Skip directly to content

PubMed Heart Transplant

Subscribe to PubMed Heart Transplant feed PubMed Heart Transplant
NCBI: db=pubmed; Term=heart transplant
Updated: 2 hours 14 min ago

Outcome of unexplained acute respiratory distress syndrome with diffuse alveolar damage after lung transplantation.

2 hours 14 min ago

Outcome of unexplained acute respiratory distress syndrome with diffuse alveolar damage after lung transplantation.

Intensive Care Med. 2018 Jan 20;:

Authors: Stéphan F, de Montpréville VT, Diarra C, Pilorge C, Fadel E, Ghigna MR

PMID: 29353458 [PubMed - as supplied by publisher]

Clinical Profile of Nonresponders to Surgical Myectomy with Obstructive Hypertrophic Cardiomyopathy.

2 hours 14 min ago

Clinical Profile of Nonresponders to Surgical Myectomy with Obstructive Hypertrophic Cardiomyopathy.

Am J Med. 2018 Jan 15;:

Authors: Wells S, Rowin EJ, Boll G, Rastegar H, Wang W, Maron MS, Maron BJ

Abstract
BACKGROUND: In the vast majority of patients with obstructive hypertrophic cardiomyopathy and drug-refractory heart failure, surgical myectomy results in reversal of heart failure symptoms. However, a small patient subgroup fails to experience sustained postoperative improvement despite relief of left ventricular outflow obstruction. Clinical profile of such patients has not been well defined.
METHODS: Consecutive obstructive hypertrophic cardiomyopathy patients undergoing myectomy at Tufts Medical Center for drug refractory NYHA III/IV heart failure symptoms, 2004 to 2017, were followed postoperatively for 2.5 ± 2.8 years and assessed for outcome.
RESULTS: Of the 503 patients, there were 4 postoperative deaths (0.8%); 480 patients (96%) had sustained improvement to NYHA classes I or II (responders), but 19 (3.8%) developed advanced symptoms (classes III or IV) in the absence of obstruction (nonresponders). Compared to responders, nonresponders were younger (40 ± 13 vs. 53 ± 14 years; p < 0.001) and had greater septal thickness (25 ± 9 vs. 20 ± 4 mm; p < 0.001). Massive hypertrophy (≥30 mm) was 5-fold more common in nonresponders (p < 0.01). Seven nonresponders developed systolic dysfunction (ejection fraction 20%-47%), 2 days to 6.1 years postoperatively. Four nonresponders underwent heart transplant 3.4 to 9.2 years after myectomy and 2 others have been listed.
CONCLUSIONS: Surgical myectomy is highly effective at reversing heart failure symptoms in the vast majority of patients with obstructive hypertrophic cardiomyopathy. However, a small minority experience persistent functional limitation despite surgical relief of outflow obstruction. Predictors of adverse postoperative course were substantial/massive septal thickness and youthful age. Hypertrophic cardiomyopathy patients who failed to respond symptomatically to myectomy were considered for advanced heart failure treatment strategies including heart transplantation.

PMID: 29353047 [PubMed - as supplied by publisher]

Worsening Renal Function in Acute Heart Failure Patients Undergoing Aggressive Diuresis is Not Associated with Tubular Injury.

Sun, 01/21/2018 - 11:04
Related Articles

Worsening Renal Function in Acute Heart Failure Patients Undergoing Aggressive Diuresis is Not Associated with Tubular Injury.

Circulation. 2018 Jan 19;:

Authors: Ahmad T, Jackson K, Rao VS, Tang WHW, Brisco-Bacik MA, Chen HH, Felker GM, Hernandez AF, O'Connor CM, Sabbisetti VS, Bonventre JV, Wilson FP, Coca SG, Testani JM

Abstract
Background -Worsening renal function (WRF) in the setting of aggressive diuresis for acute heart failure (AHF) treatment may reflect renal tubular injury or simply indicate a hemodynamic or functional change in glomerular filtration. Well-validated tubular injury biomarkers-NAG, NGAL, and KIM-1- are now available that can quantify the degree of renal tubularinjury. The ROSE-AHF trial provides an experimental platform for the study of mechanisms of WRF during aggressive diuresis for AHF, as the ROSE-AHF protocol dictated high dose loop diuretic therapy in all patients. We sought to determine whether tubular injury biomarkers are associated with WRF in the setting of aggressive diuresis and its association with prognosis. Methods -Patients in the multicenter ROSE-AHF trial with baseline and 72-hour urine tubular injury biomarkers were analyzed (N=283). WRF was defined as a ≥20% decrease in glomerular filtration rate estimated using cystatin C. Results -Consistent with protocol driven aggressive dosing of loop diuretics, participants received a median 560 mg of IV furosemide equivalents (IQR 300-815 mg) which induced a urine output of 8425 mL (IQR 6341-10528 ml) over the 72-hour intervention period. Levels of NAG and KIM-1 did not change with aggressive diuresis (P>0.59, both), whereas levels of NGAL decreased slightly [-8.7 ng/mg (-169, 35 ng/mg), P<0.001]. WRF occurred in 21.2% of the population and was not associated with an increase in any marker of renal tubular injury: NGAL (P=0.21), NAG (P=0.46), or KIM-1 (P=0.22). Increases in NGAL, NAG, and KIM-1 were paradoxically associated with improved survival (adjusted HR: 0.80 per 10 percentile increase, 95% CI: 0.69-0.91; P=0.001). Conclusions -Kidney tubular injury does not appear to have an association with WRF in the context of aggressive diuresis of AHF patients. These findings reinforce the notion that the small to moderate deteriorations in renal function commonly encountered with aggressive diuresis are dissimilar from traditional causes of acute kidney injury.

