Revistas
Autores:
Sagastagoitia-Fornie, M. (Autor de correspondencia); Morán-Fernández, L.; Blázquez-Bermejo, Z.; et al.
Revista:
TRANSPLANT INTERNATIONAL
ISSN:
0934-0874
Año:
2023
Vol.:
36
Págs.:
11042
In this observational and multicenter study, that included all patients who underwent a heart transplantation (HT) in Spain from 1984 to 2018, we analyzed the incidence, management, and prognosis of colorectal cancer (CRC) after HT. Of 6,244 patients with a HT and a median follow-up of 8.8 years since the procedure, 116 CRC cases (11.5% of noncutaneous solid cancers other than lymphoma registered) were diagnosed, mainly adenocarcinomas, after a mean of 9.3 years post-HT. The incidence of CRC increased with age at HT from 56.6 per 100,000 person-years among under 45 year olds to 436.4 per 100,000 person-years among over 64 year olds. The incidence rates for age-at-diagnosis groups were significantly greater than those estimated for the general Spanish population. Curative surgery, performed for 62 of 74 operable tumors, increased the probability of patient survival since a diagnosis of CRC, from 31.6% to 75.7% at 2 years, and from 15.8% to 48.6% at 5 years, compared to patients with inoperable tumors. Our results suggest that the incidence of CRC among HT patients is greater than in the general population, increasing with age at HT.
Revista:
CANCERS
ISSN:
2072-6694
Año:
2022
Vol.:
14
N°:
12
Págs.:
2941
Simple Summary Left ventricular dysfunction (LVD) induced by anthracycline-based cancer chemotherapy (ACC) is becoming an urgent healthcare concern. Myocardial fibrosis (MF) may contribute to LVD after ACC. We show that elevated circulating levels of procollagen type I C-terminal propeptide (PICP, biomarker of MF) are associated with early subclinical LVD and predict later development of cardiotoxicity in patients treated with ACC. In addition, an association between PICP and LVD in patients with ACC-induced heart failure is observed. These results provide novel insights into MF as a mechanism underlying LVD after ACC, with PICP emerging as a promising tool to monitor cardiotoxicity in patients treated with ACC. Anthracycline-based cancer chemotherapy (ACC) causes myocardial fibrosis, a lesion contributing to left ventricular dysfunction (LVD). We investigated whether the procollagen-derived type-I C-terminal-propeptide (PICP): (1) associates with subclinical LVD (sLVD) at 3-months after ACC (3m-post-ACC); (2) predicts cardiotoxicity 1-year after ACC (12m-post-ACC) in breast cancer patients (BC-patients); and (3) associates with LVD in ACC-induced heart failure patients (ACC-HF-patients). Echocardiography, serum PICP and biomarkers of cardiomyocyte damage were assessed in two independent cohorts of BC-patients: CUN (n = 87) at baseline, post-ACC, and 3m and 12m (n = 65)-post-ACC; and HULAFE (n = 70) at baseline, 3m and 12m-post-ACC. Thirty-seven ACC-HF-patients were also studied. Global longitudinal strain (GLS)-based sLVD (3m-post-ACC) and LV ejection fraction (LVEF)-based cardiotoxicity (12m-post-ACC) were defined according to guidelines. BC-patients: all biomarkers increased at 3m-post-ACC versus baseline. PICP was particularly increased in patients with sLVD (interaction-p < 0.001) and was associated with GLS (p < 0.001). PICP increase at 3m-post-ACC predicted cardiotoxicity at 12m-post-ACC (odds-ratio >= 2.95 per doubling PICP, p <= 0.025) in both BC-cohorts, adding prognostic value to the early assessment of GLS and LVEF. ACC-HF-patients: PICP was inversely associated with LVEF (p = 0.004). In ACC-treated BC-patients, an early increase in PICP is associated with early sLVD and predicts cardiotoxicity 1 year after ACC. PICP is also associated with LVD in ACC-HF-patients.
Autores:
González-Vilchez, F. (Autor de correspondencia); Crespo-Leiro, M. G.; Delgado-Jiménez, J.; et al.
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGIA
ISSN:
0300-8932
Año:
2022
Vol.:
75
N°:
2
Págs.:
129 - 140
Introduction and objectives: Intrapatient blood level variability (IPV) of calcineurin inhibitors has been associated with poor outcomes in solid-organ transplant, but data for heart transplant are scarce. Our purpose was to ascertain the clinical impact of IPV in a multi-institutional cohort of heart transplant recipients. Methods: We retrospectively studied patients aged >= 18 years, with a first heart transplant performed between 2000 and 2014 and surviving >= 1 year. IPV was assessed by the coefficient of variation of trough levels from posttransplant months 4 to 12. A composite of rejection or mortality/graft loss or rejection and all-cause mortality/graft loss between years 1 to 5 posttransplant were analyzed by Cox regression analysis. Results: The study group consisted of 1581 recipients (median age, 56 years; women, 21%). Cyclosporine immediate-release tacrolimus and prolonged-release tacrolimus were used in 790, 527 and 264 patients, respectively. On multivariable analysis, coefficient of variation > 27.8% showed a nonsignificant trend to association with 5-year rejection-free survival (HR, 1.298; 95%CI, 0.993-1.695; P = .056) and with 5-year mortality (HR, 1.387; 95%CI, 0.979-1.963; P = .065). Association with rejection became significant on analysis of only those patients without rejection episodes during the first year posttransplant (HR, 1.609; 95%CI, 1.129-2.295; P = .011). The tacrolimus-based formulation had less IPV than cyclosporine and better results with less influence of IPV. Conclusions: IPV of calcineurin inhibitors is only marginally associated with mid-term outcomes after heart transplant, particularly with the tacrolimus-based immunosuppression, although it could play a role in the most stable recipients.
Autores:
Solla-Buceta, M.; González-Vilchez, F.; Almenar-Bonet, L.; et al.
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGIA
ISSN:
0300-8932
Año:
2022
Vol.:
75
N°:
2
Págs.:
141 - 149
Introduction and objectives - Short-term mechanical circulatory support is frequently used as a bridge to heart transplant in Spain. The epidemiology and prognostic impact of infectious complications in these patients are unknown. Methods: Systematic description of the epidemiology of infectious complications and analysis of their prognostic impact in a multicenter, retrospective registry of patients treated with short-term mechanical devices as a bridge to urgent heart transplant from 2010 to 2015 in 16 Spanish hospitals. Results: We studied 249 patients, of which 87 (34.9%) had a total of 102 infections. The most frequent site was the respiratory tract (n = 47; 46.1%). Microbiological confirmation was obtained in 78 (76.5%) episodes, with a total of 100 causative agents, showing a predominance of gram-negative bacteria (n = 58, 58%). Compared with patients without infection, those with infectious complications showed higher mortality during the support period (25.3% vs 12.3%, P = .009) and a lower probability of receiving a transplant (73.6% vs 85.2%, P= .025). In-hospital posttransplant mortality was similar in the 2 groups (with infection: 28.3%; without infection: 23.4%; P= .471). Conclusions: Patients supported with temporary devices as a bridge to heart transplant are exposed to a high risk of infectious complications, which are associated with higher mortality during the organ waiting period. (C) 2020 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
Autores:
Angleitner, P. (Autor de correspondencia); Kaider, A.; De By, T. M. M. H.; et al.
Revista:
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
ISSN:
1010-7940
Año:
2022
Vol.:
62
N°:
3
Págs.:
ezac401
OBJECTIVES: The objective was to analyse associations between obesity and outcomes after left ventricular assist device (LVAD) implantation. METHODS: A retrospective analysis of the EUROMACS Registry was performed. Adult patients undergoing primary implantation of a continuous-flow LVAD between 2006 and 2019 were included (Medtronic HeartWare((R)) HVAD((R)), Abbott HeartMate II (R), Abbott HeartMate 3 (TM)). Patients were classified into 4 different groups according to body mass index at the time of surgery (body mass index <20 kg/m(2): n = 254; 20-24.9 kg/m(2): n = 1281; 25-29.9 kg/m(2): n = 1238; >= 30 kg/m(2): n = 691). RESULTS: The study cohort was comprised of 3464 patients. Multivariable Cox proportional cause-specific hazards regression analysis demonstrated that obesity (body mass index >= 30 kg/m(2)) was independently associated with significantly increased risk of mortality (body mass index >= 30 vs 20-24.9 kg/m(2): hazard ratio 1.36, 95% confidence interval 1.18-1.57, overall P < 0.001). Moreover, obesity was associated with significantly increased risk of infection and driveline infection. The probability to undergo heart transplantation was significantly decreased in obese patients (body mass index >= 30 vs 20-24.9 kg/m(2): hazard ratio 0.59, 95% confidence interval 0.48-0.74, overall P < 0.001). CONCLUSIONS: Obesity at the time of LVAD implantation is associated with significantly higher mortality and increased risk of infection as well as driveline infection. The probability to undergo heart transplantation is significantly decreased. These aspects should be considered when devising a treatment strategy before surgery.
Autores:
Ramírez, A. (Autor de correspondencia); Sobrinos, E.; Girón, J. J.; et al.
Revista:
CIRUGIA CARDIOVASCULAR
ISSN:
1134-0096
Año:
2022
Vol.:
29
N°:
2
Págs.:
110 - 113
An anomalous origin of the coronary artery is an uncommon congenital disorder. Even though the pathology is generally asymptomatic, it can present with life-threatening symptoms. Two cases with an anomalous origin of the right coronary artery are assessed. Though both patients' arterial anomalies were alike, the surgical procedure was different in each case. The unroofing technique and coronary artery bypass grafting are compared to evaluate different surgical approaches for a personalize treatment of the pathology.
