in group 3 (p=0.0019). Application of integrated approach was associated with absence of hemorrhagic and thrombotic complications within one year after heart valve replacement. CONCLUSION: The integrated approach comprising restoration of sinus rhythm, patient education, and pharmacogenetic testing for warfarin sensitivity was associated with improved anticoagulation control, and prevention of hemorrhagic and thrombotic complications.