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 50 min ago

Optimal and Equitable Allocation of Donor Hearts: Which Principles Are We Translating Into Practices?

Fri, 08/11/2017 - 12:45
Related Articles

Optimal and Equitable Allocation of Donor Hearts: Which Principles Are We Translating Into Practices?

Transplant Direct. 2017 Aug;3(8):e197

Authors: Frigerio M

PMID: 28795148 [PubMed]

Resting and Exercise Energy Metabolism After Liver Transplantation for Nonalcoholic Steatohepatitis.

Fri, 08/11/2017 - 12:45
Related Articles

Resting and Exercise Energy Metabolism After Liver Transplantation for Nonalcoholic Steatohepatitis.

Transplant Direct. 2017 Aug;3(8):e188

Authors: Levitsky J, Singhvi A, Sadowsky HS, Cohen A, Demzik A, VanWagner L, Rinella M

Abstract
BACKGROUND: Nonalcoholic steatohepatitis (NASH) is a leading indication for liver transplantation (LT). We hypothesized that weight gain after LT may be exacerbated by reduced metabolic rates due to the LT procedure, particularly during exercise. We aimed to compare resting and exercise energy expenditure between patients transplanted for NASH and nontransplant nonalcoholic fatty liver disease (NAFLD) subjects.
METHODS: NASH LT recipients (>1-year post, n = 14) and NAFLD controls (n = 13) underwent analysis of body composition, resting energy expenditure (REE), and exercise energy expenditure (VO2max), the latter using a ramped-Bruce protocol assessed by expired gas analysis and peak heart rate.
RESULTS: Participants were mean 61.5 ± 7.9 years, 48.1% men, and 66.7% white. Baseline comorbidities were similar between groups. Among men, mean REE adjusted for total (17.7 vs 18.8, P = 0.87) and lean body mass (23.5 vs 26.9, P = 0.26), as well as VO2 (20.1 vs 23.9, P = 0.29), was lower in NASH LT recipients compared with NAFLD controls, respectively, although not statistically significant. However, female NASH LT recipients had significantly lower mean REE than NAFLD controls when adjusted for total (14.2 vs 18.9, P = 0.01) and lean body mass (19.3 vs 26.5, P = 0.002), as well as significantly lower VO2max (14.4 vs 20.6, P = 0.017).
CONCLUSIONS: NASH LT recipients, particularly women, have lower REE and exercise energy expenditure compared with nontransplant NAFLD patients. More aggressive diet and exercise programs for post-LT NASH recipients to account for reduced resting and exercise metabolic rates may attenuate weight gain in this vulnerable population.

PMID: 28795140 [PubMed]

Successful salvage chemotherapy and allogeneic transplantation of an acute myeloid leukemia patient with disseminated Fusarium solani infection.

Fri, 08/11/2017 - 12:45
Related Articles

Successful salvage chemotherapy and allogeneic transplantation of an acute myeloid leukemia patient with disseminated Fusarium solani infection.

Leuk Res Rep. 2017;8:4-6

Authors: Sheela S, Ito S, Strich JR, Manion M, Montemayor-Garcia C, Wang HW, Oetjen KA, West KA, Barrett AJ, Parta M, Gea-Banacloche J, Holland SM, Hourigan CS, Lai C

Abstract
Disseminated Fusarium infection is associated with high mortality in immunocompromised patients. Patients with acute myeloid leukemia (AML) often have an extended duration of neutropenia during intensive induction chemotherapy, consolidation chemotherapy, and hematopoietic stem cell transplantation (SCT). There is no consensus regarding management of invasive disseminated Fusarium infections in the setting of prolonged neutropenia (Tortorano et al., 2014) [1]. We report a case of disseminated Fusarium in a patient with relapsed AML who underwent successful chemotherapy and haplo-identical allogeneic SCT with administration of granulocyte colony stimulating factor (G-CSF) and granulocyte infusions.

PMID: 28794968 [PubMed]

Pulmonary vasodilator therapy is associated with greater survival in Eisenmenger syndrome.