Revista:
ARCHIVOS DE BRONCONEUMOLOGIA
ISSN:
0300-2896
Año:
2022
Vol.:
58
N°:
7
Págs.:
565 - 565
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGIA
ISSN:
0300-8932
Año:
2022
Vol.:
75
N°:
1
Págs.:
60 - 66
Introduction and objectives: Heart retransplantation (ReHT) is controversial in the current era. The aim of this study was to describe and analyze the results of ReHT in Spain.
Methods: We performed a retrospective cohort analysis from the Spanish Heart Transplant Registry from 1984 to 2018. Data were collected on donors, recipients, surgical procedure characteristics, immunosuppression, and survival. The main outcome was posttransplant all-cause mortality or need for ReHT. We studied differences in survival according to indication for ReHT, the time interval between transplants and era of ReHT.
Results: A total of 7592 heart transplants (HT) and 173 (2.3%) ReHT were studied (median age, 52.0 and 55.0 years, respectively). Cardiac allograft vasculopathy was the most frequent indication for ReHT (42.2%) and 59 patients (80.8%) received ReHT > 5 years after the initial transplant. Acute rejection and primary graft failure decreased as indications over the study period. Renal dysfunction, hypertension, need for mechanical ventilation or intra-aortic balloon pump and longer cold ischemia time were more frequent in ReHT. Median follow-up for ReHT was 5.8 years. ReHT had worse survival than HT (weighted HR, 1.43; 95%CI, 1.17-1.44; P < .001). The indication of acute rejection (HR, 2.49; 95%CI, 1.45-4.27; P < .001) was related to the worst outcome. ReHT beyond 5 years after initial HT portended similar results as primary HT (weighted HR, 1.14; 95%CI, 0.86-1.50; P < .001).
Conclusions: ReHT was associated with higher mortality than HT, especially when indicated for acute rejection. ReHT beyond 5 years had a similar prognosis to primary HT.
Revista:
MEDICINA CLINICA
ISSN:
0025-7753
Año:
2022
Vol.:
158
N°:
11
Págs.:
543 - 546
Background and objective: We compared the efficacy and safety of standard vs. extended primary cytomegalovirus (CMV) prophylaxis in solid organ transplantation.
Materials and methods: Retrospective cohort study of CMV seronegative recipients who received CMV prophylaxis after solid organ transplantation from seropositive donor (D+/R-) (2007-2017). CMV infection in the first two years after transplantation in recipients with prophylaxis longer or shorter than 100 days were compared.
Results: CMV infection occurred in 29 of 66 patients (43.9%) with prophylaxis. Forty-five patients (68.2%) received extended prophylaxis. CMV infection and disease rates were not different between patients with extended and standard prophylaxis. However, extended prophylaxis was associated with a higher rate of myelotoxicity (68.9% vs. 42.9%, p<0.05).
Conclusions: Extending primary CMV prophylaxis over 100 days did not prevent late-onset infection but it was associated with hematological toxicity.
Autores:
de By, T. M. M. H. (Autor de correspondencia); Schoenrath, F.; Veen, K. M.; et al.
Revista:
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
ISSN:
1010-7940
Año:
2022
Vol.:
62
N°:
1
Págs.:
ezac032
OBJECTIVES In the third report of the European Registry for Patients with Mechanical Circulatory Support of the European Association for Cardio-Thoracic Surgery, outcomes of patients receiving mechanical circulatory support are reviewed in relation to implant era. METHODS Procedures in adult patients (January 2011-June 2020) were included. Patients from centres with <60% follow-ups completed were excluded. Outcomes were stratified into 3 eras (2011-2013, 2014-2017 and 2018-2020). Adverse event rates (AERs) were calculated and stratified into early phase (<3 months) and late phase (>3 months). Risk factors for death were explored using univariable Cox regression with a stepwise time-varying hazard ratio (3 months). RESULTS In total, 4834 procedures in 4486 individual patients (72 hospitals) were included, with a median follow-up of 1.1 (interquartile range: 0.3-2.6) years. The annual number of implants (range: 346-600) did not significantly change (P = 0.41). Both Interagency Registry for Mechanically Assisted Circulatory Support class (classes 4-7: 23, 25 and 33%; P < 0.001) and in-hospital deaths (18.5, 17.2 and 11.2; P < 0.001) decreased significantly between eras. Overall, mortality, transplants and the probability of weaning were 55, 25 and 2% at 5 years after the implant, respectively. Major infections were mainly noted early after the implant occurred (AER(3 months): 0.45). Bilirubin and creatinine levels were significant risk factors in the early phase but not in the late phase after the implant. CONCLUSIONS In its 10 years of existence, EUROMACS has become a point of reference enabling benchmarking and outcome monitoring. Patient characteristics and outcomes changed between implant eras. In addition, both occurrence of outcomes and risk factor weights are time dependent. As a registry of the European Association for Cardio-Thoracic Surgery, the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) offers a robust repository of clinical data on long-term mechanical circulatory support (MCS) from a large international community.
Autores:
Ortiz-Bautista, C. (Autor de correspondencia); Muniz, J.; Almenar-Bonet, L.; et al.
Revista:
CLINICAL TRANSPLANTATION
ISSN:
0902-0063
Año:
2022
Vol.:
36
N°:
9
Págs.:
e14774
Introduction and objectives The Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score was derived and validated as a predictor of mortality after heart transplantation (HT). The primary objective of this work is to externally validate the IMPACT score in a contemporary Spanish cohort. Methods Spanish Heart Transplant Registry data were used to identify adult (>16 years) HT patients between January 2000 and December 2015. Retransplantation, multiorgan transplantation and patients in whom at least one of the variables required to calculate the IMPACT score was missing were excluded from the analysis (N = 2810). Results Median value of the IMPACT score was five points (IQR: 3, 8). Overall, 1-year survival rate was 79.1%. Kaplan-Meier 1-year survival rates by IMPACT score categories (0-2, 3-5, 6-9, 10-14, >= 15) were 84.4%, 81.5%, 79.3%, 77.3%, and 58.5%, respectively (Log-Rank test: p < .001). Performance analysis showed a good calibration (Hosmer-Lemeshow chi-square for 1 year was 7.56; p = .47) and poor discrimination ability (AUC-ROC .59) of the IMPACT score as a predictive model. Conclusions In a contemporary Spanish cohort, the IMPACT score failed to accurately predict the risk of death after HT.
Autores:
López-Vilella, R. (Autor de correspondencia); González-Vílchez, F.; Crespo-Leiro, M. G.; et al.
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGIA
ISSN:
0300-8932
Año:
2021
Vol.:
74
N°:
5
Págs.:
393 - 401
Introduction and objectives: The age of heart transplant recipients and donors is progressively increasing. It is likely that not all donor-recipient age combinations have the same impact on mortality. The objective of this work was to compare survival in transplant recipients according to donor-recipient age combinations. Methods: We performed a retrospective analysis of transplants performed between 1 January 1993 and 31 December 2017 in the Spanish Heart Transplant Registry. Pediatric transplants, retransplants and combined transplants were excluded (6505 transplants included). Four groups were considered: a) donor < 50 years for recipient < 65 years; b) donor < 50 years for recipient >= 65 years; c) donor >= 50 years for recipient >= 65 years, and d) donor >= 50 years for recipient < 65 years. Results: The most frequent group was young donor for young recipient (73%). There were differences in the median survival between the groups (P<.001): a) younger-younger: 12.1 years, 95%CI, 11.5-12.6; b) younger-older: 9.1 years, 95%CI, 8.0-10.5; c) older-older: 7.5 years, 95%CI, 2.8-11.0; d) older-younger: 10.5 years, 95%CI, 9.6-12.1. On multivariate analysis, independent predictors of mortality were the age of the donor and the recipient (0.008 and 0.001, respectively). The worst combinations were older-older vs younger-younger (HR, 1.57; 95%CI, 1.22-2.01; P<.001) and younger-older vs younger-younger (HR, 1.33; 95%CI, 1.12-1.58; P=.001). Conclusions: Age (of the donor and recipient) is a relevant prognostic factor in heart transplant. The donor-recipient age combination has prognostic implications that should be identified when accepting an organ for transplant. (C) 2020 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
Autores:
Garcia-Cosio, M. D. (Autor de correspondencia); Gonzalez-Vilchez, F.; Lopez-Vilella, R.; et al.
Revista:
FRONTIERS IN CARDIOVASCULAR MEDICINE
ISSN:
2297-055X
Año:
2021
Vol.:
8
Págs.:
630113
Biological differences between males and females change the course of different diseases and affect therapeutic measures' responses. Heart failure is not an exception to these differences. Women account for a minority of patients on the waiting list for heart transplantation or other advanced heart failure therapies. The reason for this under-representation is unknown. Men have a worse cardiovascular risk profile and suffer more often from ischemic heart disease. Conversely, transplanted women are younger and more frequently have non-ischemic cardiac disorders. Women's poorer survival on the waiting list for heart transplantation has been previously described, but this trend has been corrected in recent years. The use of ventricular assist devices in women is progressively increasing, with comparable results than in men. The indication rate for a heart transplant in women (number of women on the waiting list for millions of habitants) has remained unchanged over the past 25 years. Long-term results of heart transplants are equal for both men and women. We have analyzed the data of a national registry of heart transplant patients to look for possible future directions for a more in-depth study of sex differences in this area. We have analyzed 1-year outcomes of heart transplant recipients. We found similar results in men and women and no sex-related interactions with any of the factors related to survival or differences in death causes between men and women. We should keep trying to approach sex differences in prospective studies to confirm if they deserve a different approach, which is not supported by current evidence.
