Quantitative analysis of human heart valves: does anorexigen exposure produce a distinctive morphological lesion?

The need for more detail regarding the clinical and morphological features of human heart valves has become evident due to recent controversy regarding anorexigen-associated valvular dysfunction. In the present study, we used quantitative digital image analysis of geometric and compositional features to compare the histopathology of cardiac valves excised from patients treated with anorexigens as compared to normal, floppy, rheumatic and carcinoid valves. Anorexigen-exposed valves had the greatest number of onlays/valve (P<.0001), while rheumatic valves showed the greatest average onlay size and thickness of the comparison groups studied (P=.01). The valve onlays from anorexigen-exposed, carcinoid and floppy valves contained a greater percentage of glycosaminoglycans (GAGs) as compared to normal and rheumatic valves (P=.01). The anorexigen-exposed valve propers contained more GAGs than any other comparison group (P=.02). Vessels were prominent in both onlay and valve proper regions of carcinoid valves, in the anorexigen-exposed valve onlays and in rheumatic valve propers. Thus, the number of onlays, their size, the degree of GAG deposition, and the presence and location of vessels and leukocytes were important features distinguishing anorexigen-exposed valves from normal valves. Discriminant analyses, based on geometry, color composition or color composition, and vessel and leukocyte counts combined, were able to separate the valves into distinguishable groups. Our findings demonstrate that specific microscopic features can be used to separate anorexigen-associated heart valve lesions from normal valves and valve lesions associated with other pathologies, and suggest that a distinctive pathological process may exist in many anorexigen-exposed valves.

[Effects of kavergal on indices of lipid peroxidation and the condition of the antioxidant system in patients with rheumatic heart disease presenting with circulatory insufficiency]

132 patients with rheumatic heart disease presenting with circulatory insufficiency displayed increased LPO both in the blood plasma and red cells, decline in the antioxidant enzymes activity varying with the circulatory insufficiency functional class degree of severity. Basic therapy with making use of antiinflammatory drugs, cardiac glycosides, diuretics together with drugs endowed with an antiarrhythmic activity and nitroglycerin (where indicated) was found to have practically no effect on LPO level or activity of the antioxidant system. The use of the drug kavergal, 1 g three times daily (total daily dosage being 3 g) in the complex therapy, has been shown to significantly decrease hyperlipoperoxidation both in the blood plasma and red cells increasing the activity of enzymes of the antioxidant defence.

Rheumatic heart diseases in pregnancy

Acute rheumatic fever and rheumatic valvular disease remain prevalent in many parts of the world, and are probably the most common cause of heart disease in pregnancy. Mitral stenosis is the most frequently encountered rheumatic valvular lesion. A variety of pregnancy-associated cardiovascular changes often exacerbate the signs and symptoms of valvular lesions. Pregnancy should not be allowed to proceed, if possible, in patients with uncorrected severe valvular lesions or mechanical heart valves requiring anticoagulation, as maternal and fetal morbidity and mortality are high. For those with milder disease, pregnancy is best undertaken after the valvular lesion has been rectified or stabilised. Recent advances in the management of valvular disease include the use of beta-blockers for patients with mitral stenosis, vasodilators in those with aortic and mitral regurgitation, and percutaneous balloon valvuloplasty for mitral and aortic stenosis. Application of these therapies in the pregnant patient is as yet unclear, and management decision needs to be individualized, weighing the risk and benefit to ensure maternal survival and to promote fetal well-being.

[Composition of myosin light chains from the human myocardium: prospects for diagnosis of cardiac diseases]

New data on changes in the quantitative and qualitative composition of myosin light chains of human myocardium in various cardiac diseases were obtained. The results presented are of importance for creating a new diagnostic test for the onset of acute cardiac disease and a prognostic test of the development of chronic cardiac disease.

Increased nitric oxide in exhaled air in patients with rheumatic heart disease

BACKGROUND

Endogenous production of nitric oxide and its presence in exhaled air was observed in humans. Prior studies have yielded contrasting information about the production of nitric oxide in patients with heart failure.

AIMS

The aim of this study was to measure nitric oxide in the exhaled air of patients with chronic rheumatic heart disease with and without pulmonary hypertension.

METHODS

Seventy-four patients (6 patients had isolated mitral stenosis; 13 patients had combined mitral stenosis and mitral regurgitation; 1 patient had isolated mitral regurgitation; 54 patients had combined mitral and aortic valve disease) and 27 healthy subjects were entered in the study. The nitric oxide concentration in exhaled air was determined with a chemiluminescence analyser. Echocardiography was performed in all patients to assess the severity of the valve disease and for the measurement of pulmonary artery pressure.

