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E/e' ratio and outcome prediction in hypertrophic cardiomyopathy: the influence of outflow tract obstruction.

Thu, 10/05/2017 - 12:45

E/e' ratio and outcome prediction in hypertrophic cardiomyopathy: the influence of outflow tract obstruction.

Eur Heart J Cardiovasc Imaging. 2017 Jul 11;:

Authors: Lu DY, Hailesealassie B, Ventoulis I, Liu HY, Liang HY, Pozios I, Canepa M, Phillip S, Abraham MR, Abraham T

Abstract
Aims: Diastolic dysfunction is thought to be an important pathophysiologic component of hypertrophic cardiomyopathy (HCM). However, there are conflicting data on the potential value of the mitral E/e' ratio. We examined whether left ventricular outflow tract (LVOT) obstruction influences the value of E/e' in predicting outcomes in HCM.
Methods and results: Patients who met diagnostic criteria for HCM were enrolled. Diastolic function was assessed with complete two-dimensional and Doppler echocardiography. A composite clinical outcome including new onset atrial fibrillation, sustained ventricular tachycardia/fibrillation, heart failure, transplantation, and death was examined over a mean follow-up period of 4.2 years. Among 604 patients, 206 patients had an E/e' level ≥20. Patients with higher septal E/e' level were older, with more severe NYHA class, and more severe LVOT obstruction. Higher E/e' was associated with worse event-free survival in non-obstructive group and total HCM cohort. In addition, E/e' and LVOT pressure gradient were highly correlated in non-obstructive and total HCM, but not in labile or obstructive group. During follow-up period, 95 patients underwent myectomy. Post-op E/e' correlated significantly with LVOT pressure gradient (R = 0.306, P = 0.004). In these patients, post-op E/e' was associated with worse event-free survival (log-rank P = 0.030).
Conclusion: Assessment of E/e' is useful for risk stratification in HCM patients. Nevertheless, the predictive power is confounded by dynamic LVOT obstruction. Higher E/e' predicts worse clinical outcomes in non-obstructive HCM and in labile/obstructive after myectomy.

PMID: 28977350 [PubMed - as supplied by publisher]

Reintubation of patients submitted to cardiac surgery: a retrospective analysis.

Thu, 10/05/2017 - 12:45

Reintubation of patients submitted to cardiac surgery: a retrospective analysis.

Rev Bras Ter Intensiva. 2017 Apr-Jun;29(2):180-187

Authors: Shoji CY, Figuereido LC, Calixtre EM, Rodrigues CDA, Falcão ALE, Martins PP, Anjos APRD, Dragosavac D

Abstract
OBJECTIVES: To analyze patients after cardiac surgery that needed endotracheal reintubation and identify factors associated with death and its relation with the severity scores.
METHODS: Retrospective analysis of information of 1,640 patients in the postoperative period of cardiac surgery between 2007 and 2015.
RESULTS: The reintubation rate was 7.26%. Of those who were reintubated, 36 (30.3%) underwent coronary artery bypass surgery, 27 (22.7%) underwent valve replacement, 25 (21.0%) underwent correction of an aneurysm, and 8 (6.7%) underwent a heart transplant. Among those with comorbidities, 54 (51.9%) were hypertensive, 22 (21.2%) were diabetic, and 10 (9.6%) had lung diseases. Among those who had complications, 61 (52.6%) had pneumonia, 50 (42.4%) developed renal failure, and 49 (51.0%) had a moderate form of the transient disturbance of gas exchange. Noninvasive ventilation was performed in 53 (44.5%) patients. The death rate was 40.3%, and mortality was higher in the group that did not receive noninvasive ventilation before reintubation (53.5%). Within the reintubated patients who died, the SOFA and APACHE II values were 7.9 ± 3.0 and 16.9 ± 4.5, respectively. Most of the reintubated patients (47.5%) belonged to the high-risk group, EuroSCORE (> 6 points).
CONCLUSION: The reintubation rate was high, and it was related to worse SOFA, APACHE II and EuroSCORE scores. Mortality was higher in the group that did not receive noninvasive ventilation before reintubation.

PMID: 28977259 [PubMed - in process]

Recurrence Plots: a New Tool for Quantification of Cardiac Autonomic Nervous System Recovery after Transplant.

Thu, 10/05/2017 - 12:45

Recurrence Plots: a New Tool for Quantification of Cardiac Autonomic Nervous System Recovery after Transplant.