Revista:
AMERICAN JOURNAL OF ROENTGENOLOGY
ISSN:
0361-803X
Año:
2021
Vol.:
216
N°:
5
Págs.:
1216 - 1221
OBJECTIVE. This study aimed to evaluate the long-term prognostic value of coronary CTA (CCTA) in heart transplant recipients. MATERIALS AND METHODS. The records of 114 patients who had undergone a heart transplant (mean age, 61.7 +/- 11.1 [SD] years; 83.3% men) and who underwent CCTA for the surveillance of coronary allograft vasculopathy (CAV) from June 2007 to December 2017 were retrospectively evaluated for the occurrence of major adverse cardiovascular events (MACEs) (cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, coronary revascularization, cardiac arrhythmias, stroke, and retransplant). Patients were classified according to the presence of nonobstructive CAV (lumen reduction < 50%) or obstructive disease (lumen reduction >= 50%) and using a coronary segment involvement score (SIS). Differences in MACE rate between groups were compared. RESULTS. Obstructive CAV was observed in 12 heart transplant recipients (10.5%). During a mean follow-up of 67.5 +/- 41.4 months the overall rates of MACE were 50% and 14.7% in patients with obstructive and nonobstructive CAV, respectively (p < .05), resulting in an odds ratio for MACE of 6 (95% CI, 1.7-21.2). Comparison of event-free survival showed a hazard ratio (HR) of 5 (95% CI, 1.95-13; p =. 004) for patients with obstructive disease. The presence of four or more stenotic coronary segments (SIS = 4) was associated with a higher rate of events (HR, 3.46; 95% CI, 1.46-8.23). CONCLUSION. In patients who have undergone a heart transplant, CCTA offers a significant long-term prognostic impact on the prediction of MACEs.
Autores:
Minguito-Carazo, C. (Autor de correspondencia); Gómez-Bueno, M.; Almenar-Bonet, L.; et al.
Revista:
TRANSPLANT INTERNATIONAL
ISSN:
0934-0874
Año:
2021
Vol.:
34
N°:
5
Págs.:
882 - 893
Male patients are at increased risk for developing malignancy postheart transplantation (HT); however, real incidence and prognosis in both genders remain unknown. The aim of this study was to assess differences in incidence and mortality related to malignancy between genders in a large cohort of HT patients. Incidence and mortality rates were calculated for all tumors, skin cancers (SCs), lymphoma, and nonskin solid cancers (NSSCs) as well as survival since first diagnosis of neoplasia. 5865 patients (81.6% male) were included. Total incidence rates for all tumors, SCs, and NSSCs were lower in females [all tumors: 25.7 vs. 44.8 per 1000 person-years; rate ratio (RR) 0.68, (0.60-0.78), P < 0.001]. Mortality rates were also lower in females for all tumors [94.0 (77.3-114.3) vs. 129.6 (120.9-138.9) per 1000 person-years; RR 0.76, (0.62-0.94), P = 0.01] and for NSSCs [125.0 (95.2-164.0) vs 234.7 (214.0-257.5) per 1000 person-years; RR 0.60 (0.44-0.80), P = 0.001], albeit not for SCs or lymphoma. Female sex was associated with a better survival after diagnosis of malignancy [log-rank p test = 0.0037; HR 0.74 (0.60-0.91), P = 0.004]. In conclusion, incidence of malignancies post-HT is higher in males than in females, especially for SCs and NSSCs. Prognosis after cancer diagnosis is also worse in males.
Revista:
CIRUGIA CARDIOVASCULAR
ISSN:
1134-0096
Año:
2021
Vol.:
28
N°:
6
Págs.:
353 - 356
El tratamiento percutáneo de la estenosis aórtica severa es una opción terapéutica para paciente inoperables y para aquellos de moderado o elevado riesgo quirúrgico.
Presentamos el caso de un paciente joven inicialmente considerado inoperable, sometido a una implantación transcatéter de válvula aórtica, que comenzó a mostrar signos de degeneración tras seis años, que evolucionaron hasta requerir tratamiento quirúrgico a los ocho años del implante. Durante este tiempo, su estado de salud mejoró, por lo que fue presentado en sesión médico quirúrgica para la resección de la válvula previamente implantada y sustitución por otra bioprótesis. El procedimiento transcurrió sin complicaciones.
No obstante, la resección de estas válvulas no es un procedimiento exento de riesgo, por las densas adherencias del marco a la raíz aórtica.
Por este motivo, la expansión de esta tecnología a pacientes jóvenes y de bajo riesgo, no estaría justificada.
Autores:
Valero-Masa, M. J.; Gonzalez-Vilchez, F. ; Almenar-Bonet, L. ; et al.
Revista:
INTERNATIONAL JOURNAL OF CARDIOLOGY
ISSN:
0167-5273
Año:
2020
Vol.:
319
Págs.:
14 - 19
Background: Cold ischemia time (CIT) has been associated to heart transplantation (HT) prognosis. However, there is still uncertainty regarding the CIT cutoff value that might have relevant clinical implications. Methods: We analyzed all adults that received a first HT during the period 2008-2018. CIT was defined as the time between the cross-clamp of the donor aorta and the reperfusion of the heart. Primary outcome was 1-month mortality. Results: We included 2629 patients, mean age was 53.3 +/- 12.1 years and 655 (24.9%) were female. Mean CIT was 202 +/- 67 min (minimum 20 min, maximum 600 min). One-month mortality per CIT quartile was 9, 12, 13, and 19%. One-year mortality per CIT quartile was 16, 19, 21, and 28%. CIT was an independent predictor of 1-month mortality, but only in the last quartile of CIT >246 min (odds ratio 2.1, 95% confidence interval 1.49-3.08, p < .001). We found no relevant differences in CIT during the study period. However, the impact of CIT in 1-month and 1-year mortality decreased with time (p value for the distribution of ischemic time by year 0.01), particularly during the last 5 years. Conclusions: Although the impact of CIT in HT prognosis seems to be decreasing in the last years, CIT in the last quartile (>246 min) is associated with 1-month and 1-year mortality. Our findings suggest the need to limit HT with CIT > 246 min or to use different myocardial preservation systems if the expected CIT is >4 h.
Autores:
Garcia-Cosio, M. D. (Autor de correspondencia); Gonzalez-Vilchez, F. ; Lopez-Vilella, R.; et al.
Revista:
CLINICAL TRANSPLANTATION
ISSN:
0902-0063
Año:
2020
Vol.:
34
N°:
12
Págs.:
e14096
The study of gender differences may lead into improvement in patient care. We have aimed to identify the gender differences in heart transplantation (HT) of adult HT recipients in Spain and their evolution in a study covering the years 1993-2017 in which 6740 HT (20.6% in women) were performed. HT indication rate per million inhabitants was lower in women, remaining basically unchanged during the 25-year study period. HT rate was higher in men, although this decreased over the 25-year study period. Type of heart disease differed in men versus women (p < .001): ischemic heart disease 47.6% versus 22.5%, dilated cardiomyopathy 41.3% versus 34.6%, or other 36% versus 17.8%, respectively. Men were more frequently diabetics (18% vs. 13.1%p < .001), hypertensives (33.1% vs. 24%p < .001), and smokers (21.7% vs. 12.9%p < .001), respectively. Women had more pre-HT malignancies (7.1% vs. 2.8%p < .001), and their clinical status was worse at HT due to renal function and mechanical ventilation. Adjusted survival (p = .198) and most of the mortality-related variables were similar in men and women. Death occurred more frequently in women due to rejection (7.9% vs. 5.1%p < .001) and primary failure (18.2% vs. 12.5%p < .001) and in men due to malignancies (15.1% vs. 6.6%p < .001).
Revista:
AMERICAN JOURNAL OF ROENTGENOLOGY
ISSN:
0361-803X
Año:
2020
Vol.:
215
N°:
4
Págs.:
828 - 833
OBJECTIVE. The purpose of this study was to evaluate the feasibility, image quality, and radiation dose of high-pitch coronary CT angiography (CCTA) in orthotopic heart transplant (OHT) recipients. SUBJECTS AND METHODS. Twenty-two consecutive OHT recipients (16 men, six women; median age, 66.5 years [interquartile range, 51.3-70.3 years]; median heart rate, 91 beats/min [interquartile range, 79.3-97.3 beats/min]) underwent CCTA with a third-generation dual-source CT scanner in high-pitch mode to rule out coronary allograft vasculopathy. Data acquisition was triggered at 30% of the R-R interval. Two independent observers blindly assessed image quality on a per-segment, per-vessel, and per-patient basis using a 4-point scale (4, excellent; 1, not evaluative). Scores 2-4 indicated diagnostic quality. Studies were compared with previously performed retrospective ECG-gated examinations, when available. Interobserver agreement on the image quality was assessed with kappa statistics. Radiation dose was recorded. RESULTS. A total of 322 coronary segments were evaluated. Diagnostic image quality was observed in 97.5% of the segments. Interobserver agreement for image quality assessment was very good on a per-patient (kappa = 0.82), per-vessel (kappa = 0.83), and per-segment basis (kappa = 0.89). The median per-patient image quality score was 4.0 (3.0-4.0) for the entire coronary tree. A comparison of image quality scores between high-pitch and retrospective ECG-gated CCTA examinations showed no significant differences, but the estimated mean radiation dose was significantly lower for the high-pitch mode (median dose-length product, 31.6 mGy x cm [interquartile range, 23.1-38.8 mGy x cm] vs 736.5 mGy x cm [interquartile range, 655.5-845.7 mGy x cm], p < 0.001). CONCLUSION. Performing single-heartbeat high-pitch CCTA during the systolic phase of the cardiac cycle in OHT recipients results in diagnostic image quality in coronary angiograms at very low radiation dose.
