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First Polish analysis of the treatment of advanced heart failure in children with the use of BerlinHeart EXCOR mechanical circulatory support.

Fri, 11/24/2017 - 13:45

First Polish analysis of the treatment of advanced heart failure in children with the use of BerlinHeart EXCOR mechanical circulatory support.

Kardiol Pol. 2017 Nov 23;:

Authors: Pawlak S, Przybylski R, Skalski J, Śliwka J, Kansy A, Grzybowski A, Wierzyk A, Białkowski J, Maruszewski B, Zembala M

Abstract
BACKGROUND: The treatment of advanced heart failure in children and infants poses a serious management problem. Heart failure in that patient group is usually of congenital etiology. The treatment schedules for pediatric patients are in most cases adapted from the guidelines for treatment of adults. Up to 2009, the treatment of that extremely difficult group of patients was limited to pharmacological therapy and occasional heart transplantations. Constantly increasing problems with recruiting donors, especially for the pediatric group, contribute to the fact that mechanical support with the use of ventricular assist devices is for many children the only chance to survive the period of waiting for a heart donor.
AIM: The aim of the study was to analyze the results of treatment of circulatory support in Poland and assessment of the advisability of this method for treatment of children with severe heart failure.
METHODS: This method of treatment of pediatric patients is currently used in three Polish centers. From December 28th, 2009 to August 1st, 2015, 27 implantations of Berlin Heart EXCOR mechanical circulatory support system were performed in children aged from 1 month to 16 years (10 patients below 1 year of age; 37%). Left ventricular assist devices were implanted to 21 patients, whereas the remaining children received biventricular support. The most common reason for using this method was heart failure developed in the course of cardiomyopathy. In one case, heart failure after Fontan operation was the indication.
RESULTS: The duration of the circulatory support period ranged from 6 to 1215 days. It was followed by successful heart transplantations in 10 patients (37%), in 5 (18.1%) it resulted in regeneration of the heart, enabling explantation of the device, whereas three children are still waiting for transplantations. Nine children (33%) died during the therapy because of thromboembolic complications.
CONCLUSIONS: As it follows from our data, circulatory support utilizing the Berlin Heart system is an effective and promising method used as a bridge to cardiac transplantation, or regeneration of the myocardium in pediatric patients. In the group of the youngest and the most difficult patients, the method requires close cooperation of the medical and nursing personnel.

PMID: 29168549 [PubMed - as supplied by publisher]

The prognostic significance of frailty compared to peak oxygen consumption and B-type natriuretic peptide in patients with advanced heart failure.

Fri, 11/24/2017 - 13:45

The prognostic significance of frailty compared to peak oxygen consumption and B-type natriuretic peptide in patients with advanced heart failure.

Clin Transplant. 2017 Nov 23;:

Authors: Moayedi Y, Duero Posada JG, Foroutan F, Goldraich LA, Alba AC, MacIver J, Ross HJ

Abstract
Frailty assessment has become an integral part of the evaluation of potential candidates for heart transplantation and ventricular assist device (HTx/VAD). The impact of frailty, as a heart failure risk factor or to identify those who will derive the greatest benefit with HTx/VAD remains unclear. The aim of this study was to evaluate the independent prognostic relevance of frailty assessment from peak oxygen consumption (peak VO2 ) or B-type natriuretic peptide (BNP) on mortality in patients referred for advanced heart failure therapies. Frailty was measured using a modified Fried frailty criteria. In 201 consecutive patients, during a median follow up of 17.5 months (IQR 11-29.2), there were 25 (12.4%) deaths. One year survival was 100%, 94%, and 78% in non-frail, pre-frail and frail patients, respectively (log rank p = 0.0001). Frailty was associated with a two-fold increase risk of death (HR 2.01, p<0.0001, 95% CI 1.42 -2.84). When adjusted for BNP or peak VO2 , frailty was not associated with a significant risk of all-cause death. However, when peak VO2 is stratified into two categories (≥12 ml/kg/min vs. < 12 ml/kg/min), frailty was associated with increased mortality in patients with a lower peak VO2 (HR 1.72, p=0.006). This article is protected by copyright. All rights reserved.

PMID: 29168222 [PubMed - as supplied by publisher]

Contribution of Impaired Parasympathetic Activity to Right Ventricular Dysfunction and Pulmonary Vascular Remodeling in Pulmonary Arterial Hypertension.

Fri, 11/24/2017 - 13:45

Contribution of Impaired Parasympathetic Activity to Right Ventricular Dysfunction and Pulmonary Vascular Remodeling in Pulmonary Arterial Hypertension.

