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To bridge or not to bridge?

Fri, 08/10/2012 - 19:07
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To bridge or not to bridge?

Transplant Proc. 2012 Jul;44(6):1722-5

Authors: Engin Y, Engin C, Yagdi T, Nalbantgil S, Erkul S, Ertugay S, Ozbaran M

Abstract
OBJECTIVE: Ventricular assist devices (VAD) are an important therapy that saves the lives of candidates a waiting heart transplantation (HTx). However, there are questions about posttransplantation effects of VADs.
METHODS: Seventy-four patients with end-stage heart failure who underwent HTx in our clinic between February 2007 and July 2011 were divided into two groups; a bridge cohort (n = 28) and a nonbridge group comprising 46 who underwent HTx without mechanical circulatory support. There mean ages were 39.89 ± 15.66 and 38.33 ± 16.23 years respectively. Significantly more patients in the bridge group, were man displayed anemia, were treated with anticoagulation therapy, and underwent a resternotomy. In the nonbridge group, more patients needed preoperative inotropic support.
RESULTS: Multiple logistic regression analysis revealed preoperative renal failure (P = .007, odds ratio [OR] 27) and inotropic support (P = .006, OR: 10,222) as well as longer cardiopulmonary bypasses (≥130 minutes, P = .001, OR: 11,24) to be risk factors for in-hospital mortality, which was 15.2% in nonbridge and 10.7% in bridge subjects, P = .733). Major adverse events, such as renal failure, pulmonary failure, right ventricular failure, neurological event, and reoperation due to bleeding, shown similar incidences between the groups. The amount of blood transfusion was significantly higher in the bridge group (2.34 U versus 3.56 U, P = .037). The preoperative incidence of human leukocyte antigen sensitization (panel reactive antibody ≥ 10%) and grade 2R were rejection episodes in the early period were similar.
CONCLUSION: Early posttransplant results were not adversely or beneficially influenced by the use of VADs. Similar to other types of cardiac surgery, a patients preoperative condition seemed to be the major factor affecting mortality.

PMID: 22841254 [PubMed - in process]

Human Cardiac Progenitor Cells Engineered With Pim-I Kinase Enhance Myocardial Repair.

Fri, 08/10/2012 - 19:07
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Human Cardiac Progenitor Cells Engineered With Pim-I Kinase Enhance Myocardial Repair.

J Am Coll Cardiol. 2012 Jul 23;

Authors: Mohsin S, Khan M, Toko H, Bailey B, Cottage CT, Wallach K, Nag D, Lee A, Siddiqi S, Lan F, Fischer KM, Gude N, Quijada P, Avitabile D, Truffa S, Collins B, Dembitsky W, Wu JC, Sussman MA

Abstract
OBJECTIVES: The study goal was to demonstrate the enhancement of human cardiac progenitor cell (hCPC) reparative and regenerative potential by genetic modification for the treatment of myocardial infarction. BACKGROUND: Regenerative potential of stem cells to repair acute infarction is limited. Improved hCPC survival, proliferation, and differentiation into functional myocardium will increase efficacy and advance translational implementation of cardiac regeneration. METHODS: hCPCs isolated from the myocardium of heart failure patients undergoing left ventricular assist device implantation were engineered to express green fluorescent protein (hCPCe) or Pim-1-GFP (hCPCeP). Functional tests of hCPC regenerative potential were performed with immunocompromised mice by using intramyocardial adoptive transfer injection after infarction. Myocardial structure and function were monitored by echocardiographic and hemodynamic assessment for 20 weeks after delivery. hCPCe and hCPCeP expressing luciferase were observed by using bioluminescence imaging to noninvasively track persistence. RESULTS: hCPCeP exhibited augmentation of reparative potential relative to hCPCe control cells, as shown by significantly increased proliferation coupled with amelioration of infarction injury and increased hemodynamic performance at 20 weeks post-transplantation. Concurrent with enhanced cardiac structure and function, hCPCeP demonstrated increased cellular engraftment and differentiation with improved vasculature and reduced infarct size. Enhanced persistence of hCPCeP versus hCPCe was revealed by bioluminescence imaging at up to 8 weeks post-delivery. CONCLUSIONS: Genetic engineering of hCPCs with Pim-1 enhanced repair of damaged myocardium. Ex vivo gene delivery to modify stem cells has emerged as a viable option addressing current limitations in the field. This study demonstrates that efficacy of hCPCs from the failing myocardium can be safely and significantly enhanced through expression of Pim-1 kinase, setting the stage for use of engineered cells in pre-clinical settings.

