Collagen I and III, MMP-1 and TIMP-1 immunoexpression in dilated cardiomyopathy.

The extracellular matrix (ECM) remodeling represents the pathological substrate of dilated cardiomyopathy (DCM). In this study, we statistically analyzed the immunoexpression of collagen I and III, matrix metalloproteinase-1 (MMP-1) and its tissue inhibitor-1 (TIMP-1) in the myocardial tissue in 18 cases of DCM compared to a control group. We observed a significant increase in the immunoexpression of collagen I and III in patients with DCM and a significant reduction in the immunoexpression of MMP-1 compared with the control group. Also, the collagen I and TIMP-1 expression indicated a positive linear correlation and respectively a negative linear relationship with collagen III and MMP-1. The analyzed markers in this study can be used to quantify the degree of collagen sclerosis from the ECM of DCM.

Echocardiographic Parameters in Acute Pulmonary Edema.

PURPOSE: The present study proposes the comprehensive ultrasound evaluation of a consecutive batch of patients with acute cardiogenic pulmonary edema. METHOD: The registry included all patients with acute pulmonary edema from 2 emergency hospitals between February and May 2016. During the first 3 days of admission, a transthoracic ultrasound was performed which included the parameters of systolic and diastolic function of the left ventricle, right ventricular systolic function, heart cavity dimensions, estimated pulmonary pressure, and the presence and severity of valvular disease. RESULTS: A total of 70 patients were enrolled in the registry. The mean ejection fraction of the left ventricle was 39.5±11.4% and the average indexed end-diastolic volume was 77.7±29.5ml/m⊃2, above the upper limit of normal. All patients in whom diastolic function could be evaluated had a degree of diastolic dysfunction. Functional parameters of the right ventricle were normalized as average, and the mean pulmonary artery pressure was increased: 40.9±16.7mmHg. The most common valvular heart disease were mitral and tricuspid insufficiency, with moderate or severe impairment in 82.8%, respectively 65.7% of the patients.

Changes of desmin expression pattern in the myocardium of patients with alcoholic dilated cardiomyopathy.

INTRODUCTION: It has been suggested that desmin cytoskeleton remodeling may contribute to the progression of dilated cardiomyopathy and might affect long-term prognosis. This study is aiming at evaluating desmin expression in cardiomyocytes from patients with dilated cardiomyopathy of alcoholic etiology in advanced stages of the disease and comparing the results with measurements of normal heart tissue from control patients. MATERIALS AND METHODS: For immunohistochemistry, sections from 36 myocardium fragments taken from left ventricle of dilated cardiomyopathy patients were immunolabeled with an anti-desmin antibody and negative control slides were obtained by omitting the primary antibody. We calculated the ratios between the areas of myocardiocytes and the length and number of A dark disks and assessed the desmin expression level as the integrated optical density (IOD) and, respectively, the total areas of the signal given by immunolabeling. A Student's t-test has been utilized to assess the differences, p<0.05 deemed significant data. RESULTS: We identified significant decrease in numerical density of dark disks in our cases group compared with controls (p<0.05). Also, the ratios between total cellular area and total length of dark disks and number of dark disks was significantly different between cases and controls (p=0.04). IOD was significantly different between dilative cardiomyopathy cases and controls and also, overall desmin expression area was increased in dilatative cardiomyopathy patients. CONCLUSIONS: The identification of different desmin expression and standardization in diseased myocardium may be helpful in stratifying patients and in understanding their evolution, but also in finding new therapeutic targets that aim the alterations in desmin expression.

In-hospital and short-term prognostic factors in acute pulmonary edema: clinical and morphological features.

INTRODUCTION: There are extensive records which have included patients with acute heart failure (AHF), but specific studies about prognosis in acute pulmonary edema (PE) are scarce and have enrolled a small number of patients. The objectives of this study were to evaluate the predictive factors of short-term evolution in patients with PE. PATIENTS, MATERIALS AND METHODS: This was a prospective, two-center survey of 70 consecutive patients admitted for acute cardiogenic PE. The follow-up was performed one month after discharge. The composite endpoint was in-hospital death, and death of any cause or readmission for heart failure (HF) at one month after discharge. Heart and lung tissue analysis was performed postmortem to identify morphological features of PE. RESULTS: In-hospital mortality was 4.2%, another 14.2% died in the first month, and an additional 10% required rehospitalization for HF. The characteristics significantly associated with end-point occurrence were: history of kidney disease, anemia, diabetes mellitus, lack of prior angiotensin-converting enzyme inhibitor÷angiotensin-receptor blocker treatment, lower systolic blood pressure (BP) at admission, lower diastolic BP at admission, creatinine at admission and at discharge, an increase in creatinine during stay, glomerular filtration rate at admission, serum sodium at admission, decrease in serum sodium during hospitalization, N-terminal prohormone of brain natriuretic peptide (NT-proBNP) at discharge, right ventricle fractional area change, left atrium volume index. We created a multiple logistic regression model and identified five prognostic factors: age, diabetes, creatinine, diastolic BP, serum sodium. This model correctly classified 48 (96%) patients without worsening and 13 (65%) patients with worsening, providing an overall accuracy of 87.1%. Necropsy was performed on five patients and fragments of left ventricle myocardium and lung were harvested for histopathological and immunohistochemical studies. The myocardium exhibited fibrosis areas where the myocytes were completely or partially replaced by collagen fibers. Lung tissue analysis revealed some case-to-case differences, but the common finding was alveoli size larger than normal, with the lumen completely or almost completely covered by an eosinophilic liquid. CONCLUSIONS: The factors that best predicted the short-term outcome in PE were age, diabetes, diastolic BP, creatinine, serum sodium.