Circulation. 2017 Nov 22;:

Authors: da Silva Gonçalves Bos D, Van Der Bruggen CE, Kurakula K, Sun XQ, Casali KR, Casali AG, Rol N, Szulcek R, Dos Remedios C, Guignabert C, Tu L, Dorfmuller P, Humbert M, Wijnker PJM, Kuster DWD, van der Velden J, Goumans MJ, Bogaard HJ, Vonk-Noordegraaf A, de Man FS, Handoko ML

Abstract
Background -Beneficial effects of parasympathetic stimulation have been reported in left heart failure, however, whether it would be beneficial for pulmonary arterial hypertension (PAH) remains to be explored. Here, we investigated the relationship between parasympathetic activity and right ventricular (RV) function in PAH-patients, and the potential therapeutic effects of pyridostigmine (PYR), an oral drug stimulating the parasympathetic activity through acetylcholinesterase (AchE) inhibition, in experimental pulmonary hypertension (PH). Methods -Heart rate recovery (HRR) after maximal cardiopulmonary exercise test was used as a surrogate for parasympathetic activity. RV ejection fraction (RVEF) was assessed in 112 PAH-patients. Expression of nicotinic (α-7nAchR) and muscarinic (m2AchR) receptors, and AchE activity were evaluated in RV (n=11) and lungs (n=7) from PAH-patients undergoing heart/lung transplantation and compared with tissue obtained from controls. In addition, we investigated the effects of PYR (40 mg/kg/day) in experimental PH. PH was induced in male rats by SU5416 (25 mg/kg; s.c.) injection followed by 4 weeks of hypoxia. In a subgroup sympathetic/parasympathetic modulation was assessed by power spectral analysis. At week 6, PH status was confirmed by echocardiography, and rats were randomized to vehicle or treatment (both n=12). At the end-of-study, echocardiography was repeated, with additional RV pressure-volume measurements, along with lung, RV histological and protein analyses. Results -PAH-patients with lower RVEF (<41%) had a significantly reduced HRR in comparison to patients with higher RVEF. In PAH RV-samples, α-7nAchR was increased and AchE activity was reduced versus controls. No difference in m2AchR expression was observed. Chronic PYR-treatment in PH-rats normalized the cardiovascular autonomic function, demonstrated by an increase in parasympathetic activity and baroreflex sensitivity. PYR improved survival, increased RV contractility, and reduced RV stiffness, RV hypertrophy, RV fibrosis, RV inflammation, as well as RV α-7nAchR and m2AchR expression. Furthermore, PYR reduced pulmonary vascular resistance, RV afterload and pulmonary vascular remodeling, which was associated with reduced local and systemic inflammation. Conclusions -RV dysfunction is associated with reduced systemic parasympathetic activity in PAH-patients, with an inadequate adaptive response of the cholinergic system in the right ventricle. Enhancing parasympathetic activity by PYR improved survival, RV function and pulmonary vascular remodeling in experimental-PH.

PMID: 29167228 [PubMed - as supplied by publisher]

Reply to Drs. Pageaux et al.: Cognitive demand of eccentric versus concentric cycling.

Fri, 11/24/2017 - 13:45

Reply to Drs. Pageaux et al.: Cognitive demand of eccentric versus concentric cycling.

J Appl Physiol (1985). 2017 Nov 01;123(5):1418

Authors: Nosaka K, Haynes A, Chasland LC, Maiorana A, Naylor LH, Green DJ

PMID: 29167208 [PubMed - in process]

Neurological complications of solid organ transplantation.

Thu, 11/23/2017 - 13:45

Neurological complications of solid organ transplantation.

Arq Neuropsiquiatr. 2017 Oct;75(10):736-747

Authors: Pedroso JL, Dutra LA, Braga-Neto P, Abrahao A, Andrade JBC, Silva GLD, Viana LA, Pestana JOM, Barsottini OG

Abstract
Solid organ transplantation is a significant development in the treatment of chronic kidney, liver, heart and lung diseases. This therapeutic approach has increased patient survival and improved quality of life. New surgical techniques and immunosuppressive drugs have been developed to achieve better outcomes. However, the variety of neurological complications following solid organ transplantation is broad and carries prognostic significance. Patients may have involvement of the central or peripheral nervous system due to multiple causes that can vary depending on time of onset after the surgical procedure, the transplanted organ, and the intensity and type of immunosuppressive therapy. Neurological manifestations following solid organ transplantation pose a diagnostic challenge to medical specialists despite extensive investigation. This review aimed to provide a practical approach to help neurologists and clinicians assess and manage solid organ transplant patients presenting with acute or chronic neurological manifestations.