PMID: 22841153 [PubMed - as supplied by publisher]

Cardiorenal Syndrome Type 1: Pathophysiological Crosstalk Leading to Combined Heart and Kidney Dysfunction in the Setting of Acutely Decompensated Heart Failure.

Fri, 08/10/2012 - 19:07
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Cardiorenal Syndrome Type 1: Pathophysiological Crosstalk Leading to Combined Heart and Kidney Dysfunction in the Setting of Acutely Decompensated Heart Failure.

J Am Coll Cardiol. 2012 Jul 17;

Authors: Ronco C, Cicoira M, McCullough PA

Abstract
Cardiorenal syndrome (CRS) type 1 is characterized as the development of acute kidney injury (AKI) and dysfunction in the patient with acute cardiac illness, most commonly acute decompensated heart failure (ADHF). There is evidence in the literature supporting multiple pathophysiological mechanisms operating simultaneously and sequentially to result in the clinical syndrome characterized by a rise in serum creatinine, oliguria, diuretic resistance, and in many cases, worsening of ADHF symptoms. The milieu of chronic kidney disease has associated factors including obesity, cachexia, hypertension, diabetes, proteinuria, uremic solute retention, anemia, and repeated subclinical AKI events all work to escalate individual risk of CRS in the setting of ADHF. All of these conditions have been linked to cardiac and renal fibrosis. In the hospitalized patient, hemodynamic changes leading to venous renal congestion, neurohormonal activation, hypothalamic-pituitary stress reaction, inflammation and immune cell signaling, systemic endotoxemic exposure from the gut, superimposed infection, and iatrogenesis all contribute to CRS type 1. The final common pathway of bidirectional organ injury appears to be cellular, tissue, and systemic oxidative stress that exacerbate organ function. This review explores in detail the pathophysiological pathways that put a patient at risk and then effectuate the vicious cycle now recognized as CRS type 1.

PMID: 22840531 [PubMed - as supplied by publisher]

[Vitamin D in the treatment of cardiorenal syndrome in patients with chronic nephropathy].

Fri, 08/10/2012 - 19:07
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[Vitamin D in the treatment of cardiorenal syndrome in patients with chronic nephropathy].

Kardiologiia. 2012;52(3):33-44

Authors:

Abstract
AIM: To determine place of vitamin D in prevention and treatment of cardiorenal syndrome (CRS) and chronic allograft nephropathy (CAN) in the aspect of myocardial and renal reparation.
METHODS AND MATERIAL: In Russia and the Netherlands we included in a randomized placebo controlled study 120 vitamin D deficient [25(OH) vitamin D<40 mol/l] recipients of asystolic and cadaveric donors. Patients were divided in 4 groups: paricalcitol (2-4 g/day) group (n=28), calcitriol (1-6 g/day orally) group (n=28), diet (1200-1800 IU/day of vitamin D with multivitamins and from foodstuffs) group (n=26), placebo with diet control group (n=27).
RESULTS: After 180 days degree of CAN according to the Banff classification was 1.24 and 1.22 in paricalcitol and calcitriol groups, respectively, compared with 1.43 and 1.68 in diet and placebo groups, respectively (p<0.05). Glomerular filtration rate (GFR) changed from 46.7 to 84.4, 81.4, 76.8, and 54.5 ml/min/1.73 m3 in paricalcitol, calcitriol, diet and placebo groups, respectively. Fluorescence activated cell scanning (FACS) analysis allowed to detect quantitative induction of SP+ cells amounting 7.4, 2.9 and 1.2%; 7.2, 2.7; and 1.1%; 6.1, 2.9 and 1.2%; 9.3, 1.3 and 0.7% of peripheral blood progenitors, renal epithelial cells, and cardiomyocytes in paricalcitol, calcitriol, diet and placebo groups, respectively. Levels of CD133, CD34, CD73, and CD105 were significantly elevated in patients of paricalcitol (median 161, range 0-834 copies), calcitriol (163, 0-721), and diet (119, 0-401) groups, compared with the placebo group (0,0-41), p<0.01. Level of nuclear vitamin D receptor (VDR) protein in renal tissue homogenizate and myocardium achieved 584, 599, 478, and 333 mole VRD/mg and 801, 715, 654, and 389 Φmole VRD/mg of protein in paricalcitol, calcitriol, diet and placebo groups, respectively (p<0.01). Circulating progenitor stem cells demonstrated comparatively high level of VDR expression--529, 526, 401, and 211 mole VRD/mg in CD133, CD34 cells; 432, 414, 303, and 290 mole VRD/mg in CD73, CD105 cells; 549, 558, 442, and 302 φmole VRD/mg in SP+ cells in paricalcitol, calcitriol, diet and placebo groups, respectively (p<0.05). Hypercalcemia was detected in 4(14%) patients in calcitriol group (p<0.001). Under influence of antihypertensive therapy arterial pressure decreased after transplantation from 180/101 to 143/87, 141/94, 147,102, and 165/101 mm Hg in paricalcitol, calcitriol, diet and placebo groups, respectively (p<0.01). NYHA heart failure functional class changed from 2.3 to 1.8, 1.9, 1.9, and 2.5 in paricalcitol, calcitriol, diet and placebo groups, respectively (p<0.01). In 6 months after transplantation average CCS scores were 533 (0-998), 611 (0-1712), 524 (122-1278) and 990 (120-1800) cells in paricalcitol, calcitriol, diet and placebo groups, respectively (p<0.05).
CONCLUSIONS: Vitamin D is an effective mean of prevention and treatment of CRS and CAN, stimulator of reparation of renal and myocardial tissues. Optimal for wide clinical practice is the use of active vitamin D analog paricalcitol (2-4 g/day) as well as special diet with multivitamins (up to 1800 IU of cholecalciferol).

PMID: 22839442 [PubMed - in process]

[Radial diagnosis MRT and MSCT in assessing the outcomes of surgical correction for complicated congenital heart defects: discordant atrioventricular connections with double outlet right ventricle].

Fri, 08/10/2012 - 19:07
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[Radial diagnosis MRT and MSCT in assessing the outcomes of surgical correction for complicated congenital heart defects: discordant atrioventricular connections with double outlet right ventricle].

Angiol Sosud Khir. 2012;18(1):39-44

Authors:

Abstract
Discordant atrioventricular connection with double outlet right ventricle is a rare complicated congenital heart defect (CHD) requiring accurate diagnosis and appropriate correction. Magnetic resonance imaging (MRI) and multiple spiral computed tomography (MSCT) were used to assess long-term outcomes of the «classical» repair of the double outlet right ventricle in a patient presenting with discordant atrioventricular connection. Using a modified segmental approach provided all necessary anatomical evidence concerning the condition of the heart, major vessels, and an extracardiac pulmonary valve-containing conduit. MSCT made it possible to evaluate the degree of calcinosis and stenosis of the conduit and to visualize the coronary arteries. MRI was employed to assess the pressure gradient at the level of stenosis of the conduit, the relationship between the pulmonary and systemic circulation, transvalvular regurgitation, and ventricular contractility. Comprehensive use of present-day tomographic methods of imaging made it possible to obtain complete anatomical and functional information about the condition of the heart, vessels, extracardiac vascular transplant, as well as to reveal complications and determine the indications for a repeat operative intervention.

PMID: 22836326 [PubMed - in process]

17β-Estradiol protects the liver against cold ischemia/reperfusion injury through the Akt kinase pathway.

Fri, 08/10/2012 - 19:07
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17β-Estradiol protects the liver against cold ischemia/reperfusion injury through the Akt kinase pathway.

