[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.

[Prognosis of unfavorable cardiac events in patients with severe chronic heart failure with preserved coronary myocardial reserve].

OBJECTIVE: To elucidate predictors of unfavorable cardiac events in patients with non-ischemic cardiomyopathy (CMP) complicated by congestive heart failure (CHF) with preserved myocardial coronary reserve (MCR). MATERIAL: We followed 114 patients with non-ischemic MCP and NYHA class III-IV CHF. MCR was estimated by dobutamine stress-echocardiography (SEchoCG). Prior to SEchoCG we measured blood von Willebrand factor (vWF) activity, content of endothelin-1 (ET), N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hsCRP), soluble vascular cell adhesion molecule-1 (sVCAM-1) and nitric oxide stable metabolites. At peak of dobutamine test blood was collected for measurement of ET, vWF, and NT-proBNP concentrations. Left ventricular ejection fraction (LVEF)sechoCG, ETsechoCG, vWFsechoCG and NT-proBNPsechoCG were calculated as percentage changes of these parameters from baseline at peak dobutamine load. RESULTS: Groups with low and preserved MCR were not different by relative number of patients with unfavorable course of the disease (41.2 and 34.8%, p = 0.529, respectively). The following parameters were predictors of development of unfavorable cardiac events in patients with preserved MCR (LVEFsechoCG > 10%) during 24 months: initial hsCRP > 5.2 mg/ml, LVEFsechoCG < 19.7% and ETsechoCG > 11.8%. Logistic regression model combined with binary values of LVEFsechoCG and ETsechoCG demonstrated best prognostic efficacy (sensitivity--86.7%, specificity--83.3%, prognostic accuracy--84.6%).

[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.