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Implantable Cardioverter-Defibrillator Therapy in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy: Predictors of Appropriate Therapy, Outcomes, and Complications.

Thu, 06/08/2017 - 12:45
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Implantable Cardioverter-Defibrillator Therapy in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy: Predictors of Appropriate Therapy, Outcomes, and Complications.

J Am Heart Assoc. 2017 Jun 06;6(6):

Authors: Orgeron GM, James CA, Te Riele A, Tichnell C, Murray B, Bhonsale A, Kamel IR, Zimmerman SL, Judge DP, Crosson J, Tandri H, Calkins H

Abstract
BACKGROUND: Arrhythmogenic right ventricular dysplasia/cardiomyopathy is characterized by ventricular arrhythmias and sudden cardiac death. Once the diagnosis is established, risk stratification to determine whether implantable cardioverter-defibrillator (ICD) placement is warranted is critical.
METHODS AND RESULTS: The cohort included 312 patients (163 men, age at presentation 33.6±13.9 years) with definite arrhythmogenic right ventricular dysplasia/cardiomyopathy who received an ICD. Over 8.8±7.33 years, 186 participants (60%) had appropriate ICD therapy and 58 (19%) had an intervention for ventricular fibrillation/flutter. Ventricular tachycardia at presentation (hazard ratio [HR]: 1.86; 95% confidence interval [CI], 1.38-2.49; P<0.001), inducibility on electrophysiology study (HR: 3.14; 95% CI, 1.95-5.05; P<0.001), male sex (HR: 1.62; 95% CI, 1.20-2.19; P=0.001), inverted T waves in ≥3 precordial leads (HR: 1.66; 95% CI, 1.09-2.52; P=0.018), and premature ventricular contraction count ≥1000/24 hours (HR: 2.30; 95% CI, 1.32-4.00; P=0.003) were predictors of any appropriate ICD therapy. Inducibility at electrophysiology study (HR: 2.28; 95% CI, 1.10-4.70; P=0.025) remained as the only predictor after multivariable analysis. The predictors for ventricular fibrillation/flutter were premature ventricular contraction ≥1000/24 hours (HR: 4.39; 95% CI, 1.32-14.61; P=0.016), syncope (HR: 1.85; 95% CI, 1.10-3.11; P=0.021), aged ≤30 years at presentation (HR: 1.76; 95% CI, 1.04-3.00; P<0.036), and male sex (HR: 1.73; 95% CI, 1.01-2.97; P=0.046). Younger age at presentation (HR: 3.14; 95% CI, 1.32-7.48; P=0.010) and high premature ventricular contraction burden (HR: 4.43; 95% CI, 1.35-14.57; P<0.014) remained as independent predictors of ventricular fibrillation/flutter. Complications occurred in 66 participants (21%), and 64 (21%) had inappropriate ICD interventions. Overall mortality was low at 2%, and 4% underwent heart transplantation.
CONCLUSION: These findings represent an important step in identifying predictors of ICD therapy for potentially fatal ventricular fibrillation/flutter and should be considered when developing a risk stratification model for arrhythmogenic right ventricular dysplasia/cardiomyopathy.

PMID: 28588093 [PubMed - in process]

Cytokine filtration modulates pulmonary metabolism and edema formation during ex vivo lung perfusion.

Thu, 06/08/2017 - 12:45
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Cytokine filtration modulates pulmonary metabolism and edema formation during ex vivo lung perfusion.

J Heart Lung Transplant. 2017 May 20;:

Authors: Iskender I, Cosgun T, Arni S, Trinkwitz M, Fehlings S, Yamada Y, Cesarovic N, Yu K, Frauenfelder T, Jungraithmayr W, Weder W, Inci I