Braz J Cardiovasc Surg. 2017 Jul-Aug;32(4):245-252

Authors: Takakura IT, Hoshi RA, Santos MA, Pivatelli FC, Nóbrega JH, Guedes DL, Nogueira VF, Frota TQ, Castelo GC, Godoy MF

Abstract
OBJECTIVE: To evaluate a possible evolutionary post-heart transplant return of autonomic function using quantitative and qualitative information from recurrence plots.
METHODS: Using electrocardiography, 102 RR tachograms of 45 patients (64.4% male) who underwent heart transplantation and that were available in the database were analyzed at different follow-up periods. The RR tachograms were collected from patients in the supine position for about 20 minutes. A time series with 1000 RR intervals was analyzed, a recurrence plot was created, and the following quantitative variables were evaluated: percentage of determinism, percentage of recurrence, average diagonal length, Shannon entropy, and sample entropy, as well as the visual qualitative aspect.
RESULTS: Quantitative and qualitative signs of heart rate variability recovery were observed after transplantation.
CONCLUSION: There is evidence that autonomic innervation of the heart begins to happen gradually after transplantation. Quantitative and qualitative analyses of recurrence can be useful tools for monitoring cardiac transplant patients and detecting the gradual return of heart rate variability.

PMID: 28977195 [PubMed - in process]

A case of electromagnetic interference between heartmate 3 LVAD and implantable cardioverter defibrillator.

Thu, 10/05/2017 - 12:45

A case of electromagnetic interference between heartmate 3 LVAD and implantable cardioverter defibrillator.

Pacing Clin Electrophysiol. 2017 Oct 04;:

Authors: Sehatbakhsh S, Kushnir A, Kabach M, Kolek M, Chait R, Ghumman W

Abstract
Implantable cardioverter defibrillators (ICDs) have been shown to have a significant benefit in reducing sudden cardiac death (SCD) in patients with systolic heart failure. Additionally, cardiac devices as a bridge to transplant or destination therapy are often used in patients with end stage systolic heart failure. As a result most patients with left ventricular assist devices (LVADs) also have an ICD. Here we present an electromagnetic interference (EMI) between HeartMate 3 LVAD and ICD. This issue might be critical for both electrophysiologists and advanced heart failure cardiologists to understand prior to implantation of ICD/ LVADs in these patients. This article is protected by copyright. All rights reserved.

PMID: 28976004 [PubMed - as supplied by publisher]

Chest Pain and Shortness of Breath After a Heart Transplant.

Thu, 10/05/2017 - 12:45

Chest Pain and Shortness of Breath After a Heart Transplant.

JAMA Cardiol. 2017 Sep 20;:

Authors: DeFilippis EM, Nayor M, Lewis EF

PMID: 28975203 [PubMed - as supplied by publisher]

Extracorporeal life support with left ventricular decompression-improved survival in severe cardiogenic shock: results from a retrospective study.

Thu, 10/05/2017 - 12:45

Extracorporeal life support with left ventricular decompression-improved survival in severe cardiogenic shock: results from a retrospective study.

PeerJ. 2017;5:e3813

Authors: Schmack B, Seppelt P, Weymann A, Alt C, Farag M, Arif R, Doesch AO, Raake PW, Kallenbach K, Mansur A, Popov AF, Karck M, Ruhparwar A

Abstract
OBJECTIVE: Extracorporeal life support (ECLS) is a life-saving procedure used in the treatment of severe cardiogenic shock. Within this retrospective single centre study, we examined our experience in this critically ill patient cohort to assess outcomes and clinical parameters by comparison of ECLS with or without selective left ventricular decompression.
METHODS: Between 2004 and 2014 we evaluated 48 adult patients with INTERMACS level 1 heart failure (age 49.7 ± 19.5 years), who received either central ECLS with (n = 20, 41.7%) or ECLS without (n = 28, 58.3%, including 10 peripheral ECLS) integrated left ventricular vent in our retrospective single centre trial.
RESULTS: Follow up was 100% with a mean of 0.83 ± 1.85 years. Bridge to ventricular assist device was feasible in 29.2% (n = 14), bridge to transplant in 10.4% (n = 5) and bridge to recovery in 8.3% (n = 4). Overall 30-day survival was 37.5%, 6-month survival 27.1% and 1-year survival 25.0%. ECLS support with left ventricular decompression showed favourable 30-day survival compared to ECLS without left ventricular decompression (p = 0.034). Thirty-day as well as long-term survival did not differ between the subgroups (central ECLS with vent, ECLS without vent and peripheral ECLS without vent). Multivariate logistic regression adjusted for age and gender revealed ECLS without vent as independent factor influencing 30-day survival.
CONCLUSION: ECLS is an established therapy for patients in severe cardiogenic shock. Independent of the ECLS approach, 30-day mortality is still high but with superior 30-day survival for patients with ECLS and left ventricular venting. Moreover, by unloading the ventricle, left ventricular decompression may provide an important time window for recovery or further treatment, such as bridge to bridge or bridge to transplant.