RESULTS

The level of exhaled nitric oxide was significantly greater in patients with rheumatic heart disease than in controls. The value of nitric oxide concentration in exhaled air was significantly increased in patients with pulmonary hypertension, as compared with patients who had normal pulmonary artery systolic pressure.

CONCLUSION

We found increased nitric oxide in the exhaled air in patients with rheumatic heart disease, especially in those with pulmonary hypertension, compared with healthy patients.

[The expression of proliferating cell nuclear antigen and alpha smooth muscle actin in papillary muscles of the patient with rheumatic heart disease and its significance]

OBJECTIVES

To reveal the change of chronic rheumatic cardiomyocyt phenotype and its relationship with myocardium fibrosis.

METHODS

The papillary muscles samples were obtained from patients with rheumatic heart disease during mitral valve replacement. Normal papillary muscles samples obtained from adult and fetal heart during autopsy in control group. The specimens were examined using immunohistochemistry and immunoelectron microscopy observation with monoclonal antibody of antiproliferating cell nuclear antigen (PCNA) and anti-alpha smooth muscles actin (alpha-SMA), and imaging analysis was performed.

RESULTS

The interstitial fibrosis (24.7% +/- 3.05%) and the ratio between inner and outer diamater of arteriolas (0.405 +/- 0.035) in rheumatic myocardium were higher significantly than those in normal myocardium. Immunohistochemical PCNA expression was not only in interstitial but also in hypertrophic cardiomyocytes of rheumatic heart disease. The positive expression in rheumatic myocardium increased. There were a lot of rough endoplasmic reticula, ribosomes and Golgi bodies in cytoplasm of PCNA and alpha-SMA positive cells. The degree of PCNA and alpha-SMA positive expression was increased with enlargement of fibrosis areas.

CONCLUSIONS

There is not only a high expression of PCNA and alpha-SMA in the myocardium of patients with rheumatic heart disease but also in fetal myocardium. We suggested that pathological myocardial cells are constructive phenotype and synthetive phenotype. PCNA and alpha-SMA positive expression cells are in the proliferating stage, they take part in fibrotic progress and vascular reconstruction in the myocardium.

Carnitine levels in patients with chronic rheumatic heart disease

OBJECTIVE

Carnitine, a small aminoacid derivative plays a major role in fatty acid oxidation. Myocardial carnitine deficiency may cause malfunction of the heart. Rheumatic valvular heart disease can be associated with myocardial dysfunction. We have investigated myocardial and plasma-free carnitine levels in patients with chronic rheumatic heart disease.

MATERIAL AND METHODS

Eleven patients with chronic rheumatic heart disease requiring valve replacement were selected for study. Ten patients with no cardiac failure, myocardial wall motion abnormalities and myocardial infarction and for whom coronary bypass surgery was planned were selected as the control group. Carnitine levels of myocardial tissue obtained from the right atrium and plasma during the operation were evaluated using spectrophotometric method. Myocardial-free carnitine levels expressed as mumol/g (dry weight) were determined according to Ceberblad and Lindstedt technique.

RESULTS

Myocardial-free carnitine levels in patients were found to be 0.72 +/- 0.37 mumol/g (dry weight) in comparison with 1.44 +/- 1.03 mumol/g (dry weight) in the control group. Myocardial-free carnitine levels in patients were statistically decreased when compared to control group. Plasma-free carnitine levels in patients were 80.91 +/- 28.22 mumol/L and 89.52 +/- 48.21 mumol/L in the control group, respectively. There was no significant difference between plasma-free carnitine levels of the groups.

CONCLUSION

In our study, myocardial-free carnitine levels were decreased while plasma-free carnitine levels were normal in patient with chronic rheumatic heart disease.

Serum alpha-1-antitrypsin in ischemia and rheumatic heart diseases

Tissue damage, inflammation and necrosis are hallmarks of myocardial infarction. In the present study significant elevations of serum alpha-1-antitrypsin were noted in coronary artery disease and angina cases. Interestingly chronic rheumatic heart disease which is also characterized by tissue injury. Inflammation revealed normal levels of serum alpha-1-antitrypsin. The level in chronic rheumatic heart disease was 3.37 +/- 0.57 mumol/mt/ml (control level was 3.37 +/- 0.54 mumol/mt/ml). The corollary of these observations is that in heart diseases acute phase response in terms of enhanced levels of alpha-1-antitrypsin differ depending on the causative factors. Except chronic rheumatic heart disease, in all other stressful states studied there is (to a certain degree) an altered systemic homeostasis and haemostasis. On the other hand chronic rheumatic heart disease encompass certain amount of acute phase status in terms of tissue damage and inflammation does exist unaccompanied by altered systemic homeostasis and haemostasis. However, bacteriological etiologies predominate the triggered immune responses. It is hypothesised that serum alpha-1-antitrypsin enhancement will not occur even though acute phase state exists if specific immune responses are also a part of the disease manifestation.