Abstract
BACKGROUND: Ex vivo lung perfusion (EVLP) has improved the process of donor lung management. Cytokine accumulation during EVLP has been shown to correlate with worse outcome after lung transplantation. Our objective in this study was to test the safety and efficacy of cytokine filtration during EVLP in a large animal model.
METHODS: Pig donor lungs were preserved for 24 hours at 4°C, followed by 12 hours of EVLP, according to the Toronto protocol. The perfusate was continuously run through an absorbent device (CytoSorb) via a veno-venous shunt from the reservoir in the filter group. EVLP was performed according to the standard protocol in the control group (n = 5 each). EVLP physiology, lung X-ray, perfusate biochemistry, inflammatory response and microscopic injury were assessed.
RESULTS: Cytokine filtration significantly improved airway pressure and dynamic compliance during the 12-hour perfusion period. Lung X-rays acquired at the end of perfusion showed increased consolidation in the control group. Electrolyte imbalance, determined by increased hydrogen, potassium and calcium ion concentrations in the perfusate, was markedly worsened in the control group. Glucose consumption and lactate production were markedly reduced, along with the lactate/pyruvate ratio in the filter group. Cytokine expression profile, tissue myeloperoxidase activity and microscopic lung injury were significantly reduced in the filter group.
CONCLUSIONS: Continuous perfusate filtration through sorbent beads is effective and safe during prolonged EVLP. Cytokine removal decreased the development of pulmonary edema and electrolyte imbalance through the suppression of anaerobic glycolysis and neutrophil activation in this setting. Further studies are needed to test the beneficial effect of cytokine filtration on post-transplant lung function.

PMID: 28587802 [PubMed - as supplied by publisher]

Con: Extracorporeal Membrane Oxygenation Should Not Routinely Replace Cardiopulmonary Bypass As the Preferred Method of Support During Lung Transplantation.

Thu, 06/08/2017 - 12:45
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Con: Extracorporeal Membrane Oxygenation Should Not Routinely Replace Cardiopulmonary Bypass As the Preferred Method of Support During Lung Transplantation.

J Cardiothorac Vasc Anesth. 2017 Feb 20;:

Authors: Tong MZ

PMID: 28587759 [PubMed - as supplied by publisher]

Towards the virtual benchmarking of pneumatic ventricular assist devices: application of a novel FSI-based strategy to the Penn State 12 cc device.

Wed, 06/07/2017 - 12:45

Towards the virtual benchmarking of pneumatic ventricular assist devices: application of a novel FSI-based strategy to the Penn State 12 cc device.

J Biomech Eng. 2017 Jun 01;:

Authors: Caimi A, Sturla F, Good B, Vidotto M, De Ponti R, Piatti F, Manning KB, Redaelli A

Abstract
The pediatric use of pneumatic ventricular assist devices (VADs) as a bridge to heart transplant still suffers for short-term major complications such as bleeding and thromboembolism. Although numerical techniques are increasingly exploited to support the process of device optimization, an effective virtual benchmark is still lacking. Focusing on the 12cc Penn State pneumatic VAD, we developed a novel fluid-structure interaction (FSI) model able to capture the device functioning, reproducing the mechanical interplay between the diaphragm, the blood chamber and the pneumatic actuation. The FSI model included the diaphragm mechanical response from uniaxial tensile tests, realistic VAD pressure operative conditions from a dedicated mock loop system, and the behavior of VAD valves. Our FSI-based benchmark effectively captured the complexity of the diaphragm dynamics. During diastole, the initial slow diaphragm retraction in the air chamber was followed by a more rapid phase; asymmetries were noticed in the diaphragm configuration during its systolic inflation in the blood chamber. The FSI model also captured the major features of the device fluid dynamics. In particular, during diastole, a rotational wall washing pattern is promoted by the penetrating inlet jet with a low velocity region located in the center of the device. Our numerical analysis of the 12cc Penn State VAD points out the potential of the proposed FSI approach well resembling previous experimental evidences; if further tested and validated, it could be exploited as a virtual benchmark to deepen VAD-related complications and to support the ongoing optimization of pediatric devices.

PMID: 28586917 [PubMed - as supplied by publisher]

Locating the Level and Extent of Congenital High Airway Obstruction: Fluid in the Airway Tract as Reference Points.

Wed, 06/07/2017 - 12:45

Locating the Level and Extent of Congenital High Airway Obstruction: Fluid in the Airway Tract as Reference Points.

J Ultrasound Med. 2017 Jun 06;:

Authors: Gowda M, Gupta S, Ali A, Paranthaman S

Abstract
Described here are a series of four cases of congenital high airway obstruction in the fetus. All of the patients presented in the second trimester and all had hydrops fetalis. Three cases had bilateral hyperinflated lungs, midline shift of heart, flattening or inversion of the diaphragm, and fetal ascites. Autopsy was performed in one of these three and showed laryngeal atresia. In one fetus, there was only a unilateral huge enlargement of the lung with mediastinal shift. On autopsy, this fetus had atresia of right main bronchus. All parents had terminated the pregnancy following the prenatal diagnosis. Laryngeal atresia is an extremely rare fetal anomaly with dismal prognosis. It is important to differentiate the condition from other lesions with a more favorable prognosis, such as congenital adenomatoid malformation of the lung. Much research is needed in the future to explore the therapeutic options, including fetoscopic intervention or transplantation of stem cell-derived airways.

