Transcript Morphometric parameters of myocardium as substrate for

Государственное бюджетное образовательное учреждение
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«СМОЛЕНСКАЯ ГОСУДАРСТВЕННАЯ МЕДИЦИНСКАЯ АКАДЕМИЯ»
Министерства Здравоохранения Российской Федерации
Областное государственное бюджетное учреждение здравоохранения
«СМОЛЕНСКИЙ ОБЛАСТНОЙ ИНСТИТУТ ПАТОЛОГИИ”
SMOLENSK STATE MEDICAL ACADEMY,
Department of Pathological Anatomy
“SMOLENSK REGIONAL INSTITUTE OF PATHOLOGY”
PhD, Assistant of the Department, Clinical Pathologist
KORNEVA YULIA
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One of the greatest
problems of modern
cardiology is chronic heart
failure as an outcome of
healing of myocardial
infarction (MI)
Changes in myocardium,
accompanied healing of MI,
are known as REMODELING
of myocardium
Remodeling is characterized
by structural and
geometrical changes in
heart
Morphologically the process
includes hypertrophy of
Cardiomyocytes,
reorganisation of vessels,
fibrosis and loss of
Functional elements
(especially by means of
apoptosis)
Loss of
Cardiomyocytes
Fibrosis
Reorganisation
of vessels
CHRONIC
HEART
FAILURE
Cardiomyocytes are known to be cellular populations with very limited
potential to regeneration. One of the main effects on the regulation of
remodeling have different cellular populations, entering Myocardium
through the capillaries. They also play role in loss of structural elements
through apoptosis and formation of new vessels.
Apoptosis of
Cardiomyocytes
Cellular
population
Microcirculation
 Postmortem
material - 105 hearts from
patient died due to MI, localized in one of
the free walls of left ventricle
• Acute MI 1-2
days
• Acute MY 3-5
days
• Acute MY more
then 7 days
Acute MY
Healed MY
• Recurrent MI 12 days
• Recurrent MY 35 days
• Recurrent MY
more then 7
days
Recurrent MI
Healed MY
MI 1-2 days in duration (H-E,
х200)
MI more then days in duration
(H-E, х200)
MI 3-5 days in duration (H-E,
х200)
Healed MY – scar (H-E, х100)
The specimens for
investigation were
taken from:
 The centre of
pathological process
 The border zone
 The intact zones
(centre of
interventricular
septum an centre of
right ventricle)
1.
2.
3.
4.
Cellular populations, forming inflammatory
infiltrate, were counted around capillaries;
Area of microcirculatory bed was measured by
means of special computer program
“Videotest.Morphology. 4.0”;
Apoptosis of structural elements was revealed by
means of immunohistochemical examination with
monoclonal antibodies against Caspase-3;
All the data were treated with non-parametrical
statistical methods.
Dynamic of changes of cellular
populations in the affected zone during
healing of acute and recurrent MI
Dynamic of changes of cellular
populations in the border zone during
healing of acute and recurrent MI
Dynamic of changes of cellular
populations in the intact zone
(interventricular septum) during
healing of acute and recurrent MI
Dynamic of changes of cellular
populations in the intact zone (right
ventricle) during healing of acute and
recurrent MI
Acute MI12 daysAcute MI
3-5 days
HEALING OF ACUTE MYOCARDIAL INFARCTION
BZ
AZ
RV
IVS
Acute MI
3-5 daysAcute MI
more then
7 days
BZ
RV
AZ
IVS
Acute MI
more then
7 days –
Healed MI
BZ
AZ- affected zone;
BZ – border zone;
IVS – inter-ventricular
septum;
RV – right ventricle.
RV
AZ
IVS
HEALING OF RECURRENT MYOCARDIAL INFARCTION
BZ
AZ
RV
IVS
Recurrent
MI 3-5
daysRecurrent
MI more
then 7
days
BZ
RV
AZ
IVS
Recurrent
MI more
then 7
days –
Healed MI
BZ
AZ- affected zone;
BZ – border zone;
IVS – interventricular
septum;
RV – right ventricle.
RV
Recurrent
MI1-2
daysRecurrent
MI 3-5
days
AZ
IVS
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Ventricular fibrillation is one of the fatal
and almost unpredictable complication of
myocardial infarction. But the pathogenesis
of is still very unclear as well as the
criteria for its morphological verification.
We compared cellular infiltrate in
myocardium in patients who died due to
ventricular fibrillation and the group of
cases without such complication, and
statistical methods revealed the significant
differences in cellular infiltrate.
The finding may be the key for explanation
of some steps in pathogenesis of ventricle
fibrillation and helped to create a method
of objective verification of ventricle
fibrillation.
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1. Numerical quantity of the changes of cellular infiltrate,
capillary bed and apoptosis of Cardiomyocytes (reflecting
process of myocardial remodeling) during healing of myocardial
infarction in necrotic zone, border zone and intact zones;
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2. Numerical quantities of morphometric parameters of acute
and recurrent myocardial infarction healing;
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3. Quantitative differences of morphometric parameters of acute
and recurrent myocardial infarction healing;
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4. Peculiarities of cellular infiltrate in myocardium of patients
who died due to ventricular fibrillation as a complication of
myocardial infarction.
 1.
Mathematical model of acute and recurrent
myocardial infarction healing, reflecting
differences in remodeling of the whole heart
during the diseases (based on the changes in
cellular infiltrate, microcirculation and death of
cardiomyocytes);
 2. Mathematical model of ventricular fibrillation as
myocardial infarction complication, basing on
differences in cellular infiltrate in myocardium of
such patients (in some way, it may clarify the dim
pathogenesis of the complication);
 3. The scheme for prognosis of myocardial
remodeling with formation of cardiac insufficiency,
based on morphological criteria.