IMMUNOLOGICAL MECHANISMS OF MYOCARDIAL REMODELING IN CHILDREN AFTER TRANSCATHETER CLOSURE OF VENTRICULAR SEPTAL DEFECT
Keywords:
VSD, transcatheter closure, myocardial remodeling, immune markers, cytokines, children, TLR4, TGF-β1, IPREM.Abstract
A prospective study included 180 patients, of whom 103 had favorable remodeling and 77 had signs of adverse remodeling. We assessed the indicators of innate, adaptive, and humoral immunity, the levels of pro-inflammatory and pro-fibrotic cytokines (IL-6, IL-10, TNF-α, TGF-β1), markers of innate immunity (TLR4, HLA-DR, sCD14), immunoglobulins, and biomarkers of myocardial damage (NT-proBNP, troponin I). It has been shown that a complex immune response disorder precedes and accompanies the formation of AMR. An integral profile of immune risk has been established, including nine independent predictors. The developed prognostic IPREM scale demonstrates high diagnostic accuracy and can be implemented in clinical practice. The obtained data expand the understanding of cardio-immune interactions and allow for optimizing the observation strategy for children after interventional procedures.
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