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Foley P, Thomas H, Dayer M, Robinson S, Ezzatt V, Swift M, Johal N, Roberts E. British Heart Rhythm Society Standards for Implantation and Follow-up of Cardiac Rhythm Management Devices in Adults: January 2024 Update. Arrhythm Electrophysiol Rev 2024; 13:e10. [PMID: 39082056 PMCID: PMC11287656 DOI: 10.15420/aer.2024.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/20/2024] [Indexed: 08/02/2024] Open
Abstract
This updated guidance is designed to help with implantation and follow-up with agreed standards of practice. The update includes new guidance on subcutaneous defibrillators, leadless pacemakers and conduction system pacing. It includes new guidance on considerations at the time of a potential box change and techniques to be considered to minimise the risk of infection.
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Affiliation(s)
- Paul Foley
- Wiltshire Cardiac Centre, Great Western HospitalSwindon, UK
| | - Honey Thomas
- British Heart Rhythm SocietyCheshire, UK
- Department of Cardiology, Northumbria Healthcare NHS Foundation TrustNorth Shields, UK
| | - Mark Dayer
- Somerset NHS Foundation TrustTaunton, Somerset, UK
| | - Sophie Robinson
- British Heart Rhythm SocietyCheshire, UK
- Sandwell District General HospitalWest Bromwich, UK
| | - Vivienne Ezzatt
- British Heart Rhythm SocietyCheshire, UK
- Department of Cardiac Electrophysiology, Barts Heart Center, St Bartholomew’s HospitalLondon, UK
| | - Matthew Swift
- Wiltshire Cardiac Centre, Great Western HospitalSwindon, UK
| | - Nadiya Johal
- Wiltshire Cardiac Centre, Great Western HospitalSwindon, UK
| | - Eleri Roberts
- Department of Cardiology, Wythenshawe HospitalManchester, UK
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2
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Sun YQ, Lv Q, Chen D, Da Y, Zhao XY, Dong JZ. A Case Study and Literature Review of the Diagnosis of Danon Disease in Patients Presenting Only with Severe Cardiac Symptoms. Pharmgenomics Pers Med 2023; 16:767-775. [PMID: 37609033 PMCID: PMC10441658 DOI: 10.2147/pgpm.s392800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 08/01/2023] [Indexed: 08/24/2023] Open
Abstract
The clinical manifestations of Danon disease, which result from the primary deficiency of the lysosome-associated membrane protein 2 gene, include cardiomyopathy, skeletal myopathy, and different degrees of intellectual disability that vary greatly among patients. The present study reports on two cases of Danon disease in two patients who only presented cardiac symptoms. Cardiac symptoms usually occur in adolescence and during a patient's twenties, and most patients die from heart failure. However, the lab results from these cases suggested that other systems were involved, despite no other clinical symptoms. Significantly, the two patients had elevated serum cardiac troponin I, which often manifests in the acute cardiac phase, especially in severely affected patients with rapidly fatal outcomes. Danon disease is a multi-system involvement disease. Therefore, clinicians must be aware of its complexity when evaluating newly diagnosed patients due to its vastly different clinical course and prognosis and the importance of multidisciplinary management.
