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Biventricular support with HeartWare ventricular assist device in a pediatric patient.

Mon, 12/04/2017 - 22:47

Biventricular support with HeartWare ventricular assist device in a pediatric patient.

Pediatr Transplant. 2017 Dec 01;:

Authors: Deshpande SR, Carroll MM, Mao C, Mahle WT, Kanter K

Abstract
Use of ventricular assist devices is increasing in the pediatric population. This has included the extended use of adult continuous-flow devices in the pediatric population. In a minority of cases, biventricular support may be needed. In these situations, biventricular support with continuous-flow devices can be surgically challenging, and therefore, only few cases have been reported. Here, we present a case of implantation of two HeartWare HVAD devices for biventricular support for a decompensating patient with acute myocarditis as well as present an alternative implantation surgical strategy.

PMID: 29197135 [PubMed - as supplied by publisher]

Allogeneic Transplant for Mycosis Fungoides in Patient with Wiskott-Aldrich Syndrome.

Mon, 12/04/2017 - 22:47

Allogeneic Transplant for Mycosis Fungoides in Patient with Wiskott-Aldrich Syndrome.

J Clin Immunol. 2017 Dec 01;:

Authors: Criscuolo M, Fianchi L, Chiusolo P, Giammarco S, Bacigalupo A, Pagano L

PMID: 29196934 [PubMed - as supplied by publisher]

Fifty Years: Reflections Since the First Successful Heart Transplant.

Mon, 12/04/2017 - 22:47

Fifty Years: Reflections Since the First Successful Heart Transplant.

J Cardiothorac Vasc Anesth. 2017 Oct 20;:

Authors: Swanevelder JLC, Gordon PC, Brink JG, Gutsche JT, Dyer RA, Augoustides JG

PMID: 29196138 [PubMed - as supplied by publisher]

Twenty-Five Year Outcomes of the Lateral Tunnel Fontan Procedure.

Mon, 12/04/2017 - 22:47

Twenty-Five Year Outcomes of the Lateral Tunnel Fontan Procedure.

Semin Thorac Cardiovasc Surg. 2017 Autumn;29(3):347-353

Authors: Wilson TG, Shi WY, Iyengar AJ, Winlaw DS, Cordina RL, Wheaton GR, Bullock A, Gentles TL, Weintraub RG, Justo RN, Grigg LE, Radford DJ, d'Udekem Y, Australia and New Zealand Fontan Registry

Abstract
The objective of this study was to characterize late outcomes of the lateral tunnel (LT) Fontan procedure. The outcomes of all patients who underwent an LT Fontan procedure in Australia and in New Zealand were analyzed. Original files were reviewed and outcomes data were obtained through a binational registry. Between 1980 and 2014, a total of 301 patients underwent an LT Fontan procedure across 6 major centers. There were 13 hospital mortalities, 21 late deaths, 8 Fontan conversions and revisions, 8 Fontan takedowns, and 4 heart transplantations. Overall survival at 15 and 25 years was 90% (95% confidence interval [CI]: 86%-93%) and 80% (95% CI: 69%-91%), respectively. Protein-losing enteropathy or plastic bronchitis was observed in 14 patients (5%). Freedom from late failure at 15 and 25 years was 88% (95% CI: 84%-92%) and 82% (95% CI: 76%-87%), respectively. Independent predictors of late Fontan failure were prolonged pleural effusions post Fontan operations (hazard ratio [HR] 3.06, 1.05-8.95, P = 0.041), age >7 years at Fontan (vs 3-5 years, HR 9.7, 2.46-38.21, P = 0.001) and development of supraventricular tachycardia (HR 4.67, 2.07-10.58, P < 0.001). Freedom from tachy- or bradyarrhythmias at 10 and 20 years was 87% (95% CI: 83%-91%) and 72% (95% CI: 66%-79%), respectively. Thromboembolic events occurred in 45 patients (16%, 26 strokes), and freedom from symptomatic thromboembolism at 10 and 20 years was 93% (95% CI: 89%-96%) and 80% (95% CI: 74%-86%), respectively. Over a 25-year period, the LT technique has achieved excellent late survival. As this population ages, it is at an increasing risk of failure and adverse events. We are likely to see an increasing proportion requiring heart transplantation and late reintervention.