PMID: 28975053 [PubMed]

Safety and Efficacy of the Intravenous Infusion of Umbilical Cord Mesenchymal Stem Cells in Patients With Heart Failure: A Phase 1/2 Randomized Controlled Trial (RIMECARD Trial).

Thu, 10/05/2017 - 12:45

Safety and Efficacy of the Intravenous Infusion of Umbilical Cord Mesenchymal Stem Cells in Patients With Heart Failure: A Phase 1/2 Randomized Controlled Trial (RIMECARD Trial).

Circ Res. 2017 Sep 26;:

Authors: Bartolucci JG, Verdugo FJ, González PL, Larrea RE, Abarzua E, Goset C, Rojo PG, Palma I, Lamich R, Pedreros PA, Valdivia G, Lopez VM, Nazzal C, Alcayaga F, Cuenca J, Brobeck MJ, Patel AN, Figueroa FE, Khoury M

Abstract
Rationale: Umbilical cord-derived mesenchymal stem cells (UC-MSC) are easily accessible and expanded in vitro, possess distinct properties, and improve myocardial remodeling and function in experimental models of cardiovascular disease. While bone marrow-derived mesenchymal stem cells (BM-MSCs) have been previously assessed for their therapeutic potential in individuals with heart failure and reduced ejection fraction (HFrEF), no clinical trial has evaluated UC-MSCs in these patients. Objective: Evaluate the safety and efficacy of the infusion of UC-MSC in patients with chronic stable HFrEF. Methods and Results: HFrEF patients under optimal medical treatment were randomized to intravenous infusion of allogenic UC-MSCs (Cellistem, Cells for Cells S.A., Santiago, Chile) (1x10(6) cells/Kg) or placebo (n=15 per group). UC-MSCs <em>in vitro</em>, compared to BM-MSCs, displayed a 55-fold increase in the expression of Hepatocyte Growth Factor (HGF), known to be involved in myogenesis, cell migration and immunoregulation. UC-MSC treated patients presented no adverse events related to the cell infusion and none of the patients tested at 0, 15 and 90 days presented alloantibodies to the UC-MSCs (n=7). Only the UC-MSC treated group exhibited significant improvements in left ventricular ejection fraction at 3, 6 and 12 months of follow-up assessed both through transthoracic echocardiography (p=0.0167 versus baseline) and cardiac magnetic resonance imaging (p=0.025 versus baseline). Echocardiographic LVEF change from baseline to month 12 differed significantly between groups (+7.07±6.22% vs +1.85±5.60, p=0.028). In addition, at all follow-up time points, UC-MSCs treated patients displayed improvements of NYHA functional class (p=0.0167 versus baseline) and MLHFQ (p<0.05 versus baseline). At study completion, groups did not differ in mortality, heart failure admissions, arrhythmias or incident malignancy. Conclusions: Intravenous infusion of UC-MSC was safe in this group of patients with stable HFrEF under optimal medical treatment. Improvements in left ventricular function, functional status and quality of life were observed in patients treated with UC-MSCs. Trial registration number: NCT01739777 Registry URL: https://clinicaltrials.gov/ct2/show/NCT01739777.

PMID: 28974553 [PubMed - as supplied by publisher]

Risk of Infective Endocarditis in Patients with End Stage Kidney Disease.

Thu, 10/05/2017 - 12:45

Risk of Infective Endocarditis in Patients with End Stage Kidney Disease.

Clin J Am Soc Nephrol. 2017 Oct 03;:

Authors: Chaudry MS, Carlson N, Gislason GH, Kamper AL, Rix M, Fowler VG, Torp-Pedersen C, Bruun NE