Revista:
RADIOLOGIA
ISSN:
0033-8338
Año:
2020
Vol.:
62
N°:
6
Págs.:
493 - 501
Objective: To compare the myocardial perfusion reserve index (MPRI) measured during stress cardiac magnetic resonance imaging (MRI) with regadenoson in patients with heart transplants versus in patients without heart transplants. Material and methods: We retrospectively compared 20 consecutive asymptomatic heart transplant patients without suspicion of microvascular disease who underwent stress cardiac MRI with regadenoson and coronary computed tomography angiography (CTA) to rule out cardiac alto graft vasculopathy versus 16 patients without transplants who underwent clinically indicated stress cardiac MRI who were negative for ischemia and had no signs of structural heart disease. We estimated MPRI semiquantitatively after calculating the up-slope of the first-pass enhancement curve and dividing the value obtained during stress by the value obtained at rest. We compared MPRI in the two groups. Patients with positive findings for ischemia on stress cardiac MRI or significant coronary stenosis on coronary CTA were referred for conventional coronary angiography. Results: More than half the patients remained asymptomatic during the stress test. Stress cardiac MRI was positive for ischemia in two heart transplant patients; these findings were confirmed at coronary CTA and at conventional coronary angiography. Patients with transplants had lower end-diastolic volume index (59.3 +/- 15.2 ml/m(2) vs. 71.4 +/- 15.9 ml/m(2) in those without transplants, p = 0.03), lower MPRI (1.35 +/- 0.19 vs. 1.6 +/- 0.28 in those without transplants, p = 0.003), and a less pronounced hemodynamic response to regadenoson (mean increase in heart rate 13.1 +/- 5.4 bpm vs. 28.5 +/- 8.9 bpm in those without transplants, p<0.001). Conclusion: Stress cardiac MRI with regadenoson is safe. In the absence of epicardial coronary artery disease, patients with heart transplants have lower MPRI than patients without transplants, suggesting microvascular disease. The hemodynamic response to regadenoson is less pronounced in patients with heart transplants than in patients without heart transplants. (C) 2020 SERAM. Published by Elsevier Espana, S.L.U. All rights reserved.
Autores:
Martinez-Martinez, E.; Brugnolaro, C. ; Ibarrola, J.; et al.
Revista:
HYPERTENSION
ISSN:
0194-911X
Año:
2019
Vol.:
73
N°:
3
Págs.:
602 - 611
Myocardial fibrosis is a main contributor to the development of heart failure (HF). CT-1 (cardiotrophin-1) and Gal-3 (galectin-3) are increased in HF and associated with myocardial fibrosis. The aim of this study is to analyze whether CT-1 regulates Gal-3. Proteomic analysis revealed that Gal-3 was upregulated by CT-1 in human cardiac fibroblasts in parallel with other profibrotic and proinflammatory markers. CT-1 upregulation of Gal-3 was mediated by ERK (extracellular signal-regulated kinase) 1/2 and Stat-3 (signal transducer and activator of transcription 3) pathways. Male Wistar rats and B6CBAF1 mice treated with CT-1 (20 mu g/kg per day) presented higher cardiac Gal-3 levels and myocardial fibrosis. In CT-1-treated rats, direct correlations were found between cardiac CT-1 and Gal-3 levels, as well as between Gal-3 and perivascular fibrosis. Gal-3 genetic disruption in human cardiac fibroblasts and pharmacological Gal-3 inhibition in mice prevented the profibrotic and proinflammatory effects of CT-1. Dahl salt-sensitive hypertensive rats with diastolic dysfunction showed increased cardiac CT-1 and Gal-3 expression together with cardiac fibrosis and inflammation. CT-1 and Gal-3 directly correlated with myocardial fibrosis. In HF patients, myocardial and plasma CT-1 and Gal-3 were increased and directly correlated. In addition, HF patients with high CT-1 and Gal-3 plasma levels presented an increased risk of cardiovascular death. Our data suggest that CT-1 upregulates Gal-3 which, in turn, mediates the proinflammatory and profibrotic myocardial effects of CT-1. The elevation of both molecules in HF patients identifies a subgroup of patients with a higher risk of cardiovascular mortality. The CT-1/Gal-3 axis emerges as a candidate therapeutic target and a potential prognostic biomarker in HF.
Autores:
Rodriguez-Manero, M.; Azcarate-Aguero, P. (Autor de correspondencia); Kreidieh, B. ; et al.
Revista:
ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES
ISSN:
0742-2822
Año:
2019
Vol.:
36
N°:
2
Págs.:
306 - 311
Introduction: We evaluate the ability of 2D non-contrast-enhanced echocardiography (CE-echo), 2DCE-echo, 3D-echo, 3D non-CE-echo, and 3DCE-echo to evaluate allograft function and dimensions in orthotropic heart transplantation (OHT). Cardiac resonance (CMR) was used as reference. Methods: Twenty six consecutive OHT-recipients were prospectively recruited. Bland-Altman, Spearman rank, and concordance-correlation coefficients (CCC) were determined. Results: Good CCCs were found between the four modalities and CMR for ejection fraction (r >= 0.72/P < 0.001; r >= 0.77/ P < 0.001; r >= 0.51/ P < 0.23; r >= 0.75/P < 0.001, respectively). Highest intraclass correlation coefficient (ICC) was for 2D CE-echo(CCC = 0.77). End-diastolic volume(EDV) measurements statistically differed when 2D non-CE-echo, 2DCE-echo, and 3D non-CE-echo were compared with the cross-sectional imaging modalities, but they did not differ significantly from 3DCE-echo. End-systolic volume (ESV) and stroke volume (SV) differed statistically between the four modalities; however, SV measured by CMR and 3DCE-echo were comparable. Overall, 2D non-CE-echo, 2DCE-echo, and 3D non-CE-echo showed lower mean EDV, ESV, and SV than CMR. ICC was that of the ESV variable in the 4 techniques, with the values of the ICC of the 3DCE-echo technique superior to the rest. Overall, the best CCC were found for 3DCE(r = 0.88, 0.92 and 0.76 for EDV, ESV and SV, respectively). Conclusion: Routine use of 3DCE-echo may allow more comprehensive cardiac assessment in cardiac transplant recipients.
Autores:
Barge-Caballero, E. (Autor de correspondencia); Gonzalez-Vilchez, F.; Delgado, J. F.; et al.
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGIA
ISSN:
0300-8932
Año:
2019
Vol.:
72
N°:
10
Págs.:
835 - 843
Introduction and objectives: In Spain, intra-aortic balloon pump (IABP) has been used frequently as a bridge to urgent heart transplant (HT). We sought to analyze the clinical outcomes of this strategy. Methods: We conducted a case-by-case, retrospective review of clinical records of 281 adult patients listed for urgent HT under IABP support in 16 Spanish institutions from 2010 to 2015. Pre- and post-transplant survival and adverse clinical events were analyzed. Results: A total of 194 (69%, 95%CI, 63.3-74.4) patients were transplanted and 20 (7.1%, 95%CI, 4.4-10.8) died during a mean period of IABP support of 10.9 +/- 9.7 days. IABP support was withdrawn before an organ became available in 32 (11.4%) patients. Thirty-five (12.5%, 95%CI, 8.8-16.9) patients transitioned from IABP to full-support mechanical devices. Mean urgent waiting list time increased from 5.9 +/- 6.3 days in 2010 to 15 +/- 11.7 days in 2015 (P = .001). Post-transplant survival rates at 30-days, 1-year, and 5-years were 88.1% (95%CI, 85.7-90.5), 76% (95%CI, 72.9-79.1), and 67.8% (95%CI, 63.7-71.9), respectively. The incidence rate of major adverse clinical outcomes-device dysfunction, stroke, bleeding or infection-during IABP support was 26 (95%CI, 20.6-32.4) episodes per 1000 patient-days. The incidence rate of IABP explantation due to complications was 7.2 (95%CI, 4.5-10.8) cases per 1000 patient-days. Conclusions: In a setting of short waiting list times, IABP can be used to bridge candidates to urgent HT with acceptable postoperative results, but there were significant rates of adverse clinical events during support. (C) 2018 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
Autores:
Couto-Mallon, D.; Gonzalez-Vilchez, F.; Almenar-Bonet, L.; et al.
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGIA
ISSN:
0300-8932
Año:
2019
Vol.:
72
N°:
3
Págs.:
208 - 214
Introduction and objectives: To study the prognostic value of serum lactate in patients under temporary preoperative mechanical circulatory support who underwent urgent heart transplant.
Methods: We conducted a subanalysis of a Spanish multicenter registry recording data on patients under temporary mechanical circulatory support listed for highly urgent heart transplant from 2010 to 2015. Participants selected for the present study were those who received a transplant and who had known preoperative serum lactate levels. The main study outcome was 1-year survival after transplant.
Results: A total of 177 heart transplant recipients were studied; preoperatively, 90 were supported on venoarterial extracorporeal membrane oxygenation, 51 on temporary left ventricular assist devices, and 36 on temporary biventricular assist devices. Preoperative hyperlactatemia (¿ 2 mmol/L) was present in 44 (25%) patients. On multivariable analysis, pretransplant serum lactate was identified as an independent predictor of 1-year posttransplant survival (adjusted HR per 0.1 mmol/L, 1.02; 95%CI, 1.01-1.03; P = .007). One-year posttransplant survival was 53.1% (95%CI, 45.3-60.9) in patients with preoperative hyperlactatemia and 75.6% (95%CI, 71.8-79.4) in those without preoperative hyperlactatemia (adjusted HR, 1.94; 95%CI, 1.04-3.63; P = .039). Preoperative hyperlactatemia correlated with adverse outcomes in patients supported with extracorporeal membrane oxygenation, but not in patients supported
Autores:
Barge-Caballero, G. (Autor de correspondencia); Castel-Lavilla, M. A.; Almenar-Bonet, L.; et al.