J Surg Res. 2012 Jul 21;

Authors: Yang X, Qin L, Liu J, Tian L, Qian H

Abstract
BACKGROUND: Hepatic ischemia-reperfusion (IR) injury occurs during liver resection and transplantation. Recent studies have shown that 17β-estradiol (E2) can protect the heart and liver against warm IR. The present study focused on the cytoprotective effects of E2 on cold IR injury to the liver. MATERIALS AND METHODS: Sprague-Dawley male rats were randomly divided into three groups: sham, IR, and IR plus E2. The model of rat orthotopic liver transplantation was used. The rats in the IR plus E2 group were intraperitoneally injected with E2 (100 μg/kg/d) for 7 d before surgery. The sham and IR group received the same quantity of saline. The donor livers were then orthotopically transplanted into rats after cold ischemia preservation for 4 h at 4°C lactated Ringer's solution. After 6 h reperfusion, liver function, bile flow volume, hepatocyte apoptosis, and activation of Akt, glycogen synthase kinase-3β, and Bcl-2-associated death promoter were assessed. The survival rate of the rats was also investigated. RESULTS: The administration of E2 significantly prolonged the survival of liver grafts by improving liver function and decreasing hepatocyte apoptosis. Rats undergoing E2 demonstrated a greater level activation of Akt in the liver compared with the IR group. In addition, E2 also inhibited the activities of glycogen synthase kinase-3β, Bcl-2-associated death promoter, and caspase-3-induced by IR injury. CONCLUSIONS: E2 pretreatment attenuated the hepatocellular damage caused by hepatic cold IR injury through the Akt pathway. Estrogen therapy might be important in clinical settings associated with cold IR injury during liver transplantation.

PMID: 22835949 [PubMed - as supplied by publisher]

Physical rehabilitation should be required for all pediatric heart transplant recipients.

Fri, 08/10/2012 - 19:07
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Physical rehabilitation should be required for all pediatric heart transplant recipients.

Pediatr Transplant. 2012 Jul 27;

Authors: Pahl E

PMID: 22835158 [PubMed - as supplied by publisher]

Prehospital Care of Left Ventricular Assist Device Patients by Emergency Medical Services.

Fri, 08/10/2012 - 19:07
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Prehospital Care of Left Ventricular Assist Device Patients by Emergency Medical Services.

Prehosp Emerg Care. 2012 Jul 26;

Authors: Schweiger M, Vierecke J, Stiegler P, Prenner G, Tscheliessnigg KH, Wasler A

Abstract
Abstract Left ventricular assist devices (LVADs) are frequently implanted as permanent (bridge to destination [BTD]) or temporary (bridge to transplantation [BTT]) cardiac support. When LVAD patients are discharged to home, they are very likely to require emergency medical services (EMS), but there is very little literature on out-of-hospital emergency care for patients with LVADs. We present two typical cases of LVAD patients for whom EMS was called. In the first case, the patient was in an ambulance two hours distant from our university hospital when a pulsatile system malfunctioned. In the second case, EMS was called to an unconscious LVAD patient. Emergency reference cards, training programs for emergency medical staff, and a 24-hour emergency hotline for the local VAD team are advisable. Key words: left ventricular assist device; emergency medical services; prehospital care.

PMID: 22834938 [PubMed - as supplied by publisher]

Progenitor/stem cell transplantation for repair of myocardial infarction: Hype or hope?

Fri, 08/10/2012 - 19:07
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Progenitor/stem cell transplantation for repair of myocardial infarction: Hype or hope?

Ann Palliat Med. 2012;1(1):65-77

Authors: Feng Y, Wang Y, Cao N, Yang H, Wang Y

Abstract
Despite significant therapeutic advances, heart failure remains the predominant cause of mortality worldwide. Currently, progenitor/stem cell biology holds great promise for a new era of cell-based therapy for salvaging the failing heart. However, the translational arm of progenitor/stem cell science is in a relatively primitive state. For the time being, the clinical trials have been both encouraging and disappointing. How to improve the engraftment, long-term survival and appropriate differentiation of transplanted progenitor/stem cell within the cardiovascular tissues may be the key issues to facilitate the transition of cardiogenic stem cell research from bench to bedside. In this review article we discuss the state-of-the-art in adult stem cell therapies for cardiovascular diseases and approaches to release cardiac regeneration potentials of progenitor/stem cells.

PMID: 22833840 [PubMed - as supplied by publisher]

Acute heart failure patient profiles, management and in-hospital outcome: results of the Italian Registry on Heart Failure Outcome.

Fri, 08/10/2012 - 19:07
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Acute heart failure patient profiles, management and in-hospital outcome: results of the Italian Registry on Heart Failure Outcome.