Abstract
BACKGROUND AND OBJECTIVES: Endocarditis is a serious complication in patients treated with RRT. The study aimed to examine incidence and risk factors of endocarditis in patients with ESRD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The Danish National Registry on Regular Dialysis and Transplantation contains data on all Danish patients receiving renal replacement (hemodialysis, peritoneal dialysis, or kidney transplantation) for ESRD. Incidence of endocarditis was estimated for each RRT modality. Independent risk factors of endocarditis were identified in multivariable Cox regression models.
RESULTS: From January 1st, 1996 to December 31st, 2012, 10,612 patients (mean age 63 years, 36% female) initiated RRT (7233 hemodialysis, 3056 peritoneal dialysis, 323 pre-emptive kidney transplantation). Endocarditis developed in 267 (2.5%); of these 31 (12%) underwent valve surgery. The overall incidence of endocarditis was 627 per 100,000 person-years in patients receiving RRT. Incidence was higher in patients receiving hemodialysis compared with those receiving peritoneal dialysis or kidney transplantation (1092 per 100,000 person-years, 212 per 100,000 person-years, and 85 per 100,000 person-years, respectively). Adjusted hazard ratios for endocarditis in patients receiving hemodialysis were 5.46 (95% confidence interval [95% CI], 3.28 to 9.10) and 0.41 (95% CI, 0.18 to 0.91) for kidney-transplanted recipients, respectively, as compared with patients in peritoneal dialysis. The incidence of endocarditis in hemodialysis recipients with central venous catheters was more than two-fold higher as compared with those with arteriovenous fistulas. Overall mortality, subsequent to endocarditis, was 22% in-hospital and 51% at 1 year. The first 6 months in RRT, aortic valve disease, and previous endocarditis were identified as significant risk factors of endocarditis.
CONCLUSIONS: Patients receiving RRT have a high incidence of endocarditis, in particular during hemodialysis treatment using central venous catheters. The first 6 months in RRT, aortic valve disease, and previous endocarditis are significant risk factors for developing endocarditis.

PMID: 28974524 [PubMed - as supplied by publisher]

Longitudinal Heart Failure Medication Use and Adherence Following Left Ventricular Assist Device Implantation in Privately Insured Patients.

Thu, 10/05/2017 - 12:45

Longitudinal Heart Failure Medication Use and Adherence Following Left Ventricular Assist Device Implantation in Privately Insured Patients.

J Am Heart Assoc. 2017 Oct 03;6(10):

Authors: Tan NY, Sangaralingham LR, Schilz SR, Dunlay SM

Abstract
BACKGROUND: There are few data describing the longitudinal use of and adherence to heart failure medications following left ventricular assist device (LVAD) implantation.
METHODS AND RESULTS: Using a large US commercial insurance database, patients who received an LVAD (International Classification of Diseases, 9th Revision, Clinical Modification code 37.66) and survived to hospital discharge without heart transplantation between January 1, 2006, and March 31, 2015, were identified. Heart failure medication use from 3 months before 1-year post-LVAD was examined using linked pharmacy claims. Differences in the proportion of patients taking heart failure medications post LVAD compared with pre LVAD were examined using McNemar test. Predictors of post-LVAD medication use and poor medication adherence (proportion of days covered <0.8) were identified via logistic regression. Among 362 patients (mean age, 57.4 years; 75.1% men), compared with pre LVAD, the proportion of patients taking anticoagulants and antiarrhythmics following LVAD increased; mineralocorticoid receptor antagonists, thiazide diuretics, and digoxin decreased; and β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and loop diuretics did not change. Pre-LVAD medication use was associated with post-LVAD use across all medication classes. The proportion of patients with poor medication adherence was 28.8%, 39.0%, and 36.0% for β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and anticoagulants, respectively. Many patients with poor adherence completely discontinued use of the medication.
CONCLUSIONS: Neurohormonal antagonist use after LVAD was inconsistent, perhaps reflecting uncertainty of therapeutic benefit in this population. Medication adherence post-LVAD was poor in many patients. Further work is needed to delineate the reasons for nonadherence after LVAD.

PMID: 28974501 [PubMed - in process]

Bone marrow cell migration to the heart in a chimeric mouse model of acute chagasic disease.

Thu, 10/05/2017 - 12:45
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Bone marrow cell migration to the heart in a chimeric mouse model of acute chagasic disease.