Effects of different left ventricular load conditions on myocardial beta-adrenoceptor density in patients with rheumatic heart valvular disease

1. The possibility that different left ventricular load conditions may influence myocardial beta-adrenoceptor function in various ways was evaluated by determining the receptor density in all four chambers of 69 patients with rheumatic heart valvular disease. 2. The left ventricular beta-adrenoceptor density was reduced by 44% in patients with left ventricular pressure overload (LVP), 66% in left ventricular volume overload (LVV), 56% in mixed volume and pressure overload (MOL), and 60% in those with no left ventricular pressure overload (NOL). Similarly, the right ventricular receptor density decreased significantly by 46%, 54%, 43%, and 46%, left atrial by 15%, 29%, 14%, and 21%; and right atrial by 27%, 30%, 28%, and 12% in LVP, LVV, MOL, and NOL, respectively. Thus, the general trend in the decrease in receptor density was LVV > MOL = NOL > LVP. 3. Furthermore, the LVV patients with the largest decrease in receptor density in all four chambers, similarly exhibited the largest ejection fractions (EF) and left ventricular internal diastolic and systolic diameters. 4. The results show that left ventricular volume overload is a major cause of attenuation in myocardial beta-adrenoceptor density, compared to other forms of ventricular overload in heart valvular disease. 5. Since elevated EF in volume overload patients is an indication of the severity of the disease, the decrease in their myocardial receptor density may be a reflection of the degree of influence of the disease on their sympathetic activity.

Effect of left ventricular pressure and volume overload on alpha-adrenoceptor activity in patients with rheumatic heart valvular disease

We have investigated the possibility that the various left ventricular load conditions may exert different effects on the sympathetic function by comparing the influence of volume (VOL) and pressure (POL) overload on platelet alpha-adrenoceptor activity, plasma catecholamines and cAMP in 44 patients with rheumatic heart valvular disease. Receptor activity was determined by radioligand binding methods, catecholamines by HPLC using an electrochemical detector, and cAMP by radioimmunoassay. The mean alpha-adrenoceptor density (Bmax) of the control group (n = 29) was 4.71 +/- 0.41 fmol per 10(7) platelets and the corresponding dissociation constant (Kd) was 2.47 +/- 0.15 nM. In VOL patients, the density was elevated by 70% (P < 0.0001), but it remained unchanged in the POL patients. In contrast to the Bmax, the Kd of the VOL group was not changed, and it increased by 34% (P < 0.01) in the POL group. Norepinephrine was elevated by 91% (P < 0.05) in POL, and epinephrine increased by 65% (P < 0.05) in POL and 71% (P < 0.05) in VOL. These results suggest that the sympathetic nervous system responds to left ventricular volume overload by increasing alpha-adrenoceptor density with no apparent change in receptor affinity toward [3H]-yohimbine binding, and to left ventricular pressure overload by decreasing their binding affinity without a parallel decrease in receptor density. The increase in receptor density in VOL is accompanied by an increase in plasma epinephrine, and the decrease in binding affinity in POL is associated with increased plasma norepinephrine and epinephrine levels.

[Pathological observation and immunohistochemistry study of Type I, III, IV collagen in mitral valve and cardiac interstitium of rheumatic disease]

OBJECTIVES

To examine the pathological base of mitral valve and cardiac interstitium of rheumatic disease, and to explore the relationship between Type I, and III, IV collagen in mitral and cardiac interstitium of rheumatic heart disease.

METHODS

HE and ABC method special staining were used to observe the mitral valve and cardiac interstitium pathology in 26 case.

RESULTS

Diffused collagen fibroplasia, hyaline and amyloid degeneration were noted and sometimes associated local necrosis and calcification in myocardial interstitium and in mitral valve. It was a significant pathologic characteristic of rheumatic heart disease. The localization of Type I, III and IV collagen in the valve and myocardiac tissues was studied by ABC method of immunohistochemistry. Significant fibroplasia of collagen Type I and III was found in the valve, cordae tendon and myocardial interstitium of rheumatic heart disease. The composition and secretion of collagen Type I and III were expressed not only in fibroblasts but also in myocardial cells.