Eur J Heart Fail. 2012 Jul 25;

Authors: Oliva F, Mortara A, Cacciatore G, Chinaglia A, Di Lenarda A, Gorini M, Metra M, Senni M, Maggioni AP, Tavazzi L, on the behalf of the IN-HF Outcome Investigators

Abstract
AIMS: Registries and surveys improve knowledge of the 'real world'. This paper aims to describe baseline clinical profiles, management strategies, and the in-hospital outcome of patients admitted to hospital for an acute heart failure (AHF) episode. METHODS AND RESULTS: IN-HF Outcome is a nationwide, prospective, multicentre, observational study conducted in 61 Cardiology Centres in Italy. Up to December 2009, 5610 patients had been enrolled, 1855 (33%) with AHF and 3755 (67%) with chronic heart failure (CHF). Baseline and in-hospital outcome data of AHF patients are presented. Mean age was 72 ± 12 years, and 39.8% were female. Hospital admission was due to new-onset heart failure (HF) in 43% of cases. Co-morbid conditions were observed more frequently in the worsening HF group, while those with de novo HF showed a higher heart rate, blood pressure, and more preserved left ventricular ejection fraction (LVEF). Electrical devices were previously implanted in 13.3% of the entire group. Inotropes were administered in 19.4% of the patients. The median duration of hospital stay was 10 days (interquartile range 7-15). All-cause in-hospital death was 6.4%, similar in worsening and de novo HF. Older age, hypotension, cardiogenic shock, pulmonary oedema, symptoms of hypoperfusion, hyponatraemia, and elevated creatinine were independent predictors of all-cause death. CONCLUSION: Our registry confirms that in-hospital mortality in AHF is still high, with a long length of stay. Pharmacological treatment seems to be practically unchanged in the last decades, and the adherence to HF guidelines concerning implantable cardioverter defibrillators/cardiac resynchronization therapy is still very low. Some AHF phenotypes are characterized by worst prognosis and need specific research projects.

PMID: 22833614 [PubMed - as supplied by publisher]

The utilization of solid organs for transplantation in the setting of infection with multidrug-resistant organisms: an expert opinion.

Fri, 08/10/2012 - 19:07
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The utilization of solid organs for transplantation in the setting of infection with multidrug-resistant organisms: an expert opinion.

Clin Transplant. 2012 Jul 25;

Authors: Bishara J, Goldberg E, Lev S, Singer P, Ashkenazi T, Cohen J

Abstract
Organ transplantation remains the optimal treatment for many patients suffering from end-stage organ disease. Increasing numbers of patients admitted to intensive care units, among them potential heart-beating, brain-dead organ donors, are exposed to infections with multidrug-resistant organisms, in particular carbapenem-resistant Klebsiella pneumoniae (CR-KP). An extensive literature search failed to reveal any information regarding the eligibility for transplantation of organs from such donors. For this reason, in 2009, the Israel Transplant Center, together with the Israeli Society for Infectious Diseases, established a working group with the intention of developing a national-specific approach to the use of these organs. In this viewpoint article, we present an algorithm based on expert opinion and our clinical experience with a donor who was found to be an asymptomatic carrier of CR-KP.

PMID: 22831178 [PubMed - as supplied by publisher]

Invasive aspergillosis among heart transplant recipients is rare but causes rapid death due to septic shock and multiple organ dysfunction syndrome.

Fri, 08/10/2012 - 19:07
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Invasive aspergillosis among heart transplant recipients is rare but causes rapid death due to septic shock and multiple organ dysfunction syndrome.

Scand J Infect Dis. 2012 Jul 25;

Authors: Shields RK, Nguyen MH, Shullo MA, Silveira FP, Kwak EJ, Abdel Massih RC, Toyoda Y, Bermudez CA, Bhama JK, Kormos RL, Clancy CJ

Abstract
Between 2000 and 2011, proven or probable invasive aspergillosis (IA) was diagnosed in 1.7% (8/455) of heart transplant (HTx) recipients at our center, in the absence of antifungal prophylaxis. All patients had invasive pulmonary infections and 75% (6/8) were diagnosed during 2 separate 3-month periods. Cases were notable for their association with septic shock and multiple organ dysfunction syndrome (MODS) (75%, 6/8 each), non-specific clinical and radiographic findings, and rapid mortality despite mould-active antifungal therapy (88%, 7/8; occuring at a median 11 days after diagnosis). All patients had predisposing conditions known to be risk factors for IA. For patients with early IA (within 90 days of HTx), conditions included hemodialysis, thoracic re-operation, and the presence of another case in the institution within the preceding 3 months. For late-onset IA, conditions included hemodialysis and receipt of augmented immunosuppression. Clinicians should suspect IA in HTx recipients with risk factors who present with non-specific and unexplained respiratory syndromes, including those in septic shock and MODS, and institute prompt antifungal therapy without waiting for the results of cultures or other diagnostic tests.