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Affiliation(s)
- Yu-Qing Sun
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung & Blood Vessel Diseases, Beijing, People’s Republic of China
| | - Qiang Lv
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung & Blood Vessel Diseases, Beijing, People’s Republic of China
| | - Dong Chen
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung & Blood Vessel Diseases, Beijing, People’s Republic of China
| | - Yuwei Da
- Department of Neurology, Beijing Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xiao-Yan Zhao
- Department of Cardiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung & Blood Vessel Diseases, Beijing, People’s Republic of China
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3
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Masarone D, Kittleson MM, Falco L, Martucci ML, Catapano D, Brescia B, Petraio A, De Feo M, Pacileo G. The ABC of Heart Transplantation-Part 1: Indication, Eligibility, Donor Selection, and Surgical Technique. J Clin Med 2023; 12:5217. [PMID: 37629260 PMCID: PMC10455167 DOI: 10.3390/jcm12165217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Cardiac transplantation represents the gold standard of treatment for selected patients with advanced heart failure who have poor functional capacity and prognosis despite guideline-directed medical therapy and device-based therapy. Proper patient selection and appropriate referral of patients to centers for the treatment of advanced heart failure are the first but decisive steps for screening patients eligible for cardiac transplantation. The eligibility and the decision to list for cardiac transplantation, even for patients with relative contraindications, are based on a multidisciplinary evaluation of a transplant team. This review will discuss the practical indications, the process of patient eligibility for cardiac transplantation, the principle of donor selection, as well as the surgical technique.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Michelle M. Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Hospital, Los Angeles, CA 90048, USA
| | - Luigi Falco
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Maria L. Martucci
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Dario Catapano
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy
| | - Benedetta Brescia
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiac Surgery and Transplants, AORN dei Colli Monaldi Hospital, 80131 Naples, Italy
| | - Marisa De Feo
- Cardiac Surgery Unit, Department of Cardiac Surgery and Transplants, AORN dei Colli Monaldi Hospital, 80131 Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy
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4
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Akiyama K, Colombo PC, Stöhr EJ, Ji R, Wu IY, Itatani K, Miyazaki S, Nishino T, Nakamura N, Nakajima Y, McDonnell BJ, Takeda K, Yuzefpolskaya M, Takayama H. Blood flow kinetic energy is a novel marker for right ventricular global systolic function in patients with left ventricular assist device therapy. Front Cardiovasc Med 2023; 10:1093576. [PMID: 37260947 PMCID: PMC10228750 DOI: 10.3389/fcvm.2023.1093576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/02/2023] [Indexed: 06/02/2023] Open
Abstract
Objectives Right ventricular (RV) failure remains a major concern in heart failure (HF) patients undergoing left ventricular assist device (LVAD) implantation. We aimed to measure the kinetic energy of blood in the RV outflow tract (KE-RVOT) - a new marker of RV global systolic function. We also aimed to assess the relationship of KE-RVOT to other echocardiographic parameters in all subjects and assess the relationship of KE-RVOT to hemodynamic parameters of RV performance in HF patients. Methods Fifty-one subjects were prospectively enrolled into 4 groups (healthy controls, NYHA Class II, NYHA Class IV, LVAD patients) as follows: 11 healthy controls, 32 HF patients (8 NYHA Class II and 24 Class IV), and 8 patients with preexisting LVADs. The 24 Class IV HF patients included 21 pre-LVAD and 3 pre-transplant patients. Echocardiographic parameters of RV function (TAPSE, St', Et', IVA, MPI) and RV outflow color-Doppler images were recorded in all patients. Invasive hemodynamic parameters of RV function were collected in all Class IV HF patients. KE-RVOT was derived from color-Doppler imaging using a vector flow mapping proprietary software. Kruskal-Wallis test was performed for comparison of KE-RVOT in each group. Correlation between KE-RVOT and echocardiographic/hemodynamic parameters was assessed by linear regression analysis. Receiver operating characteristic curves for the ability of KE-RVOT to predict early phase RV failure were generated. Results KE-RVOT (median ± IQR) was higher in healthy controls (55.10 [39.70 to 76.43] mW/m) than in the Class II HF group (22.23 [15.41 to 35.58] mW/m, p < 0.005). KE-RVOT was further reduced in the Class IV HF group (9.02 [5.33 to 11.94] mW/m, p < 0.05). KE-RVOT was lower in the LVAD group (25.03 [9.88 to 38.98] mW/m) than the healthy controls group (p < 0.005). KE-RVOT had significant correlation with all echocardiographic parameters and no correlation with invasive hemodynamic parameters. RV failure occurred in 12 patients who underwent LVAD implantation in the Class IV HF group (1 patient was not eligible due to death immediately after the LVAD implantation). KE-RVOT cut-off value for prediction of RV failure was 9.15 mW/m (sensitivity: 0.67, specificity: 0.75, AUC: 0.66). Conclusions KE-RVOT, a novel noninvasive measure of RV function, strongly correlates with well-established echocardiographic markers of RV performance. KE-RVOT is the energy generated by RV wall contraction. Therefore, KE-RVOT may reflect global RV function. The utility of KE-RVOT in prediction of RV failure post LVAD implantation requires further study.