CONCLUSIONS

The pathologic foundation of valve and myocardial fibrosis is collagen fibroplasia. The degree of fibroplasia is related to the repeated reaction of chronic rheumatic inflammation.

Physicochemical characterization of natural and bioprosthetic heart valve calcific deposits: implications for prevention

This investigation was performed to provide a comprehensive physicochemical characterization of calcific deposits (CDs) that form on human heart valves under various pathological conditions. We examined and characterized CDs associated with aortic stenosis on congenitally bicuspid valves (n = 10), degenerative aortic stenosis on valves with previously normal anatomy (n = 10), and rheumatic aortic (n = 10) and mitral (n = 10) stenosis. Native and deproteinated CDs underwent chemical analysis and structural characterization, whereas deproteinated CDs were measured for thermodynamic solubility. The CDs in valvular heart disease were microcrystalline apatitic products containing substantial amounts of sodium, magnesium, carbonate, fluoride, and organic fraction. The properties of natural heart valve CDs were compared with those of previously measured CDs that form on or in heart valve bioprostheses. Compared with bioprosthetic valve CDs, natural valve CDs have a higher ratio of calcium to phosphorus, higher crystallinity, and lower solubility. These differences indicate that natural heart valve CDs appear to comprise a more mature biomineral. If the formation of mature CDs proceeds through transient stages involving unstable precursors, then the main strategy for prevention of calcific deterioration of bioprosthetic heart valves would be the development of locally applied long-term inhibitors that both (1) suppress nucleation and growth of more soluble precursors and (2) inhibit subsequent augmentation of less soluble CDs.

Characterization of lymphocyte beta-adrenoceptor activity and Gs-protein in patients with rheumatic heart valvular disease

In order to test whether the beta-adrenoceptor activity in rheumatic heart valvular disease depends on the ventricular load conditions, we determined their density and binding affinity to [125I]-iodocyanopindolol in lymphocytes, as well as plasma catecholamine and cAMP levels in 69 patients with regurgitant and stenotic lesions of the aortic and mitral valves. The patients were classified as having left ventricular pressure overload (LVP), left ventricular volume overload (LVV), mixed lesions (MOL) or right ventricular pressure overload (RVP). The beta-adrenoceptor activity was determined by radioligand binding methods, catecholamines by high performance liquid chromatography using an electrochemical detector and cAMP by radioimmunoassay. The mean beta-adrenoceptor density (Bmax) of the control group was 60.1 +/- 9.5 fmol (n = 29) per 10(6) lymphocytes. In the study population, the density was decreased by 83% in LVP, 78% in LVV, 87% in MOL and 86% in RVP. Plasma norepinephrine was elevated by 89% in LVP and 60% in MOL, epinephrine by 43% in LVP, 50% in VOL, 115% in MOL and 20% in RVP, while dopamine was not significantly changed, and cAMP was slightly elevated in all four groups. Screening for activating mutational changes in the Gs alpha-protein gave negative results, possibly dissociating the elevation in plasma cAMP from stimulatory effects of such abnormalities in the Gs-protein signaling.(ABSTRACT TRUNCATED AT 250 WORDS)

Endothelin production in pulmonary circulation of patients with mitral stenosis

BACKGROUND

Although plasma endothelin concentrations are elevated in patients with pulmonary hypertension, the precise sites of endothelin production have not been defined. We investigated the endothelin production in the pulmonary circulation of patients with mitral stenosis and its effects on pulmonary vascular tone.

METHODS AND RESULTS

We measured plasma concentrations of endothelin-1, angiotensin II, and thrombomodulin in blood samples obtained from the right and left atria of 10 consecutive patients with rheumatic mitral stenosis (mean age, 55 years; range, 39 to 68) who were undergoing percutaneous mitral valvuloplasty. Plasma levels of endothelin-1 were significantly higher in the left atrium than in the right atrium (3.25 +/- 0.45 versus 2.53 +/- 0.36 pg/mL, mean +/- SE, P < .001). The increased plasma endothelin-1 level in the left atrium, which reflected endothelin-1 production in the pulmonary circulation, was correlated with mean pulmonary artery pressure (r = .65, P = .04), mean pulmonary arterial wedge pressure (r = .67, P = .03), total pulmonary resistance (r = .68, P = .03), and 1/mitral valve area (r = .85, P = .002) but not with pulmonary vascular resistance (r = .04, P = .91). There were no significant differences in plasma levels of angiotensin II and thrombomodulin between the right and left atria (angiotensin II, 16.40 +/- 3.08 versus 15.50 +/- 4.85 pg/mL; thrombomodulin, 2.96 +/- 0.34 versus 2.85 +/- 0.37 ng/mL).