PMID: 29352071 [PubMed - as supplied by publisher]

CD83 is a new potential biomarker and therapeutic target for Hodgkin lymphoma.

Sun, 01/21/2018 - 11:04
Related Articles

CD83 is a new potential biomarker and therapeutic target for Hodgkin lymphoma.

Haematologica. 2018 Jan 19;:

Authors: Li Z, Ju X, Lee K, Clarke C, Hsu JL, Abadir E, Bryant CE, Pears S, Sunderland N, Heffernan S, Hennessy A, Lo TH, Pietersz GA, Kupresanin F, Fromm PD, Silveira PA, Tsonis C, Cooper WA, Cunningham I, Brown C, Clark GJ, Hart DNJ, Australia National Health and Medical Research Council Development Grant, Cancer Institute NSW Translationl Program Grant

Abstract
Chemotherapy and hematopoietic stem cell transplantation are effective treatments for most Hodgkin lymphoma patients, however there remains a need for better tumor-specific target therapy in Hodgkin lymphoma patients with refractory or relapsed disease. We demonstrate that membrane CD83 is a diagnostic and therapeutic target, highly expressed in Hodgkin lymphoma cell lines and Hodgkin and Reed-Sternberg cells in 29/35 (82.9%) Hodgkin lymphoma patient lymph node biopsies. CD83 from Hodgkin lymphoma tumor cells was able to trogocytose to surrounding T cells and interestingly, the trogocytosing CD83+T cells expressed significantly more PD-1 compared to CD83- T cells. Hodgkin lymphoma tumor cells secreted soluble CD83 that inhibited T cell proliferation and anti-CD83 antibody partially reversed the inhibitory effect. High levels of soluble CD83 were detected in Hodgkin lymphoma patient sera and these returned to normal in patients who had good clinical responses to chemotherapy confirmed by positron emission tomography scans. We generated a human anti-human CD83 antibody, 3C12C, and its toxin monomethyl auristatin E conjugate, that killed CD83 positive Hodgkin lymphoma cells but not CD83 negative cells. The 3C12C antibody was tested in dose escalation studies in non- human primates. No toxicity was observed but there was evidence of CD83 positive target cell depletion. These data establish CD83 as a potential biomarker and therapeutic target in Hodgkin lymphoma.

PMID: 29351987 [PubMed - as supplied by publisher]

Transitions Between Circulatory States After Out-of-Hospital Cardiac Arrest: Protocol for an Observational, Prospective Cohort Study.

Sun, 01/21/2018 - 11:04
Related Articles

Transitions Between Circulatory States After Out-of-Hospital Cardiac Arrest: Protocol for an Observational, Prospective Cohort Study.

JMIR Res Protoc. 2018 Jan 19;7(1):e17

Authors: Langeland H, Bergum D, Løberg M, Bjørnstad K, Damås JK, Mollnes TE, Skjærvold NK, Klepstad P

Abstract
BACKGROUND: The post cardiac arrest syndrome (PCAS) is responsible for the majority of in-hospital deaths following cardiac arrest (CA). The major elements of PCAS are anoxic brain injury and circulatory failure.
OBJECTIVE: This study aimed to investigate the clinical characteristics of circulatory failure and inflammatory responses after out-of-hospital cardiac arrest (OHCA) and to identify patterns of circulatory and inflammatory responses, which may predict circulatory deterioration in PCAS.
METHODS: This study is a single-center cohort study of 50 patients who receive intensive care after OHCA. The patients are followed for 5 days where detailed information from circulatory variables, including measurements by pulmonary artery catheters (PACs), is obtained in high resolution. Blood samples for inflammatory and endothelial biomarkers are taken at inclusion and thereafter daily. Every 10 min, the patients will be assessed and categorized in one of three circulatory categories. These categories are based on mean arterial pressure; heart rate; serum lactate concentrations; superior vena cava oxygen saturation; and need for fluid, vasoactive medications, and other interventions. We will analyze predictors of circulatory failure and their relation to inflammatory biomarkers.
RESULTS: Patient inclusion started in January 2016.
CONCLUSIONS: This study will obtain advanced hemodynamic data with high resolution during the acute phase of PCAS and will analyze the details in circulatory state transitions related to circulatory failure. We aim to identify early predictors of circulatory deterioration and favorable outcome after CA.
TRIAL REGISTRATION: ClinicalTrials.gov: NCT02648061; https://clinicaltrials.gov/ct2/show/NCT02648061 (Archived by WebCite at http://www.webcitation.org/6wVASuOla).