PMID: 29166466 [PubMed - in process]

Use of organs from hepatitis C virus positive donors for uninfected recipients: a potential cost-effective approach to save lives?

Thu, 11/23/2017 - 13:45

Use of organs from hepatitis C virus positive donors for uninfected recipients: a potential cost-effective approach to save lives?

Transplantation. 2017 Nov 22;:

Authors: Trotter PB, Summers DM, Ushiro-Lumb I, Robb M, Bradley JA, Powell J, Watson CJE, Neuberger J

Abstract
BACKGROUND: Organs from hepatitis C virus (HCV) seropositive (HCVpos) individuals are seldom used for transplantation because of the risk of disease transmission. Because transmitted HCV is now amenable to effective treatment we estimated the potential impact of using HCVpos deceased donor organs for transplantation.
METHODS: The Potential Donor Audit (PDA) of patients (<80years) dying in UK critical care units and the UK Transplant Registry (UKTR) was searched to identify HCVpos potential and proceeding deceased donors. Donor organ quality was assessed using validated donor organ quality indices. Cost analysis was performed by comparing the cumulative cost of direct acting antivirals with haemodialysis and renal transplantation.
RESULTS: Between 2009-2016, 120 patients identified from the PDA were not considered as potential donors because of the presence of HCV. Between 2000-2015, 244 HCVpos potential deceased donors were identified from the UKTR, and 76 (31%) proceeded to donation, resulting in 63 liver, 27 kidney and 2 heart transplants. Recipient and graft survival was not adversely impacted by donor HCVpos status. Most (69%) offered organs were declined because of positive virology although their quality was similar to that of other transplanted organs. The additional costs of treating recipients exposed to HCV by receiving a HCVpos kidney was cost-neutral with dialysis 5 years from transplantation.
CONCLUSIONS: HCVpos donors represent a potential source of organs for HCVneg recipients as many good quality HCVpos donor organs are not currently used for transplantation. This change in practice may increase access to transplantation without having an adverse effect on transplant outcome.

PMID: 29166338 [PubMed - as supplied by publisher]

The effect of 1.5 T cardiac magnetic resonance on human circulating leucocytes.

Thu, 11/23/2017 - 13:45

The effect of 1.5 T cardiac magnetic resonance on human circulating leucocytes.

Eur Heart J. 2017 Nov 18;:

Authors: Critchley WR, Reid A, Morris J, Naish JH, Stone JP, Ball AL, Major T, Clark D, Waldron N, Fortune C, Lagan J, Lewis GA, Ainslie M, Schelbert EB, Davis DM, Schmitt M, Fildes JE, Miller CA

Abstract
Aims: Investigators have proposed that cardiovascular magnetic resonance (CMR) should have restrictions similar to those of ionizing imaging techniques. We aimed to investigate the acute effect of 1.5 T CMR on leucocyte DNA integrity, cell counts, and function in vitro, and in a large cohort of patients in vivo.
Methods and results: In vitro study: peripheral blood mononuclear cells (PBMCs) were isolated from healthy volunteers, and histone H2AX phosphorylation (γ-H2AX) expression, leucocyte counts, and functional parameters were quantified using flow cytometry under the following conditions: (i) immediately following PBMC isolation, (ii) after standing on the benchside as a temperature and time control, (iii) after a standard CMR scan. In vivo study: blood samples were taken from 64 consecutive consenting patients immediately before and after a standard clinical scan. Samples were analysed for γ-H2AX expression and leucocyte counts. CMR was not associated with a significant change in γ-H2AX expression in vitro or in vivo, although there were significant inter-patient variations. In vitro cell integrity and function did not change with CMR. There was a significant reduction in circulating T cells in vivo following CMR.
Conclusion: 1.5 T CMR was not associated with DNA damage in vitro or in vivo. Histone H2AX phosphorylation expression varied markedly between individuals; therefore, small studies using γ-H2AX as a marker of DNA damage should be interpreted with caution. Cardiovascular magnetic resonance was not associated with loss of leucocyte viability or function in vitro. Cardiovascular magnetic resonance was associated with a statistically significant reduction in viable leucocytes in vivo.

PMID: 29165554 [PubMed - as supplied by publisher]

Factors Associated with the Need for, and the Impact of, Extracorporeal Membrane Oxygenation in Children with Congenital Heart Disease during Admissions for Cardiac Surgery.

Thu, 11/23/2017 - 13:45

Factors Associated with the Need for, and the Impact of, Extracorporeal Membrane Oxygenation in Children with Congenital Heart Disease during Admissions for Cardiac Surgery.