PMID: 29195575 [PubMed - in process]

Improving medication adherence: The proof of the pudding will be in the eating.

Sat, 12/02/2017 - 13:45

Improving medication adherence: The proof of the pudding will be in the eating.

Liver Transpl. 2017 Nov 30;:

Authors: Dobbels F, Vanhoof J, Schoemans H, Duerinckx N, Verbeeck I, De Geest S

PMID: 29194957 [PubMed - as supplied by publisher]

Cholinesterase levels predict exercise capacity in cardiac recipients early after transplantation.

Sat, 12/02/2017 - 13:45

Cholinesterase levels predict exercise capacity in cardiac recipients early after transplantation.

Clin Transplant. 2017 Dec 01;:

Authors: Kitagaki K, Nakanishi M, Ono R, Yamamoto K, Suzuki Y, Fukui N, Yanagi H, Konishi H, Yanase M, Fukushima N

Abstract
PURPOSE: Although cardiac rehabilitation is recommended for patients early after heart transplantation (HTx), adequate exercise effect cannot always be obtained, partly because in patients with chronic heart failure, exercise capacity is reduced due to malnutrition during waiting for HTx. This study aimed to investigate the relationships between exercise capacity and clinical variables, including nutritional indicators, early after HTx.
PATIENTS AND METHODS: Forty three HTx recipients were studied. The mean age at HTx was 38±14 years, and 86% were male. We assessed the relationships between peak oxygen uptake (VO2 ) and clinical variables, including plasma B-type natriuretic peptide (BNP), isometric knee extensor muscle strength (KEMS), and nutritional indicators within 1 week of their respective discharges.
RESULTS: Peak VO2 correlated positively with isometric KEMS (r=0.63, p <0.0001) and negatively with BNP level (r=-0.37, p=0.015). Of the nutritional indicators, only cholinesterase levels had a significant relationship with peak VO2 (r=0.34, p=0.028), whereas the Geriatric Nutritional Risk Index and the Controlling Nutritional Status scores did not. In multiple linear regression analysis, cholinesterase levels and isometric KEMS were independent predictors of peak VO2 .
CONCLUSION: Cholinesterase levels predicted exercise capacity early after HTx. This article is protected by copyright. All rights reserved.

PMID: 29194762 [PubMed - as supplied by publisher]

Paradoxic eczema in infants after heart transplantation.

Sat, 12/02/2017 - 13:45

Paradoxic eczema in infants after heart transplantation.

Pediatr Dermatol. 2017 Dec 01;:

Authors: Jackson Cullison SR, Siegfried EC

Abstract
New-onset psoriasis in patients receiving tumor necrosis factor inhibitors is well recognized in children and adults. We describe three children who underwent cardiac transplantation and developed an analogous form of paradoxic eczema occurring 2-48 months after starting systemic tacrolimus, a drug widely used topically to treat eczema. Anecdotal reports and our experience suggest that tacrolimus taper with alternative systemic antirejection immunosuppressant may lead to skin clearance. Pending additional insight, treatment should include optimizing skin barrier function, minimizing microbial and allergic triggers, and coordinating care to choose the best-tolerated systemic immunosuppressant regimen at the lowest effective dose.

PMID: 29194735 [PubMed - as supplied by publisher]

Technology Experience of Solid Organ Transplant Patients and Their Overall Willingness to Use Interactive Health Technology.

Sat, 12/02/2017 - 13:45

Technology Experience of Solid Organ Transplant Patients and Their Overall Willingness to Use Interactive Health Technology.