PMID: 28586146 [PubMed - as supplied by publisher]

Obstructive sleep apnea is associated with increased readmission in heart failure patients.

Wed, 06/07/2017 - 12:45

Obstructive sleep apnea is associated with increased readmission in heart failure patients.

Clin Cardiol. 2017 Jun 06;:

Authors: Sommerfeld A, Althouse AD, Prince J, Atwood CW, Mulukutla SR, Hickey GW

Abstract
BACKGROUND: Heart failure (HF) readmission rates have become an increasingly important quality metric since the advent of the Hospital Readmissions Reduction Program. Despite many well-intentioned efforts to reduce readmissions, clinicians continue to struggle with the problem of high HF readmission rates.
HYPOTHESIS: HF patients with obstructive sleep apnea (OSA) will have higher burden of rehospitalization and mortality than HF patients without OSA.
METHODS: Our study included 344 patient encounters (among 271 unique patients) with a diagnosis of HF from September 2014 through September 2015. Our primary endpoints were all-cause readmission within 30 and 90 days. Multivariate logistic regression was used to assess the relationship between OSA and readmission when accounting for potential confounders.
RESULTS: The patients' were 72 ± 10 years old, and predominantly white (76.2%) and male (99.4%). Among the 344 patient encounters, 247 (71.8%) had diagnosed coronary artery disease, 159 (46.2%) had atrial fibrillation, and 99 (28%) had obstructive sleep apnea (OSA). Notably, patients with OSA had an elevated rate of readmission within 30 days (OSA: 30.3% vs no OSA: 19.6%, P = 0.037) and within 90 days (OSA: 57.6% vs no OSA: 36.3P < 0.01). Patients with OSA had increased risk of readmission within 90 days (odds ratio: 2.38, 95% confidence interval: 1.47-3.83, P < 0.01) even after adjustment for potential confounders of age, race, obesity, diabetes, and chronic obstructive pulmonary disease.
CONCLUSIONS: HF patients with OSA have an elevated rate of readmission compared to the general HF population, particularly within the first 90 days after discharge.

PMID: 28586100 [PubMed - as supplied by publisher]

Hemodynamic Changes Are Predictive of Coagulopathic Hemorrhage After Living Donor Liver Transplant.

Wed, 06/07/2017 - 12:45

Hemodynamic Changes Are Predictive of Coagulopathic Hemorrhage After Living Donor Liver Transplant.

Exp Clin Transplant. 2017 Jun 05;:

Authors: Hsieh CE, Chou CT, Lin CC, Lin KH, Lin PY, Lin HC, Ko CJ, Chang YY, Wang SH, Chen YL

Abstract
OBJECTIVES: Our goal was to evaluate the predictors of coagulopathic hemorrhage after living-donor liver transplant.
MATERIALS AND METHODS: We retrospectively evaluated 161 patients who had undergone living-donor liver transplant from July 2005 to April 2014 at a single medical institution. Of these patients, 32 developed hemorrhage after transplant. Patients were separated into those with coagulopathy-related hemorrhage (n=15) or noncoagulopathy-related hemorrhage (n=17) based on the results of computed tomography images. Predictors of hemorrhage after living-donor liver transplant evaluated in this study included preoperative, perioperative, and posttransplant factors and hemodynamic status.
RESULTS: Patients who developed coagulopathy-related hemorrhage had significantly lower pretransplant platelet counts (P = .040), a longer cold-ischemia time (P = .045), more blood loss (P = .040), and earlier onset of hemorrhage (P = .048) than patients who had noncoagulopathy-related hemorrhage after transplant. Results of the generalized estimating equation analysis showed that heart rate and central venous pressure differed significantly between the 2 groups of patients. Heart rates increased significantly during hemorrhage (P < .010). Central venous pressure was higher in the coagulopathic group (P = .005) than in the noncoagulopathic group.
CONCLUSIONS: Lower pretransplant platelet counts, longer cold ischemia time, more blood loss, earlier onset of hemorrhage, and higher central venous pressure level are indicators of coagulopathic hemorrhage after living-donor liver transplant.