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Affiliation(s)
- Koichi Akiyama
- Department of Anesthesiology, Kindai University Hospital, Osakasayama, Japan
- Department of Medicine, Division of Cardiothoracic and Vascular Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Paolo C. Colombo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, United States
| | - Eric J. Stöhr
- COR-HELIX (CardiOvascular Regulation and Exercise Laboratory-Integration and Xploration), Institute of Sport Science, Leibniz University Hannover, Hannover, Germany
| | - Ruiping Ji
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, United States
| | - Isaac Y. Wu
- Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY, United States
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Nagoya City University, Nagoya, Japan
| | | | | | - Naotoshi Nakamura
- iBLab (interdisciplinary Biology Laboratory), Division of Natural Science, Graduate School of Science, Nagoya University, Nagoya, Japan
| | - Yasufumi Nakajima
- Department of Anesthesiology, Kindai University Hospital, Osakasayama, Japan
| | - Barry J McDonnell
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Koji Takeda
- Department of Medicine, Division of Cardiothoracic and Vascular Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, United States
| | - Hiroo Takayama
- Department of Medicine, Division of Cardiothoracic and Vascular Surgery, Columbia University Irving Medical Center, New York, NY, United States
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Rešetar Maslov D, Farkaš V, Rubić I, Kuleš J, Beletić A, Beer Ljubić B, Šmit I, Mrljak V, Torti M. Serum Proteomic Profiles Reflect the Stages of Myxomatous Mitral Valve Disease in Dogs. Int J Mol Sci 2023; 24:ijms24087142. [PMID: 37108311 PMCID: PMC10138901 DOI: 10.3390/ijms24087142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Canine myxomatous mitral valve disease (MMVD) is similar to Barlow's form of MMVD in humans. These valvulopathies are complex, with varying speeds of progression. We hypothesized that the relative abundances of serum proteins would help identify the consecutive MMVD stages and discover new disease pathways on a systemic level. To identify distinction-contributing protein panels for disease onset and progression, we compared the proteomic profiles of serum from healthy dogs and dogs with different stages of naturally occurring MMVD. Dogs were divided into experimental groups on the basis of the left-atrium-to-aorta ratio and normalized left ventricular internal dimension in diastole values. Serum was collected from healthy (N = 12) dogs, dogs diagnosed with MMVD in stages B1 (N = 13) and B2 (N = 12) (asymptomatic), and dogs diagnosed with MMVD in chronic stage C (N = 13) (symptomatic). Serum biochemistry and selected ELISAs (galectin-3, suppression of tumorigenicity, and asymmetric dimethylarginine) were performed. Liquid chromatography-mass spectrometry (LC-MS), tandem mass tag (TMT) quantitative proteomics, and statistical and bioinformatics analysis were employed. Most of the 21 serum proteins with significantly different abundances between experimental groups (p < 0.05, FDR ˂ 0.05) were classified as matrix metalloproteinases, protease inhibitors, scaffold/adaptor proteins, complement components, anticoagulants, cytokine, and chaperone. LC-MS TMT proteomics results obtained for haptoglobin, clusterin, and peptidase D were further validated analytically. Canine MMVD stages, including, for the first time, asymptomatic B1 and B2 stages, were successfully distinguished in dogs with the disease and healthy dogs on the basis of the relative abundances of a panel of specific serum proteins. Most proteins with significantly different abundances were involved in immune and inflammatory pathways. Their role in structural remodeling and progression of canine MMVD must be further investigated. Further research is needed to confirm the resemblance/difference with human MMVD. Proteomics data are available via ProteomeXchange with the unique dataset identifier PXD038475.