J Nurs Scholarsh. 2017 Nov 28;:

Authors: Vanhoof JMM, Vandenberghe B, Geerts D, Philippaerts P, De Mazière P, DeVito Dabbs A, De Geest S, Dobbels F, PICASSO-Tx Consortium

Abstract
BACKGROUND: The use of interactive health technology (IHT) is a promising pathway to tackle self-management problems experienced by many chronically ill patients, including solid organ transplant (Tx) patients. Yet, to ensure that the IHT is accepted and used, a human-centered design process is needed, actively involving end users in all steps of the development process. A first critical, predevelopment step involves understanding end users' characteristics. This study therefore aims to (a) select an IHT platform to deliver a self-management support intervention most closely related to Tx patients' current use of information and communication technologies (ICTs), (b) understand Tx patients' overall willingness to use IHT for self-management support, and investigate associations with relevant technology acceptance variables, and (c) explore Tx patients' views on potential IHT features.
DESIGN AND METHODS: We performed a cross-sectional, descriptive study between October and December 2013, enrolling a convenience sample of adult heart, lung, liver, and kidney Tx patients from the University Hospitals Leuven, Belgium. Broad inclusion criteria were applied to ensure a representative patient sample. We used a 35-item newly designed interview questionnaire to measure Tx patients' use of ICTs, their overall willingness to use IHT, and their views on potential IHT features, as well as relevant technology acceptance variables derived from the Unified Theory of Acceptance and Use of Technology and a literature review. Descriptive statistics were used as appropriate, and an ordinal logistic regression model was built to determine the association between Tx patients' overall willingness to use IHT, the selected technology acceptance variables, and patient characteristics.
FINDINGS: Out of 139 patients, 122 agreed to participate (32 heart, 30 lung, 30 liver, and 30 kidney Tx patients; participation rate: 88%). Most patients were male (57.4%), married or living together (68%), and had a mean age of 55.9 ± 13.4 years. Only 27.9% of Tx patients possessed a smartphone, yet 72.1% owned at least one desktop or laptop PC with wireless Internet at home. On a 10-point numeric scale, asking patients whether they think IHT development is important to support them personally in their self-management, patients gave a median score of 7 (25th percentile 5 points; 75th percentile 10 points). Patients who were single or married or living together were more likely to give a higher rating than divorced or widowed patients; patients who completed only secondary education gave a higher rating than higher educated patients; and patients with prior ICT use gave a higher rating than patients without prior ICT use. Tx patients also had clear preferences regarding IHT features, such as automatic data transfer, as much as possible, visual aids (e.g., graphs) over text messages, and personally deciding when to access the IHT.
CONCLUSIONS: By investigating Tx patients' possession and use of ICTs, we learned that computers and the Internet, and not smartphones, are the most suitable IHT platforms to deliver self-management interventions for our Tx patients. Moreover, Tx patients generally are open to using IHT, yet patient acceptance variables and their preferences for certain IHT features should be taken into account in the next steps of IHT development. Designers intending to develop or use existing IHTs should never overlook this critical first step in a human-centered design.
CLINICAL RELEVANCE: Before considering using eHealth technology in clinical practice, professionals should always check whether patients are familiar with using information and communication technology, and whether they are willing to use technology for health-related purposes.

PMID: 29193654 [PubMed - as supplied by publisher]

Sacubitril/valsartan reduces serum uric acid concentration, an independent predictor of adverse outcomes in PARADIGM-HF.

Sat, 12/02/2017 - 13:45

Sacubitril/valsartan reduces serum uric acid concentration, an independent predictor of adverse outcomes in PARADIGM-HF.

Eur J Heart Fail. 2017 Nov 30;:

Authors: Mogensen UM, Køber L, Jhund PS, Desai AS, Senni M, Kristensen SL, Dukát A, Chen CH, Ramires F, Lefkowitz MP, Prescott MF, Shi VC, Rouleau JL, Solomon SD, Swedberg K, Packer M, McMurray JJV, PARADIGM-HF Investigators and Committees