PMID: 28585915 [PubMed - as supplied by publisher]

Diffuse Large B-Cell Lymphoma with Secondary Hemophagocytic Lymphohistiocytosis Presenting as Acute Liver Failure.

Wed, 06/07/2017 - 12:45

Diffuse Large B-Cell Lymphoma with Secondary Hemophagocytic Lymphohistiocytosis Presenting as Acute Liver Failure.

ACG Case Rep J. 2017;4:e68

Authors: Patel R, Patel H, Mulvoy W, Kapoor S

Abstract
Hemophagocytic lymphohistiocytosis (HLH) and newly diagnosed malignant infiltration of liver are rare presentations of acute liver failure associated with poor prognosis. We report a case of a patient with acute liver failure caused by malignant infiltration by diffuse large B-cell lymphoma and secondary HLH.

PMID: 28584842 [PubMed]

Comparison of 3 Times a Week 4- and 5-Hour In-Center Hemodialysis Sessions with Use of Continuous Non-Invasive Hemodynamic Monitoring.

Wed, 06/07/2017 - 12:45

Comparison of 3 Times a Week 4- and 5-Hour In-Center Hemodialysis Sessions with Use of Continuous Non-Invasive Hemodynamic Monitoring.

Ann Transplant. 2017 Jun 06;22:346-353

Authors: Czyżewski Ł, Wyzgał J, Sierdziński J, Czyżewska E, Smereka J, Szarpak Ł

Abstract
BACKGROUND Very aggressive ultrafiltration rate (lasting 3.5-4 h) may result in inadequate hemodialysis (HD). Our aim was to characterize HD-induced cardiovascular adaptation and its links to fluid removal during 4- vs. 5-h HD sessions. MATERIAL AND METHODS The study involved 50 HD patients. A Cardioscreen device (Messtechnik, Ilmenau, Germany) was used to perform non-invasive hemodynamic measurements during mid-week HD sessions. Body fluids and nutritional status were assessed with a Body Composition Monitor (Fresenius Medical Care). Clinical and laboratory data were also analyzed. RESULTS It was shown that when comparing 3 times a week 4- vs. 5-h dialysis sessions, body mass index (BMI [kg/m²]), Kt/V, and ultrafiltration volume (UFV [mL]) were significantly lower in the 4-h dialysis group (23.1±3.5 vs. 27.1±4.7; 1.36±0.28 vs. 1.55±0.23; 1770±601 vs. 2831±836; P<0.05, respectively). Cardiac index (CI [L/min/m²]) and thoracic fluid content (TFC [1/kW]) were significantly reduced in 4-h dialysis sessions (3.1±0.6 to 2.7±0.7; 35.1±8.4 to 32.8±6.8; P<0.05, respectively). In patients treated with 5-h dialysis sessions, we found that heart rate (HR [bpm]) was significantly increased (69±10 to 74±15; P<0.05) and TFC was reduced (34.3±8.9 to 31.5±8.2; P<0.05). In patients treated with 4-h dialysis sessions, systemic vascular resistance index (SVRI [dyn·s·cm^-5/m²]) increased from 2369±799 before HD to 2592±735 after HD (P=0.342). CONCLUSIONS The obtained data indicate that in extended (5-h) HD sessions, hemodynamic compensation occurred with increased HR, while in short (4-h) HD sessions, compensation occurred with increased SVRI. Providing longer but less intensive HD is more physiologic than the conventional therapy, and will improve patient tolerability and clinical outcomes.

PMID: 28584226 [PubMed - in process]

Stem cell therapy with skeletal myoblasts accelerates neointima formation in a mouse model of vein graft disease.

Wed, 06/07/2017 - 12:45

Stem cell therapy with skeletal myoblasts accelerates neointima formation in a mouse model of vein graft disease.

Exp Toxicol Pathol. 2017 Jun 02;:

Authors: Steger CM, Bonatti J, Rieker RJ, Bonaros N, Schachner T

Abstract
Although still a matter of controversial discussion, skeletal myoblasts are one of the options for stem cell transplantation improving cardiac function after myocardial infarction, exhibiting several advantages including the availability, the ability of self-renewal and differentiation, and the lack of ethical and immunological problems. The aim of this study was to investigate the impact of stem cell therapy with skeletal myoblasts on experimental venous bypass grafts in a mouse model of vein graft disease. Forty C57BL/6J mice underwent bypass grafting interposing a venous bypass graft of the donor mouse into the carotid artery of the recipient mouse. Twenty mice received periadventitially treatment with 1 million fluorescence labeled skeletal myoblasts suspended in culture medium (treatment group), the other twenty mice received only culture medium without myoblasts (control group). Two weeks after bypass surgery, the vein grafts of all 40 mice were harvested, stained and histologically investigated under light and immunofluorescence microscope. Against our expectations, skeletal myoblasts stayed in place and were still located in the adventitia after bypass grafting. Additionally, vein grafts of the myoblast group revealed a 2fold increased neoneointima formation, a decreased media thickness, a slightly increased neovascularization, a higher percentage of reendothelialization and also a slightly higher percentage of PDGFR ɑ, PDGFR ß, MMP-7 and MMP-9 positive cells, suggesting a paracrine mechanism responsible for accelerated neointima formation. In conclusion, the results of our study do not support the use of skeletal myoblast for the treatment of vein graft disease after coronary artery bypass surgery.

PMID: 28583699 [PubMed - as supplied by publisher]

Pretransplant Resting Heart Rate and Its Association With All-Cause Mortality in Liver Transplant Recipients.

Wed, 06/07/2017 - 12:45

Pretransplant Resting Heart Rate and Its Association With All-Cause Mortality in Liver Transplant Recipients.

Transplant Proc. 2017 Jun;49(5):1092-1096

Authors: Kwon HM, Jun IG, Jung KW, Moon YJ, Shin WJ, Song JG, Hwang GS

Abstract
BACKGROUND: The importance of heart rate (HR) measurement as a prognostic factor has been recognized in many clinical conditions, such as hypertension, coronary artery disease, or heart failure. Patients with liver cirrhosis tend to have increased resting HR as consequence of hyperdynamic circulation. In the current study, we examined whether pretransplant resting increased HR is associated with overall mortality in cirrhotic patients following liver transplantation (LT).
PATIENTS AND METHODS: We retrospectively collected and analyzed the data of 881 liver recipients who underwent LT surgery between October 2009 and September 2012. Patients were categorized into 3 groups by tertile of resting HR as follows: tertile 1 group, HR ≤ 65 beats per minute (bpm); tertile 2 group, HR 66 to 80 bpm; and tertile 3 group, HR > 80 bpm.
RESULTS: Kaplan-Meier analysis showed that the all-cause mortality rate was significantly different according to tertiles of HR (P = .016, log-rank test). The multivariate Cox regression analysis showed that tertile 3 group was significantly associated with higher risk for all-cause mortality (hazard ratio 1.83, 95% confidence interval, 1.10-3.07; P = .021) compared with tertile 1 group, after adjusting for clinically significant variables in univariate analysis.
CONCLUSIONS: Our results demonstrate that pretransplant resting tachycardia can identify patients at high risk of death in cirrhotic patients following LT, suggesting that further study will be need to clarify relationship between HR burden and sympathetic cardiac neuropathy.

PMID: 28583534 [PubMed - in process]

Prediction of Fluid Responsiveness by a Non-invasive Respiratory Systolic Time Interval Variation Using Heart Sound Signals in Recipients Undergoing Liver Transplantation.

Wed, 06/07/2017 - 12:45

Prediction of Fluid Responsiveness by a Non-invasive Respiratory Systolic Time Interval Variation Using Heart Sound Signals in Recipients Undergoing Liver Transplantation.

Transplant Proc. 2017 Jun;49(5):1082-1086

Authors: Kim SH, Moon YJ, Kim JW, Song JG, Hwang GS

Abstract
BACKGROUND: The fluid management of cirrhotic patients undergoing liver transplantation (LT) is challenging. Phonocardiography, a graphic recording of heart sounds, provides valuable information concerning heart function and hemodynamic condition. We assessed whether the systolic time interval (STI) and its respiratory variation could predict fluid responsiveness in cirrhotic patients undergoing LT.
METHODS: Thirty LT recipients who needed volume expansion were included. The fluid challenge consisted of 500 mL 5% albumin administered over a period of 10 minutes. STI was measured as the time interval between the maximal amplitude of each heart sound corrected with the corresponding RR interval (cSTI). The respiratory variation in STI (STV) induced by mechanical ventilation was calculated. Responders were defined as those showing a ≥10% increase in stroke volume index after volume expansion.
RESULTS: In all, 14 of the 30 patients were responders. Significant increases in cSTI were observed after volume expansion in both responders (P < .001) and non-responders (P = .008). Responders showed significant decreases in STV (11.1% ± 4.3% vs 6.1% ± 2.6%, P < .001) after fluid loading, whereas STV in non-responders remained unchanged (6.4% ± 2.6% vs 6.4% ± 4.2%, P = .86). A cut-off value of ≥7.5% STV from baseline could predict fluid responsiveness with an area under the receiver operating characteristic curve of 0.804 (95% confidence interval, 0.618-0.925).
CONCLUSIONS: Intra-operative STV can predict fluid responsiveness in patients undergoing LT. Beat-to-beat monitoring of STI and STV may be useful as a non-invasive hemodynamic index and for fluid management.