CONCLUSIONS

Endothelin-1 production is increased in the pulmonary circulation of patients with mitral stenosis in response to increased pulmonary artery pressure but is not directly related to increased pulmonary vascular tone in this disorder.

Zinc in rheumatic heart valves

This study included 48 patients with chronic rheumatic heart disease, 60 control subjects for plasma zinc comparison and 20 control specimens of heart valves from postmortem cases of accident deaths. Plasma and cardiac tissue levels of zinc in patients with rheumatic heart disease were significantly lowered compared to controls. Since zinc is important in the synthesis of nucleic acids and proteins it may influence tissue growth, reparative process and structure and function of biomembrane. Low zinc levels may also influence cell mediated immunity and may increase susceptibility of patients to infection and increased rheumatic activity which needs further study.

Action of oxygen free radical scavengers and inhibitors on the chemiluminescence response of monocytes and neutrophils in rheumatic fever

Various scavengers of oxygen free radicals or inhibitors of their production were used to measure the relative amounts of oxygen free radicals generated in phagocytic cells. The agents used were iodoacetate, superoxide dismutase, sodium benzoate, catalase and mannitol. The studies were made in patients with a recurrence of rheumatic activity, chronic rheumatic heart disease or pharyngitis, and in normal controls. Monocytes and neutrophils of the subjects were stimulated with latex in the presence or absence of a scavenger/inhibitor and the per cent inhibition of the chemiluminescence response was calculated. There were 10 patients in each group. Follow-up studies were done at 15 days, 3 months and 6 months. In the patients with a recurrence of rheumatic activity, the level of oxygen free radicals generated in the initial study was so high that the scavenger/inhibitors were able to reduce the chemiluminescence only in part. The diminution in chemiluminescence increased during the follow-up period. In the patients with chronic rheumatic heart disease, the per cent inhibition of the chemiluminescence response was significantly higher in the initial study than that observed in patients with a recurrence of rheumatic activity, and it remained constant during the follow-up period. The scavenger/inhibitors were almost completely able to inhibit the generation of oxygen free radicals in patients with pharyngitis and in normal controls.

[A study of immunocompetence of peptide hormones in human pericardium]

With RIA/HPLC and immunohistochemistry, the presence of angiotensin(A) and atrial natriuretic factor-like materials (ANF-LMs) was demonstrated in the pericardium of human and rats; the distributions of AII and ANF-LMs were found to be identical; AI was more than AII; renin activity was detected in the pericardium. There were three molecular forms of ANF-LMs in the pericardium. Mesothelial cells were the principal endocrine-secreting cells. AII and ANF-LMs of the pericardium were significantly increased in rheumatic heart disease. There were no correlations between plasma AII, ANF, urine AII, ANF and pericardial AII, ANF (P > 0.05). The data reported showed that the pericardium may have endocrine function under normal and abnormal conditions (heart failure) of the heart, in addition to its known mechanical properties.

[Myocardial catecholamine levels in patients with congenital and acquired heart defects]

Catecholamine levels were determined in the myocardial slices from 66 patients with congenital and acquired heart diseases by the trihydroxyindole++ method on a Lumilan fluorescence spectrophotometer. The patients were found to have greatly varying epinephrine and norepinephrine levels. The accumulation of catecholamine reflected, to a certain extent, the occurrence of disorders in relation to the functional load, hyperfunctions of the myocardium. Blood hypoxemia and myocardial hypoxia affected the status of the patients.

Release of oxygen free radicals by macrophages and neutrophils in patients with rheumatic fever

The generation of oxygen free radicals (OFR) by peripheral blood monocytes and neutrophils of patients with rheumatic fever (RF) and rheumatic heart disease (RHD) has been studied using the luminol-enhanced chemiluminescence technique. The mechanism of OFR generation was studied by measuring NADPH oxidase enzyme activity. The effect of substrate was studied by measuring the hexose monophosphate (HMP) shunt enzymes: glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase. Three groups of patients [i) recurrent rheumatic activity, (ii) chronic RHD, (iii) acute pharyngitis) and normal controls were studied at day 0 and followed-up serially at 15, 90 and 180 days. The release of OFR, was significantly higher (P less than 0.001) in patients with recurrent rheumatic activity than in those with acute pharyngitis or chronic RHD, throughout the study period. A significant decline (P less than 0.001) in OFR release was observed from day 0 to day 180 in these patients, whereas no such change was observed in the chronic RHD group. This study raises the possibility that these phagocytic cells, which infiltrate the myocardium, may through generation of OFR, have a role in the pathogenesis of cardiac damage seen in patients with RHD.