PMID: 22830948 [PubMed - as supplied by publisher]

Measurement of multiple biomarkers in advanced stage heart failure patients treated with pulmonary artery catheter guided therapy.

Fri, 08/10/2012 - 19:07
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Measurement of multiple biomarkers in advanced stage heart failure patients treated with pulmonary artery catheter guided therapy.

Crit Care. 2012 Jul 25;16(4):R135

Authors: Zilinski JL, Shah RV, Gaggin HK, Gantzer ML, Wang TJ, Januzzi JL

Abstract
ABSTRACT: INTRODUCTION: To investigate prognostic utility of biomarkers in advanced stage heart failure (HF) patients requiring intensive care unit (ICU) admission for pulmonary artery catheter (PAC) guided therapy. METHODS: 30 patients admitted to an ICU for PAC guided HF therapy were enrolled; concentrations of soluble ST2 (sST2), highly sensitive troponin I, an experimental ultrasensitive troponin I, amino-terminal pro-B type natriuretic peptide, cystatin C, and myeloperoxidase were measured over the first 48 hours. Outcomes included response of filling pressures and hemodynamics to tailored therapy and 90-day event-free survival (death, left ventricular assist device implantation, transplant). RESULTS: Of the biomarkers evaluated, only sST2 concentrations were higher in those who failed to achieve goals for central venous pressure ([CVP], 225.3 vs 104.6 ng/mL; p=0.003) and pulmonary capillary wedge pressure ([PCWP], 181.7 vs 88.2 ng/mL; p=0.05). Only sST2 concentrations were associated with adverse events (186.7 vs 92.2 ng/mL; p=0.01). In age-adjusted Cox proportional hazards analysis, an elevated sST2 during the first 48 hours following ICU admission independently predicted 90-day outcomes (Hazard Ratio=5.53; p=0.03) superior to the Simplified Acute Physiology Score for this application; in Kaplan-Meier analysis the risk associated with elevated sST2 concentrations was present early and sustained through the duration of follow-up (log rank p=0.01). CONCLUSIONS: In patients undergoing HF therapy guided by invasive monitoring, sST2 concentrations were associated with impending failure to reduce filling pressures, and predicted impending events. Elevated sST2 values early in the ICU course theoretically could assist therapeutic decision-making in advanced stage HF patients. Trial registration: ClinicalTrials.gov Identifier: NCT00595738.

PMID: 22830581 [PubMed - as supplied by publisher]

The Mutations Associated with Dilated Cardiomyopathy.

Fri, 08/10/2012 - 19:07
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The Mutations Associated with Dilated Cardiomyopathy.

Biochem Res Int. 2012;2012:639250

Authors: Parvari R, Levitas A

Abstract
Cardiomyopathy is an important cause of heart failure and a major indication for heart transplantation in children and adults. This paper describes the state of the genetic knowledge of dilated cardiomyopathy (DCM). The identification of the causing mutation is important since presymptomatic interventions of DCM have proven value in preventing morbidity and mortality. Additionally, as in general in genetic studies, the identification of the mutated genes has a direct clinical impact for the families and population involved. Identifying causative mutations immediately amplifies the possibilities for disease prevention through carrier screening and prenatal testing. This often lifts a burden of social isolation from affected families, since healthy family members can be assured of having healthy children. Identification of the mutated genes holds the potential to lead to the understanding of disease etiology, pathophysiology, and therefore potential therapy. This paper presents the genetic variations, or disease-causing mutations, contributing to the pathogenesis of hereditary DCM, and tries to relate these to the functions of the mutated genes.

PMID: 22830024 [PubMed - as supplied by publisher]

Demographics, Trends, and Outcomes in Pediatric Acute Myocarditis in the United States, 2006 to 2011.

Fri, 08/10/2012 - 19:07
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Demographics, Trends, and Outcomes in Pediatric Acute Myocarditis in the United States, 2006 to 2011.