Abstract
AIMS: Elevated serum uric acid concentration (SUA) has been associated with an increased risk of cardiovascular disease, but this may be due to unmeasured confounders. We examined the association between SUA and outcomes as well as the effect of sacubitril/valsartan on SUA in patients with heart failure with reduced ejection fraction (HFrEF) in PARADIGM-HF.
METHODS AND RESULTS: The association between SUA and the primary composite outcome of cardiovascular death or heart failure (HF) hospitalization, its components, and all-cause mortality was examined using Cox regression analyses among 8213 patients using quintiles (Q1-Q5) of SUA adjusted for baseline prognostic variables including estimated glomerular filtration rate (eGFR), diuretic dose, and log N-terminal pro-brain natriuretic peptide. Change in SUA from baseline over 12 months was also evaluated in each treatment group. Patients in Q5 (SUA ≥8.6 mg/dL) compared with Q1 (<5.4 mg/dL) were younger (62.8 vs. 64.2 years), more often male (88.7% vs. 63.1%), had lower systolic blood pressure (119 vs. 123 mmHg), lower eGFR (57.4 vs. 76.6 mL/min/1.73 m2 ), and greater diuretic use. Higher SUA was associated with a higher risk of the primary outcome (adjusted hazard ratios) Q5 vs. Q1 = 1.28 [95% confidence intervals (1.09-1.50), P = 0.003], cardiovascular death [1.44 (1.11-1.77), P = 0.001], HF hospitalization [1.37 (1.11-1.70), P = 0.004], and all-cause mortality [1.36 (1.13-1.64), P = 0.001]. Compared with enalapril, sacubitril/valsartan reduced SUA by 0.24 (0.17-0.32) mg/dL over 12 months (P < 0.0001). Sacubitril/valsartan improved outcomes, irrespective of SUA concentration.
CONCLUSION: Serum uric acid concentration was an independent predictor of worse outcomes after multivariable adjustment in patients with HFrEF. Compared with enalapril, sacubitril/valsartan reduced SUA and improved outcomes irrespective of SUA.

PMID: 29193563 [PubMed - as supplied by publisher]

RePHILL: protocol for a randomised controlled trial of pre-hospital blood product resuscitation for trauma.

Sat, 12/02/2017 - 13:45

RePHILL: protocol for a randomised controlled trial of pre-hospital blood product resuscitation for trauma.

Transfus Med. 2017 Nov 28;:

Authors: Smith IM, Crombie N, Bishop JR, McLaughlin A, Naumann DN, Herbert M, Hancox JM, Slinn G, Ives N, Grant M, Perkins GD, Doughty H, Midwinter MJ, RePHILL Trial Collaborators

Abstract
OBJECTIVES: To describe the 'Resuscitation with Pre-HospItaL bLood products' trial (RePHILL) - a multi-centre randomised controlled trial of pre-hospital blood product (PHBP) administration vs standard care for traumatic haemorrhage.
BACKGROUND: PHBP are increasingly used for pre-hospital trauma resuscitation despite a lack of robust evidence demonstrating superiority over crystalloids. Provision of PHBP carries additional logistical and regulatory implications, and requires a sustainable supply of universal blood components.
METHODS: RePHILL is a multi-centre, two-arm, parallel group, open-label, phase III randomised controlled trial currently underway in the UK. Patients attended by a pre-hospital emergency medical team, with traumatic injury and hypotension (systolic blood pressure <90 mmHg or absent radial pulse) believed to be due to traumatic haemorrhage are eligible. Exclusion criteria include age <16 years, blood product receipt on scene prior to randomisation, Advanced Medical Directive forbidding blood product administration, pregnancy, isolated head injury and prisoners. A total of 490 patients will be recruited in a 1 : 1 ratio to receive either the intervention (up to two units of red blood cells and two units of lyophilised plasma) or the control (up to four boluses of 250 mL 0.9% saline). The primary outcome measure is a composite of failure to achieve lactate clearance of ≥20%/h over the first 2 hours after randomisation and all-cause mortality between recruitment and discharge from the primary receiving facility to non-acute care. Secondary outcomes include pre-hospital time, coagulation indices, in-hospital transfusion requirements and morbidity.
RESULTS: Pilot study recruitment began in December 2016. Approval to proceed to the main trial was received in June 2017. Recruitment is expected to continue until 2020.
CONCLUSIONS: RePHILL will provide high-quality evidence regarding the efficacy and safety of PHBP resuscitation for trauma.