Connective tissue changes in rheumatic heart disease

The connective matrix of 17 surgically excised mitral complexes from patients with clinical diagnosis of rheumatic carditis was evaluated by semi-quantitative histopathological, immunohistochemical and ultrastructural parameters. Different and concomitant patterns of loose and dense fibrosis were observed with variable constitution and organization of collagen I, III, IV, procollagen III, laminin, fibronectin and elastin. Loose fibrosis exhibited codistribution of all matrix components, Initial phase of fibrosis was characterized by deposition of all matrix components organized in a network pattern. In dense fibrosis a parallel disposition of type I collagen bundles predominated. In the denser (hyalin) fibrosis, the collagen exhibited abnormalities in fiber diameters and in fiber conformation (hyperfibers) and there was reduction or disappearance of other matrix components. The presence of these different kinds of connective matrix and the ultrastructural alterations in collagen fibers are associated to different stages of fibrosis organization and probably reflect changes in collagen susceptibility to degradation. These morphologic patterns may be related to the evolution (stability or reversibility) of rheumatic sequelae.

Immunohistochemical characterization of Aschoff nodules and endomyocardial inflammatory infiltrates in resected left atrial appendages

Presence of Aschoff nodules and other chronic inflammatory cells in the left atrial appendage even in the absence of rheumatic activity has been reported in a high percentage of patients with chronic rheumatic valvular heart disease. This study was conducted on 37 left atrial appendages resected at the time of closed mitral valvotomy. Aschoff nodules were present in 61.2 percent of resected appendages, positivity being 71.4 percent in the age group of 20 years of less and 53.3 percent in patients more than 20 years of age. The histological findings did not change significantly in the presence of activity. The frequency of Aschoff nodules and chronic inflammatory cells and their subtypes also did not show any correlation with age, sex, duration of symptoms or severity of mitral stenosis.

Role of oxygen free radicals generated by blood monocytes and neutrophils in the pathogenesis of rheumatic fever and rheumatic heart disease

The generation of oxygen free radicals by peripheral blood monocytes and neutrophils of patients with rheumatic fever and rheumatic heart disease has been studied using luminol enhanced chemiluminescence technique. Five groups of patients; acute rheumatic fever, recurrence of rheumatic activity, chronic rheumatic heart disease, acute pharyngitis and normal controls were studied. In all groups except the controls, measurements were made on 0, 15, 90 and 180 days. The chemiluminescence was measured in response to streptococcal membrane antigen, carbohydrate antigen and latex as triggering agents. Chemiluminescent response of monocytes, as well as, neutrophils was significantly higher (P less than 0.01) in acute rheumatic fever and recurrence of rheumatic heart disease as compared to patients with acute pharyngitis and chronic rheumatic heart disease through the study period and with all the triggering agents. A significant decline (P less than 0.001) in chemiluminescence was observed from day 0 to day 180 in the acute rheumatic fever, recurrence of rheumatic heart disease and pharyngitis patients while no such change, was observed in the chronic rheumatic heart disease group. This study raises the possibility that these phagocytic cells, which infiltrate the myocardium, may have a role in the pathogenesis of cardiac disease seen in patients with rheumatic heart disease, through the generation of oxygen free radicals.

Cytokines and immunoglobulin in rheumatic heart disease: production by blood and tonsillar mononuclear cells

Rheumatic fever and rheumatic heart disease are considered to result from abnormal immune responses after Group A streptococcal pharyngitis. Production of interleukin 1 (IL-1), tumor necrosis factor-alpha (TNF), interleukin 2 (IL-2) and immunoglobulin (Ig) by blood and tonsillar mononuclear cells from rheumatic or healthy children was measured after stimulation in vitro by pokeweed mitogen (PWM) or the streptococcal extracellular product, blastogen A (BLA). Tonsillar cells from patients with rheumatic heart disease produced significantly less IL-1, TNF, IL-2, and Ig than control tonsillar cells. In contrast, blood mononuclear cell cultures from rheumatic children produced more TNF and IL-2 than controls. Our findings suggest that abnormal regulation of cytokine and Ig production may contribute to the pathogenesis of acute rheumatic fever and rheumatic heart disease.

A geochemical basis for endomyocardial fibrosis

Analysis of hearts of patients dying from endomyocardial fibrosis showed a significantly greater concentration of cerium, a lanthanide present in leafy vegetables and root tubers, than in control hearts. This may be important in the pathogenesis of the disease and provides a geographical basis for the prevalence of the disease in the tropics.