Circ Cardiovasc Qual Outcomes. 2012 Jul 24;

Authors: Ghelani SJ, Spaeder MC, Pastor W, Spurney CF, Klugman D

Abstract
BACKGROUND: =0.03) and an increase in the use of magnetic resonance imaging (P<0.01) over the study period. Although the use of medications and procedures varied between different regions, the occurrence of death or heart transplantation showed no significant regional associations. The use of extracorporeal membrane oxygenation (odds ratio, 5.8; 95% confidence interval, 2.9-11.4; P<0.01), ventricular assist device (odds ratio, 8.2; 95% confidence interval, 2.7-24.9; P<0.01), and vasoactive medications (odds ratio, 5.7; 95% confidence interval, 1.2-26.1; P=0.03) was independently associated with death/transplantation.Conclusions-There is significant temporal and regional variation in the diagnostic modalities and management used for pediatric myocarditis, which continues to have high morbidity and mortality. Extracorporeal membrane oxygenation, ventricular assist device, and vasoactive medications are independently associated with increased mortality/transplantation.

PMID: 22828827 [PubMed - as supplied by publisher]

Cardiovascular complications of chronic renal failure - an updated review.

Fri, 08/10/2012 - 19:07
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Cardiovascular complications of chronic renal failure - an updated review.

Mymensingh Med J. 2012 Jul;21(3):573-9

Authors: Roy GC, Sutradhar SR, Barua UK, Datta NC, Debnath CR, Hoque MM, Hossain AS, Haider MS, Das M

Abstract
Chronic kidney disease (CKD) is a worldwide public health problem. Cardiovascular disease (CVD) is frequently associated with CKD, which is important because individuals with CKD are more likely to die from CVD than to develop kidney failure. CVD in CKD is treatable and potentially preventable and CKD appears to be a risk factor for CVD. In order of incidence and frequency systemic hypertension, left ventricular failure, congestive cardiac failure, ischemic heart disease, anaemic heart failure, rhythm disturbances, pericarditis with or without effusion, cardiac tamponade, uraemic cardiomyopathy are various cardiovascular complications encountered in patients with chronic renal failure. A patient may present with one or more complications of cardiovascular system. The survival rate and prognosis to a great extent depends on proper management of these complications. Use of regular dialysis and renal transplant has changed the death pattern in developed countries but it is still a major problem in developing country. The aim of this article is early detection of CKD and proper management of it thereby preventing the major cardiovascular complications.

PMID: 22828566 [PubMed - in process]

Recent developments in the physiological assessment of sarcoidosis: clinical implications.

Fri, 08/10/2012 - 19:07
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Recent developments in the physiological assessment of sarcoidosis: clinical implications.

Curr Opin Pulm Med. 2012 Sep;18(5):499-505

Authors: Baydur A

Abstract
PURPOSE OF REVIEW: This review emphasizes key findings in physiologic research of sarcoidosis reported over the past year.
RECENT FINDINGS: Sarcoidosis, a multiorgan disease involving the formation of epithelioid-cell granulomas, is characterized by reduced lung volumes, compliance, and diffusion capacity (DLCO), and, in a small number of cases, by airflow limitation. Recent studies do not show a close relationship between changes in lung volume and radiographic stage. Fatigue and exercise limitation are characteristic of this condition, and can be assessed by health-related quality of life (HRQOL) instruments. Recent investigations have focused on the evaluation of the extent of parenchymal and nodal inflammatory activity by PET using 18F-fluorodeoxyglucose (FDG-PET imaging). Pulmonary hypertension in advanced cases of sarcoidosis contributes to increased physical impairment, and decreased HRQOL and survival. It is best associated with ambulatory desaturation, reduced DLCO, and abnormal cardiopulmonary exercise testing findings indicative of pulmonary vascular disease. If pulmonary hypertension is suspected, it should be screened for by echocardiography and confirmed by right heart catheterization. Selected patients with progressive disease unresponsive to medical therapy or with severe pulmonary hypertension should be considered for lung transplantation. Current criteria for lung transplantation include New York Heart Association functional class III-IV, pulmonary hypertension, and/or right atrial pressure at least 15 mmHg.
SUMMARY: Periodic assessment of HRQOL measures, exercise-induced hypoxemia, and right-sided cardiac pressures for pulmonary hypertension provides, to date, the best insight into the magnitude of physiologic impairment, serving as guideposts for management (including lung transplantation) and prognosis.