PMID: 29193548 [PubMed - as supplied by publisher]

Stereological assessment of the blood-air barrier and the surfactant system after mesenchymal stem cell pretreatment in a porcine non-heart-beating donor model for lung transplantation.

Sat, 12/02/2017 - 13:45

Stereological assessment of the blood-air barrier and the surfactant system after mesenchymal stem cell pretreatment in a porcine non-heart-beating donor model for lung transplantation.

J Anat. 2017 Nov 28;:

Authors: Schnapper A, Christmann A, Knudsen L, Rahmanian P, Choi YH, Zeriouh M, Karavidic S, Neef K, Sterner-Kock A, Guschlbauer M, Hofmaier F, Maul AC, Wittwer T, Wahlers T, Mühlfeld C, Ochs M

Abstract
More frequent utilization of non-heart-beating donor (NHBD) organs for lung transplantation has the potential to relieve the shortage of donor organs. In particular with respect to uncontrolled NHBD, concerns exist regarding the risk of ischaemia/reperfusion (IR) injury-related graft damage or dysfunction. Due to their immunomodulating and tissue-remodelling properties, bone-marrow-derived mesenchymal stem cells (MSCs) have been suspected of playing a beneficial role regarding short- and long-term survival and function of the allograft. Thus, MSC administration might represent a promising pretreatment strategy for NHBD organs. To study the initial effects of warm ischaemia and MSC application, a large animal lung transplantation model was generated, and the structural organ composition of the transplanted lungs was analysed stereologically with particular respect to the blood-gas barrier and the surfactant system. In this study, porcine lungs (n = 5/group) were analysed. Group 1 was the sham-operated control group. In pigs of groups 2-4, cardiac arrest was induced, followed by a period of 3 h of ventilated ischaemia at room temperature. In groups 3 and 4, 50 × 106 MSCs were administered intravascularly via the pulmonary artery and endobronchially, respectively, during the last 10 min of ischaemia. The left lungs were transplanted, followed by a reperfusion period of 4 h. Then, lungs were perfusion-fixed and processed for light and electron microscopy. Samples were analysed stereologically for IR injury-related structural parameters, including volume densities and absolute volumes of parenchyma components, alveolar septum components, intra-alveolar oedema, and the intracellular and intra-alveolar surfactant pool. Additionally, the volume-weighted mean volume of lamellar bodies (lbs) and their profile size distribution were determined. Three hours of ventilated warm ischaemia was tolerated without eliciting histological or ultrastructural signs of IR injury, as revealed by qualitative and quantitative assessment. However, warm ischaemia influenced the surfactant system. The volume-weighted mean volume of lbs was reduced significantly (P = 0.024) in groups subjected to ischaemia (group medians of groups 2-4: 0.180-0.373 μm³) compared with the sham control group (median 0.814 μm³). This was due to a lower number of large lb profiles (size classes 5-15). In contrast, the intra-alveolar surfactant system was not altered significantly. No significant differences were encountered comparing ischaemia alone (group 2) or ischaemia plus application of MSCs (groups 3 and 4) in this short-term model.

PMID: 29193065 [PubMed - as supplied by publisher]

Understanding the Current Status of Korean Heart Transplantation Based on Initial KOTRY Report.

Sat, 12/02/2017 - 13:45

Understanding the Current Status of Korean Heart Transplantation Based on Initial KOTRY Report.

Korean Circ J. 2017 Nov;47(6):858-860

Authors: Kim IC, Youn JC

PMID: 29192425 [PubMed]

An International External Validation Study of the 2014 European Society of Cardiology Guideline on Sudden Cardiac Death Prevention in Hypertrophic Cardiomyopathy (Evidence from HCM).

Sat, 12/02/2017 - 13:45

An International External Validation Study of the 2014 European Society of Cardiology Guideline on Sudden Cardiac Death Prevention in Hypertrophic Cardiomyopathy (Evidence from HCM).