Mem Inst Oswaldo Cruz. 2017 Aug;112(8):551-560

Authors: Irion CI, Paredes BD, Brasil GV, Cunha STD, Paula LF, Carvalho AR, Carvalho ACC, Carvalho AB, Goldenberg RCDS

Abstract
BACKGROUND: Chagas disease is a public health problem caused by infection with the protozoan Trypanosoma cruzi. There is currently no effective therapy for Chagas disease. Although there is some evidence for the beneficial effect of bone marrow-derived cells in chagasic disease, the mechanisms underlying their effects in the heart are unknown. Reports have suggested that bone marrow cells are recruited to the chagasic heart; however, studies using chimeric mouse models of chagasic cardiomyopathy are rare.
OBJECTIVES: The aim of this study was to investigate the migration of bone marrow cells to the heart after T. cruzi infection in a model of chagasic disease in chimeric mice.
METHODS: To obtain chimerical mice, wild-type (WT) C57BL6 mice were exposed to full body irradiation (7 Gy), causing bone marrow ablation. Then, bone marrow cells from green fluorescent protein (GFP)-transgenic mice were infused into the mice. Graft effectiveness was confirmed by flow cytometry. Experimental mice were divided into four groups: (i) infected chimeric (iChim) mice; (ii) infected WT (iWT) mice, both of which received 3 × 104 trypomastigotes of the Brazil strain; (iii) non-infected chimeric (Chim) mice; and (iv) non-infected WT mice.
FINDINGS: At one-month post-infection, iChim and iWT mice showed first degree atrioventricular block with decreased heart rate and treadmill exercise parameters compared to those in the non-infected groups.
MAIN CONCLUSIONS: iChim mice showed an increase in parasitaemia, myocarditis, and the presence of amastigote nests in the heart tissue compared to iWT mice. Flow cytometry analysis did not detect haematopoietic progenitor cells in the hearts of infected mice. Furthermore, GFP+ cardiomyocytes were not detected in the tissues of chimeric mice.

PMID: 28767980 [PubMed - indexed for MEDLINE]

Early Intervention with Highly Condensed Adipose-Derived Stem Cells for Complicated Wounds Following Filler Injections.

Thu, 10/05/2017 - 12:45
Related Articles

Early Intervention with Highly Condensed Adipose-Derived Stem Cells for Complicated Wounds Following Filler Injections.

Aesthetic Plast Surg. 2016 Jun;40(3):428-34

Authors: Kim JH, Park SH, Lee BH, Jeong HS, Yang HJ, Suh IS

Abstract
BACKGROUND: A rise in cosmetic procedures has seen the use of fillers become more prevalent. Complications resulting from use of fillers have prompted introduction of various medical and surgical interventions. Recently, stem cell therapies have become more widely used as a new treatment option for tissue repair and regeneration.
METHODS: We utilized adipose-derived stem cells (ASCs) for tissue regeneration in patients with filler-related complications such as necrosis. All 12 patients were treated with ASCs and some patients had additional treatment. After relief of symptoms, wound surface area was compared in terms of pixel numbers and scar condition was evaluated using the Vancouver Scar Scale (VSS).
RESULTS: In general, we achieved satisfactory resolution of filler-related complications in a short period of time without serious side effects. The average number of days from stem cell treatment to symptom relief was 7.3 days. The proportion of wound surface area from photographic record was 4.39 % before treatment, decreasing considerably to 1.01 % following treatment. Last, the VSS showed almost all patients scored below 3, with two patients receiving scores of 7 and 8; the average score was 2.78 (range from 0 to 8).
CONCLUSIONS: ASCs are a new treatment option for post-filler injection wounds such as necrosis. Using stem cells, we were able to obtain satisfactory results in a short period of time without complications requiring surgical procedures. We suggest stem cell injections could be used as the first option for treatment of complications from filler injections.
LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

PMID: 27102776 [PubMed - indexed for MEDLINE]

End-stage heart failure: Two surgical approaches with different rehabilitative outcomes.

Wed, 10/04/2017 - 12:45

End-stage heart failure: Two surgical approaches with different rehabilitative outcomes.

PLoS One. 2017;12(10):e0185717

Authors: Racca V, Castiglioni P, Panzarino C, Oliva F, Perna E, Ferratini M

Abstract
BACKGROUND: A rising number of patients are surgically treated for heart failure at the more advanced stage, thanks to the increasing use of left ventricular assist device (LVAD) as a reliable alternative to heart transplantation (HTx). However, it is still unknown whether differences exist between the two surgical approaches in the efficacy of rehabilitation programmes. Therefore, aim of this study was to evaluate whether functional capacity and rehabilitative outcomes differ between HTx and implantation of LVAD.
METHODS AND RESULTS: We enrolled 51 patients with HTx and 46 with LVAD upon admission to our rehabilitation-unit. We evaluated six-minute walking test (6MWT), resting oxygen saturation (SaO2) and nutritional assessment before and after a standardised cardiovascular rehabilitation programme. HTx and LVAD groups differed in age, anthropometric variables, gender distribution. Upon enrolment, 6MWT distance was similar in the two groups, whereas malnutrition was less frequent and the waist circumference/height ratio (WHtR) was greater in LVAD patients. SaO2 was greater in HTx patients. Rehabilitation improved SaO2, 6MWT distance and nutritional status. The difference in malnutrition disappeared, but WHtR remained higher in the LVAD and SaO2 higher in the HTx patients; the 6MWT distance improved more in the HTx patients. Multivariate linear regression analysis confirmed that the type of intervention was independent predictor of 6MWT distance after rehabilitation.
CONCLUSIONS: HTx patients improve more rapidly and perform better after rehabilitation, suggesting the need for more tailored rehabilitation training for LVAD patients.