Revista:
INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY
ISSN:
1569-9293
Año:
2019
Vol.:
29
N°:
5
Págs.:
670 - 677
OBJECTIVES: To investigate the potential clinical benefit of an intra-aortic balloon pump (IABP) in patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to heart transplantation (HT). METHODS: We studied 169 patients who were listed for urgent HT under VA-ECMO support at 16 Spanish institutions from 2010 to 2015. The clinical outcomes of patients under simultaneous IABP support (n=73) were compared to a control group of patients without IABP support (n=96). RESULTS: There were no statistically significant differences between the IABP and control groups with regard to the cumulative rates of transplantation (71.2% vs 81.2%, P=0.17), death during VA-ECMO support (20.6% vs 14.6%, P=0.31), transition to a different mechanical circulatory support device (5.5% vs 5.2%, P=0.94) or weaning from VA-ECMO support due to recovery (2.7% vs 0%, P=0.10). There was a higher incidence of bleeding events in the IABP group (45.2% vs 25%, P=0.006; adjusted odds ratio 2.18, 95% confidence interval 1.02-4.67). In-hospital postoperative mortality after HT was 34.6% in the IABP group and 32.5% in the control group (P=0.80). One-year survival after listing for urgent HT was 53.3% in the IABP group and 52.2% in the control group (log rank P=0.75). Multivariate adjustment for potential confounders did not change this result (adjusted hazard ratio 0.94, 95% confidence interval 0.56-1.58). CONCLUSIONS: In our study, simultaneous IABP therapy in transplant candidates under VA-ECMO support did not significantly reduce morbidity or mortality.
Autores:
Barge-Caballero, E. (Autor de correspondencia); Almenar-Bonet, L.; Gonzalez-Vilchez, F. ; et al.
Revista:
EUROPEAN JOURNAL OF HEART FAILURE
ISSN:
1388-9842
Año:
2018
Vol.:
20
N°:
1
Págs.:
178 - 186
Background In Spain, listing for high-urgent heart transplantation is allowed for critically ill candidates not weanable from temporary mechanical circulatory support (T-MCS). We sought to analyse the clinical outcomes of this strategy. Methods and results We conducted a case-by-case, retrospective review of clinical records of 291 adult patients listed for high-urgent heart transplantation under temporary devices from 2010 to 2015 in 16 Spanish institutions. Survival after listing and adverse clinical events were studied. At the time of listing, 169 (58%) patients were supported on veno-arterial extracorporeal membrane oxygenation (VA-ECMO), 70 (24%) on temporary left ventricular assist devices (T-LVAD) and 52 (18%) on temporary biventricular assist devices (T-BiVAD). Seven patients transitioned from VA-ECMO to temporary ventricular assist devices while on the waiting list. Mean time on T-MCS was 13.112.6days. Mean time from listing to transplantation was 7.6 +/- 8.5 days. Overall, 230 (79%) patients were transplanted and 54 (18.6%) died during MCS. In-hospital postoperative mortality after transplantation was 33.3%, 11.9% and 26.2% for patients bridged on VA-ECMO, T-LVAD and T-BiVAD, respectively (P = 0.008). Overall survival from listing to hospital discharge was 54.4%, 78.6% and 55.8%, respectively (P = 0.002). T-LVAD support was independently associated with a lower risk of death over the first year after listing (hazard ratio 0.52, 95% confidence interval 0.30-0.92). Patients treated with VA-ECMO showed the highest incidence rate of adverse clinical events associated with T-MCS. Conclusion Temporary devices may be used to bridge critically ill candidates directly to heart transplantation in a setting of short waiting list times, as is the case of Spain. In our series, bridging with T-LVAD was associated with more favourable outcomes than bridging with T-BiVAD or VA-ECMO.
Revista:
INDIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
ISSN:
0970-9134
Año:
2018
Vol.:
34
N°:
2
Págs.:
161 - 163
Left main coronary artery aneurysm is an extremely uncommon coronary pathology that can present with angina, myocardial infarction, pericardial tamponade, or sudden death, and whose treatment still remains controversial. Here, we present a 64-year-old woman admitted due to angina with a previous mitral and aortic valve replacement. Transthoracic echocardiogram revealed an aortic prosthesis dysfunction and preoperative angiogram showed a large left main coronary artery aneurysm. Surgical aneurysm exclusion with concomitant coronary artery bypass grafting and aortic prosthesis replacement were performed after defining the aneurysm's anatomical details and relationship using contrast-enhanced computed tomography.
Autores:
Barge-Caballero, E. (Autor de correspondencia); Almenar-Bonet, L.; Crespo-Leiro, M. G..; et al.
Revista:
INTERNATIONAL JOURNAL OF CARDIOLOGY
ISSN:
0167-5273
Año:
2018
Vol.:
250
Págs.:
183 - 187
Background: It's unclear whether pre-transplant T. gondii seropositivity is associated with impaired survival in heart transplant recipients. Objectives: To test the above-mentioned hypothesis in the Spanish Heart Transplantation Registry. Methods: Post-transplant outcomes of 4048 patients aged >16 years who underwent first, single-organ heart transplantation in 17 Spanish institutions from 1984 to 2014 were studied. Long-term post-transplant survival and survival free of cardiac death or retransplantation of 2434 (60%) T. gondii seropositive recipients and 1614 (40%) T. gondii seronegative recipients were compared. Results: T. gondii seropositive recipients were older, had higher body mass index, and presented higher prevalence of hypertension, hypercholesterolemia, COPD and Cytomegalovirus seropositivity than T. gondii seronegative recipients. In univariable analysis, pre-transplant T. gondii seropositivity was associated with increased post-transplant all-cause mortality (non-adjusted HR 1.15; 95% CI 1.04-1.26). However, this effect was no longer statistically significant after multivariable adjustment by recipient's age and sex (adjusted HR 1.01, 95% CI 0.92-1.11). Extended multivariable adjustment by other potential confounders showed similar results (adjusted HR 0.99, 95% CI 0.89-1.11). T. gondii seropositivity had no significant effect on the composite outcome cardiac death or retransplantation (non-adjusted HR 1.08, 95% CI 0.95-1.24, p = 0.235). The distribution of the causes of death was comparable in T. gondii seropositive and T. gondii seronegative recipients. No statistically significant impact of donor's T. gondii serostatus or donor-recipient T. gondii serostatus matching on post-transplant survival was observed. Conclusions: Our analysis did not show a significant independent effect of preoperative T. gondii serostatus on long-term outcomes after heart transplantation. (C) 2017 Elsevier B.V. All rights reserved.
Revista:
TRANSPLANT INFECTIOUS DISEASE
ISSN:
1398-2273
Año:
2018
Vol.:
20
N°:
3
Págs.:
e12873
Background: Cytomegalovirus (CMV) is the most important viral pathogen in solid organ transplant (SOT) recipients. The role of secondary CMV prophylaxis in this population remains unclear.
Methods: Retrospective cohort study in a single center. SOT recipients treated for CMV infection from 2007 to 2014 were studied to determine the efficacy and safety of secondary prophylaxis and its impact on graft loss and mortality. The outcome variable was CMV replication in the first 3 months after the end of therapy. Secondary variables were crude mortality and graft lost censored at 5 years after transplantation. Propensity score for the use of secondary prophylaxis was used to control selection bias.
Results: Of the 126 treated patients, 103 (83.1%) received CMV secondary prophylaxis. CMV relapse occurred in 44 (35.5%) patients. The use of secondary prophylaxis was not associated with fewer relapses (34.0% in patients with prophylaxis vs. 42.9% in those without prophylaxis, p= 0.29).After a mean follow-up of 32.1 months, graft loss was not different between both groups but patient mortality was significantly lower in patients who received secondary prophylaxis (5.8% vs. 28.6%, p= 0.003).
Conclusion: Secondary prophylaxis did not prevent CMV infection relapse but it was associated with improved patient survival.
Revista:
CIRUGIA CARDIOVASCULAR
ISSN:
1134-0096
Año:
2018
Vol.:
25
N°:
4
Págs.:
208 - 211
Mitral valve aneurysms are very rare complications of bacterial endocarditis. We present the case of an 88-year-old woman with moderate aortic insufficiency and an aneurysm in the anterior leaflet of the mitral valve secondary to endocarditis. After completing a full course of antibiotic, we performed though the aortotomy, mitral leaflet aneurysm resection, repairing the defect with an autologous pericardial patch, and aortic valve replacement by a bioprosthesis. The evolution of the patient was uneventful and was discharged on the ninth postoperative day. (C) 2018 Sociedad Espanola de Cirugia Toracica-Cardiovascular. Published by Elsevier Espana, S.L.U.
Revista:
JOURNAL OF CARDIAC SURGERY
ISSN:
0886-0440
Año:
2017
Vol.:
32
N°:
1
Págs.:
64 - 65
Autores:
Sarmiento, E.; Jaramillo, M.; Calahorra, L.; et al.
Revista:
JOURNAL OF HEART AND LUNG TRANSPLANTATION
ISSN:
1053-2498
Año:
2017
Vol.:
36
N°:
5
Págs.:
529 - 539
BACKGROUND: New biomarkers are necessary to improve detection of the risk of infection in heart transplantation. We performed a multicenter study to evaluate humoral immunity profiles that could better enable us to identify heart recipients at risk of severe infections. METHODS: We prospectively analyzed 170 adult heart recipients at 8 centers in Spain. Study points were before transplantation and 7 and 30 days after transplantation. Immune parameters included IgG, IgM, IgA and complement factors C3 and C4, and titers of specific antibody to pneumococcal polysaccharide antigens (anti-PPS) and to cytomegalovirus (CMV). To evaluate potential immunologic mechanisms leading to IgG hypogammaglobulinemia, before heart transplantation we assessed serum B-cell activating factor (BAFF) levels using enzyme-linked immunoassay. The clinical follow-up period lasted 6 months. Clinical outcome was need for intravenous anti-microbials for therapy of infection. RESULTS: During follow-up, 53 patients (31.2%) developed at least 1 severe infection. We confirmed that IgG hypogammaglobulinemia at Day 7 (defined as IgG <600 mg/dl) is a risk factor for infection in general, bacterial infections in particular, and CMV disease. At Day 7 after transplantation, the combination of IgG <600 mg/dl + C3 <80 mg/dl was more strongly associated with the outcome (adjusted odds ratio 7.40; 95% confidence interval 1.48 to 37.03; p = 0.014). We found that quantification of anti-CMV antibody titers and lower anti-PPS antibody concentrations were independent predictors of CMV disease and bacterial infections, respectively. Higher pre-transplant BAFF levels were a risk factor of acute cellular rejection. CONCLUSION: Early immunologic monitoring of humoral immunity profiles proved useful for the identification of heart recipients who are at risk of severe infection. (C) 2017 International Society for Heart and Lung Transplantation. All rights reserved.