PMID: 29351897 [PubMed]

Reversibility of severe mitral valve regurgitation after left ventricular assist device implantation: single-centre observations from a real-life population of patients.

Sat, 01/20/2018 - 13:45

Reversibility of severe mitral valve regurgitation after left ventricular assist device implantation: single-centre observations from a real-life population of patients.

Eur J Cardiothorac Surg. 2018 Jan 16;:

Authors: Dobrovie M, Spampinato RA, Efimova E, da Rocha E Silva JG, Fischer J, Kuehl M, Voigt JU, Belmans A, Ciarka A, Bonamigo Thome F, Schloma V, Dmitrieva Y, Lehmann S, Hahn J, Strotdrees E, Mohr FW, Garbade J, Meyer AL

Abstract
OBJECTIVES: This study evaluates the impact of untreated preoperative severe mitral valve regurgitation (MR) on outcomes after left ventricular assist device (LVAD) implantation.
METHODS: Of the 234 patients who received LVAD therapy in our centre during a 6-year period, we selected those who had echocardiographic images of good quality and excluded those who underwent mitral valve replacement prior to or mitral valve repair during LVAD placement. The 128 patients selected were divided into 2 groups: Group A with severe MR (n = 65) and Group B with none to moderate MR (n = 63, 28 with moderate MR). We evaluated transthoracic echocardiography preoperatively [15 (7-28) days before LVAD implantation; median (interquartile range)] and postoperatively up to the last available follow-up [501 (283-848) days after LVAD]. We collected mortality, complications and clinical status indicators of the patient cohort.
RESULTS: We observed a significant decrease in the severity of MR after LVAD implantation (severe MR 51% pre- vs 6% post-LVAD implantation, P < 0.001). There was no difference between groups in terms of right heart failure, rate of urgent heart transplantation, pump thrombosis or ventricular arrhythmias. There was no difference in 1-year survival and 3-year survival (87.7% vs 88.4% and 71.8% vs 66.6% for Groups A and B, respectively, P = 0.97).
CONCLUSIONS: Preoperative severe MR resolves in the majority of patients early on after LVAD implantation and is not associated with worse clinical outcomes or intermediate-term survival.

PMID: 29351635 [PubMed - as supplied by publisher]

The beginning at the end: non-invasive assessment of post-transplant coronary allograft vasculopathy at the microcirculatory level.

Sat, 01/20/2018 - 13:45

The beginning at the end: non-invasive assessment of post-transplant coronary allograft vasculopathy at the microcirculatory level.

Eur Heart J. 2017 Dec 18;:

Authors: Rimoldi O, Camici PG

PMID: 29351613 [PubMed - as supplied by publisher]

Prognostic relevance of elevated pulmonary arterial pressure assessed non-invasively: Analysis in a large patient cohort with invasive measurements in near temporal proximity.

Sat, 01/20/2018 - 13:45

Prognostic relevance of elevated pulmonary arterial pressure assessed non-invasively: Analysis in a large patient cohort with invasive measurements in near temporal proximity.

PLoS One. 2018;13(1):e0191206

Authors: Greiner S, Jud A, Aurich M, Geisenberger C, Uhlmann L, Hilbel T, Kieser M, Katus HA, Mereles D

Abstract
BACKGROUND: The clinical relevance of non-invasively derived pulmonary arterial pressure (PAP) by Doppler echocardiography (DE) has been questioned in the past. However, transthoracic echocardiography is used as a cornerstone examination for patients with dyspnea and suspected pulmonary hypertension (PH). This study aimed to evaluate the prognostic value of non-invasive assessed PAP in a large population of patients with known or suspected cardiopulmonary disease.
METHODS: The analyses are based on data of patients of a tertiary cardiology center that received right heart catheterization (RHC) as well as non-invasively assessed PAP by DE within five days, and includes serological and clinical parameters in a retrospective follow-up for up to eight years.
RESULTS: Of 1,237 patients, clinical follow-up was possible in 1,038 patients who were included in the statistical analysis. The mean-follow up time was 1,002 days. The composite endpoint of heart transplantation (HTx) or death occurred in n = 308 patients. Elevated PAP measured non-invasively as well as invasively had significant prognostic impact (hazard ratio (HR) 2.32; 95% confidence interval (CI) 1.78-3.04; χ2 = 37.9; p<0.001 versus HR 2.84; 95%CI 2.11-3.82; χ2 = 51.9; p<0.001, respectively). By multivariate analysis, NYHA functional class, N-terminal pro-brain natriuretic peptide, cardiac troponin T, left ventricular ejection fraction, and right ventricular dysfunction remained independently predictive. Incremental prognostic information in a multimodal approach was highly relevant.
CONCLUSIONS: In this comprehensive study, elevated pulmonary arterial pressure measured by DE offers similar prognostic information on survival or need for HTx as right heart catheterization. Furthermore, the addition of functional capacity and serological biomarkers delivered incremental prognostic information.

