[Predictors of survival after heart transplantation: role of pretransplantation and posttransplantation factors].

Objective of this study was to assess the impact of pre- and posttransplantation factors on 12-month survival after orthotopic heart transplantation (OHT). Annual survival after OHT was 79.2%. The following factors were significantly negatively associated with annual survival: recipient's serum C-reactive protein (CRP) > or = 11.5 mg/ml prior to donor heart transplant (odds ratio [OR] 5.74, p = 0.011) and infectious complications after OHT (OR = 4.80, p = 0.009). Recipient's high CRP level was associated with mortality due to infectious complications (r(pb) = 0.47, p = 0.006), elevated troponin I concentrations (r(s) = 0.44, p = 0.012), and impaired hemodynamics of both recipient's heart and graft: right ventricular (RV) end diastolic area (EDA) prior to OHT (r(s) = 0.41, p = 0.015), elevated pulmonary artery pressure (PAP) (r(s) = 0.36, p < 0.001), and decreased left ventricular ejection fraction (LVEF) (r(s) = -0.45, p < 0.001) of the transplanted heart. Hearts of those who died after OHT irrespective of cause of death were characterized by more severe right heart dilation as evidenced by statistically significant increase of median RV EDA prior to OHT. After heart transplantation in those who later died decreased RV contractility was accompanied with elevation of PAP and decrease of LVEF. Acute graft rejection events 71.4% of which occurred in patients younger than 30 years had no influence on survival during 12 months after OHT. Other factors not associated with 12 months survival were donor and recipient age, pretransplant pathology, patient's UNOS status, graft ischemia duration, artificial circulatory support and preexistent surgical interventions. Development of diabetes mellitus in posttransplantation period, arterial hypertension and sinus node dysfunction requiring permanent pacing also were not identified as factors affecting 1 year survival after OTH.

[Noninvasive diagnosis of acute cellular rejection of transplanted heart].

Endomyocardial biopsy remains the gold standard of diagnosis of acute cellular rejection after heart transplantation. However, routine biopsies are of major inconvenience to patients and are also risky and costly. In the present research we considered possibility of non-invasive diagnosis of acute cellular rejection in patients after orthotopic heart transplantation. Results of research are based on studying 34 endomyocardial biopsys in combination with Holter monitoring and ECHO findings in 21 heart recipients. It is demonstrated that case follow-up with Holter monitoring and ECHO is mandatory for diagnosis of acute cellular rejection and optimal treatment tactics.

[The anticoagulant action of the nitric acid ester of oxidized starch]. / Antikoaguliantnoe deistvie nitroéfira okislennogo krakhmala.

The effect of oxidized starch (OS) which contained 15% of COOH groups and its nitroether (NOS) with 4% of nitrogen on coagulation properties of rat blood was studied in vitro and in vivo. The results of the study in vitro showed that OS did not affect the function of the coagulation system. In contrast to OS, a dose-dependent increase in prothrombin-, thrombin time, and activated partial thromboplastin time was observed for NOS. The activity of the components of the internal coagulation pathway changed when the NOS concentration reached 0.1 mg/ml. At a concentration of 0.6 mg/ml and higher this compound affect the external pathway and final stage of coagulation. According to the efficiency (in vitro) of the influence on the thrombine time I mg/ml NOS corresponded to 0.2 U/ml of heparine. The anticoagulant effect of NOS was also observed in vivo along with reliable changes in thromboplastin and thrombin time. Antithrombin activity of plasma remained the same. Standard test was negative and indicated to the absence of fibrin monomers. The pronounced anticoagulant effect of NOS in the experiments in vitro and quick response in the experiments in vivo make it possible to consider this compound as anticoagulant of direct action.

[The antiarrhythmic activity of the polymeric forms of quinidine, trimecaine, etatsizin, propranolol and verapamil]. / Antiaritmicheskaia aktivnost' polimernykh form khinidina, trimekaina, étatsizina, propranolola i verapamila.

The antiarrhythmic activity and acute toxicity of polymeric formulations of quinidine, trimecaine, ethacizine, propranolol, verapamil which had been immobilized on a cellulose carrier (monocarboxylcellulose) and low molecular analogues were studied in various experimental animals (rats, mice, dogs). The polymeric formulations of trimecaine and verapamil were found to have a higher antiarrhythmic activity in different arrhythmia models than trimecaine and verapamil. The toxicity of all new compounds was no more than the values of conventional antiarrhythmic drugs.