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Affiliation(s)
- Dina Rešetar Maslov
- Internal Diseases Clinic, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
| | - Vladimir Farkaš
- Internal Diseases Clinic, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
| | - Ivana Rubić
- Internal Diseases Clinic, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
| | - Josipa Kuleš
- Department of Chemistry and Biochemistry, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
| | - Anđelo Beletić
- Internal Diseases Clinic, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
| | - Blanka Beer Ljubić
- Internal Diseases Clinic, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
| | - Iva Šmit
- Internal Diseases Clinic, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
| | - Vladimir Mrljak
- Internal Diseases Clinic, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
| | - Marin Torti
- Internal Diseases Clinic, Faculty of Veterinary Medicine, University of Zagreb, Heinzelova Street 55, 10000 Zagreb, Croatia
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6
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Valente F, Stefanidis C, Vachiéry JL, Dewachter C, Engelman E, Vanden Eynden F, Roussoulières A. A novel metrics to predict right heart failure after left ventricular assist device implantation. J Artif Organs 2023; 26:24-35. [PMID: 35482120 DOI: 10.1007/s10047-022-01334-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Right Heart Failure (RHF) is a severe complication that can occur after left ventricular assist device (LVAD) implantation, increasing early and late mortality. Although numerous RHF predictive scores have been developed, limited data exist on the external validation of these models. We therefore aimed at comparing existent risk score models and identifying predictors of severe RHF at our center. METHODS In this retrospective, single-center analysis, clinical, biological and functional data were collected in patients implanted with a LVAD between 2011 and 2020. Early severe RHF was defined as the use of inotropes for ≥ 14 days, nitric oxide use for ≥ 48 h or unplanned right-sided circulatory support. Risk models were evaluated for the primary outcome of RHF or RVAD implantation by means of logistic regression and receiver operating characteristic curves. RESULTS Among 92 patients implanted, 24 (26%) developed early severe RHF. The EUROMACS-RHF risk score performed the best in predicting RHF (C = 0.82-95% CI: 0.68-0.90), compared with the other scores (Michigan, CRITT). In addition, we developed a new model, based on four variables selected for the best reduced logistic model: the INTERMACS level, the number of inotropes used, the ratio of right atrial/pulmonary capillary wedge pressure and the ratio of right ventricle/left ventricle diameters by echocardiography. This model demonstrated significant discrimination of RHF (C = 0.9-95% CI: 0.76-0.96). CONCLUSION Amongst available risk scores, EUROMACS-RHF performs best to predict the occurrence of RHF after LVAD implantation. Our model's performance compares well to the EUROMACS-RHF score, adding a more objective parameter to RV function evaluation.
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Affiliation(s)
- Federica Valente
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium.
| | - Constantin Stefanidis
- Department of Cardiac Surgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Luc Vachiéry
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium
| | - Céline Dewachter
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium
| | | | - Frédéric Vanden Eynden
- Department of Cardiac Surgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Ana Roussoulières
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium
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7
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Asemota N, Ike ID, Oo AY, Lopez-Marco A. Fulminant Herpes Pneumonia Postaortic Surgery with Known Ankylosing Spondylitis. AORTA (STAMFORD, CONN.) 2022; 10:256-258. [PMID: 36539119 PMCID: PMC9767785 DOI: 10.1055/s-0042-1757791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Herpes simplex virus (HSV) pneumonitis is rare after cardiac surgery. A 36-year-old gentleman with ankylosing spondylitis underwent emergency surgery for a complex aortic aneurysmal disease. Preoperative treatment of aortitis with antitumor necrosis factor and steroid medication and surgical stress including cardiopulmonary bypass potentially created an immunosuppressive state and reactivation of undiagnosed HSV. Rapid HSV pneumonia ensued, culminating in fulminant organ failure and mortality. HSV pneumonia should be considered postoperatively in patients with severe respiratory distress, especially if immunocompromised.
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Affiliation(s)
- Nicole Asemota
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - Ikenna David Ike
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - Aung Ye Oo
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - Ana Lopez-Marco
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, United Kingdom,Address for correspondence Ana Lopez-Marco, PhD, FRCS-CTh Department of Cardiothoracic Surgery, St Bartholomew's HospitalWest Smithfield, London EC1A 7BEUnited Kingdom
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8
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Affiliation(s)
- Paul M Haydock
- Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrew S Flett
- Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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9
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Doğanözü E, Ersoy O, Sezgin A, Ozin B. A Case Report of Ventricular Fibrillation Survival by Left Ventricular Assist Device for Hours. EXP CLIN TRANSPLANT 2022. [PMID: 35037608 DOI: 10.6002/ect.2021.0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In recent years, the population of patients implanted with a left ventricular assist device has been increasing. Ventricular arrhythmias are the most interesting and most deadly complications among patients with these implants. Ventricular arrhythmias may cause cardiovascular collapse and death in some cases, whereas they may be asymptomatic or less symptomatic in others. In the case described here, we present the therapeutic approach to a patient with a left ventricular assist device who had ventricular fibrillation and the pathophysiology of his clinical condition.