Fri, 08/11/2017 - 12:45
Related Articles

Pulmonary vasodilator therapy is associated with greater survival in Eisenmenger syndrome.

Heart. 2017 Aug 09;:

Authors: Arnott C, Strange G, Bullock A, Kirby AC, O'Donnell C, Radford DJ, Grigg LE, Celermajer DS

Abstract
OBJECTIVE: Eisenmenger syndrome (ES) is a severe form of pulmonary hypertension in adults with congenital heart disease (CHD) and has a poor prognosis. We aimed to understand factors associated with survival in ES and particularly to assess the potential benefits of advanced pulmonary vasodilator therapy (AT).
METHODS: From January 2004, when AT became generally available for patients with ES, we followed 253 ES adults from 12 adult congenital heart disease centres across Australia and New Zealand. Demographic, medical and outcome data were collected and analysed prospectively and retrospectively.
RESULTS: The patients with ES were predominantly female (60%), aged 31 (SD 12) years. At diagnosis of ES, 64% were WHO functional class ≥3. The most common underlying lesion was ventricular septal defect (33%) with 21% having 'complex' anatomy. Over a median follow-up time of 9.1 years, the majority (72%) had been prescribed at least one AT (49% single agent), mostly bosentan (66%, 168 patients). The mean time on AT was 6 (SD 3.6) years. Those on AT were more functionally impaired at presentation (69% WHO ≥3 vs 51%, p=0.007) and more likely to have been prescribed anticoagulation (47% vs 27%, p=0.003). The risk of death/transplant was 4.8 %/year in AT exposed versus 8.4% in those never exposed. On multivariable analysis, exposure to AT was independently associated with greater survival (survival HR 2.27, 95% CI 1.49 to 3.45; p<0.001). WHO ≥3 at presentation was associated with a worse prognosis (mortality HR 1.82, 95% CI 1.19 to 2.78; p=0.006).
CONCLUSION: Treatment with AT was independently associated with greater survival in patients with ES, even though they were comparatively sicker prior to treatment.

PMID: 28794135 [PubMed - as supplied by publisher]

Does standardization improve care or stifle innovation?

Fri, 08/11/2017 - 12:45
Related Articles

Does standardization improve care or stifle innovation?

Pediatr Transplant. 2017 08;21(5):

Authors: Law Y

PMID: 28707756 [PubMed - indexed for MEDLINE]

Mononuclear Phagocytes Are Dispensable for Cardiac Remodeling in Established Pressure-Overload Heart Failure.

Fri, 08/11/2017 - 12:45
Related Articles

Mononuclear Phagocytes Are Dispensable for Cardiac Remodeling in Established Pressure-Overload Heart Failure.

PLoS One. 2017;12(1):e0170781

Authors: Patel B, Ismahil MA, Hamid T, Bansal SS, Prabhu SD

Abstract
BACKGROUND: Although cardiac and splenic mononuclear phagocytes (MPs), i.e., monocytes, macrophages and dendritic cells (DCs), are key contributors to cardiac remodeling after myocardial infarction, their role in pressure-overload remodeling is unclear. We tested the hypothesis that these immune cells are required for the progression of remodeling in pressure-overload heart failure (HF), and that MP depletion would ameliorate remodeling.
METHODS AND RESULTS: C57BL/6 mice were subjected to transverse aortic constriction (TAC) or sham operation, and assessed for alterations in MPs. As compared with sham, TAC mice exhibited expansion of circulating LyC6hi monocytes and pro-inflammatory CD206- cardiac macrophages early (1 w) after pressure-overload, prior to significant hypertrophy and systolic dysfunction, with subsequent resolution during chronic HF. In contrast, classical DCs were expanded in the heart in a biphasic manner, with peaks both early, analogous to macrophages, and late (8 w), during established HF. There was no significant expansion of circulating DCs, or Ly6C+ monocytes and DCs in the spleen. Periodic systemic MP depletion from 2 to 16 w after TAC in macrophage Fas-induced apoptosis (MaFIA) transgenic mice did not alter cardiac remodeling progression, nor did splenectomy in mice with established HF after TAC. Lastly, adoptive transfer of splenocytes from TAC HF mice into naïve recipients did not induce immediate or long-term cardiac dysfunction in recipient mice.
CONCLUSIONS: Mononuclear phagocytes populations expand in a phasic manner in the heart during pressure-overload. However, they are dispensable for the progression of remodeling and failure once significant hypertrophy is evident and blood monocytosis has normalized.