Biochemical characterization of individual normal, floppy and rheumatic human mitral valves

Human mitral valves (32 floppy and 17 rheumatic) obtained at surgery were analysed and compared with 35 normal (autopsy) valves. Total amounts of collagen, proteoglycan and elastin were increased approx. 3-fold in floppy and rheumatic valves. The water content of rheumatic cusps was lower than normal. The most significant changes in floppy valves were the 59% increase in mean value of the proteoglycan content, a large increase in the ease of extractability of proteoglycans from 26.7 to 57.2% of the total and a 62% increase in mean value of the elastin content in the anterior cusps. Normal human mitral valve cusps contained a mean proportion of 29.3 (and chordae 26.6) type III collagen (as % of total types III + I collagen), the values increasing significantly to 33.2 and 36.3% respectively in chronic rheumatic disease. The ratio observed in floppy valves depended on the extent of secondary surface fibrosis, which could be demonstrated histologically; in valve cusps with considerable secondary fibrosis, the percentage of type III increased significantly (to 34.4%), whereas it decreased significantly (to 25.2%) when fibrosis was negligible. It is concluded that the ratio of collagen types in floppy valves reflects the extent of secondary fibrosis rather than the pathogenesis of the disrupted collagen in the central core of the valve.

[Lipid peroxidation and anti-oxidative systems of an organism in experimental streptococcal myocarditis and rheumocarditis]

Lipid peroxidation rate and activity of glutathione and tocopherol antioxidant systems were studied in rats with experimental streptococcal myocarditis and in patients with rheumatic carditis. During the acute period of inflammation content of diene conjugates and activity of glutathione reductase were increased in myocardium and erythrocytes of rats simultaneously with a decrease in tocopherol concentration in blood plasma. In the patients with rheumatic carditis activation of lipid peroxidation and the glutathione reductase was found in erythrocytes as well as a decrease of the tocopherol content--in blood plasma. Interrelationship between alterations in these patterns and their functions in rheumatic carditis pathogenesis are discussed.

[Lipid peroxidation in cardiac insufficiency]

Peroxidation of lipids was studied in patients with heart failure after coronary heart disease and acquired valvular diseases. Even at early stages of the heart failure an increase in the concentration of dien conjugates, malonic dialdehyde and intensification of the peroxidation of blood lipids under stimulation by bivalent iron have been revealed. These changes do not depend on reasons which caused heart failure.

Defective DNA-receptor function in systemic lupus erythematosus and related diseases: evidence for an autoantibody influencing cell physiology

The receptor for DNA was functionally defective in the majority of patients with systemic lupus erythematosus (SLE; 91% of 35 studied) and allied rheumatic disorders. This functional defect was manifest by impaired binding of exogenous DNA to the cell surface of peripheral blood mononuclear cells and an inability of cells to internalise and degrade DNA. The receptor defect was not constitutive, since it could be reversed by overnight incubation of cells; this process was sensitive to cycloheximide, suggesting a requirement for active receptor regeneration. The DNA-receptor defect could be induced in healthy controls, by incubating their cells with the serum of patients with SLE. The humoral factor inducing the defect was an autoantibody.

[Nicotinic acid metabolism in patients with non-coronarogenic heart diseases]

To study the supply with nicotinic acid, 74 patients with rheumatic fever of varying degree and circulatory disorders, 10 patients with infectious-allergic myocarditis, 15 with tonsilogenous myocardiodystrophy were examined. Seventy normal subjects served as control. The supply with vitamin PP was evaluated from the blood content of NAD, NADP and N'-methylnicotinamide and its excretion with urine. All the patients with myocarditis and rheumatic fever demonstrated a decrease in the nicotinic acid supply which became more marked as the degree of rheumatic fever rose and circulatory failure supervened. In patients with tonsilogenous myocardiodystrophy , the disturbance of the vitamin supply was less overt.

[Use of nicotinamide for correcting the disordered nicotinic acid allowance of patients with noncoronarogenic heart diseases]

A study was made of the effects of different doses of nicotinamide (NA) on the nicotinic acid supply in 37 patients with rheumocarditis of varying severity without circulation failure, in 5 patients with infectious-allergic myocarditis, and in 10 patients with tonzilogenous myocardiodystrophy. Twenty-eight patients with analogous diseases given unified therapy without NA and 70 healthy subjects were examined for control purposes. The rate of vitamin PP supply was evaluated from the content of NAD and NADP in red cells, from that of N'-methylnicotinamide in the blood and its excretion with urine. Administration of NA in a dose of 50 mg a day for 2 weeks to patients with tonsilogenous myocardiodystrophy made the indicators under consideration return to normal. The attainment of complete correction of abnormal vitamin PP supply in patients with rheumocarditis and infectious-allergic myocarditis demands a 2-time increase of the drug dose.