PMID: 28583532 [PubMed - in process]

Dose-dependent association between amiodarone and severe primary graft dysfunction in orthotopic heart transplantation.

Wed, 06/07/2017 - 12:45

Dose-dependent association between amiodarone and severe primary graft dysfunction in orthotopic heart transplantation.

J Heart Lung Transplant. 2017 May 20;:

Authors: Wright M, Takeda K, Mauro C, Jennings D, Kurlansky P, Han J, Truby L, Stein S, Topkara V, Garan AR, Yuzefpolskaya M, Colombo P, Naka Y, Farr M, Takayama H

Abstract
BACKGROUND: There is growing concern regarding the association between pre-transplant amiodarone exposure and post-transplant adverse outcomes. We hypothesized that amiodarone use would be associated with the development of severe primary graft dysfunction (PGD) in a dose-dependent manner.
METHODS: This was a retrospective review of 269 adult orthotopic heart transplantation (OHT) recipients at our institution between 2010 and 2014. At the time of OHT, 100 were receiving amiodarone therapy (Group 1) and 169 were not (Group 2).
RESULTS: Pre-OHT creatinine was higher in Group 1 (1.49 ± 0.63 vs 1.27 ± 0.68 mg/dl, p = 0.011). At time of listing, Group 1 had higher frequency of status 2 (42.0% vs 29.0%), and Group 2 had higher frequency of status 1A (20.7% vs 8.0%; p = 0.009). Severe PGD (mechanical circulatory support within 24 hours post-OHT) was significantly higher in Group 1 (20.0% vs 5.3%, p < 0.001). Pre-OHT amiodarone use was an independent risk factor for severe PGD (odds ratio [OR], 6.05; 95% confidence interval [CI], 2.47-14.83; p < 0.001) and in-hospital mortality (OR, 2.88; 95% CI, 1.05-7.88; p = 0.039) in multivariable analysis. Each 100-mg increase in the day-of-OHT amiodarone dose (OR, 1.55; 95% CI, 1.26-1.90) and each 18,300-mg increase in the 6-month cumulative dose (OR, 1.67; 95% CI, 1.31-2.15) was associated with increased odds of developing severe PGD (p < 0.001 for both).
CONCLUSIONS: Amiodarone use pre-OHT is independently associated with increased incidence of severe PGD and in-hospital mortality and linearly associated with increased incidence of severe PGD in a dose-dependent manner.

PMID: 28583372 [PubMed - as supplied by publisher]

Bacterial infections after pediatric heart transplantation: Epidemiology, risk factors and outcomes.

Wed, 06/07/2017 - 12:45

Bacterial infections after pediatric heart transplantation: Epidemiology, risk factors and outcomes.

J Heart Lung Transplant. 2017 May 11;:

Authors: Rostad CA, Wehrheim K, Kirklin JK, Naftel D, Pruitt E, Hoffman TM, L'Ecuyer T, Berkowitz K, Mahle WT, Scheel JN

Abstract
BACKGROUND: Bacterial infections represent a major cause of morbidity and mortality in heart transplant recipients. However, data describing the epidemiology and outcomes of these infections in children are limited.
METHODS: We analyzed the Pediatric Heart Transplant Study database of patients transplanted between 1993 and 2014 to determine the etiologies, risk factors and outcomes of children with bacterial infections post-heart transplantation.
RESULTS: Of 4,458 primary transplants in the database, there were 4,815 infections that required hospitalization or intravenous therapy, 2,047 (42.51%) of which were bacterial. The risk of bacterial infection was highest in the first month post-transplant, and the bloodstream was the most common site (24.82%). In the early post-transplant period (<30 days post-transplant), coagulase-negative staphylococci were the most common pathogens (16.97%), followed by Enterobacter sp (11.99%) and Pseudomonas sp (11.62%). In the late post-transplant period, community-acquired pathogens Streptococcus pneumoniae (6.27%) and Haemophilus influenzae (2.82%) were also commonly identified. Patients' characteristics independently associated with acquisition of bacterial infection included younger age (p < 0.0001) and ventilator (p < 0.0001) or extracorporeal membrane oxygenation (p = 0.03) use at time of transplant. Overall mortality post-bacterial infection was 33.78%, and previous cardiac surgery (p < 0.001) and multiple sites of infection (p = 0.004) were independent predictors of death.
CONCLUSIONS: Bacteria were the most common causes of severe infections in pediatric heart transplant recipients and were associated with high mortality rates. The risk of acquiring a bacterial infection was highest in the first month post-transplant, and a large proportion of the infections were caused by multidrug-resistant pathogens.