Circulation. 2017 Nov 30;:

Authors: O'Mahony C, Jichi F, Ommen SR, Christiaans I, Arbustini E, Garcia-Pavia P, Cecchi F, Olivotto I, Kitaoka H, Gotsman I, Carr-White G, Mogensen J, Antoniades L, Mohiddin S, Maurer MS, Tang HC, Geske JB, Siontis KC, Mahmoud K, Vermeer A, Wilde A, Favalli V, Guttmann O, Gallego-Delgado M, Dominguez F, Tanini I, Kubo T, Keren A, Bueser T, Waters S, Issa IF, Malcolmson J, Burns T, Sekhri N, Hoeger CW, Omar RZ, Elliott PM

Abstract
Background -Identification of people with hypertrophic cardiomyopathy (HCM) who are at risk of sudden cardiac death (SCD) and require prophylactic implantable cardioverter defibrillator (ICD) is challenging. In 2014, the European Society of Cardiology (ESC) proposed a new risk stratification method based on a risk prediction model (HCM Risk-SCD) which estimates the 5-year risk of SCD. The aim was to externally validate the 2014 ESC recommendations in a geographically diverse cohort of patients recruited from North America, Europe, The Middle East and Asia. Methods -This was an observational, retrospective, longitudinal cohort study. Results -The cohort consisted of 3703 patients. Seventy three (2%) patients reached the SCD end-point within 5 years of follow-up [5-year incidence 2.4% (95% CI 1.9, 3.0)]. The validation study revealed a calibration slope of 1.02 (95% CI 0.93 to 1.12); C-index 0.70 (95% CI 0.68 to 0.72) and D-statistic 1.17 (95% CI 1.05 to 1.29). In a complete case analysis (n= 2147; 44 SCD end-points at 5 years) patients with a predicted 5-year risk of <4% (n=1524; 71%) had an observed 5-year SCD incidence of 1.4% (95% CI 0.8, 2.2); patients with a predicted risk of ≥6% (n=297; 14%) had an observed SCD incidence of 8.9% (95% CI 5.96, 13.1) at 5 years. For every 13 (297/23) ICD implantations in patients with an estimated 5 year SCD risk ≥6%, 1 patient can potentially be saved from SCD. Conclusions -This study confirms that the HCM Risk-SCD model provides accurate prognostic information which can be used to target ICD therapy in patients at the highest risk of SCD.

PMID: 29191938 [PubMed - as supplied by publisher]

In vivo performance of freeze-dried decellularized pulmonary heart valve allo- and xenografts orthotopically implanted into juvenile sheep.

Sat, 12/02/2017 - 13:45

In vivo performance of freeze-dried decellularized pulmonary heart valve allo- and xenografts orthotopically implanted into juvenile sheep.

Acta Biomater. 2017 Nov 27;:

Authors: Goecke T, Theodoridis K, Tudorache I, Ciubotaru A, Cebotari S, Ramm R, Höffler K, Sarikouch S, Vásquez-Rivera A, Haverich A, Wolkers WF, Hilfiker A

Abstract
The decellularization of biological tissues decreases immunogenicity, allows repopulation with cells, and may lead to improved long-term performance after implantation. Freeze drying these tissues would ensure off-the-shelf availability, save storage costs, and facilitates easy transport. This study evaluates the in vivo performance of freeze-dried decellularized heart valves in juvenile sheep. TritonX-100 and sodium dodecylsulfate decellularized ovine and porcine pulmonary valves (PV) were freeze-dried in a lyoprotectant sucrose solution. After rehydration for 24h, valves were implanted into the PV position in sheep as allografts (fdOPV) and xenografts (fdPPV), while fresh dezellularized ovine grafts (frOPV) were implanted as controls. Functional assessment was performed by transesophageal echocardiography at implantation and at explantation six months later. Explanted grafts were analysed histologically to assess the matrix, and immunofluorescence stains were used to identify the repopulating cells. Although the graft diameters and orifice areas increased, good function was maintained, except for one insufficient, strongly deteriorated frOPV. Cells which were positive for either endothelial or interstitial markers were found in all grafts. In fdPPV, immune-reactive cells were also found. Our findings suggest that freeze-drying does not alter the early hemodynamic performance and repopulation potential of decellularized grafts in vivo, even in the challenging xenogeneic situation. Despite evidence of an immunological reaction for the xenogenic valves, good early functionalities were achieved.
STATEMENT OF SIGNIFICANCE: Decellularized allogeneic heart valves show excellent results as evident from large animal experiments and clinical trials. However, a long-term storing method is needed for an optimal use of this limited resource in the clinical setting, where an optimized matching of graft and recipient is requested. As demonstrated in this study, freeze-dried and freshly decellularized grafts reveal equally good results after implantation in the juvenile sheep concerning function and repopulation with recipients' cells. Thus, freeze-drying arises as a promising method to extend the shelf-life of valvular grafts compared to those stored in antibiotic-solution as currently practised.