Children (Basel). 2017 Nov 22;4(11):

Authors: Aiello S, Loomba RS

Abstract
INTRODUCTION: This study aimed to determine factors associated with the need for extracorporeal membrane oxygenation (ECMO) in children with congenital heart disease (CHD) during admission for cardiac surgery (CS). A secondary aim was to determine how ECMO impacted length, cost, and mortality of the admission.
METHODS: Data from the Kids' Inpatient Database (KIDS) were utilized. Admissions with CHD under 18 years of age with cardiac surgery were included. Need for ECMO in these admissions was then identified. Univariate analysis was conducted to compare characteristics between admissions with and without ECMO. Regression analyses were conducted to determine what factors were independently associated with ECMO and whether ECMO independently impacted admission characteristics.
RESULTS: A total of 46,176 admissions with CHD and CS were included in the final analysis. Of these, 798 (1.7%) required ECMO. Median age of ECMO admissions was 0.5 years. The following were associated with ECMO: decreased age, heart failure, acute kidney injury, arrhythmia, double outlet right ventricle, atrioventricular septal defect, transposition, Ebstein anomaly, hypoplastic left heart syndrome, common arterial trunk, tetralogy of Fallot, coronary anomaly, valvuloplasty, repair of total anomalous pulmonary venous connection, arterial switch, RV to PA conduit placement, and heart transplant (p < 0.01). ECMO independently increased length of stay by 17.8 days, cost of stay by approximately $415,917, and inpatient mortality 22-fold.
CONCLUSION: Only a small proportion of CHD patients undergoing CS require ECMO, although these patients require increased resource utilization and have high mortality. Specific cardiac lesions, cardiac surgeries, and comorbidities are associated with increased need for ECMO.

PMID: 29165381 [PubMed]

Improving the Biological Function of Decellularized Heart Valves through Integration of Protein Tethering and Three-Dimensional Cell Seeding in a Bioreactor.

Thu, 11/23/2017 - 13:45

Improving the Biological Function of Decellularized Heart Valves through Integration of Protein Tethering and Three-Dimensional Cell Seeding in a Bioreactor.

J Tissue Eng Regen Med. 2017 Nov 21;:

Authors: Namiri M, Ashtiani MK, Abbasalizadeh S, Mazidi Z, Mahmoudi E, Nikeghbalian S, Aghdami N, Baharvand H

Abstract
Decellularized xenogeneic heart valves (DHVs) are promising products for valve replacement. However, the widespread clinical application of such products is limited due to the risk of immune reaction, progressive degeneration, inflammation, and calcification. Here, we have developed an optimized decellularization protocol for a xenogeneic heart valve. We improved the biological function of DHVs by protein tethering onto DHV and three-dimensional (3D) cell seeding in a bioreactor. Our results showed that heart valves treated with a Triton X-100 (TX-100) and sodium deoxycholate (SDC)-based protocol were completely cell-free, with preserved biochemical and biomechanical properties. The immobilization of stromal derived factor-1α (SDF-1α) and basic fibroblast growth factor (bFGF) on DHV significantly improved recellularization with endothelial progenitor cells (EPCs) under the 3D culture condition in the bioreactor compared to static culture conditions. Cell phenotype analysis showed higher fibroblast-like cells and less myofibroblast-like cells in both protein-tethered DHVs. However, SDF-DHV significantly enhanced recellularization both in vitro and in vivo compared to bFGF-DHV, and demonstrated less inflammatory cell infiltration. SDF-DHV had less calcification and platelet adhesion. Altogether, integration of SDF-1α immobilization and three-dimensional cell seeding in a bioreactor might provide a novel, promising approach for production of functional heart valves.

PMID: 29164801 [PubMed - as supplied by publisher]

Prevalence of left ventricular systolic dysfunction in pre-dialysis and dialysis patients with preserved left ventricular ejection fraction.

Thu, 11/23/2017 - 13:45

Prevalence of left ventricular systolic dysfunction in pre-dialysis and dialysis patients with preserved left ventricular ejection fraction.