PMID: 28583371 [PubMed - as supplied by publisher]

The adjustable slipknot technique for implanting neochordae in the repair of mitral valve prolapse.

Wed, 06/07/2017 - 12:45
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The adjustable slipknot technique for implanting neochordae in the repair of mitral valve prolapse.

Multimed Man Cardiothorac Surg. 2016 Dec 06;2017:

Authors: Yano M, Matsuyama M, Nishimura M, Kawagoe K

Abstract
The adjustable slipknot technique is a novel procedure for implanting neochordae. The neochorda acts like a lasso. The procedure facilitates accurate assessment of the length of the neochordae. We performed repairs for 30 of 31 (97.7%) patients using this technique. Less than mild residual regurgitation was observed in all patients at hospital discharge.

PMID: 28106962 [PubMed - indexed for MEDLINE]

Therapeutic effect of mesenchymal stem cells on experimentally induced hypertensive cardiomyopathy in adult albino rats.

Wed, 06/07/2017 - 12:45
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Therapeutic effect of mesenchymal stem cells on experimentally induced hypertensive cardiomyopathy in adult albino rats.

Ultrastruct Pathol. 2017 Jan-Feb;41(1):36-50

Authors: Khater NA, Selim SA, Abd El-Baset SA, Abd El Hameed SH

Abstract
Hypertensive heart diseases affect millions of people worldwide. We aimed to investigate the hypertensive left ventricular histological changes and assess the effectiveness of bone marrow derived mesenchymal stem cells (MSCs) therapy in the treatment of hypertensive cardiomyopathy. Adult male albino rats were assigned into two groups: group I (control), group II (Experimental) subdivided into subgroup IIa (hypertensive) and subgroup IIb (stem cell therapy). Left ventricles (LVs) were processed for light and electron microscope. Mallory's trichrome and immunostaining for caspase-3 and desmin were carried out. Hypertension caused left ventricular histological and immunohistochemical changes that had been effectively improved by MSCs therapy.

PMID: 28029272 [PubMed - indexed for MEDLINE]

Dystrophin-Deficient Cardiomyopathy.

Wed, 06/07/2017 - 12:45
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Dystrophin-Deficient Cardiomyopathy.

J Am Coll Cardiol. 2016 May 31;67(21):2533-46

Authors: Kamdar F, Garry DJ

Abstract
Dystrophinopathies are a group of distinct neuromuscular diseases that result from mutations in the structural cytoskeletal Dystrophin gene. Dystrophinopathies include Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD), X-linked dilated cardiomyopathy, as well as DMD and BMD female carriers. The primary presenting symptom in most dystrophinopathies is skeletal muscle weakness. However, cardiac muscle is also a subtype of striated muscle and is similarly affected in many of the muscular dystrophies. Cardiomyopathies associated with dystrophinopathies are an increasingly recognized manifestation of these neuromuscular disorders and contribute significantly to their morbidity and mortality. Recent studies suggest that these patient populations would benefit from cardiovascular therapies, annual cardiovascular imaging studies, and close follow-up with cardiovascular specialists. Moreover, patients with DMD and BMD who develop end-stage heart failure may benefit from the use of advanced therapies. This review focuses on the pathophysiology, cardiac involvement, and treatment of cardiomyopathy in the dystrophic patient.

PMID: 27230049 [PubMed - indexed for MEDLINE]

Inflammation as a Driver of Adverse Left Ventricular Remodeling After Acute Myocardial Infarction.

Wed, 06/07/2017 - 12:45
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Inflammation as a Driver of Adverse Left Ventricular Remodeling After Acute Myocardial Infarction.