PMID: 28125666 [PubMed - indexed for MEDLINE]

Seen from the moon we are all the same size: Deceased donation in the Netherlands.

Fri, 08/11/2017 - 12:45
Related Articles

Seen from the moon we are all the same size: Deceased donation in the Netherlands.

Neth J Med. 2016 Aug;74(7):282-4

Authors: Hesselink DA, Weimar W

PMID: 27571942 [PubMed - indexed for MEDLINE]

3K3A-activated protein C stimulates postischemic neuronal repair by human neural stem cells in mice.

Fri, 08/11/2017 - 12:45
Related Articles

3K3A-activated protein C stimulates postischemic neuronal repair by human neural stem cells in mice.

Nat Med. 2016 Sep;22(9):1050-5

Authors: Wang Y, Zhao Z, Rege SV, Wang M, Si G, Zhou Y, Wang S, Griffin JH, Goldman SA, Zlokovic BV

Abstract
Activated protein C (APC) is a blood protease with anticoagulant activity and cell-signaling activities mediated by the activation of protease-activated receptor 1 (F2R, also known as PAR1) and F2RL1 (also known as PAR3) via noncanonical cleavage. Recombinant variants of APC, such as the 3K3A-APC (Lys191-193Ala) mutant in which three Lys residues (KKK191-193) were replaced with alanine, and/or its other mutants with reduced (>90%) anticoagulant activity, engineered to reduce APC-associated bleeding risk while retaining normal cell-signaling activity, have shown benefits in preclinical models of ischemic stroke, brain trauma, multiple sclerosis, amyotrophic lateral sclerosis, sepsis, ischemic and reperfusion injury of heart, kidney and liver, pulmonary, kidney and gastrointestinal inflammation, diabetes and lethal body radiation. On the basis of proof-of-concept studies and an excellent safety profile in humans, 3K3A-APC has advanced to clinical trials as a neuroprotectant in ischemic stroke. Recently, 3K3A-APC has been shown to stimulate neuronal production by human neural stem and progenitor cells (NSCs) in vitro via a PAR1-PAR3-sphingosine-1-phosphate-receptor 1-Akt pathway, which suggests the potential for APC-based treatment as a strategy for structural repair in the human central nervous (CNS) system. Here we report that late postischemic treatment of mice with 3K3A-APC stimulates neuronal production by transplanted human NSCs, promotes circuit restoration and improves functional recovery. Thus, 3K3A-APC-potentiated neuronal recruitment from engrafted NSCs might offer a new approach to the treatment of stroke and related neurological disorders.

PMID: 27548576 [PubMed - indexed for MEDLINE]

René Favaloro: the heart surgeon.

Thu, 08/10/2017 - 12:45
Related Articles

René Favaloro: the heart surgeon.

Wien Med Wochenschr. 2017 Aug 08;:

Authors: Fioranelli M, Roccia MG, Rovesti M, Satolli F, Petrelli P, Feliciani C, Lotti T

Abstract
The story of René Favaloro is almost unknown to the general public. Christian Barnard, the cardiac surgeon who performed the world's first human-to-human heart transplant, is much more famous than him; still, nowadays many more lives are saved thanks to Favaloro's work rather than to heart transplants. This paper wants to pay tribute to a great doctor and an extraordinary man: René Favaloro.

PMID: 28791557 [PubMed - as supplied by publisher]

[Perioperative Management of Fontan Operation].

Thu, 08/10/2017 - 12:45
Related Articles

[Perioperative Management of Fontan Operation].

