[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.

[Cerebral oximeter INVOS-3100]. / Tserebral'nyi oksimetr INVOS-3100.

A new device is described: cerebral oximeter intended for monitoring cerebral oxygenation and early diagnosis of cerebral ischemia and hypoxia. The advantages and shortcomings of the proposed method are analyzed in comparison with other current methods for the early diagnosis of cerebral ischemia.

[Evaluation of the basal metabolic requirements of patients with grave brain lesions]. / Otsenka obshchikh metabolicheskikh potrebnostei u bol'nykh s tiazhelym porazheniem golovnogo mozga.

Basal metabolism (BM) was studied in 26 patients with a brain lesion treated at the neuro-resuscitation department. The complex of examination methods included dynamic appraisal of total energy expenditure and contribution of carbohydrates, fats, and proteins to the total energy expenditures by indirect calorimetry in combination with tests for daily nitrogen excretion, determination of biochemical indices characterizing BM: total lymphocyte count, concentration of blood total protein, albumin, blood urea nitrogen, and creatinine. It is shown that the character and degree of changes of BM depend on the clinico-neurological features of the disease in the postoperative (posttraumatic) period. Aspontaneity of various genesis leads to reduction of total energy expenditure by 18-25% of the normal values. Increased motor activity and the spasmodic syndrome increase total energy expenditure by 30-50%. Concurrent development of infectious complications increases total energy expenditure and changes its structure at the cost of increase of protein expenditure (proteins become responsible for up to 50% of energy expenditure). Indirect calorimetry in combination with tests for daily nitrogen losses is recommended for the evaluation and correction of BM disorders in patients requiring intensive therapy.