PMID: 29351312 [PubMed - in process]

Recombinant Relaxin Protects Liver Transplants from Ischemia Damage via Hepatocyte Glucocorticoid Receptor: From Bench-to-Bedside.

Sat, 01/20/2018 - 13:45

Recombinant Relaxin Protects Liver Transplants from Ischemia Damage via Hepatocyte Glucocorticoid Receptor: From Bench-to-Bedside.

Hepatology. 2018 Jan 19;:

Authors: Kageyama S, Nakamura K, Fujii T, Ke B, Sosa RA, Reed EF, Datta N, Zarrinpar A, Busuttil RW, Kupiec-Weglinski JW

Abstract
Hepatic ischemia-reperfusion injury (IRI) represents a major risk factor of early graft dysfunction and acute/chronic rejection as well as a key obstacle to expanding the donor pool in orthotopic liver transplantation (OLT). Although glucocorticoid receptor (GR) signaling may enhance cytoprotective programs, clinical use of glucocorticoid is limited due to adverse effects, while clinical relevance of GR-facilitated cytoprotection in OLT remains unknown. We aimed to evaluate the significance of hepatic GR in clinical OLT and verify the impact of recombinant human relaxin (rhRLX), which may function as GR agonist in tissue/disease-specific manner. Fifty-one liver transplant patients were recruited under IRB protocol. Liver biopsies were collected after cold storage (prior to the surgery) and 2h post-reperfusion (prior to the abdominal closure), followed by Western blot-assisted hepatic analyses. Forty-three percent of OLTs failed to increase GR peri-operatively under surgical stress. Post-/pre-GR ratios at post-operative day 1 correlated negatively with serum AST/cleaved caspase-3 and positively with Bcl-xL/Bcl-2 levels. In a murine OLT model with extended (18h) cold storage, treatment with rhRLX ameliorated IR-damage and improved survival while upregulating hepatocyte GR and Bcl-xL/Bcl-2 expression in OLT. rhRLX-induced GR suppressed hepatocyte HMGB1 translocation/release, accompanied by decreased TLR4/RAGE, suppressed IL1β, CCL2, CXCL10, TNFα, CXCL1 and CXCL2 levels and attenuated neutrophil/macrophage accumulation in OLT. Inhibition of GR in hepatocyte culture and in OLT diminished rhRLX-mediated cytoprotection.
CONCLUSION: This translational study underscores the role of rhRLX - GR signaling as a novel regulator of hepatocellular protection against IR-stress in OLT. In the context of a recent phase III clinical trial demonstrating positive outcomes of rhRLX in patients with acute heart failure, studies on rhRLX for the management of IRI in liver transplant recipients are warranted. This article is protected by copyright. All rights reserved.

PMID: 29350771 [PubMed - as supplied by publisher]

'We're like a gang, we stick together': experiences of ventricular assist device communities.

Sat, 01/20/2018 - 13:45

'We're like a gang, we stick together': experiences of ventricular assist device communities.

Eur J Cardiovasc Nurs. 2018 Jan 01;:1474515118754738

Authors: Standing HC, Exley C, MacGowan GA, Rapley T

Abstract
BACKGROUND: Ventricular assist devices (VADs) are a relatively new development in the management of advanced heart failure. In the UK, VAD recipients comprise a unique group of less than 200 patients. This is the first paper to explore the experience of VAD communities, the extent to which communities are developed around the device, and how these influence the experience of living with the VAD.
METHODS: Qualitative interviews were conducted with 20 VAD recipients (implanted as a bridge to transplantation), 11 interviews also included the VAD recipients' partners. Interpretive phenomenology was employed as the theoretical basis guiding the analysis of the interviews.
RESULTS: Four key themes emerged from the data: the existence of VAD communities; experiential knowledge and understanding; social comparisons; and the impacts of deaths within the VAD community. Many of the interviewees valued the VAD communities and the relationships they had formed with fellow recipients. The beneficial impacts of the VAD communities included offering recently implanted patients a realistic view of what to expect from life with a VAD; this could aid them in accepting and adapting to the changes imparted by the device. However, negative impacts of the VAD communities were also reported, in particular following deaths within the group, which were a source of distress for many of the interviewees.
CONCLUSIONS: In general, the VAD communities appeared to be a beneficial source of support for the majority of interviewees. Consideration should be given to how these communities could be supported by clinicians.

PMID: 29350546 [PubMed - as supplied by publisher]

Primary cardiac angiosarcoma: A case report.

Sat, 01/20/2018 - 13:45

Primary cardiac angiosarcoma: A case report.