PMID: 29191508 [PubMed - as supplied by publisher]

Patient-specific evolution of renal function in chronic heart failure patients dynamically predicts clinical outcome in the Bio-SHiFT study.

Sat, 12/02/2017 - 13:45

Patient-specific evolution of renal function in chronic heart failure patients dynamically predicts clinical outcome in the Bio-SHiFT study.

Kidney Int. 2017 Nov 28;:

Authors: Brankovic M, Akkerhuis KM, van Boven N, Anroedh S, Constantinescu A, Caliskan K, Manintveld O, Cornel JH, Baart S, Rizopoulos D, Hillege H, Boersma E, Umans V, Kardys I

Abstract
Renal dysfunction is an important component of chronic heart failure (CHF), but its single assessment does not sufficiently reflect clinically silent progression of CHF prior to adverse clinical outcome. Therefore, we aimed to investigate temporal evolutions of glomerular and tubular markers in 263 stable patients with CHF, and to determine if their patient-specific evolutions during this clinically silent period can dynamically predict clinical outcome. We determined the risk of clinical outcome (composite endpoint of Heart Failure hospitalization, cardiac death, Left Ventricular Assist Device placement, and heart transplantation) in relation to marker levels, slopes and areas under their trajectories. In each patient, the trajectories were estimated using repeatedly measured glomerular markers: creatinine/estimated glomerular filtration rate (eGFR), cystatin C (CysC), and tubular markers: urinary N-acetyl-beta-D-glucosaminidase (NAG) and kidney injury molecule (KIM)-1, plasma and urinary neutrophil gelatinase-associated lipocalin (NGAL). During 2.2 years of follow-up, we collected on average 8 urine and 9 plasma samples per patient. All glomerular markers predicted the endpoint (univariable hazard ratio [95% confidence interval] per 20% increase: creatinine: 1.18[1.07-1.31], CysC: 2.41[1.81-3.41], and per 20% eGFR decrease: 1.13[1.05-1.23]). Tubular markers, NAG, and KIM-1 also predicted the endpoint (NAG: 1.06[1.01-1.11] and KIM-1: 1.08[1.04-1.11]). Larger slopes were the strongest predictors (creatinine: 1.57[1.39-1.84], CysC: 1.76[1.52-2.09], eGFR: 1.59[1.37-1.90], NAG: 1.26[1.11-1.44], and KIM-1: 1.64[1.38-2.05]). Associations persisted after multivariable adjustment for clinical characteristics. Thus, during clinically silent progression of CHF, glomerular and tubular functions deteriorate, but not simultaneously. Hence, patient-specific evolutions of these renal markers dynamically predict clinical outcome in patients with CHF.

PMID: 29191357 [PubMed - as supplied by publisher]

Happy 50th Birthday, Cardiac Transplantation: Happy 5th Birthday, JACC: Heart Failure.

Sat, 12/02/2017 - 13:45

Happy 50th Birthday, Cardiac Transplantation: Happy 5th Birthday, JACC: Heart Failure.

JACC Heart Fail. 2017 Dec;5(12):946-947

Authors: Rogers JG, Lindenfeld J

PMID: 29191304 [PubMed - in process]

Older and Wiser: Personalized Immunosuppression in the Current Era.

