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The inflammatory response in patients with acute myocardial infarction during the development of adaptive and pathological remodeling of the myocardium


Author: Munteanu Mihaela
Degree:doctor of medicine
Speciality: 14.00.06 - Cardiology and Reumatology
Year:2022
Scientific advisers: Lucia Ciobanu
doctor habilitat, associate professor (docent)
Valeriu Cobeţ
doctor habilitat, professor
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 14 April, 2022
Approved by NCAA on the 1 July, 2022

Abstract

Adobe PDF document – 6.91 Mb / in romanian
Adobe PDF document – 0.55 Mb / in english

Thesis

CZU 616.12-008.331.1-085

Adobe PDF document 2.25 Mb / in romanian
132 pages

Keywords

acute myocardial infarction, anti-inflammatory markers, cardiac remodeling, ischemia, inflammatory response, isolated heart, TNF-α antagonist, IL-10

Summary

Structure of the thesis: introduction, 4 chapters, synthesis of the obtained results, general conclusions and practical recommendations, bibliography of 115 titles, 3 annexes, 123 pages of basic text, 31 tables, 18 figures. The obtained results are published in 37 scientific papers.

Aim of the study: to evaluate the serum level of inflammation markers during the development of post-myocardial remodeling in patients with STEMI, as well as the particularities of the reactive effort of the heart and coronary system in experimental myocardial infarction, to predict the type of myocardial remodeling.

Research objectives: Evaluation of the dynamics of serum levels of pro- and antiinflammatory markers in the acute and distant phase after revascularization in patients with STEMI who develop adaptive or pathological post-infarction remodeling. Evaluation of serum levels of markers of fibrillar collagen type III and type I at a distance of 1 and 3 months, respectively, from revascularization of patients with STEMI in contiguity with the particularities of quantitative changes of pro- and anti-inflammatory markers in the acute phase of heart attack. Evaluation of the mechanisms of danger of cardiac and coronary reactivity in experimental myocardial infarction, as well as of the effect of the anti-inflammatory treatment performed by the TNF-α and IL-10 antagonist. Strengthening the algorithm of biochemical markers with predictive value on the pattern of development of post-infarction remodeling in patients with STEMI, as well as functional predictors on exacerbation of post-infarction heart failure.

Scientific novelty and originality: Conducted for the first time in Republic of Moldova, a clinical-experimental study on acute myocardial infarction was performed to highlight biochemical predictors of the pattern of postmyocardial remodeling, markers with pro- and anti-inflammatory effect, markers of synthesis and collagen fiber degradation, in patients with STEMI undergoing primary revascularization, as well was assessed the effect of attenuating inflammation by repeated administration of TNF-α and IL10 antagonist in rats. Scientific problem solved: resides in the clinical-experimental substantiation of the role of inflammation, markers of fibrillar collagen turnover in adaptive or pathological myocardial remodeling that contributes to establishing predictors of prognosis and treatment in patients with STEMI after revascularization.

Theoretical significance: The results have a theoretical impact on the determining role of the imminent inflammatory response to the acute phase of infarction in the evolution of the pattern of post-infarction myocardial remodeling in patients with STEMI undergoing angioplasty.

Applied value:

The study may serve to strengthen the algorithm for predicting the risk of evolution of post-infarction remodeling of the pathological myocardium in patients with STEMI.

Implementation of scientific results: The results of the study were implemented in the therapeutic activity of IMSP Institute of Cardiology, Novamed Polyvalent Hospital and in the teaching process at USMF "Nicolae Testemitanu".