Echocardiography. 2018 Jan 19;:

Authors: Ambrus N, Havasi K, Kalapos A, Sághy L, Makai A, Bogáts G, Hegedűs Z, Iványi B, Besenyi Z, Pápai Z, Nagy L, Forster T, Nemes A

Abstract
Cardiac angiosarcomas are the most common primary malignant cardiac tumors in adults. The diagnosis is often delayed due to nonspecific clinical symptoms at presentation. The cornerstones of diagnosis are echocardiography and the histological evaluation of the cardiac biopsy. The knowledge on the treatment is limited; the outcomes of chemotherapy, radiotherapy, complete surgical removal, and heart transplantation are controversial. We report a 38-year-old woman with a primary heart tumor which infiltrated the right atrial wall and the pericardium and caused pericardial effusion. Angiosarcoma was verified histologically. The surgical excision could not be radical, and the patient died 3 months from diagnosis.

PMID: 29349900 [PubMed - as supplied by publisher]

Incidence and predictors of sudden cardiac death after heart transplantation: A systematic review and meta-analysis.

Sat, 01/20/2018 - 13:45

Incidence and predictors of sudden cardiac death after heart transplantation: A systematic review and meta-analysis.

Clin Transplant. 2018 Jan 19;:

Authors: Alba AC, Foroutan F, Ng Fat Hing NKV, Fan CS, Manlhiot C, Ross HJ

Abstract
PORPUSE: Sudden cardiac death (SCD) is an important post-transplant problem being responsible for approximately 10% of deaths. We conducted a systematic review and meta-analysis to evaluate incidence and predictors of post-heart transplant SCD, and use of implantable cardiac defibrillator (ICD).
METHODS: Citations were identified in electronic databases and references of included studies. Observational studies on adults reporting on incidence and predictors of post-transplant SCD and ICD use were selected. We meta-analyzed SCD in person-years using random effect models. We qualitatively summarized predictors.
RESULTS: This study includes 55 studies encompassing 47,901 recipients. The pooled SCD incidence SCD was 1.30 per 100 person-years (95%CI 1.08-1.52). Cardiac allograft vasculopathy (CAV) was associated with higher SCD risk (2.40 per 100 patient-years, 95%CI 1.46-3.34). Independent predictors of SCD identified by 2 moderate quality studies were older donor and younger recipient age, non-Caucasian race, reduced left ventricular ejection fraction, rejection, infection and cancer. Authors rarely reported on ICD use.
CONCLUSION: This meta-analysis found that post-transplant SCD risk in heart transplant recipients is higher than in the general population. CAV was associated with increased SCD risk. Observational studies reporting on absolute risk of SCD are needed to better identify populations at a clinically significant increased risk. This article is protected by copyright. All rights reserved.

PMID: 29349819 [PubMed - as supplied by publisher]

Cancer incidence among children and young adults who have undergone x-ray guided cardiac catheterization procedures.

Sat, 01/20/2018 - 13:45

Cancer incidence among children and young adults who have undergone x-ray guided cardiac catheterization procedures.

Eur J Epidemiol. 2018 Jan 18;:

Authors: Harbron RW, Chapple CL, O'Sullivan JJ, Lee C, McHugh K, Higueras M, Pearce MS

Abstract
Children and young adults with heart disease appear to be at increased risk of developing cancer, although the reasons for this are unclear. A cohort of 11,270 individuals, who underwent cardiac catheterizations while aged ≤ 22 years in the UK, was established from hospital records. Radiation doses from cardiac catheterizations and CT scans were estimated. The cohort was matched with the NHS Central Register and NHS Transplant Registry to determine cancer incidence and transplantation status. Standardized incidence ratios (SIR) with associated confidence intervals (CI) were calculated. The excess relative risk (ERR) of lymphohaematopoietic  neoplasia was also calculated using Poisson regression. The SIR was raised for all malignancies (2.32, 95% CI 1.65, 3.17), lymphoma (8.34, 95% CI 5.22, 12.61) and leukaemia (2.11, 95% CI 0.82, 4.42). After censoring transplant recipients, post-transplant, the SIR was reduced to 0.90 (95% CI 0.49, 1.49) for all malignancies. All lymphomas developed post-transplant. The SIR for all malignancies developing 5 years from the first cardiac catheterization (2 years for leukaemia/lymphoma) remained raised (3.01, 95% CI 2.09, 4.19) but was again reduced after censoring transplant recipients (0.98, 95% CI 0.48, 1.77). The ERR per mGy bone marrow dose for lymphohaematopoietic neoplasia was reduced from 0.541 (95% CI 0.104, 1.807) to 0.018 (95% CI - 0.002, 0.096) where transplantation status was accounted for as a time-dependent background risk factor. In conclusion, transplantation appears to be a large contributor to elevated cancer rates in this patient group. This is likely to be mainly due to associated immunosuppression, however, radiation exposure may also be a contributing factor.

PMID: 29349586 [PubMed - as supplied by publisher]

Impaired Recovery of Left Ventricular Function in Patients With Cardiomyopathy and Left Bundle Branch Block.

Sat, 01/20/2018 - 13:45

Impaired Recovery of Left Ventricular Function in Patients With Cardiomyopathy and Left Bundle Branch Block.