Sat, 12/02/2017 - 13:45

Older and Wiser: Personalized Immunosuppression in the Current Era.

JACC Heart Fail. 2017 Dec;5(12):943-945

Authors: Gupta R, Schlendorf K, Lindenfeld J

PMID: 29191303 [PubMed - in process]

Are Neurogenic Stress Cardiomyopathy and Takotsubo Different Syndromes With Common Pathways?: Etiopathological Insights on Dysfunctional Hearts.

Sat, 12/02/2017 - 13:45

Are Neurogenic Stress Cardiomyopathy and Takotsubo Different Syndromes With Common Pathways?: Etiopathological Insights on Dysfunctional Hearts.

JACC Heart Fail. 2017 Dec;5(12):940-942

Authors: Tavazzi G, Zanierato M, Via G, Iotti GA, Procaccio F

PMID: 29191302 [PubMed - in process]

Incremental Value of Deformation Imaging and Hemodynamics Following Heart Transplantation: Insights From Graft Function Profiling.

Sat, 12/02/2017 - 13:45

Incremental Value of Deformation Imaging and Hemodynamics Following Heart Transplantation: Insights From Graft Function Profiling.

JACC Heart Fail. 2017 Dec;5(12):930-939

Authors: Kobayashi Y, Sudini NL, Rhee JW, Aymami M, Moneghetti KJ, Bouajila S, Kobayashi Y, Kim JB, Schnittger I, Teuteberg JJ, Khush KK, Fearon WF, Haddad F

Abstract
OBJECTIVES: This study investigated to define graft dysfunction and to determine its incremental association with long-term outcome after heart transplantation (HT).
BACKGROUND: Although graft failure is an established cause of late mortality after HT, few studies have analyzed the prognostic value of graft dysfunction at 1- and 5-year follow-up of HT.
METHODS: Patients who underwent HT and completed their first annual evaluation with right heart catheterization and echocardiography at Stanford University between January 1999 and December 2011 were included in the study. Hierarchical clustering was used to identify modules to capture independent features of graft dysfunction at 1 year. The primary endpoint for analysis consisted of the composite of cardiovascular mortality, re-transplantation, or heart failure hospitalization within 5 years of HT. The study further explored whether changes in graft dysfunction between 1 and 5 years were associated with 10-year all-cause mortality.
RESULTS: A total of 215 HT recipients were included in the study. Using hierarchical clustering, 3 functional modules were identified; among them, left ventricular global longitudinal strain (LVGLS), stroke volume index, and right atrial pressure (RAP) or pulmonary capillary wedge pressure (PCWP) captured key features of graft function. Graft dysfunction based on pre defined LVGLS in absolute value <14%, stroke volume index <35 ml/m2, RAP >10 mm Hg, or PCWP >15 mm Hg were present in 41%, 36%, and 27%, respectively. The primary endpoint at 5 years occurred in 52 patients (24%), whereas 10-year all-cause mortality occurred in 30 (27%) of 110 patients alive at 5 years. On multivariate analysis, RAP (standardized hazard ratio: 1.63), LVGLS (standardized hazard ratio: 1.39), and a history of hemodynamically compromising rejection within 1 year (hazard ratio: 2.18) were independent predictors of 5-year outcome. RAP at 5 years, as well as change in RAP from 1 to 5 years, was predictive of 10-year all-cause mortality.
CONCLUSIONS: RAP and LVGLS at the first annual evaluation provide complementary prognostic information in predicting 5-year outcome after HT.

PMID: 29191301 [PubMed - in process]

Implantable Cardioverter-Defibrillators in Patients With Left Ventricular Assist Devices: On Trial and in Need of a Trial.

Sat, 12/02/2017 - 13:45

Implantable Cardioverter-Defibrillators in Patients With Left Ventricular Assist Devices: On Trial and in Need of a Trial.

JACC Heart Fail. 2017 Dec;5(12):927-929

Authors: Pokorney SD, Al-Khatib SM

PMID: 29191300 [PubMed - in process]

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