PMID: 22828212 [PubMed - in process]

Ventilatory support in critically ill haematological patients with respiratory failure.

Fri, 08/10/2012 - 19:07
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Ventilatory support in critically ill haematological patients with respiratory failure.

Crit Care. 2012 Jul 24;16(4):R133

Authors: Molina R, Bernal T, Borges M, Zaragoza R, Bonastre J, Granada RM, Rodriguez-Borregan JC, Nunez K, Seijas I, Ayestaran I, Albaiceta GM, Study Investigators E

Abstract
ABSTRACT: INTRODUCTION: Haematological patients admitted to the ICU frequently experience respiratory failure and require mechanical ventilation. Non-invasive mechanical ventilation (NIMV) may decrease the risk of intubation, but NIMV failure poses its own risks. METHODS: To establish the impact of ventilatory management and NIMV failure on outcome, data from a prospective, multicentre, observational study were analysed. All haematological patients admitted to one of the 34 participating ICUs in a 17-month period were followed. Data on demographics, diagnosis, severity, organ failure, and supportive therapies were recorded. A logistic regression analysis was done to evaluate the risk factors associated with death and NIVM failure. RESULTS: Of 450 patients, 300 required ventilatory support. A diagnosis of congestive heart failure and the initial use of NIMV significantly improved survival, whereas APACHE-II score, allogeneic transplantation, and NIMV failure increased the risk of death. The risk factors associated to NIMV success were age, congestive heart failure, and bacteraemia. Patients with NIMV failure experience a more severe respiratory impairment than those electively intubated. CONCLUSIONS: NIMV improves the outcome of haematological patients with respiratory insufficiency, but NIMV failure may have the opposite effect. A careful selection of patients with rapidly reversible causes of respiratory failure may increase NIMV success.

PMID: 22827955 [PubMed - as supplied by publisher]

Cardiac transplant coronary allograft vasculopathy in children: achilles' heel.

Fri, 08/10/2012 - 19:07
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Cardiac transplant coronary allograft vasculopathy in children: achilles' heel.

Congenit Heart Dis. 2012 Jul;7(4):301

Authors: Denfield SW

PMID: 22827570 [PubMed - in process]

Progenitor cell homing in the postischemic myocardium: just an unmotivated pitstop in the microcirculation ?

Fri, 08/10/2012 - 19:07
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Progenitor cell homing in the postischemic myocardium: just an unmotivated pitstop in the microcirculation ?

Microcirculation. 2012 Jul 25;

Authors: Tuche F, Menger MD, Körbel C, Nickels RM, Bouskela E, Schramm R

Abstract
OBJECTIVE: We developed a model for direct assessment of bone marrow-derived progenitor cell (BMC) sequestration in the postischemic murine myocardium after direct antegrade intracoronary injection. METHODS: Modified syngeneic heterotopic heart transplantation was used as a basic model for global myocardial ischemia/reperfusion (I/R) injury in a total of n=29 animals. Intravital fluorescence microscopy (IVM) was employed to analyze of the right ventricular subepicardial coronary microcirculation and for tracking fluorescently labeled BMCs. RESULTS: IVM allowed to monitor all segments of the coronary microcirculation including feeding arterioles, nutritive capillaries and postcapillary venules. Warm ischemia and generalized atherosclerosis induced profound reperfusion failure, particularly in nutritive myocardial capillaries. BMCs were found to exclusively sequester in myocardial capillaries, but not in coronary arterioles or postcapillary venules. The sequestration of BMCs in coronary capillaries occurred independent of warm ischemia, generalized atherosclerosis or adhesion molecule function. CONCLUSIONS: This is the first study allowing direct assessment of BMC homing to the postischemic myocardium. Heterotopic heart transplantation and intravital fluorescence microscopy are proper means to study the myocardial sequestration of BMCs after direct antegrade intracoronary injection in vivo. We show for the first time that intracoronarily injected BMCs sequester exclusively in nutritive myocardial capillaries. © 2012 John Wiley & Sons Ltd.

PMID: 22827532 [PubMed - as supplied by publisher]

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