Kyobu Geka. 2017 Jul;70(8):627-633

Authors: Sughimoto K, Miyaji K

Abstract
Surgical results of Fontan operation has been improved over the decades due to the introduction of the staged operations and some modifications of Fontan route from the classical atrio-pulmonary connection to total cavo-pulmonary connection. However, issues remain because of the single ventricular physiology of Fontan circulation. This article explains about the preoperative checklist for Fontan operation and tips on the postoperative management including an early extubation, use of inhaled nitric oxide after extubation, anticoagulation therapy, and efficacy of angiotensin converting enzyme inhibitor, supported by the cutting-edge evidence. Some patients who underwent Fontan operation, however, suffer from protein-losing enteropathy, heart failure, and thus are classified as failing Fontan. Treatment for these patients with failed Fontan is an unsolved problem in the state where heart transplantation is inadequately available in Japan.

PMID: 28790279 [PubMed - in process]

Multiple Gene Variants in Hypertrophic Cardiomyopathy in the Era of Next-Generation Sequencing.

Thu, 08/10/2017 - 12:45
Related Articles

Multiple Gene Variants in Hypertrophic Cardiomyopathy in the Era of Next-Generation Sequencing.

Circ Cardiovasc Genet. 2017 Aug;10(4):

Authors: Burns C, Bagnall RD, Lam L, Semsarian C, Ingles J

Abstract
BACKGROUND: Multiple likely pathogenic/pathogenic (LP/P; ≥2) variants in patients with hypertrophic cardiomyopathy were described 10 years ago with a prevalence of 5%. We sought to re-examine the significance of multiple rare variants in patients with hypertrophic cardiomyopathy in the setting of comprehensive and targeted panels.
METHODS AND RESULTS: Of 758 hypertrophic cardiomyopathy probands, we included 382 with ≥45 cardiomyopathy genes screened. There were 224 (59%) with ≥1 rare variant (allele frequency ≤0.02%). Variants were analyzed using varying sized gene panels to represent comprehensive or targeted testing. Based on a 45-gene panel, 127 (33%) had a LP/P variant, 139 (36%) had variants of uncertain significance, and 66 (17%) had multiple rare variants. A targeted 8-gene panel yielded 125 (32%) LP/P variants, 52 (14%) variants of uncertain significance, and 14 (4%) had multiple rare variants. No proband had 2 LP/P variants. Including affected family members (total n=412), cluster-adjusted analyses identified a phenotype effect, with younger age (odds ratio, 0.95; 95% confidence interval, 0.92-0.98; P=0.004) and family history of sudden cardiac death (odds ratio, 3.5; 95% confidence interval, 1.3-9.9; P=0.02) significantly more likely in multiple versus single variant patients when considering an 8-gene panel but not larger panels. Those with multiple variants had worse event-free survival from all-cause death, cardiac transplantation, and cardiac arrest (log-rank P=0.008).
CONCLUSIONS: No proband had multiple LP/P variants in contrast to previous reports. However, multiple rare variants regardless of classification were seen in 4% and contributed to earlier disease onset and cardiac events. Our findings support a cumulative variant hypothesis in hypertrophic cardiomyopathy.

PMID: 28790153 [PubMed - in process]

Serum exosomal protein profiling for the non-invasive detection of cardiac allograft rejection.

Thu, 08/10/2017 - 12:45
Related Articles

Serum exosomal protein profiling for the non-invasive detection of cardiac allograft rejection.

J Heart Lung Transplant. 2017 Jul 19;:

Authors: Kennel PJ, Saha A, Maldonado DA, Givens R, Brunjes DL, Castillero E, Zhang X, Ji R, Yahi A, George I, Mancini DM, Koller A, Fine B, Zorn E, Colombo PC, Tatonetti N, Chen EI, Schulze PC