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Affiliation(s)
- Ersin Doğanözü
- From the Department of Cardiology, 29 Mayis State Hospital, Ankara, Turkey
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10
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Evaluation and Management of Liver Transplant Candidates With Prior Nonhepatic Cancer: Guidelines From the ILTS/SETH Consensus Conference. Transplantation 2022; 106:e3-e11. [PMID: 34905758 DOI: 10.1097/tp.0000000000003997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Liver transplant in patients with prior nonhepatic cancer is a matter of concern, needing further research, development, and consensus guidelines. This International Liver Transplantation Society/Sociedad Española De Trasplante Hepático consensus conference document focuses on the role of liver transplantation in patients with a prior history of nonhepatic cancer. This document addresses (1) the evaluation of transplant candidates with prior cancers based on the assessment of prognosis, the natural history of individual cancers, and the emerging role for circulating DNA and minimal residual disease in these patients; (2) the impact of prior treatments, including immunotherapy for prior malignancies; and (3) the surveillance of posttransplant cancer recurrence. The consensus statement is based on previously published guidelines, as well as a review of the current, relevant, published literature.
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Boggi U, Vistoli F, Andres A, Arbogast HP, Badet L, Baronti W, Bartlett ST, Benedetti E, Branchereau J, Burke GW, Buron F, Caldara R, Cardillo M, Casanova D, Cipriani F, Cooper M, Cupisti A, Davide J, Drachenberg C, de Koning EJP, Ettorre GM, Fernandez Cruz L, Fridell JA, Friend PJ, Furian L, Gaber OA, Gruessner AC, Gruessner RW, Gunton JE, Han D, Iacopi S, Kauffmann EF, Kaufman D, Kenmochi T, Khambalia HA, Lai Q, Langer RM, Maffi P, Marselli L, Menichetti F, Miccoli M, Mittal S, Morelon E, Napoli N, Neri F, Oberholzer J, Odorico JS, Öllinger R, Oniscu G, Orlando G, Ortenzi M, Perosa M, Perrone VG, Pleass H, Redfield RR, Ricci C, Rigotti P, Paul Robertson R, Ross LF, Rossi M, Saudek F, Scalea JR, Schenker P, Secchi A, Socci C, Sousa Silva D, Squifflet JP, Stock PG, Stratta RJ, Terrenzio C, Uva P, Watson CJ, White SA, Marchetti P, Kandaswamy R, Berney T. First World Consensus Conference on pancreas transplantation: Part II - recommendations. Am J Transplant 2021; 21 Suppl 3:17-59. [PMID: 34245223 PMCID: PMC8518376 DOI: 10.1111/ajt.16750] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 02/07/2023]
Abstract
The First World Consensus Conference on Pancreas Transplantation provided 49 jury deliberations regarding the impact of pancreas transplantation on the treatment of diabetic patients, and 110 experts' recommendations for the practice of pancreas transplantation. The main message from this consensus conference is that both simultaneous pancreas-kidney transplantation (SPK) and pancreas transplantation alone can improve long-term patient survival, and all types of pancreas transplantation dramatically improve the quality of life of recipients. Pancreas transplantation may also improve the course of chronic complications of diabetes, depending on their severity. Therefore, the advantages of pancreas transplantation appear to clearly surpass potential disadvantages. Pancreas after kidney transplantation increases the risk of mortality only in the early period after transplantation, but is associated with improved life expectancy thereafter. Additionally, preemptive SPK, when compared to SPK performed in patients undergoing dialysis, appears to be associated with improved outcomes. Time on dialysis has negative prognostic implications in SPK recipients. Increased long-term survival, improvement in the course of diabetic complications, and amelioration of quality of life justify preferential allocation of kidney grafts to SPK recipients. Audience discussions and live voting are available online at the following URL address: http://mediaeventi.unipi.it/category/1st-world-consensus-conference-of-pancreas-transplantation/246.