Revista:
EUROPEAN JOURNAL OF HAEMATOLOGY
ISSN:
0902-4441
Año:
2017
Vol.:
98
N°:
1
Págs.:
38 - 43
This retrospective study evaluates the impact of rituximab on PTLD response and survival in a single-centre cohort. PTLD cases between 1984 and 2009, including heart, kidney, liver and lung transplant recipients, were included. Survival was analysed taking into account the type of PTLD (monomorphic vs. polymorphic), EBV infection status, IPI score, Ann Arbor stage and use of rituximab. Among 1335 transplanted patients, 24 developed PTLD. Median age was 54 yr (range 29-69), median time to diagnosis 50 months (range 0-100). PTLD type was predominantly late/monomorphic (79% and 75%), mostly diffuse large B-cell type. Overall response rate (ORR) was 62% (66% rituximab vs. 50% non-rituximab; P = 0.5). R-CHOP-like regimens were used most frequently (72% of patients treated with rituximab). Median overall survival was 64 months (CI 95% 31-96). OS was significantly increased in patients treated with rituximab (P = 0.01; CI 95% rituximab 58-79 months; non-rituximab 1-30 months). Post-transplant immunosuppression regimen had no effect on survival or time to PTLD, except for cyclosporine A (CyA), which associated with increased time to PTLD (P = 0.02). Rituximab was associated with increased survival in our single-centre series, and it should be considered as first-line therapy for PTLD patients. The possible protective effect of CyA for development of PTLD should be prospectively evaluated.
Revista:
PLOS ONE
ISSN:
1932-6203
Año:
2017
Vol.:
12
N°:
2
Págs.:
e0172021
Perioperative anemia is an important risk factor for cardiac surgery-associated acute kidney injury (CSA-AKI). Nonetheless, the severity of the anemia and the time in the perioperative period in which the hemoglobin level should be considered as a risk factor is conflicting. The present study introduces the concept of perioperative hemoglobin area under the curve (pHb-AUC) as a surrogate marker of the evolution of perioperative hemoglobin concentration. Through a retrospective analysis of prospectively collected data, we assessed this new variable as a risk factor for the development of acute kidney injury after cardiac surgery in 966 adult patients who underwent cardiac surgery with cardiopulmonary bypass, at twenty-three academic hospitals in Spain. Exclusion criteria were patients on renal replacement therapy, who needed a reoperation because of bleeding and/or with missing perioperative hemoglobin or creatinine values. Using a multivariate regression analysis, we found that a pHb-AUC < 19 g/dL was an independent risk factor for CSA-AKI even after adjustment for intraoperative red blood cell transfusion (OR 1.41, p < 0.05). It was also associated with mortality (OR 2.48, p < 0.01) and prolonged hospital length of stay (4.67 +/- 0.99 days, p < 0.001).
Revista:
JOURNAL OF HYPERTENSION
ISSN:
0263-6352
Año:
2016
Vol.:
34
N°:
1
Págs.:
130 - 138
OBJECTIVES:
Cystatin C has been shown to be associated with heart failure with preserved ejection fraction (HFPEF). In addition, myocardial fibrosis has been involved in diastolic dysfunction in HFPEF. Therefore, we hypothesized that increased cystatin C levels may be associated with altered collagen metabolism, contributing to diastolic dysfunction in patients with HFPEF.
METHODS:
One hundred and forty-one elderly hypertensive patients with HFPEF were included. Cardiac morphology and function was assessed by echocardiography. Circulating levels of cystatin C, biomarkers of collagen type I synthesis (carboxy-terminal propeptide of procollagen type I) and degradation [matrix metalloproteinase-1 (MMP-1) and its inhibitor TIMP-1] and osteopontin were analyzed by ELISA. Twenty elderly sex-matched patients with no identifiable cardiac disease were used as controls. In-vitro studies were performed in human cardiac fibroblasts.
RESULTS:
Compared with controls, cystatin C was increased (P¿<¿0.001) in patients with HFPEF, even in those with a normal estimated glomerular filtration rate (eGFR; P¿<¿0.05). Cystatin C was directly correlated with the estimated pulmonary capillary wedge pressure (P¿<¿0.01), TIMP-1 and osteopontin (P¿<¿0.001) and inversely correlated with MMP-1:TIMP-1 (P¿<¿0.01), but not with carboxy-terminal propeptide of procollagen type I or MMP-1 in all patients with HFPEF. These associations were independent of eGFR. In vitro, osteopontin (P¿<¿0.01) and TIMP-1 (P¿<¿0.0
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGIA
ISSN:
0300-8932
Año:
2015
Vol.:
68
N°:
7
Págs.:
638-640
Nuestra experiencia indica que, para los pacientes con asistencia ventricular que sufran TIH sin trombosis asociada, en ausencia de test de activación plaquetaria disponible, la reexposición precoz a HNF exclusivamente durante el trasplante cardiaco podría ser una alternativa al uso de inhibidores directos de la trombina durante la CEC, siempre y cuando el recuento plaquetario se haya recuperado previamente y tras la intervención se reinicie un tratamiento anticoagulante alternativo a la heparina.
Autores:
Martinez Selles, M.; Almenar, L.; Paniagua Martin, M. J.; et al.
Revista:
TRANSPLANT INTERNATIONAL
ISSN:
0934-0874
Año:
2015
Vol.:
28
N°:
3
Págs.:
305 - 313
The results of studies on the association between sex mismatch and survival after heart transplantation are conflicting. Data from the Spanish Heart Transplantation Registry. From 4625 recipients, 3707 (80%) were men. The donor was female in 943 male recipients (25%) and male in 481 female recipients (52%). Recipients of male hearts had a higher body mass index (25.9 +/- 4.1 vs. 24.3 +/- 3.7; P < 0.01), and male donors were younger than female donors (33.4 +/- 12.7 vs. 38.2 +/- 12.3; P < 0.01). No further relevant differences related to donor sex were detected. In the univariate analysis, mismatch was associated with mortality in men (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.06-1.32; P = 0.003) but not in women (HR, 0.91; 95% CI 0.74-1.12; P = 0.4). A significant interaction was detected between sex mismatch and recipient gender (P = 0.02). In the multivariate analysis, sex mismatch was associated with long-term mortality (HR, 1.14; 95% CI 1.01-1.29; P = 0.04), and there was a tendency toward significance for the interaction between sex mismatch and recipient gender (P = 0.08). In male recipients, mismatch increased mortality mainly during the first month and in patients with pulmonary gradient >13 mmHg. Sex mismatch seems to be associated with mortality after heart transplantation in men but not in women.
Revista:
INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY
ISSN:
1569-9293
Año:
2015
Vol.:
20
N°:
2
Págs.:
254 - 259
Coenzyme Q10 (CoQ10) is a lipid-soluble antioxidant that could have beneficial effects in patients undergoing cardiac surgery with cardiopulmonary bypass. There is no clear evidence about its clinical effects or a systematic review published yet. We aimed to conduct a systematic review and meta-analysis of the literature to elucidate the role of coenzyme Q10 in preventing complications in patients undergoing cardiac surgery with cardiopulmonary bypass. We searched the PubMed Database using the following keywords: Coenzyme Q10, ubiquinone, ubiquinol, CoQ10, Heart Surgery, Cardiac surgery. Articles were systematically retrieved, selected, assessed and summarized for this review. We performed separate meta-analyses for different outcomes (inotropic drug requirements after surgery, incidence of ventricular arrhythmias and atrial fibrillation, cardiac index 24 h after surgery and hospital stay), estimating pooled odds ratios (ORs) or mean differences of the association of CoQ10 administration with the risk of these outcomes. Eight clinical trials met our inclusion criteria. Patients with CoQ10 treatment were significantly less likely to require inotropic drugs after surgery {OR [95% confidence interval (CI) 0.47 (0.27-0.81)]}, and to develop ventricular arrhythmias after surgery [OR (95% CI) 0.05 (0.01-0.31)]. However, CoQ10 treatment was not associated with Cardiac index 24 h after surgery [mean difference (95% CI) 0.06 (-0.30 to 0.43)], hospital stay (days) [mean difference (95% CI) -0.61 (-4.61 to 3.39)] and incidence of atrial fibrillation [OR (95% CI) 1.06 (0.19-6.04)]. Since none of the clinical trials included in this review report any adverse effects associated to CoQ10 administration, and coenzyme Q10 has been demonstrated to be safe even at much higher doses in other studies, we conclude that CoQ10 should be considered as a prophylactic treatment for preventing complications in patients undergoing cardiac surgery with cardiopulmonary bypass. However, better quality randomized, controlled trials are needed to clarify the role of CoQ10 in patients undergoing cardiac surgery with cardiopulmonary bypass.