Abstract
BACKGROUND: Exosomes are cell-derived circulating vesicles that play an important role in cell-cell communication. Exosomes are actively assembled and carry messenger RNAs, microRNAs and proteins. The "gold standard" for cardiac allograft surveillance is endomyocardial biopsy (EMB), an invasive technique with a distinct complication profile. The development of novel, non-invasive methods for the early diagnosis of allograft rejection is warranted. We hypothesized that the exosomal proteome is altered in acute rejection, allowing for a distinction between non-rejection and rejection episodes.
METHODS: Serum samples were collected from heart transplant (HTx) recipients with no rejection, acute cellular rejection (ACR) and antibody-mediated rejection (AMR). Liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis of serum exosome was performed using a mass spectrometer (Orbitrap Fusion Tribrid).
RESULTS: Principal component analysis (PCA) revealed a clustering of 3 groups: (1) control and heart failure (HF); (2) HTx without rejection; and (3) ACR and AMR. A total of 45 proteins were identified that could distinguish between groups (q < 0.05). Comparison of serum exosomal proteins from control, HF and non-rejection HTx revealed 17 differentially expressed proteins in at least 1 group (q < 0.05). Finally, comparisons of non-rejection HTx, ACR and AMR serum exosomes revealed 15 differentially expressed proteins in at least 1 group (q < 0.05). Of these 15 proteins, 8 proteins are known to play a role in the immune response. Of note, the majority of proteins identified were associated with complement activation, adaptive immunity such as immunoglobulin components and coagulation.
CONCLUSIONS: Characterizing of circulating exosomal proteome in different cardiac disease states reveals unique protein expression patterns indicative of the respective pathologies. Our data suggest that HTx and allograft rejection alter the circulating exosomal protein content. Exosomal protein analysis could be a novel approach to detect and monitor acute transplant rejection and lead to the development of predictive and prognostic biomarkers.

PMID: 28789823 [PubMed - as supplied by publisher]

Improvement of Local Cell Delivery Using Helix Transendocardial Delivery Catheter in a Porcine Heart.

Thu, 08/10/2017 - 12:45
Related Articles

Improvement of Local Cell Delivery Using Helix Transendocardial Delivery Catheter in a Porcine Heart.

Int Heart J. 2017 May 31;58(3):435-440

Authors: Mitsutake Y, Pyun WB, Rouy D, Foo CWP, Stertzer SH, Altman P, Ikeno F

Abstract
Cardiac regeneration strategies using stem cells have shown variable and inconsistent results with respect to patient cardiac function and clinical outcomes. There has been increasing consensus that improving the efficiency of delivery may improve results. The Helix transendocardial delivery system (BioCardia Inc.) has been developed to enable percutaneous transendocardial biotherapeutic delivery. Therefore, we evaluated cell retention using this unique system compared with direct transepicardial injection and intracoronary infusion in an animal model.Twelve healthy swine were used in this study. (18)Fluorodeoxyglucose (FDG)-labeled bone marrow mononuclear cells were delivered via percutaneous transendocardial route using the Helix system (TE group, n = 5), via direct transepicardial injection using a straight 27-gauge needle in an open chest procedure (TP group, n = 4), or via percutaneous intracoronary (IC) infusion (IC group, n = 3). One hour after cell delivery, the distribution of injected cells within the myocardium was assessed by PET-CT. Regions of interest were defined and their signals were compared in each group. Retention rates were calculated as a percentage of the comparing signal.The distribution of injected cells in the myocardium was higher in the TE group (17.9%) than in the TP group (6.0%, versus TE, P < 0.001) and the IC group (1.0%, versus TE, P < 0.001). Consistent with previous reports, there were signal distributions in the lungs, liver, and kidneys in qualitative whole body PET assessment.TE cell delivery using a helical infusion catheter is more efficient in cell retention than either TP delivery or IC delivery using PET-CT analysis.

PMID: 28539564 [PubMed - indexed for MEDLINE]

Tricuspid Valve Replacement in Infants and Children With Exclusively Autologous Tissue.

Thu, 08/10/2017 - 12:45
Related Articles

Tricuspid Valve Replacement in Infants and Children With Exclusively Autologous Tissue.

World J Pediatr Congenit Heart Surg. 2017 Jan;8(1):88-91

Authors: Mohamed KS

Abstract
Tricuspid valve replacement has always been a challenge in the pediatric population, with high rates of mortality and morbidity. This article describes a new technique that we have used to replace the tricuspid valve with exclusively autologous tissues. The pulmonary autograft is used for tricuspid valve replacement. Pulmonary artery wall and autologous pericardium are utilized for right ventricular out flow tract reconstruction with the creation of a monocusp.