Eur J Heart Fail. 2017 Nov 21;:

Authors: Hensen LCR, Goossens K, Delgado V, Abou R, Rotmans JI, Jukema JW, Bax JJ

Abstract
AIMS: Patients with chronic kidney disease (CKD) have an excess of cardiovascular morbidity and mortality, with heart failure (HF) being particularly frequent. Reduced left ventricular ejection fraction (LVEF) defines left ventricular (LV) systolic dysfunction and is associated with poor prognosis. However, CKD patients may have HF symptoms with preserved LVEF. In this subgroup of patients, two-dimensional speckle tracking echocardiography can detect LV systolic dysfunction by analysing LV myocardial deformation. The present study evaluated the prevalence of impaired LV global longitudinal strain (GLS) in CKD patients with preserved LVEF and its prognostic consequences.
METHODS AND RESULTS: Overall, 200 pre-dialysis and dialysis patients (65% men, mean age 60 ± 14 years) with CKD stage 3b-5 and preserved LVEF (≥50%) were evaluated. Left ventricular systolic dysfunction despite preserved LVEF was defined by LV GLS ≤15.2% (cut-off value derived from two standard deviations below the mean value of individuals without structural heart disease). Impaired LV GLS (≤15.2%) despite preserved LVEF was observed in 32% of patients. During a median follow-up of 33 months (interquartile range 17-62 months), 47% of patients underwent renal transplantation, 9% were admitted with HF, and 28% died. Patients with LV GLS ≤15.2% showed significantly worse cumulative event-free survival rates of the combined endpoint of HF hospitalization and all-cause mortality compared to patients with LV GLS >15.2% (log-rank P = 0.018).
CONCLUSION: The prevalence of impaired LV GLS despite preserved LVEF in pre-dialysis and dialysis patients is relatively high. Patients with preserved LVEF but impaired LV GLS have an increased risk of HF hospitalization and all-cause mortality.

PMID: 29164753 [PubMed - as supplied by publisher]

Capsule endoscopy in young patients with iron deficiency anaemia and negative bidirectional gastrointestinal endoscopy.

Thu, 11/23/2017 - 13:45

Capsule endoscopy in young patients with iron deficiency anaemia and negative bidirectional gastrointestinal endoscopy.

United European Gastroenterol J. 2017 Nov;5(7):974-981

Authors: Yung DE, Rondonotti E, Giannakou A, Avni T, Rosa B, Toth E, Lucendo AJ, Sidhu R, Beaumont H, Ellul P, Negreanu L, Jiménez-Garcia VA, McNamara D, Kopylov U, Elli L, Triantafyllou K, Shibli F, Riccioni ME, Bruno M, Dray X, Plevris JN, Koulaouzidis A, And the Capsule Endoscopy in Young Patients with IDA research group, Argüelles-Arias F, Becq A, Branchi F, Tejero-Bustos MÁ, Cotter J, Eliakim R, Ferretti F, Gralnek IM, Herrerias-Gutierrez JM, Hussey M, Jacobs M, Johansson GW, McAlindon M, Montiero S, Nemeth A, Pennazio M, Rattehalli D, Stemate A, Tortora A, Tziatzios G

Abstract
Background: Recent data imply young patients (age ≤50 years) undergoing small-bowel (SB) capsule endoscopy (CE) for iron deficiency anaemia (IDA) show higher diagnostic yield (DY) for sinister pathology. We aimed to investigate DY of CE in a large cohort of young IDA patients, and evaluate factors predicting significant SB pathology.
Materials and methods: This was a retrospective, multicentre study (2010-2015) in consecutive, young patients (≤50 years) from 18 centres/12 countries, with negative bidirectional gastrointestinal (GI) endoscopy undergoing SBCE for IDA. Exclusion criteria: previous/ongoing obscure-overt GI bleeding; age <19 or >50 years; comorbidities associated with IDA. Data retrieved: SBCE indications; prior investigations; medications; SBCE findings; final diagnosis. Clinical and laboratory data were analysed by multivariate logistic regression.
Results: Data on 389 young IDA patients were retrieved. In total, 169 (43.4%) were excluded due to incomplete clinical data; data from 220 (122F/98M; mean age 40.5 ± 8.6 years) patients were analysed. Some 71 patients had at least one clinically significant SBCE finding (DY: 32.3%). They were divided into two groups: neoplastic pathology (10/220; 4.5%), and non-neoplastic but clinically significant pathology (61/220; 27.7%). The most common significant but non-neoplastic pathologies were angioectasias (22/61) and Crohn's disease (15/61). On multivariate analysis, weight loss and lower mean corpuscular volume(MCV) were associated with significant SB pathology (OR: 3.87; 95%CI: 1.3-11.3; p = 0.01; and OR: 0.96; 95%CI: 0.92-0.99; p = 0.03; respectively). Our model also demonstrates association between use of antiplatelets and significant SB pathology, although due to the small number of patients, definitive conclusions cannot be drawn.
Conclusion: In IDA patients ≤50 years with negative bidirectional GI endoscopy, overall DY of SBCE for clinically significant findings was 32.3%. Some 5% of our cohort was diagnosed with SB neoplasia; lower MCV or weight loss were associated with higher DY for SB pathology.