Revista:
HYPERTENSION
ISSN:
0194-911X
Año:
2014
Vol.:
63
N°:
3
Págs.:
483 - 489
Cardiotrophin-1 has been shown to be profibrogenic in experimental models. The aim of this study was to analyze whether cardiotrophin-1 is associated with left ventricular end-diastolic stress and myocardial fibrosis in hypertensive patients with heart failure. Endomyocardial biopsies from patients (n=31) and necropsies from 7 control subjects were studied. Myocardial cardiotrophin-1 protein and mRNA and the fraction of myocardial volume occupied by collagen were increased in patients compared with controls (P<0.001). Cardiotrophin-1 overexpression in patients was localized in cardiomyocytes. Cardiotrophin-1 protein was correlated with collagen type I and III mRNAs (r=0.653, P<0.001; r=0.541, P<0.01) and proteins (r=0.588, P<0.001; r=0.556, P<0.005) in all subjects and with left ventricular end-diastolic wall stress (r=0.450; P<0.05) in patients. Plasma cardiotrophin-1 and N-terminal pro-brain natriuretic peptide and serum biomarkers of myocardial fibrosis (carboxy-terminal propeptide of procollagen type I and amino-terminal propeptide of procollagen type III) were increased (P<0.001) in patients compared with controls. Plasma cardiotrophin-1 was correlated with N-terminal pro-brain natriuretic peptide (r=0.386; P<0.005), carboxy-terminal propeptide of procollagen type I (r=0.550; P<0.001), and amino-terminal propeptide of procollagen type III (r=0.267; P<0.05) in all subjects. In vitro, cardiotrophin-1 stimulated the differentiation of human cardiac fibroblast to myofibroblasts (P<0.05) and the expression of procollagen type I (P<0.05) and III (P<0.01) mRNAs. These findings show that an excess of cardiotrophin-1 is associated with increased collagen in the myocardium of hypertensive patients with heart failure. It is proposed that exaggerated cardiomyocyte production of cardiotrophin-1 in response to increased left ventricular end-diastolic stress may contribute to fibrosis through stimulation of fibroblasts in heart failure of hypertensive origin.
Autores:
Cosío Carmena, M. D. G.; Gómez Bueno, M.; Almenar, L.; et al.
Revista:
JOURNAL OF HEART AND LUNG TRANSPLANTATION
ISSN:
1053-2498
Año:
2013
Vol.:
32
N°:
12
Págs.:
1187 - 1195
BACKGROUND: Primary graft failure (PGF) is the leading cause of early heart transplantation (HT) mortality. Our aim was to analyze PGF currently and explore the ability of a dedicated score for PGF risk stratification. METHODS: After applying a dedicated PGF definition, we analyzed its incidence, mortality, and associated factors in a multicenter cohort of 857 HTs performed in 2006 to 2009. We used the following criteria: recipient right (R) atrial pressure >= 10 mm Hg; age (A) >= 60 years; diabetes (D) mellitus, and inotrope (I) dependence; donor age (A) >= 30 years, and length (L) of ischemia >= 240 minutes to calculate the RADIAL score for PGF risk prediction. RESULTS: PGF incidence was 22%. The right ventricle was almost always affected, alone (45%) or as part of biventricular failure (47%). Mechanical circulatory support was used in 55%. Mortality attributable to PGF was 53% and extended through the third month after HT, but thereafter, PGF had little influence in long-term outcome. The RADIAL score was higher in PGF patients (2.78 +/- 1.1 vs 2.42 +/- 1.1, p = 0.001) and stratified 3 groups with incremental PGF incidence: low risk (12.1%), intermediate risk (19.4%), and high risk (27.5%, p = 0.001). CONCLUSIONS: PGF had a strong impact, with an incidence of 22% and a mortality exceeding 50% that extends through the third post-HT month. The RADIAL score classified patients into 3 groups with incremental risk for PGF and may be useful for its prevention and early therapy. (C) 2013 International Society for Heart and Lung Transplantation. All rights reserved.
Revista:
RADIOLOGY
ISSN:
0033-8419
Año:
2012
Vol.:
54
N°:
5
Págs.:
432-441
Revista:
EUROPEAN JOURNAL OF RADIOLOGY
ISSN:
0720-048X
Año:
2012
Vol.:
81
N°:
11
Págs.:
3282-3288
Objectives: To establish the accuracy and reliability of cardiac dual-source CT (DSCT) and two-dimensional contrast-enhanced echocardiography (CE-Echo) in estimating left ventricular (LV) parameters with respect to cardiac magnetic resonance imaging (CMR) as the reference standard. Methods: Twenty-five consecutive heart transplant recipients (20 male, mean age 62.7 +/- 10.4 years, mean time since transplantation 8.1 +/- 5.9 years) were prospectively recruited. Two blinded readers independently assessed LV ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV) for each patient after manual tracing of the endo-and epicardial contours in DSCT, CE-Echo and CMR cine images. Student's t-test for paired samples for differences, and Bland and Altman plots and Lin's concordance-correlation coefficients (CCC) for agreement were calculated. Results: There was no statistical difference between left ventricular parameters determined by DSCT and CMR. CE-Echo resulted in significant underestimation of left ventricular volumes (mean difference EDV: 15.94 +/- 14.19 ml and 17.1 +/- 17.06 ml, ESV: 8.5 +/- 9.3 and 7.32 +/- 9.14 ml with respect to DSCT and CMR), and overestimation of EF compared with the cross-sectional imaging modalities (3.78 +/- 8.47% and 2.14 +/- 8.35% with respect to DSCT and CMR). Concordance correlation coefficients for LV parameters using DSCT and CMR were higher (CCC >= 0.75) than CCC values observed between CE-Echo and DSCT- or CMR-derived data (CCC >= 0.54 and CCC >= 0.49, respectively). Interobserver agreement was higher for DSCT and CMR values (CCC >= 0.72 and CCC >= 0.87, respectively). Conclusion: In orthotopic heart transplantation cardiac DSCT allows accurate and reliable estimation of LV parameters compared with CMR, whereas CE-Echo seems to be insufficient to obtain precise measurements. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
Revista:
INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY
ISSN:
1569-9293
Año:
2012
Vol.:
14
N°:
4
Págs.:
457-462
Despite a more physiological morphology of atrial anastomosis in the bicaval technique with respect to standard biatrial anastomosis in orthotopic heart transplantation (OHT), the impact on the long-term outcome is still not clear. In this retrospective study, we sought to investigate the morphology and function of the atria through magnetic resonance imaging (MRI) and transthoracic echocardiography (TIE). Moreover, we aimed to analyse the accuracy of TIE with respect to MRI. Cox regression analysis of 216 consecutive patients receiving OHT between August 1987 and January 2010 identified only recipient age at the time of transplant to be an independent predictor of mortality (P = 0.048, odds ratio = 1.04). After a mean follow-up of 96.6 +/- 77.7 months, 108 patients were alive, of which 35 were found to be eligible for MRI assessment. In this analysis, left and right atrial volumes were found to be significantly larger in the standard group in comparison with the bicaval group (P = 0.001), and no significant difference between the two techniques was observed in left and right atrio-ventricular output. Moreover, a significantly reduced accuracy was observed (CCC < 0.3) when TIE results were compared with MRI assessment in evaluating atrial dimensions. Although left and right atrial volumes are significantly larger in the standard group in comparison with the bicaval group, we concluded that no significant difference in the atrial output and survival between the two techniques could be demonstrated.
Revista:
JOURNAL OF CARDIOVASCULAR SURGERY
ISSN:
0021-9509
Año:
2012
Vol.:
53
N°:
3
Págs.:
381-386
Aim. We report on nine highly selected patients in whom the resection of the tumor was only possible with cardiopulmonary bypass (CPB). Methods. Between November 1996 and November 2009, nine patients with non-cardiac tumors underwent surgery under CPB. Indications were: infiltration of the pulmonary vein in the left atrium (four cases), one case where the tumor (a paraganglioma apparently located in the subcarinal space) was actually in the atrium wall, one mediastinal liposarcoma with massive infiltration of the pericardium and the main pulmonary artery, and three tracheal tumors (2 cylindromas and 1 carcinoid). Results. Indication for CPB was decided preoperatively in 7 cases and intraoperatively in the other 2 patients. Cardiac infiltration was confirmed with intraoperative transesophageal cardiac echography in 2 patients, which proved to be very useful. Concerning postoperative complications, one patient died intraoperatively because it was impossible to stop the CPB after reconstruction of the bifurcation of the main pulmonary artery. Although the duration of the operation was significantly increased by the use of cardiopulmonary by-pass, it did not influence postoperative recovery in any of the other eight patients, as far as bleeding or infection was concerned. In one patient, a thoracic drain had to be replaced due to a partial pneumothorax. In another patient a partial dehiscence of the neo-carina was conservatively treated. Long-term results were influenced by the initial pathology of the patient. Conclusion. CPB provides the possibility of safely re-secting intrathoracic tumors invading cardiac structures that were previously inoperable. This can be achieved with an acceptable level of risk and - in very selected cases - may achieve long-term survival.
Revista:
MEDICINA INTENSIVA
ISSN:
0210-5691
Año:
2012
Vol.:
36
N°:
5
Págs.:
377-9
Se trata por tanto de un caso particular debido a dos razones. La primera es la presentación temprana de una TA proveniente del donante que debuta con signos de IC. En el TC ortotópico con técnica bicava se conserva la aurícula derecha y se efectúa anastomosis de cada vena cava por separado. Por lo tanto, aunque esta técnica conlleva menores tasas de arritmias auriculares y menor necesidad de marcapasos6,7 que con la técnica clásica, en este caso concreto facilitó la preservación del foco responsable de la TA. En segundo lugar, el caso presenta como novedad la estrategia terapéutica escogida. Debido a la repercusión hemodinámica el arsenal terapéutico disponible para revertir las TSV presenta ciertos riesgos y las maniobras vagales no tienen utilidad en esta población particular. Por ende, la adenosina, en pacientes con taquicardias de QRS ancho, no está exenta de riesgos en caso de que se trate de una taquicardia ventricular. En este caso la simple sobreestimulación auricular con un catéter en la aurícula derecha yuguló la crisis de TA. Además el EEF proporcionó el diagnóstico certero a la par que la posibilidad de ablación del sustrato responsable
Revista:
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
ISSN:
1010-7940
Año:
2012
Vol.:
41
N°:
1
Págs.:
134 - 136
Left atrial appendage (LAA) plays a crucial role as a source of atrial thrombus in patients with atrial fibrillation (AF). Thus, the need to close LAA becomes evident in patients with AF who undergo concomitant mitral valve surgery. Unfortunately, it has been reported a high rate of unsuccessful LAA occlusion, regardless of the technique employed. We propose a safe and simple method for LAA occlusion consisting in invagination of the appendage into the left atrium, followed by two sutures (purse string suture around the base of the LAA and a reinforce running suture).