PMID: 28033086 [PubMed - indexed for MEDLINE]

Common Arterial Trunk Repair by Means of a Handmade Bovine Pericardial-Valved Woven Dacron Conduit.

Thu, 08/10/2017 - 12:45
Related Articles

Common Arterial Trunk Repair by Means of a Handmade Bovine Pericardial-Valved Woven Dacron Conduit.

World J Pediatr Congenit Heart Surg. 2017 Jan;8(1):69-76

Authors: Ramírez-Marroquín S, Curi-Curi PJ, Calderón-Colmenero J, García-Montes JA, Cervantes-Salazar JL

Abstract
BACKGROUND: Surgical repair of common arterial trunk (CAT) by means of a homograft conduit has become a standard practice. We report our experience in the correction of this heart disease with a handmade bovine pericardial-valved woven Dacron conduit as an alternative procedure to homografts, with a focus on early, mid-term, and long-term results.
METHODS: We designed a retrospective study that included 15 patients with a mean age of 1.5 years (range: three months to eight years), who underwent primary repair of simple CAT. Right ventricular outflow tract was reconstructed in all the cases with this handmade graft that was explanted at the time of its biological stenotic degeneration. A peeling procedure was performed at this time, in order to reconstruct the right ventricle-to-pulmonary artery continuity.
RESULTS: Overall mortality was 13.3% (one death at the early postoperative primary repair and the other at the mid-term postoperative peeling reoperation). Actuarial survival rate was 93.3%, 86.7%, and 86.7% at 5, 10, and 15 years, respectively. All of the 14 survivors developed stenosis of the handmade conduit at the mid-term period (8 ± 3 years), but after the peeling procedure, 13 survivors remain asymptomatic to date.
CONCLUSIONS: Primary repair of common arterial trunk using a handmade conduit can be performed with very low perioperative mortality and satisfactory mid-term and long-term results, which can be favorably compared with those reported with the use of homografts. When graft obstruction develops, peeling procedure is a good option because it does not affect the overall survival, although long-term outcomes warrant further follow-up.

PMID: 28033080 [PubMed - indexed for MEDLINE]

Coronary Ostioplasty for Congenital Atresia of the Left Main Coronary Artery Ostium in a Teenage Boy.

Thu, 08/10/2017 - 12:45
Related Articles

Coronary Ostioplasty for Congenital Atresia of the Left Main Coronary Artery Ostium in a Teenage Boy.

World J Pediatr Congenit Heart Surg. 2016 Nov;7(6):773-776

Authors: Sugimoto A, Shiraishi S, Moon J, Takahashi M, Tsuchida M

Abstract
Atresia of the left coronary artery ostium is extremely rare. We report the case of a 13-year-old boy who played volleyball in school and collapsed with severe chest pain during practice. He was referred to our hospital, and imaging modalities showed atresia of the left main coronary artery ostium. Urgent coronary ostioplasty was performed using a patch of 0.6% glutaraldehyde-treated autologous pericardium. His postoperative course was uneventful, and he has had a normal everyday life without chest pain 8 months postoperatively. Physicians should be aware of the patient's history, as in this case, because prompt imaging diagnosis is essential when there is a high likelihood that the event is related to myocardial ischemia. Since long-term outcome is uncertain even after successful surgical revascularization, close follow-up is required.

PMID: 26993756 [PubMed - indexed for MEDLINE]

Regression of asymptomatic cardiomyopathy and clinical outcome of renal transplant recipients: a long-term prospective cohort study.

Thu, 08/10/2017 - 12:45
Related Articles

Regression of asymptomatic cardiomyopathy and clinical outcome of renal transplant recipients: a long-term prospective cohort study.