PMID: 29163963 [PubMed]

Potential Role of Exosomes in Mending a Broken Heart: Nanoshuttles Propelling Future Clinical Therapeutics Forward.

Thu, 11/23/2017 - 13:45

Potential Role of Exosomes in Mending a Broken Heart: Nanoshuttles Propelling Future Clinical Therapeutics Forward.

Stem Cells Int. 2017;2017:5785436

Authors: Dougherty JA, Mergaye M, Kumar N, Chen CA, Angelos MG, Khan M

Abstract
Stem cell transplantation therapy is a promising adjunct for regenerating damaged heart tissue; however, only modest improvements in cardiac function have been observed due to poor survival of transplanted cells in the ischemic heart. Therefore, there remains an unmet need for therapies that can aid in attenuating cardiac damage. Recent studies have demonstrated that exosomes released by stem cells could serve as a potential cell-free therapeutic for cardiac repair. These exosomes/nanoshuttles, once thought to be merely a method of waste disposal, have been shown to play a crucial role in physiological functions including short- and long-distance intercellular communication. In this review, we have summarized studies demonstrating the potential role of exosomes in improving cardiac function, attenuating cardiac fibrosis, stimulating angiogenesis, and modulating miRNA expression. Furthermore, exosomes carry an important cargo of miRNAs and proteins that could play an important role as a diagnostic marker for cardiovascular disease post-myocardial infarction. Although there is promising evidence from preclinical studies that exosomes released by stem cells could serve as a potential cell-free therapeutic for myocardial repair, there are several challenges that need to be addressed before exosomes could be fully utilized as off-the-shelf therapeutics for cardiac repair.

PMID: 29163642 [PubMed]

A "Wearable" Test for Maximum Aerobic Power: Real-Time Analysis of a 60-m Sprint Performance and Heart Rate Off-Kinetics.

Thu, 11/23/2017 - 13:45

A "Wearable" Test for Maximum Aerobic Power: Real-Time Analysis of a 60-m Sprint Performance and Heart Rate Off-Kinetics.

Front Physiol. 2017;8:868

Authors: Storniolo JL, Pavei G, Minetti AE

Abstract
Maximum aerobic power ([Formula: see text]) as an indicator of body fitness is today a very well-known concept not just for athletes but also for the layman. Unfortunately, the accurate measurement of that variable has remained a complex and exhaustive laboratory procedure, which makes it inaccessible to many active people. In this paper we propose a quick estimate of it, mainly based on the heart rate off-kinetics immediately after an all-out 60-m sprint run. The design of this test took into account the recent availability of wrist wearable, heart band free, multi-sensor smart devices, which could also inertially detect the different phases of the sprint and check the distance run. 25 subjects undertook the 60-m test outdoor and a [Formula: see text] test on the laboratory treadmill. Running average speed, HR excursion during the sprint and the time constant (τ) of HR exponential decay in the off-kinetics were fed into a multiple regression, with measured [Formula: see text] as the dependent variable. Statistics revealed that within the investigated range (25-55 ml O2/(kg min)), despite a tendency to overestimate low values and underestimate high values, the three predictors confidently estimate individual [Formula: see text] (R(2) = 0.65, p < 0.001). The same analysis has been performed on a 5-s averaged time course of the same measured HR off-kinetics, as these are the most time resolved data for HR provided by many modern smart watches. Results indicate that despite of the substantial reduction in sample size, predicted [Formula: see text] still explain 59% of the variability of the measured [Formula: see text].

PMID: 29163210 [PubMed]

SAFETY OF PERITONEAL DIALYSIS AFTER NONRENAL SOLID-ORGAN TRANSPLANTATION.

Thu, 11/23/2017 - 13:45

SAFETY OF PERITONEAL DIALYSIS AFTER NONRENAL SOLID-ORGAN TRANSPLANTATION.