J Am Coll Cardiol. 2018 Jan 23;71(3):306-317

Authors: Sze E, Samad Z, Dunning A, Campbell KB, Loring Z, Atwater BD, Chiswell K, Kisslo JA, Velazquez EJ, Daubert JP

Abstract
BACKGROUND: Patients with left bundle branch block (LBBB) often respond to cardiac resynchronization therapy (CRT) with left ventricular ejection fraction (LVEF) improvement. Guideline-directed medical therapy (GDMT), not CRT, is first-line therapy for patients with reduced LVEF with LBBB. However, there are little data on how patients with reduced LVEF and LBBB respond to GDMT.
OBJECTIVES: This study examined patients with cardiomyopathy and sought to assess rates of LVEF improvement for patients with LBBB compared to other QRS morphologies.
METHODS: Using data from the Duke Echocardiography Laboratory Database, the study identified patients with baseline electrocardiography and LVEF ≤35% who had a follow-up LVEF 3 to 6 months later. The study excluded patients with severe valve disease, a cardiac device, left ventricular assist device, or heart transplant. QRS morphology was classified as LBBB, QRS duration <120 ms (narrow QRS duration), or a wide QRS duration ≥120 ms but not LBBB. Analysis of variance testing compared mean change in LVEF among the 3 groups with adjustment for significant comorbidities and GDMT.
RESULTS: There were 659 patients that met the criteria: 111 LBBB (17%), 59 wide QRS duration ≥120 ms but not LBBB (9%), and 489 narrow QRS duration (74%). Adjusted mean increase in LVEF over 3 to 6 months in the 3 groups was 2.03%, 5.28%, and 8.00%, respectively (p < 0.0001). Results were similar when adjusted for interim revascularization and myocardial infarction. Comparison of mean LVEF improvement between patients with LBBB on GDMT and those not on GDMT showed virtually no difference (3.50% vs. 3.44%). The combined endpoint of heart failure hospitalization or mortality was highest for patients with LBBB.
CONCLUSIONS: LBBB is associated with a smaller degree of LVEF improvement compared with other QRS morphologies, even with GDMT. Some patients with LBBB may benefit from CRT earlier than guidelines currently recommend.

PMID: 29348023 [PubMed - in process]

Positive impact of a clinical goal-directed protocol on reducing cardiac arrests during potential brain-dead donor maintenance.

Sat, 01/20/2018 - 13:45
Related Articles

Positive impact of a clinical goal-directed protocol on reducing cardiac arrests during potential brain-dead donor maintenance.

Crit Care. 2016 Oct 11;20(1):323

Authors: Westphal GA, Coll E, de Souza RL, Wagner S, Montemezzo A, Cani de Souza FC, Torres G, Halla S, Carnin TC, Machado MC, Berbigier E, Busetto F, Bittencourt I, Gerent K, de Souza BS, Tassinari M, de Andrade J

Abstract
BACKGROUND: The disproportion between the large organ demand and the low number of transplantations performed represents a serious public health problem worldwide. Reducing the loss of transplantable organs from deceased potential donors as a function of cardiac arrest (CA) may contribute to an increase in organ donations. Our purpose was to test the hypothesis that a goal-directed protocol to guide the management of deceased donors may reduce the losses of potential brain-dead donors (PBDDs) due to CA.
METHODS: The quality improvement project included 27 hospitals that reported deceased donors prospectively to the Transplant Center of the State of Santa Catarina, Brazil. All deceased donors reported prospectively between May 2012 and April 2014 were analyzed. Hospitals were encouraged to use the VIP approach checklist during the management of PBDDs. The checklist was composed of the following goals: protocol duration 12-24 hours, temperature > 35 °C, mean arterial pressure ≥ 65 mmHg, diuresis 1-4 ml/kg/h, corticosteroids, vasopressin, tidal volume 6-8 ml/kg, positive end-expiratory pressure 8-10 cmH2O, sodium < 150 mEq/L, and glycemia < 180 mg/dl. A logistic regression model was used to identify predictors of CA.
RESULTS: There were 726 PBDD notifications, of which 324 (44.6) were actual donors, 141 (19.4 %) CAs, 226 (31.1 %) family refusals, and 35 (4.8 %) contraindications. Factors associated with CA reduction included use of the checklist (odds ratio (OR) 0.43, p < 0.001), maintenance performed inside the ICU (OR 0.49, p = 0.013), and vasopressin administration (OR 0.56, p = 0.04). More than three interventions had association with less CAs (OR 0.19, p < 0.001). After 24 months, CAs decreased from 27.3 % to 14.6 % (p = 0.002), reaching 12.1 % in the following two 4-month periods (p < 0.001). Simultaneous increases in organ recovered per donor and in actual donors were observed.
CONCLUSIONS: A quality improvement program based on education and the use of a goal checklist for the management of potential donors inside the ICU is strongly associated with a decrease in donor losses and an increase in organs recovered per donor.