Revista:
MEDICINA CLINICA
ISSN:
0025-7753
Año:
2012
Vol.:
138
N°:
6
Págs.:
254 - 260
Revista:
REVISTA ESPAÑOLA DE CARDIOLOGIA
ISSN:
0300-8932
Año:
2011
Vol.:
64
N°:
8
Págs.:
727-728
Revista:
ANNALI ITALIANI DI CHIRURGIA
ISSN:
0003-469X
Año:
2011
Vol.:
82
N°:
6
Págs.:
469 - 474
Early and late Troponin T determination after elective cardiac surgery. Two different meanings AIM: Although Troponins are demonstrated to be better predictors than CK-MB in quantification of myocardial damage, the relation between cut-off values for the diagnosis of perioperative myocardial infarction (PMI) and sample time is still not clear. In the present study we sought to analyse the clinical consequence of an early and late cTnt determinations after elective cardiac surgery. MATERIAL OF STUDY: Data of 117 patients undergone elective open heart surgery between January 2006 and June 2007 were prospectively collected. PMI was detected on the basis of postoperative electrocardiography/echocardiography and hemo-dynamic state. RESULTS: The in-hospital mortality was 1.7%. Eight patients (68%) presented PMI. Receiver-operating characteristic (ROC) analyses showed a cTnt cut-off of 1.22 mg/L (CI 0.94 to 0.99, P=0.0001, 100% sensitivity and 96% specificity) on arrival to ICU for the diagnosis of PMI. On the second post-operative day the cut-off value was 2.8 mg/L (CI 95% 0.84 to 0.98, P=0.0001) (sensitivity 66 % and specificity 100%). At this time the Pearson's test revealed the best correlation to ICU (P=0.008) and in-hospital (P=0.01) length of stay (LOS). DISCUSSION: A better sensibility of cTnt in diagnosis of PMI in the early postoperative period has been demonstrated to be associated to an increasing specificity in the late post-operative period. CONCLUSIONS: PMI must be suspected in patients with a cTnt > 1.22 mg/L. A second later assessment on the 2nd post-operative can exclude false positives and significantly predict the ICU and the in-hospital length of stay.
Revista:
CIRUGIA CARDIOVASCULAR
ISSN:
1134-0096
Año:
2011
Vol.:
18
N°:
1
Págs.:
15 - 19
La trombosis es una de las causas de muerte más importante en los países industrializados. La trombosis arterial es responsable del infarto de miocardio y de los accidentes cerebrovasculares y se genera en zonas de daño arterial. Los antiplaquetarios y anticoagulantes desempeñan un papel fundamental en la prevención y tratamiento. La enfermedad tromboembólica venosa, a través de la trombosis venosa profunda y la embolia pulmonar, es la tercera causa de muerte después de los eventos arteriales. Ésta suele tratarse con anticoagulantes. En este trabajo se revisan los nuevos fármacos antiplaquetarios y anticoagulantes y su impacto en la cirugía cardiovascular.
Thrombosis is the main cause of mortality in the industrialized countries. Arterial thrombosis, responsible of acute myocardial infarction and cerebrovascular accidents are characterized by the presence of rich clots in platelets and with scanty fibrin (called ¿white thrombus¿) that are generated in places of vascular injury. Under these circumstances antiplatelet agents are required for prevention and treatment. Nevertheless, as thrombin is the main enzyme of the coagulation system and is also a powerful platelet activator, anticoagulants are used to prevent arterial thrombosis. Venous tromboembolism, which includes deep venous thrombosis (DVT) and pulmonary embolism (PE), constitutes the third reason of cardiovascular mortality after myocardial infarction and stroke. Venous thrombi result from an activation of the coagulation and are constituted principally by fibrin, in which the red blood cells remain trapped together with scanty platelets (called ¿red thrombus¿); they are generally treated with anticoagulant agents. In this paper we will discuss the new antiplatelet and anticoagulant agents and their impact in cardiovascular surgery.
Autores:
Alloway, R.; Vanhaecke, J.; Yonan, N.; et al.
Revista:
JOURNAL OF HEART AND LUNG TRANSPLANTATION
ISSN:
1053-2498
Año:
2011
Vol.:
30
N°:
9
Págs.:
1003 - 1010
BACKGROUND: A prolonged-release formulation of tacrolimus for once-daily administration (tacrolimus QD) has been developed. This phase II, open-label, multicenter, prospective single-arm study compared the pharmacokinetics (PK) of tacrolimus in stable heart transplant patients before and after conversion from twice-daily tacrolimus (tacrolimus BID) to tacrolimus QD. METHODS: Heart transplant recipients (>= 6 months after transplant), previously maintained on tacrolimus BID based therapy, received tacrolimus BID from Days 1 to 7 and were converted on a I: I (mg/mg) basis to tacrolimus QD. Five 24-hour PK profiles were collected (Days 1, 7, 8, 14, 21). Safety parameters were also evaluated. RESULTS: Of 85 patients, 45 (50.6%) completed all 5 evaluable PK profiles. Steady-state tacrolimus area under the curve, 0 to 24 hours (AUC(0-24)) and minimum concentration (C-min) were comparable for both formulations, with treatment ratio means of 90.5% (90% confidence intervals [CI], 86.4%-94.6%) and 87.4% (95% CI, 82.9%-92.0%), respectively (acceptance interval, 80%-125%). There was good correlation between AUC(0-24) and C-min for tacrolimus QD (r = 0.94) and BID (r = 0.91). The relationship between these 2 parameters was also similar. CONCLUSIONS: This study provides evidence for successful conversion from tacrolimus BID to QD on a 1:1 (mg/mg) total doily dose basis. Approximately one-third of patients may require dose adjustments. Both formulations were well tolerated, with stable renal function during the study. Adverse events were reported by approximately one-tenth of patients receiving tacrolimus BID and a quarter of those who received QD. J Heart Lung Transplant 2011;30:1003-10 (C) 2011 International Society for Heart and Lung Transplantation. All rights reserved.
Revista:
European Radiology
ISSN:
0938-7994
Año:
2011
Vol.:
21
N°:
9
Págs.:
1887 - 1894
Revista:
Investigative Radiology
ISSN:
0020-9996
Año:
2010
Vol.:
45
N°:
2
Págs.:
72 - 76
Introduction: To compare left atrial performance with dual-source CT (DSCT) with respect to magnetic resonance imaging (MRI) in orthotopic heart transplant recipients.
Methods: Twenty-nine consecutive heart transplant recipients (27 male,mean age 64.1 +/- 13 years; mean time from transplantation 122.8 +/- 69.7 months) referred for exclusion of cardiac allograft vasculopathy underwent cardiac DSCT and MRI. Standard biatrial technique was employed in 13 subjects whereas 16 were transplanted after the bicaval technique. Axial 5-mm slice-thickness DSCT datasets reconstructed in 5% steps of the cardiac cycle and axial 5-mm SSFP-MRI images were analyzed. Two blinded readers manually traced left atrial contours in random order to estimate end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF). Parameters were compared with a paired sample Student t test. Concordance correlation coefficient (CCC) was calculated to determine measurement agreement between techniques and observers.
Results: Left atrial volumes were significantly higher with cardiac DSCT (EDV: 170.9 +/- 78.1 mL; ESV: 139.5 +/- 76.6 mL) than with MRI (EDV: 158.2 +/- 72.5 mL; ESV: 124.2 +/- 68.2 mL), whereas left atrial EF was lower with DSCT (EF: 20.8% +/- 7.5% vs. 23.6% +/- 7.7%) (P < 0.05). Measurement agreement between DSCT and MRI was excellent for all parameters (CCC >= 0.82). Individuals operated with the biatrial anastomosis technique presented significantly higher left atrial volumes and lower EF compared with subjects with bicaval anastomosis. Interobserver agreement was excellent for all parameters (CCC >= 0.80).
Conclusion: Even if DSCT slightly overestimates left atrial volumes with respect to MRI, results remain clinically valid. Bicaval surgical technique offers improved left atrial performance compared with standard biatrial anastomosis. DSCT may be used as a reliable tool to estimate left atrial parameters in orthotopic heart transplant recipients.
Revista:
INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY
ISSN:
1569-9293
Año:
2010
Vol.:
11
N°:
4
Págs.:
499 - 500
Revista:
UROTODAY INTERNATIONAL JOURNAL
ISSN:
1939-4810
Año:
2010
Vol.:
3
N°:
4
Págs.:
1 - 8
INTRODUCTION: The objectives were to: (1) analyze clinical and pathological features of renal cell carcinoma (RCC) with caval thrombosis in order to indentify independent prognostic factors, and (2) analyze perioperative morbidity and mortality. METHODS: The authors retrospectively analyzed clinical and pathological data of 56 patients treated for RCC with caval thrombosis during a 20-year period. The surgical procedure was essentially unchanged. Independent variables were: TNM, creatinine value, age, histological extent, histological type, adjuvant treatment, and surgical technique; the dependent variable was overall survival. Contingency and logistic regression tables were used. Kaplan-Meier method, log-rank, and Cox models were used to analyze survival rates. RESULTS: There were complications in 15 patients and 2 perioperative deaths. Overall mean (SD) survival rates were 32% (7%) and 24% (6%) at 3 and 5 years, respectively. Multivariate results showed that the significant prognostic indicators of survival were: the size of the tumor > 8 cm (P < .01), the presence of metastasis (P < .04), and lymph node invasion (P < .009). These were also regarded as the relevant variables, independent of patient survival. CONCLUSIONS: The surgical approach for this disorder is challenging and not exempt of complications. Nodal involvement, tumor size, and distant metastases are the most important prognostic factors; thrombus extension has a clear impact on surgical planning and performance.
Revista:
Revista española de enfermedades digestivas
ISSN:
1130-0108
Año:
2010
Vol.:
102
N°:
5
Págs.:
338 -339