PMID: 28972991 [PubMed - in process]

Delayed Development of Hemolytic Anemia with Fragmented Red Blood Cells and Cardiac and Renal Impairments after High-Dose Chemotherapy and Autologous Hematopoietic Stem Cell Transplantation for Malignant Lymphoma.

Wed, 10/04/2017 - 12:45

Delayed Development of Hemolytic Anemia with Fragmented Red Blood Cells and Cardiac and Renal Impairments after High-Dose Chemotherapy and Autologous Hematopoietic Stem Cell Transplantation for Malignant Lymphoma.

Acta Haematol. 2017 Oct 04;138(3):152-161

Authors: Iioka F, Toda Y, Nagai Y, Akasaka T, Shimomura D, Tsuda K, Nakamura F, Ohno H

Abstract
Among 42 consecutive patients with malignant lymphoma who underwent high-dose chemotherapy (HDC) followed by autologous hematopoietic stem cell transplantation (AHSCT), 5 developed hemolytic anemia with fragmented red blood cells (HA-FrRBCs) on days 87-125 (median 107) of AHSCT. Nadir Hb levels ranged between 5.0 and 6.4 g/dL with 2.2-5.6% FrRBCs. All patients developed grade ≥3 hypoxia and heart failure, and 4 developed grade ≥3 hypertension. The ejection fraction of the left ventricle assessed by echocardiography was significantly reduced in 3 patients. Peak creatinine levels were >4 times above the baseline and estimated glomerular filtration rates were reduced to <30 mL/min/1.73 m2. One patient received plasma exchange, while the remaining 4 responded to treatment with diuretics and cardiovascular agents. Hematological parameters normalized within a median duration of 91 days after the development of HA-FrRBCs. Renal and cardiac functions gradually improved, even though renal function did not return to the baseline. HA-FrRBCs associated with cardiac and renal impairments may represent a thrombotic microangiopathy syndrome and are a delayed complication of HDC/AHSCT. The close monitoring of laboratory abnormalities and persistent treatment with cardiovascular agents and diuretics are the mainstay for the management of this condition.

PMID: 28972944 [PubMed - as supplied by publisher]

Importance of Routine Antihuman/Leukocyte Antibody Monitoring: De Novo Donor Specific Antibodies Are Associated With Rejection and Allograft Vasculopathy After Heart Transplantation.

Wed, 10/04/2017 - 12:45

Importance of Routine Antihuman/Leukocyte Antibody Monitoring: De Novo Donor Specific Antibodies Are Associated With Rejection and Allograft Vasculopathy After Heart Transplantation.

Circulation. 2017 Oct 03;136(14):1350-1352

Authors: Wong KL, Taner T, Smith BH, Kushwaha SS, Edwards BS, Gandhi MJ, Kremers WK, Daly RC, Pereira NL

PMID: 28972064 [PubMed - in process]

Messy entanglements: research assemblages in heart transplantation discourses and practices.

Wed, 10/04/2017 - 12:45

Messy entanglements: research assemblages in heart transplantation discourses and practices.

Med Humanit. 2017 Sep 28;:

Authors: Shildrick M, Carnie A, Wright A, McKeever P, Jan EH, De Luca E, Bachmann I, Abbey S, Dal Bo D, Poole J, El-Sheikh T, Ross H

Abstract
The paper engages with a variety of data around a supposedly single biomedical event, that of heart transplantation. In conventional discourse, organ transplantation constitutes an unproblematised form of spare part surgery in which failing biological components are replaced by more efficient and enduring ones, but once that simple picture is complicated by employing a radically interdisciplinary approach, any biomedical certainty is profoundly disrupted. Our aim, as a cross-sectorial partnership, has been to explore the complexities of heart transplantation by explicitly entangling research from the arts, biosciences and humanities without privileging any one discourse. It has been no easy enterprise yet it has been highly productive of new insights. We draw on our own ongoing funded research with both heart donor families and recipients to explore our different perceptions of what constitutes data and to demonstrate how the dynamic entangling of multiple data produces a constitutive assemblage of elements in which no one can claim priority. Our claim is that the use of such research assemblages and the collaborations that we bring to our project breaks through disciplinary silos to enable a fuller comprehension of the significance and experience of heart transplantation in both theory and practice.