PMID: 27724931 [PubMed - indexed for MEDLINE]

Derepression of the Iroquois Homeodomain Transcription Factor Gene IRX3 Confers Differentiation Block in Acute Leukemia.

Fri, 01/19/2018 - 13:45

Derepression of the Iroquois Homeodomain Transcription Factor Gene IRX3 Confers Differentiation Block in Acute Leukemia.

Cell Rep. 2018 Jan 16;22(3):638-652

Authors: Somerville TDD, Simeoni F, Chadwick JA, Williams EL, Spencer GJ, Boros K, Wirth C, Tholouli E, Byers RJ, Somervaille TCP

Abstract
The Iroquois homeodomain transcription factor gene IRX3 is expressed in the developing nervous system, limb buds, and heart, and transcript levels specify obesity risk in humans. We now report a functional role for IRX3 in human acute leukemia. Although transcript levels are very low in normal human bone marrow cells, high IRX3 expression is found in ∼30% of patients with acute myeloid leukemia (AML), ∼50% with T-acute lymphoblastic leukemia, and ∼20% with B-acute lymphoblastic leukemia, frequently in association with high-level HOXA gene expression. Expression of IRX3 alone was sufficient to immortalize hematopoietic stem and progenitor cells (HSPCs) in myeloid culture and induce lymphoid leukemias in vivo. IRX3 knockdown induced terminal differentiation of AML cells. Combined IRX3 and Hoxa9 expression in murine HSPCs impeded normal T-progenitor differentiation in lymphoid culture and substantially enhanced the morphologic and phenotypic differentiation block of AML in myeloid leukemia transplantation experiments through suppression of a terminal myelomonocytic program. Likewise, in cases of primary human AML, high IRX3 expression is strongly associated with reduced myelomonocytic differentiation. Thus, tissue-inappropriate derepression of IRX3 contributes significantly to the block in differentiation, which is the pathognomonic feature of human acute leukemias.

PMID: 29346763 [PubMed - in process]

Do Patients Supported With Continuous-Flow Left Ventricular Assist Device (CF-LVADS) Have a Sufficient Risk of Death to Justify a Priority Allocation? A Propensity-score Matched Analysis of Patients Listed In UNOS Status 2.

Fri, 01/19/2018 - 13:45

Do Patients Supported With Continuous-Flow Left Ventricular Assist Device (CF-LVADS) Have a Sufficient Risk of Death to Justify a Priority Allocation? A Propensity-score Matched Analysis of Patients Listed In UNOS Status 2.

Transplantation. 2018 Jan 18;:

Authors: Mastrobuoni S, Dell'Aquila AM, Van Caenegem O, Poncelet A, Jacquet LM, Garcia J

Abstract
BACKGROUND: Outcomes of Continuous Flow Left Ventricular Assist Devices (CF-LVADs) as bridge to transplant have significantly improved. The question has arisen whether patients on CF-LVADs have an increased risk of death on the waiting list as to justify a priority allocation (status 1). The aim of this study was to compare the survival following implantation of CF-LVADs to the survival on the waiting list for patients initially listed in United Network for Organ Sharing (UNOS) status 2.
METHODS: All patients >18 years listed for Heart Transplantation (HT) in the United States between 2011 and 2013 in UNOS status 2 with no mechanical circulatory support at time of listing were analyzed. Patients were divided into two groups depending on whether they received a new CF-LVAD while listed (CF-LVAD group) or not (NO-LVAD) and were further matched on their Propensity Score (PS) in a 1:2 ratio.
RESULTS: Two hundreds and eighty-seven CF-LVAD patients were matched to 574 NO-LVAD patients. Survival after CF-LVAD was significantly lower at 24-month compared to waiting list (75.4+4.4 versus 91.2+8.9%, p<0.0001). Further, survival was not significantly different between the two groups at 24-month after transplantation (81.3+5.9% versus 86.7+3.3%, p=0.3).
CONCLUSIONS: Survival of patients listed in UNOS status 2 who receive a CF-LVAD while listed is significantly lower compared to patients who do not receive mechanical support on the waiting list. The current priority in the allocation system given to patients on CF-LVAD seems justified. Further post-transplant survival is not negatively influenced by previous CF-LVAD implantation.

PMID: 29346259 [PubMed - as supplied by publisher]

Image Quality, Overall Evaluability, and Effective Radiation Dose of Coronary Computed Tomography Angiography With Prospective Electrocardiographic Triggering Plus Intracycle Motion Correction Algorithm in Patients With a Heart Rate Over 65 Beats Per...

Fri, 01/19/2018 - 13:45

Image Quality, Overall Evaluability, and Effective Radiation Dose of Coronary Computed Tomography Angiography With Prospective Electrocardiographic Triggering Plus Intracycle Motion Correction Algorithm in Patients With a Heart Rate Over 65 Beats Per Minute.