Nephrol Dial Transplant. 2016 Jul;31(7):1168-74

Authors: Paoletti E, Bellino D, Signori A, Pieracci L, Marsano L, Russo R, Massarino F, Ravera M, Fontana I, Carta A, Cassottana P, Garibotto G

Abstract
BACKGROUND: Asymptomatic left ventricular hypertrophy (LVH) is highly prevalent and associated with an adverse outcome in renal transplant recipients (RTRs). Nonetheless, there are currently no available studies analyzing the effect of LVH regression on solid clinical endpoints in these patients.
METHODS: This study is the prospective observational extension of two randomized controlled trials aimed at assessing the effect of active intervention on post-transplant LVH in RTRs. We evaluated the incidence of a composite of death and any cardiovascular (CV) or renal event in 60 RTRs in whom LVH regression was observed and in 40 whose LVH remained unchanged or worsened.
RESULTS: During an 8.4 ± 3.5-year follow-up, 8 deaths, 18 CV events and 6 renal events occurred in the entire cohort. Multivariable analysis showed that age [hazard ratio (HR) 1.07, 95% confidence interval (CI) 1.03-1.12 each 1 year, P = 0.002] and LVH regression (HR 0.42, 95% CI 0.22-0.87, P = 0.019) were significant predictors of the composite endpoint. Kaplan-Meier estimates showed better survival rates in patients in whom actual LVH regression was achieved (P < 0.001, log-rank test). Age (HR 1.09, 95% CI 1.03-1.15 each 1 year, P = 0.004), better graft function (HR 0.95, 95% CI 0.91-0.99 each 1 mL/min/1.73 m(2) increase in estimated glomerular filtration rate, P = 0.03) and LVH regression (HR 0.41, 95% CI 0.22-0.79, P = 0.01) were significant predictors of the CV endpoint. Patients with a left ventricular mass index decrease also showed better cardiac event-free survival (P = 0.0022, log-rank test).
CONCLUSIONS: This is the first study to demonstrate that LVH regression, regardless of the therapeutic strategy adopted to achieve it, portends better long-term clinical outcome in RTRs.

PMID: 26472820 [PubMed - indexed for MEDLINE]

Cardiac Auscultation for Noncardiologists: Application in Cardiac Rehabilitation Programs: PART II: ADULT PATIENTS AFTER HEART SURGERY.

Wed, 08/09/2017 - 12:45

Cardiac Auscultation for Noncardiologists: Application in Cardiac Rehabilitation Programs: PART II: ADULT PATIENTS AFTER HEART SURGERY.

J Cardiopulm Rehabil Prev. 2017 Aug 04;:

Authors: Compostella L, Russo N, Compostella C, Setzu T, Iliceto S, Bellotto F

Abstract
This clinical skills review describes the most common cardiac auscultatory findings in adults after heart surgery and correlates them with prognostic indicators. It was written for noncardiologist health care providers who work in outpatient cardiac rehabilitation programs.Mechanical prosthetic valves produce typical closing and opening clicks. Listening to their timing and features, as well as to presence and quality of murmurs, contributes to the awareness of potential prosthesis malfunction before other dramatic clinical signs or symptoms become evident. In patients with biological prostheses, murmurs should be carefully evaluated to rule out both valve malfunction and degeneration. Rubs of post-pericardiotomy pericarditis should prompt further investigation for early signs of cardiac tamponade. Third and fourth heart sounds and systolic murmurs in anemic patients should be differentiated from pathological conditions. Relatively new groups of heart surgery patients are those with chronic heart failure treated with continuous-flow left ventricle assist devices. These devices produce characteristic continuous noise that may suddenly disappear or vary in quality and intensity with device malfunction. After heart transplantation, a carefully performed and regularly repeated cardiac auscultation may contribute to suspicion of impending acute rejection. During cardiac rehabilitation, periodic cardiac auscultation may provide useful information regarding clinical-hemodynamic status and allow detection of heralding signs of possible complications in an efficient and low-cost manner.

PMID: 28787352 [PubMed - as supplied by publisher]

PASE (Physical Activity Scale for the Elderly) Score Is Related to Sarcopenia in Noninstitutionalized Older Adults.