PMID: 28972037 [PubMed - as supplied by publisher]

Derivation and Implementation of a Protocol in Israel for Organ Donation after Cardio-Circulatory Death.

Wed, 10/04/2017 - 12:45

Derivation and Implementation of a Protocol in Israel for Organ Donation after Cardio-Circulatory Death.

Isr Med Assoc J. 2017 Sep;19(9):566-569

Authors: Cohen J, Rahamimov R, Hoffman A, Katvan E, Grozovski K, Ashkenazi T

Abstract
BACKGROUND: Strategies aimed at expanding the organ donor pool have been sought, which has resulted in renewed interest in donation after cardio-circulatory death (DCCD), also known as non-heart beating donors (NHBDs).
OBJECTIVES: To describe the derivation and implementation of a protocol for DCCD in Israel and report on the results with the first six cases.
METHODS: After receiving approval from an extraordinary ethics committee, Ministry of Health, the steering committee of the National Transplant Center defined and reached consensus on the unique challenges presented by a DCCD program. These protocol included medical aspects (construction of a clinical pathway), social and ethical aspects (presentation of the protocol at a public gathering(, legal/ethical aspects (consent for organ preservation procedures being either implied if the donor had signed an organ donor card or received directly from a surrogate decision maker), and logistical aspects (pilot study confined to kidney retrieval and to four medical centers). Data regarding organ donors and recipients were recorded.
RESULTS: The protocol was implemented at four medical centers. Consent for organ donation was received from four of the six potential donors meeting criteria for inclusion, in all cases, from a surrogate decision maker. Of the eight kidneys retrieved, only four were suitable for transplantation, which was carried out successfully for four recipients. Graft function remained normal in all cases in 6-12 months follow-up.
CONCLUSIONS: The DCCD program was successfully implemented and initial results are encouraging, suggesting that expansion of the program might further aid in decreasing the gap between needs and availability of organs.

PMID: 28971641 [PubMed - in process]

The Diabetic Foot as a Proxy for Cardiovascular Events and Mortality Review.

Wed, 10/04/2017 - 12:45

The Diabetic Foot as a Proxy for Cardiovascular Events and Mortality Review.

Curr Atheroscler Rep. 2017 Oct 02;19(11):44

Authors: Dietrich I, Braga GA, de Melo FG, da Costa Silva Silva ACC

Abstract
PURPOSE OF REVIEW: This article reviewed very recent papers (2016) discussing or bringing clinical evidences of the possible common pathways leading to diabetic foot syndrome (DFS) and increased mortality rates.
RECENT FINDINGS: Diabetic patients with diabetic foot syndrome have a mortality rate greater than twofold when compared with non-ulcerated diabetics. In addition, the 5-year mortality rate following amputation is estimated at 39-68%, a life expectancy comparable to aggressive types of cancer or advanced congestive heart failure. The majority of patients with diabetic foot ulcer also present insulin resistance, central obesity, dyslipidemia, and hypertension that characterize the metabolic syndrome that, in turn, is associated with an elevated risk of major cardiovascular events. Sensory neuropathy is the primary cause of more the 60% of diabetic foot ulcer. Diabetic peripheral neuropathy is a microvascular complication of diabetes mellitus and in type 2 diabetes, not only hyperglycemia but also other metabolic alterations and persistent inflammatory status due to adiposity play a major role in axon injury. Elevated triglycerides have been showed to be an independent risk factor for lower extremity amputation in diabetic patients. Also, toxic adiposity, oxidative stress, mitochondrial dysfunction, activation of the polyol pathway, accumulation of advanced glycation end products (AGEs), and elevation of inflammatory markers are also implicated in diabetic vascular disease and neuropathy. The hypotheses that the association between DFS and increased rates of mortality reflects the progression of micro- and macrovascular complications are reinforced by the additional association of DFU to renal failure and retinopathy.

PMID: 28971322 [PubMed - in process]

Successful Treatment of T Cell-Mediated Acute Rejection with Delayed CTLA4-Ig in Mice.

Wed, 10/04/2017 - 12:45

Successful Treatment of T Cell-Mediated Acute Rejection with Delayed CTLA4-Ig in Mice.