J Am Coll Cardiol. 2016 May 03;67(17):2050-60

Authors: Westman PC, Lipinski MJ, Luger D, Waksman R, Bonow RO, Wu E, Epstein SE

Abstract
Treatment of acute myocardial infarction (AMI) has improved significantly in recent years, but many patients have adverse left ventricular (LV) remodeling, a maladaptive change associated with progressive heart failure. Although this change is usually associated with large infarcts, some patients with relatively small infarcts have adverse remodeling, whereas other patients with larger infarcts (who survive the first several days after AMI) do not. This paper reviews the relevant data supporting the hypothesis that individual differences in the intensity of the post-AMI inflammatory response, involving 1 or more inflammatory-modulating pathways, may contribute to adverse LV remodeling. It concludes by outlining how individual variations in the inflammatory response could provide important novel therapeutic targets and strategies.

PMID: 27126533 [PubMed - indexed for MEDLINE]

Long-term adaptation to hypoxia preserves hematopoietic stem cell function.

Wed, 06/07/2017 - 12:45
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Long-term adaptation to hypoxia preserves hematopoietic stem cell function.

Exp Hematol. 2016 Sep;44(9):866-873.e4

Authors: Chen J, Kang JG, Keyvanfar K, Young NS, Hwang PM

Abstract
Molecular oxygen sustains aerobic life, but it also serves as the substrate for oxidative stress, which has been associated with the pathogenesis of disease and with aging. Compared with mice housed in normoxia (21% O2), reducing ambient oxygen to 10% O2 (hypoxia) resulted in increased hematopoietic stem cell (HSC) function as measured by bone marrow (BM) cell engraftment onto lethally irradiated recipients. The number of BM c-Kit(+)Sca-1(+)Lin(-) (KSL) cells as well as the number of cells with other hematopoietic stem and progenitor cell markers were increased in hypoxia mice, whereas the BM cells' colony-forming capacity remained unchanged. KSL cells from hypoxia mice showed a decreased level of oxidative stress and increased expression of transcription factor Gata1 and cytokine receptor c-Mpl, consistent with the observations of increased erythropoiesis and enhanced HSC engraftment. These observations demonstrate the benefit of a hypoxic HSC niche and suggest that hypoxic conditions can be further optimized to preserve stem cell integrity in vivo.

PMID: 27118043 [PubMed - indexed for MEDLINE]

Circulating fibroblast activation protein activity and antigen levels correlate strongly when measured in liver disease and coronary heart disease.

Tue, 06/06/2017 - 18:45

Circulating fibroblast activation protein activity and antigen levels correlate strongly when measured in liver disease and coronary heart disease.

PLoS One. 2017;12(6):e0178987

Authors: Uitte de Willige S, Keane FM, Bowen DG, Malfliet JJMC, Zhang HE, Maneck B, McCaughan GW, Leebeek FWG, Rijken DC, Gorrell MD

Abstract
BACKGROUND AND AIM: Circulating fibroblast activation protein (cFAP) is a constitutively active enzyme expressed by activated fibroblasts that has both dipeptidyl peptidase and endopeptidase activities. We aimed to assess the correlation between cFAP activity and antigen levels and to compare variations in levels.
METHODS: In plasma of 465 control individuals, 368 patients with coronary heart disease (CHD) and 102 hepatitis C virus (HCV) infected patients with severe liver disease before and after liver transplant, cFAP activity levels were measured with a newly developed cFAP activity assay. In the same samples, cFAP antigen levels were measured using a commercially available cFAP ELISA. Correlation analyses between activity and antigen levels were performed by calculating Pearson's correlation coefficient (ρ). Additionally, normal ranges, determinants and differences between cohorts and between anticoagulants were investigated.
RESULTS: cFAP activity and antigen levels significantly correlated in controls (ρ: 0.660, p<0.001) and in CHD patients (ρ: 0.709, p<0.001). cFAP activity and antigen levels in the HCV cohort were significantly lower in the samples taken after liver transplantation (p<0.001) and normalized toward levels of healthy individuals. Furthermore, cFAP activity and antigen levels were higher in men and significantly associated with body mass index. Also, cFAP activity and antigen levels were higher in EDTA plasma as compared to the levels in citrated plasma from the same healthy individuals.
CONCLUSIONS: For analyzing cFAP levels, either activity levels or antigen levels can be measured to investigate differences between individuals. However, it is of importance that blood samples are collected in the same anticoagulant.

PMID: 28582421 [PubMed - in process]

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