J Thorac Imaging. 2018 Jan 16;:

Authors: Pontone G, Muscogiuri G, Baggiano A, Andreini D, Guaricci AI, Guglielmo M, Fazzari F, Mushtaq S, Conte E, Annoni A, Formenti A, Mancini E, Verdecchia M, Fusini L, Bonfanti L, Consiglio E, Rabbat MG, Bartorelli AL, Pepi M

Abstract
PURPOSE: Recently, a new intracycle motion correction algorithm (MCA) was introduced to reduce motion artifacts from heart rate (HR) in coronary computed tomography angiography (cCTA). The aim of the study was to evaluate the image quality, overall evaluability, and effective radiation dose (ED) of cCTA with prospective electrocardiographic (ECG) triggering plus MCA as compared with standard protocol with retrospective ECG triggering in patients with HR≥65 bpm.
MATERIALS AND METHODS: One hundred consecutive patients (67±10 y) scheduled for cCTA with 65<HR<80 bpm were retrospectively analyzed. The patients were assigned to 2 groups undergoing prospective (group 1) or retrospective (group 2) triggered cCTA. The study protocol was approved by the Institutional Ethics Committee and a written informed consent was obtained from all patients. Image noise, signal to noise ratio, contrast to noise ratio, Likert image quality score (score 1, nondiagnostic; score 2, adequate; score 3, good; score 4, excellent), overall image evaluability, and ED were measured and compared between the 2 groups. Both vessel-based and patient-based analyses were evaluated. Student test or Wilcoxon test were used to evaluate differences of continuous variables, whereas the χ test was used to study differences with regard to categorical data. A P-value <0.05 was considered statistically significant.
RESULTS: cCTA was successfully performed in all patients. In a segment-based model, group 1 compared with group 2 showed a lower rate of overall artifacts (67% vs. 83%; P<0.001) and motion artifacts (49% vs. 66%; P<0.001), resulting in a better Likert image quality score (2.83±1.03 vs. 2.37±1.02; P<0.01) and overall evaluability (85% vs. 75%; P<0.01). Group 1 showed a lower ED as compared with group 2 (3.1±1.9 vs. 11.9±3.3 mSv; P<0.01).
CONCLUSION: MCA and cCTA with prospective ECG-triggering acquisition in patients with high HR improves image quality and overall evaluability compared with cCTA with standard retrospective ECG triggering.

PMID: 29346192 [PubMed - as supplied by publisher]

Sinus node dysfunction after heart transplantation - How much pacing is required?

Fri, 01/19/2018 - 13:45

Sinus node dysfunction after heart transplantation - How much pacing is required?

Clin Transplant. 2018 Jan 18;:

Authors: Herrmann FEM, Wellmann P, Sadoni S, Schramm R, Hagl C, Juchem G

Abstract
INTRODUCTION: We investigated the development of sinus node dysfunction (SND) requiring pacemaker implantation after heart transplant (HTx) especially regarding pacing burden in these patients.
PATIENTS AND METHODS: Patients requiring a pacemaker for SND were compared to all other patients in an HTx cohort including transplant patients from 1981-2016.
RESULTS: SND requiring pacemaker implantation developed in 118 patients (10%). These patients had received a biatrial anastomosis more frequently than those in the No SND group 95.8% vs. 90.0% (p=0.042). The ratio of reperfusion time to aortic cross clamp time was significantly smaller in the SND group compared to the No SND group 71.7% vs. 80.3% (p=0.033). This also holds for the ratio of reperfusion time to ischemia time which was 23.2% and 28.6% respectively (p=0.032). Pacing burden decreased from 90.5% to 66.3% after 2 years and remained around this value in the remaining 4 years of follow-up.
CONCLUSION: We identified the biatrial anastomosis and a low ratio of reperfusion time to aortic cross clamp time as well as to ischemia time as risk factors for SND requiring pacing. After implantation pacemakers continue to pace for over 60% of the time after 6 years. This article is protected by copyright. All rights reserved.

PMID: 29345729 [PubMed - as supplied by publisher]

Catheter-based edge-to-edge mitral valve repair for pulmonary pressure reduction and to postpone heart transplantation in a teenaged patient.

Fri, 01/19/2018 - 13:45

Catheter-based edge-to-edge mitral valve repair for pulmonary pressure reduction and to postpone heart transplantation in a teenaged patient.

ESC Heart Fail. 2018 Jan 18;:

Authors: Messner M, Hintringer F, Müller S, Zaruba MM, Bonaros N, Antretter H, Basic D, Pölzl G

Abstract
We report a case of catheter-based edge-to-edge mitral valve repair in a teenage male patient with non-ischaemic cardiomyopathy to improve pulmonary hypertension secondary to severe functional mitral regurgitation (FMR) to defer anticipated heart transplantation. A 19-year-old patient with previous history of fulminant myocarditis followed by markedly left ventricular dysfunction presented with severe mitral regurgitation 3 years after initial recovery. Slightly over time, deterioration of FMR was associated with gradual increase in pulmonary artery pressures despite optimal medical therapy. MitraClip implantation in this young patient was successfully performed with sustainable improvement of pulmonary hypertension.

PMID: 29345417 [PubMed - as supplied by publisher]

Pages