RESUMO
The study included 62 patients with uncomplicated primary and secondary infectious endocarditis admitted to S.PBotkin city hospital from 2011 to 2014. The emphasis is laid on diagnostic significance of dynamic measurements of the levels of C-reactive protein, tumour necrosis factor and highly sensitive troponin-1 for the evaluation of activity of the infectious/toxic process, severity of the disease, and detection of complications. The study revealed the relationship of the enhanced level of troponin-1 with changes of inflammation markers, morphofunctional characteristics of myocardium, and circulatory failure. Morphologicl study demonstrated inflammatory and dystrophic changes in myocardium, focal and diffuse cardiofibrosis suggesting development of non-coronarogenic myocardial lesions that play an important role in the progress of cardiac failure associated with infectious endocarditis.
Assuntos
Proteína C-Reativa/análise , Endocardite , Insuficiência Cardíaca , Inflamação , Miocárdio/metabolismo , Troponina I/sangue , Fator de Necrose Tumoral alfa/sangue , Adulto , Antibacterianos/uso terapêutico , Biomarcadores/sangue , Fármacos Cardiovasculares/uso terapêutico , Ecocardiografia , Endocardite/sangue , Endocardite/complicações , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Endocardite/fisiopatologia , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/metabolismo , Insuficiência Cardíaca/fisiopatologia , Humanos , Inflamação/sangue , Inflamação/etiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Índice de Gravidade de Doença , Estatística como AssuntoRESUMO
Comparative analysis of anamnestic, clinical, laboratory and instrumental data involved 106 patients with infectious endocarditis treated in S.P. Botkin City Clinical Hospital in 2000-2011 and 92 ones admitted in 1985-1977. The results give evidence of ongoing pathomorphosis of infectious endocarditis as is apparent from the growing number of male patients, increased frequency of primary cases and previous invasive or intravascular manipulations, thromboembolic complications including pulmonary thromboembolism, right heart chamber endocarditis. Over half of the patients are socially unadapted C-peptide level is of diagnostic value for the assessment of inflammation activity, precursors of natriuretic peptide can be used to detect preclinical and clinical stages of cardiac failure related to infectious endocarditis. There is correlation between severity of inflammation and myocardial dysfunction. Early surgical intervention in the absence of effect of combined antibacterial therapy improves prognosis. Morphological studies of inflammation-related changes in myocardium, destruction of cardiomyocytes, dystrophic processes, and fibrosis play an important role in the development of cardiac insufficiency and prognosis of infectious endocarditis.
Assuntos
Antibacterianos/uso terapêutico , Procedimentos Cirúrgicos Cardíacos , Endocardite Bacteriana , Insuficiência Cardíaca/prevenção & controle , Tromboembolia/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Ecocardiografia/métodos , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/mortalidade , Endocardite Bacteriana/fisiopatologia , Endocardite Bacteriana/terapia , Feminino , Insuficiência Cardíaca/etiologia , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Fatores de Risco , Federação Russa/epidemiologia , Fatores Sexuais , Fatores Socioeconômicos , Análise de Sobrevida , Tromboembolia/etiologiaRESUMO
This work was designed to analyse dynamics of inflammation markers (C-reactive protein, TNF-alpha) and procalcitonin in 66 patients with infectious endocarditis (IE) followed up during 6 months. Comparison of clinical observations and laboratory data revealed specific trends in these parameters in patients with different clinical course of IE and at its different stages. Some of the changes are shown to be responsible for the unfavourable prognosis of IE. TNF-alpha levels are considered to be a sensitive and informative index of the patients" clinical conditions throughout the entire period of IE evolvement.