Wed, 08/09/2017 - 12:45

PASE (Physical Activity Scale for the Elderly) Score Is Related to Sarcopenia in Noninstitutionalized Older Adults.

J Geriatr Phys Ther. 2017 Aug 03;:

Authors: Curcio F, Liguori I, Cellulare M, Sasso G, Della-Morte D, Gargiulo G, Testa G, Cacciatore F, Bonaduce D, Abete P

Abstract
BACKGROUND AND PURPOSE: Sarcopenia, a loss of muscle mass and strength accompanying aging, is common in older adults who are not physically active. Nevertheless, the association between physical activity and sarcopenia has not been extensively studied. Therefore, we examined the relationship of both muscle mass and muscle strength with physical activity as quantified using the Physical Activity Scale for Elderly (PASE).
METHODS: PASE score, muscle mass by bioimpendiometry, and muscle strength by handgrip were evaluated in a cohort study of 420 older adult participants (mean age 82.4 [5.9] years), admitted to the Comprehensive Geriatric Assessment Center. Sarcopenia was assessed as indicated in the European Working Group on Sarcopenia in Older People (EWGSOP) consensus.
RESULTS: PASE score was lower in sarcopenic (40.2 [89.0]) than in non sarcopenic (92.0 [52.4]) older adults (P < .001). Curvilinear regression analysis demonstrated that PASE score is related with muscle mass (R = 0.63; P < .001) and strength (R = 0.51; P < .001).
CONCLUSIONS: The present study indicates that PASE score is curvilinearly related to muscle mass and strength and that low PASE score identifies sarcopenic noninstitutionalized older adults. This evidence suggests that PASE score evaluated together with muscle mass and strength may identify older adults at high risk of sarcopenia.

PMID: 28786911 [PubMed - as supplied by publisher]

Angiogenesis on Coronary Angiography Is a Marker for Accelerated Cardiac Allograft Vasculopathy as Assessed by Intravascular Ultrasound.

Wed, 08/09/2017 - 12:45

Angiogenesis on Coronary Angiography Is a Marker for Accelerated Cardiac Allograft Vasculopathy as Assessed by Intravascular Ultrasound.

Clin Transplant. 2017 Aug 08;:

Authors: Cheng R, Kransdorf EP, Wei J, Patel JK, Kobashigawa JA, Azarbal B

Abstract
BACKGROUND: Errant neovascularization and coronary artery fistulae (CAF) are frequently observed after cardiac transplantation. The relationship between angiographic neovascularization/CAF and coronary plaque progression is unknown.
METHODS: Angiography and intravascular ultrasound were routinely performed at 4-6 weeks and 1-yr post-transplant. Pts were divided into three groups: no angiographic angiogenesis (Group 1), neovascularization only (Group 2), and CAF (Group 3). First-year changes in maximal intimal thickness (MIT), maximal intimal area (MIA), and percent atheroma volume (PAV) were compared between groups.
RESULTS: 106 pts were included, 40/106 in Group 1, 42/106 in Group 2, and 24/106 in Group 3. Respectively, first-year ΔMIT was 0.14±0.13 mm, 0.32±0.26 mm, and 0.50±0.34 mm, p<0.001. ΔMIA was 0.6±0.6 mm(2) , 1.7±1.8 mm(2) , and 3.0±2.6 mm(2) , p<0.001. ΔPAV was 2.3±2.5%, 6.0±5.1%, and 9.6±9.0%, p<0.001. Rapid plaque progression occurred in 1/40 (2.5%) pts in Group 1, 12/42 (28.6%) in Group 2, and 12/24 (50%) in Group 3, p<0.001. Multivariate analysis identified both antithymocyte globulin and presence of CAF as independently associated with rapid plaque progression: OR 0.29 (p=0.038) and 4.04 (p=0.014).
CONCLUSION: Neovascularization and CAF are commonly present on surveillance angiography after cardiac transplantation and may signify amplified angiogenesis. Their presence is associated with accelerated coronary plaque progression by IVUS. This article is protected by copyright. All rights reserved.

PMID: 28786501 [PubMed - as supplied by publisher]

Pages