Perit Dial Int. 2017 Nov 21;:

Authors: Buffet A, Guillouët S, Lobbedez T, Ficheux M, Lanot A, Bechade C

Abstract
BACKGROUND: End-stage renal disease is a well-known complication after solid-organ transplantation, mostly as a result of calcineurin-inhibitor therapy. Among recipients of solid-organ transplants other than kidneys, peritoneal dialysis (PD) has been considered an accessory technique as an increased risk of infectious complications has been reported. The aim of our study was to evaluate the outcome of patients with a liver, heart, or lung transplant who underwent PD for replacement therapy.
METHODS: This was a retrospective, monocentric study. Every adult patient starting PD between January 1, 2001, and December 31, 2016, at our center was included. The history of previous solid-organ transplantation was determined. For the statistical analysis, we considered 2 groups of patients: 1 group having a history of transplantation of an organ other than the kidney (lung, heart, liver), and 1 group that was starting dialysis without any prior history of organ transplantation. Patients who had previously undergone kidney transplantation were excluded. The events of interest were the first peritonitis episode, death, and PD failure, defined as transfer to hemodialysis.
RESULTS: A total of 383 patients started PD during this period, 13 of whom had a history of organ transplantation. We found no significant difference between the solid-organ transplantation patients and those without a history of transplantation in terms of the occurrence of peritonitis (HR [hazard ratio] 0.91 [0.37 - 2.22]), death (HR 0.83 [0.26 - 2.63]), and PD failure (HR 1.01 [0.32 - 3.22]).
CONCLUSION: Peritoneal dialysis appears to be an effective replacement therapy for patients with a previous history of solid-organ transplantation.

PMID: 29162679 [PubMed - as supplied by publisher]

Heart transplantation for Chagas cardiomyopathy.

Thu, 11/23/2017 - 13:45

Heart transplantation for Chagas cardiomyopathy.

Rev Port Cardiol. 2017 Nov 18;:

Authors: Ramalho AR, Prieto D, Franco F, Antunes MJ

Abstract
Chagas disease is an endemic disease in Latin America that is increasingly found in non-endemic areas all over the world due to the flow of migrants from Central and South America. We present the case of a Brazilian immigrant in Portugal who underwent orthotopic heart transplantation for end-stage Chagas cardiomyopathy. Immunosuppressive therapy included prednisone, mycophenolate mofetil and tacrolimus. Twelve months after the procedure she is asymptomatic, with good graft function, and with no evidence of complications such as graft rejection, opportunistic infections, neoplasms or reactivation of Trypanosoma cruzi infection. By reporting the first case in Portugal of heart transplantation for Chagas cardiomyopathy, we aim to increase awareness of Chagas disease as an emerging global problem and of Chagas cardiomyopathy as a serious complication for which heart transplantation is a valuable therapeutic option.

PMID: 29162358 [PubMed - as supplied by publisher]

Right Ventricular Function is Important for Pulmonary Artery Banding in Left Ventricular Dysfunction.

Thu, 11/23/2017 - 13:45

Right Ventricular Function is Important for Pulmonary Artery Banding in Left Ventricular Dysfunction.

World J Pediatr Congenit Heart Surg. 2017 Jan 01;:2150135117723902

Authors: Felmly LM, Savage AJ, Kavarana MN

Abstract
Small infants with severe left ventricular dysfunction (LVD) carry a poor prognosis with limited therapeutic options. Although mechanical support and heart transplantation are definitive therapies, improvement of left ventricular function with reversible pulmonary artery banding (rPAB) has been described. We report two cases of LVD treated with rPAB. One was successfully temporized, and one progressed to requiring transplantation, indicating that appropriate patient selection is critical to this technique's success.

PMID: 29161959 [PubMed - as supplied by publisher]

Existing issues and valid concerns in continuous-flow ventricular assist devices.

Thu, 11/23/2017 - 13:45

Existing issues and valid concerns in continuous-flow ventricular assist devices.

Expert Rev Med Devices. 2017 Nov 22;:

Authors: Hetzer R, Delmo Walter EM

Abstract
INTRODUCTION: Through concerted endeavours in the fields of surgery, medicine, and biomedical engineering, patronized by government and industry, ventricular assist devices have become an established surgical treatment to support the failing heart, which could easily and simply surpass the frequency of heart transplantation. Be it as it may, complications and adverse events have unfolded, and these facilitated the way to newer biomedically-engineered pump designs in search of the perfect support for a failing heart. Areas covered: This review focuses on the evolution of the continous-flow ventricular assist device as an accepted mode of treatment in advanced heart failure, as a bridge to myocardial recovery, as a bridge to heart transplantation and as a permanent therapy, with its attendant complications and long-term outcome. Expert commentary: Continuous flow devices offer improved durability, less surgical trauma due to their smaller size, high-energy efficiency, and lower thrombogenicity, regardless of administration of single or dual anti-thrombotic therapy. These benefits translate into better survival, lower frequency of adverse events, improved quality of life and higher functional capacity of patients. Through ceaseless innovations and technology, newer pumps have been developed; however, none has been proven to be superior over the others.

PMID: 29161922 [PubMed - as supplied by publisher]

Endotoxin Effects on Cardiac and Renal Functions and Cardiorenal Syndromes.