Front Immunol. 2017;8:1169

Authors: Young JS, Khiew SH, Yang J, Vannier A, Yin D, Sciammas R, Alegre ML, Chong AS

Abstract
Clinical observations that kidney transplant recipients receiving belatacept who experienced T cell-mediated acute rejection can be successfully treated and subsequently maintained on belatacept-based immunosuppression suggest that belatacept is able to control memory T cells. We recently reported that treatment with CTLA4-Ig from day 6 posttransplantation successfully rescues allografts from acute rejection in a BALB/c to C57BL/6 heart transplant model, in part, by abolishing B cell germinal centers and reducing alloantibody titers. Here, we show that CTLA4-Ig is additionally able to inhibit established T cell responses independently of B cells. CTLA4-Ig inhibited the in vivo cytolytic activity of donor-specific CD8(+) T cells, and the production of IFNγ by graft-infiltrating T cells. Delayed CTLA4-Ig treatment did not reduce the numbers of graft-infiltrating T cells nor prevented the accumulation of antigen-experienced donor-specific memory T cells in the spleen. Nevertheless, delayed CTLA4-Ig treatment successfully maintained long-term graft acceptance in the majority of recipients that had experienced a rejection crisis, and enabled the acceptance of secondary BALB/c heart grafts transplanted 30 days after the first transplantation. In summary, we conclude that delayed CTLA4-Ig treatment is able to partially halt ongoing T cell-mediated acute rejection. These findings extend the functional efficacy of CTLA4-Ig therapy to effector T cells and provide an explanation for why CTLA4-Ig-based immunosuppression in the clinic successfully maintains long-term graft survival after T cell-mediated rejection.

PMID: 28970838 [PubMed]

The Need for Extracorporeal Membrane Oxygenation in Adults Undergoing Congenital Heart Surgery: Impact and Trends of Utilization.

Wed, 10/04/2017 - 12:45

The Need for Extracorporeal Membrane Oxygenation in Adults Undergoing Congenital Heart Surgery: Impact and Trends of Utilization.

Indian J Crit Care Med. 2017 Sep;21(9):547-551

Authors: Aiello S, Loomba RS, Kriz C, Buelow M, Aggarwal S, Arora RR

Abstract
INTRODUCTION: Adults with congenital heart disease (ACHD) represent a population with unique health-care needs. Many patients require cardiac surgery, with some requiring postoperative extracorporeal membrane oxygenation (ECMO). This study aimed to identify the risk factors for the need of postoperative ECMO and characterize the impact of ECMO on admission characteristics.
METHODS: Data from the 2005-2012 iterations of the Nationwide Inpatient Sample were used. ACHD admissions over 18 years with a documented cardiac surgery were included. Univariate analysis was conducted to compare the characteristics between those requiring ECMO and those who did not. Regression analysis was done to identify the independent risk factors associated with ECMO and to determine the impact of ECMO on length, cost, and mortality of the admission.
RESULTS: A total of 186,829 admissions were included. Of these, 446 (0.2%) admissions required ECMO. Those with acute kidney injury, double-outlet right ventricle, or total anomalous pulmonary venous connection were more likely to require ECMO. ECMO was also significantly more utilized in patients undergoing septal defect repair, complete repair of tetralogy of Fallot, atrial switch, and heart transplant. The use of ECMO significantly increased length, cost, and mortality of stay. Overall mortality was 62.6% in the ECMO group.
CONCLUSION: ECMO is only needed in a small proportion of postoperative ACHD patients. The use of ECMO significantly increases cost, length of stay and mortality in these patients. Improved identification of postoperative ACHD patients who are more likely to survive ECMO may facilitate improved survival and decreased resource utilization.

PMID: 28970652 [PubMed]

Post-cardiac transplant recipient: Implications for anaesthesia.

Wed, 10/04/2017 - 12:45

Post-cardiac transplant recipient: Implications for anaesthesia.

Indian J Anaesth. 2017 Sep;61(9):768-774

Authors: Choudhury M

Abstract
The annual heart transplant rate is gradually increasing worldwide. A proportion of this patient population present for an elective or emergency surgery which may or may not be related to the transplanted heart. A MEDLINE search for heart transplant, anaesthesia, adult, paediatric and surgery was conducted to review anaesthetic management for heart transplant recipients. Anaesthesia and perioperative management are different in these cases. A thorough understanding of the physiology of denervated heart, post-transplant morbidities and pharmacology of immunosuppressants is essential for best perioperative management and improved post-operative outcome.

PMID: 28970636 [PubMed]

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