The purpose of the study is to investigate the clinical and morphological characteristics of chronic subclinical inflammation in the myocardium in patients with decompensated heart failure with ischemic systolic dysfunction.
Important reason for the development of chronic heart failure is a viral disease of the heart, the three phenotypes associated with: the presence of inflammation without viral agent, implying an autoimmune disease; presence of inflammation and persistent viruses; and the presence of persistent virus without signs of inflammation. There is a group of patients with coronary heart disease, which on the background of optimal treatment is observed progression of clinical symptoms of coronary heart disease with the subsequent development of heart failure, leading to ischemic cardiomyopathy. Perhaps the reason for this is the combination of inflammatory and ischemic cardiomyopathies. Inflammatory cardiomyopathy, involved in the pathogenesis of DCM, includes idiopathic, autoimmune and infectious subtypes. Inflammatory disease of the myocardium diagnosed by established histological, immunological and immunohistochemical criteria. This study will include 60 patients with decompensated heart failure with ischemic left ventricular systolic dysfunction (LVEF \<40%) were hospitalized not earlier than 6 months after myocardial revascularization. This group of patients will receive standard treatment, according to national guidelines RSC and ESC, to stabilize heart failure. All patients will be held PCI to exclude ischemic heart failure decompensation. Also, all patients will be performed endomyocardial biopsy as a result of immunohistochemical studies will be made on the separation of the virus and the virus-negative-positive group. After that, the group will be divided into subgroups: virus - and inflammation in the myocardium inflammation without viral antigen, viral inflammation of the presence of antigen and the group with the presence of viral antigen without any signs of inflammation in the myocardium. The study is nonrandomized.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
60
Endomyocardial biopsy will be performed through a puncture in the femoral vein. 3-6 samples taken under the control of myocardial echocardiography or flyuroskopii. Samples of biopsy material then transmitted Pathomorphology for immunohistochemistry, light microscope.
Research Institutite for Cardiology
Tomsk, Tomskii Region, Russia
RECRUITINGScientific and Research Institution of Cardiology of Siberian Department of RAMS
Tomsk, Russia
RECRUITINGIncidence of inflammatory infiltrate in the myocardial tissue
Time frame: 6 month after PCI or CABG
Incidence of the virus - positive inflammatory infiltrate in the myocardial tissue
Time frame: 6 month after PCI or CABG
The most frequent viral agents in myocardial tissue in this region
Time frame: 6 month after PCI or CABG
Incidence of the acute myocardial infarction
Time frame: 6 and 12 month after PCI or CABG
Incidence of disturbance rhythm and conduction of the heart
Time frame: 6 and 12 month after PCI or CABG
Left ventricular ejection fraction (Echo)
Time frame: 6 and 12 month after PCI or CABG
Еnd-diastolic volume of the left ventricle (Echo)
Time frame: 6 and 12 month after PCI or CABG
Еnd-systolic volume of the left ventricle (Echo)
Time frame: 6 and 12 month after PCI or CABG
Incidence of the mortality
Time frame: 6 and 12 month after PCI or CABG
Incidence of the stroke
Time frame: 6 and 12 month after PCI or CABG
Incidence of hospitalizations for decompensation heart failure
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Time frame: 6 and 12 month after PCI or CABG