Collagen biosynthesis in normal and abnormal human heart valves

Absolute rates of collagen and non-collagen protein synthesis were measured in organ cultures of normal, rheumatic and floppy heart valves. The incorporation of 14C-proline into the cultures was measured and standardised according to the specific activity of the isotope in the tissue and the amount of DNA present. It was observed that the mean rate of collagen synthesis in floppy and rheumatic valves was significantly higher than normal, but that there was no difference in the rates of non-collagen protein synthesis. This stimulated synthetic activity in the abnormal valves was coupled with elevated collagen and total protein content of the tissue. The proportion of total protein synthesis that was devoted to the production of collagen was also significantly higher in the pathological tissues.

Myocardial metal content in patients who expired from cyanotic congenital heart disease and acute rheumatic heart disease

The importance of metals in normal and pathologic cardiovascular function has been recognized. Significant derangements in myocardial Ca2+, Mg2+, and Cu2+ have been reported in ischemic heart injury. We studied 3 groups of hearts: 1) fifteen specimens obtained from patients who had no heart disease, 2) nine specimens from patients who had expired from cyanotic congenital heart disease, and 3) ten specimens from patients who had expired from acute rheumatic heart disease with carditis and severe heart failure. None of the patients had undergone cardiac surgery. Left ventricular lateral wall Mg2+, Ca2+, Cu2+, and Zn2+ contents were measured by atomic absorption spectrometry. The results showed a significant decrease in myocardial Mg2- (Group I 177.06 +/- 32.71; Group II 155.66 +/- 14.79; Group III 149.00 +/- 13.29, p less than 0.05 and p less than 0.01, respectively), and Cu2+ contents (Group I 3.22 +/- 0.37; Group II 2.94 +/- 0.22; Group III 2.56 +/- 0.32, p less than 0.02 and p less than 0.001, respectively), and a rise in myocardial Ca2+ content (Group I 36.06 +/- 10.72; Group II 43.22 +/- 7.01; Group III 46.30 +/- 4.85, p = not significant, and p less than 0.01, respectively). The myocardial Zn2+ content did not change significantly (Group I 26.53 +/- 3.99; Group II 26.00 +/- 4.15; Group III 26.40 +/- 3.53). The myocardial Mg2+/Ca2+ ratio was reduced markedly in both groups (Group I 5.328 +/- 1.879; Group II 3.685 +/- 0.735; Group III 3.135 +/- 0.291, p less than 0.001 for both Groups II and III vs Group I). The latter results correlated closely with the myocardial Mg2+/Ca2+ ratios reported in experimental models in peri-infarction zones. Thus, the myocardium of patients who had expired from cyanotic congenital heart disease and acute rheumatic carditis is jeopardized by ischemia, with metal contents similar to the border areas in myocardial infarction.

Acid mucopolysaccharides of congenitally defective, rheumatic, and normal human aortic valves

The qualitative nature, total amount, and relative proportion of various acid mucopolysaccharides (AMPSs) found in congenitally defective (bicuspid), young rheumatic, and normal aortic valvular tissue were compared. No differences in the qualitative nature of AMPSs were found in any of the aortic tissues studies; hyaluronic acid, chondroitin sulfate B, and chondroitin sulfate A/C were the primary AMPS components, with a trace amount of heparin. Congenitally defective aortic valves showed increasing amounts of calcification, a lowering of total AMPS content, and an alteration in the relative proportions of various AMPS with advancing age, as compared with age-matched normal aortic valves. The total AMPS content of rheumatic aortic valves from individuals under the age of 21 years was found to be significantly higher than that of age-matched normal controls. In addition, these rheumatic aortic valves showed an alteration in AMPS composition that was similar to that of congenitally defective aortic valves obtained from older individuals. These observations suggest nonspecific changes in the AMPS composition caused by chronic tissue damage, calcification, and fibrosis.

[Extracellular fluid and total potassium content in obesity patients]

The content of extracellular fluid and total potassium was studied by total-body radiometry with 82Br and according to 40K in 162 females aged 41 to 55 years suffering from obesity. It was established that in patients with obesity the volume of extracellular tissue, in per cent, and the amount of total potassium, in gramms and millieequivalent per unit of actual body mass, were reduced. An increase in the content of extracellular fluid and a decrease in the level of total potassium in obese patients with circulatory insufficiency may be revealed only when the real content of extracellular fluid and the total potassium are stimated in relation to the unit of body surface. In obese patients with no signs of circulatory insufficiency these relative values hardly differ from the control values.