Wed, 11/22/2017 - 13:45

Endotoxin Effects on Cardiac and Renal Functions and Cardiorenal Syndromes.

Blood Purif. 2017 Nov 22;44(4):314-326

Authors: Virzì GM, Clementi A, Brocca A, Ronco C

Abstract
Gram-negative sepsis is a major cause of morbidity and mortality in critical ill patients. Recent findings in molecular biology and in signaling pathways have enhanced our understanding of its pathogenesis and opened up opportunities of innovative therapeutic approaches. Endotoxin plays a pivotal role in the pathogenesis of multi-organ dysfunction in the setting of gram-negative sepsis. Indeed, heart and kidney impairments seem to be induced by the release of circulating pro-inflammatory and pro-apoptotic mediators triggered by endotoxin interaction with immune cells. These molecules are responsible for cellular apoptosis, autophagy, cell cycle arrest, and microRNAs activation. Therefore, the early identification of sepsis-associated acute kidney injury and heart dysfunction may improve the patient clinical outcome. In this report, we will consider the role of endotoxin in the pathogenesis of sepsis, its effects on both cardiac and renal functions, and the interactions between these 2 systems in the setting of cardiorenal syndromes (CRS), particularly in CRS type 5. Finally, we will discuss the possible role of extracorporeal therapies in reducing endotoxin levels.

PMID: 29161706 [PubMed - as supplied by publisher]

Lung and heart-lung transplantation in pulmonary arterial hypertension.

Wed, 11/22/2017 - 13:45

Lung and heart-lung transplantation in pulmonary arterial hypertension.

PLoS One. 2017;12(11):e0187811

Authors: López-Meseguer M, Quezada CA, Ramon MA, Lázaro M, Dos L, Lara A, López R, Blanco I, Escribano P, Roman A, REHAP Investigators

Abstract
BACKGROUND: Real use of lung (LT) and heart-lung (HLT) transplantation in pulmonary arterial hypertension (PAH) is unknown. The objectives were to describe the indication of these procedures on PAH treatment in a national cohort of PAH patients, and to analyze the potential improvement of its indication in severe patients.
METHODS: Eligibility for LT/HLT was assessed for each deceased patient. Incident patients from REHAP diagnosed between January 2007 and March 2015 and considered eligible for LT/HLT were grouped as follows: those who finally underwent transplantation (LTP) and those who died (D-Non-LT).
FINDINGS: Of 1391 patients included in REHAP, 36 (3%) were LTP and 375 (27%) died. Among those who died, 36 (3%) were D-Non-LT. LTP and D-Non-LT were equal in terms of age, gender, and clinical status. Ten percent of those who died were functional class I-II. Patients functional class IV were less likely to undergo LT (8.3% LTP vs. 30.6% D-Non-LT, p = 0.017). Patients with idiopathic and drug/toxin-associated PAH were more likely to undergo LT (44.4% LTP vs. 16.7% D-Non-LT, p = 0.011).
CONCLUSIONS: The present results show that the use of LT/HLT could double for this indication. Relevant mortality in early functional class reflects the difficulties in establishing the risk of death in PAH.

PMID: 29161284 [PubMed - in process]

Thymic function is a major determinant of antibody-mediated rejection onset in heart transplantation.

Wed, 11/22/2017 - 13:45

Thymic function is a major determinant of antibody-mediated rejection onset in heart transplantation.

Am J Transplant. 2017 Nov 21;:

Authors: Sannier A, Stroumza N, Caligiuri G, Le Borgne-Moynier M, Andreata F, Senemaud J, Louedec L, Even G, Gaston AT, Deschildre C, Couvelard A, Ou P, Cheynier R, Nataf P, Dorent R, Nicoletti A

Abstract
Thymic function progressively decreases with age but may be boosted in certain circumstances. We questioned whether heart transplantation was such a situation and whether the thymic function was related to the onset of rejection. Twenty-eight antithymocyte globulin-treated heart transplant recipients were included. Patients diagnosed for an antibody-mediated rejection on endomyocardial biopsy had higher proportion of circulating recent thymic emigrant CD4+ T cells and T cell receptor excision circle levels than other transplanted subjects. Thymus volume and density, assessed by computed tomography in a subset of patients, was also higher in patient experiencing antibody-mediated rejection. We demonstrate that thymic function is a major determinant of antibody-mediated rejection onset and question whether thymectomy could be a prophylactic strategy to prevent alloimmune humoral responses. This article is protected by copyright. All rights reserved.

PMID: 29160947 [PubMed - as supplied by publisher]

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