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12
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Dungu JN, Langley SG, Hardy-Wallace A, Li B, Barbagallo RM, Field D, Homfray T, Savage HO. Dilated cardiomyopathy: the role of genetics, highlighted in a family with Filamin C (FLNC) variant. Heart 2021; 108:676-682. [PMID: 34417207 DOI: 10.1136/heartjnl-2021-319682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/09/2021] [Indexed: 12/30/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is a heterogenous group of disorders characterised by left ventricular dilatation and dysfunction, in the absence of factors affecting loading conditions such as hypertension or valvular disease, or significant coronary artery disease. The prevalence of idiopathic DCM is estimated between 1:250 and 1:500 individuals. Determining the aetiology of DCM can be challenging, particularly when evaluating an individual and index case with no classical history or investigations pointing towards an obvious acquired cause, or no clinical clues in the family history to suggest a genetic cause. We present a family affected by DCM associated with Filamin C variant, causing sudden cardiac death at a young age and heart failure due to severe left ventricular impairment and myocardial scarring. We review the diagnosis and treatment of DCM, its genetic associations and potential acquired causes. Thorough assessment is mandatory to risk stratify and identify patients who may benefit from primary prevention implantable cardioverter defibrillator therapy according to international guidelines. Genetic testing has some limitations, and is positive in only 20%-35% of DCM, but should be considered in specific cases to identify families who may benefit from cascade screening after appropriate counselling. The management of often complex familial cardiomyopathy requires specialist input for every case, and the appropriate infrastructure to coordinate investigations.
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Affiliation(s)
- Jason N Dungu
- Cardiology, Essex Cardiothoracic Centre, Mid & South Essex NHS Foundation Trust, Basildon, UK .,Circulatory Health Research Group, Anglia Ruskin University, Chelmsford, UK
| | - Samantha G Langley
- Cardiology, Essex Cardiothoracic Centre, Mid & South Essex NHS Foundation Trust, Basildon, UK
| | - Amy Hardy-Wallace
- Cardiology, Essex Cardiothoracic Centre, Mid & South Essex NHS Foundation Trust, Basildon, UK
| | - Brian Li
- Cardiology, Essex Cardiothoracic Centre, Mid & South Essex NHS Foundation Trust, Basildon, UK.,Circulatory Health Research Group, Anglia Ruskin University, Chelmsford, UK
| | - Rossella M Barbagallo
- Cardiology, Essex Cardiothoracic Centre, Mid & South Essex NHS Foundation Trust, Basildon, UK
| | - Duncan Field
- Cardiology, Essex Cardiothoracic Centre, Mid & South Essex NHS Foundation Trust, Basildon, UK
| | - Tessa Homfray
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Henry Oluwasefunmi Savage
- Cardiology, Essex Cardiothoracic Centre, Mid & South Essex NHS Foundation Trust, Basildon, UK.,Circulatory Health Research Group, Anglia Ruskin University, Chelmsford, UK
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13
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Edwards S, Allen S, Sidebotham D. Anaesthesia for heart transplantation. BJA Educ 2021; 21:284-291. [PMID: 34306729 DOI: 10.1016/j.bjae.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- S Edwards
- Plymouth NHS Trust, Derriford Hospital, Plymouth, UK
| | - S Allen
- Auckland City Hospital, Auckland, New Zealand
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Sopek Merkaš I, Slišković AM, Lakušić N. Current concept in the diagnosis, treatment and rehabilitation of patients with congestive heart failure. World J Cardiol 2021; 13:183-203. [PMID: 34367503 PMCID: PMC8326153 DOI: 10.4330/wjc.v13.i7.183] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/20/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a major public health problem with a prevalence of 1%-2% in developed countries. The underlying pathophysiology of HF is complex and as a clinical syndrome is characterized by various symptoms and signs. HF is classified according to left ventricular ejection fraction (LVEF) and falls into three groups: LVEF ≥ 50% - HF with preserved ejection fraction (HFpEF), LVEF < 40% - HF with reduced ejection fraction (HFrEF), LVEF 40%-49% - HF with mid-range ejection fraction. Diagnosing HF is primarily a clinical approach and it is based on anamnesis, physical examination, echocardiogram, radiological findings of the heart and lungs and laboratory tests, including a specific markers of HF - brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide as well as other diagnostic tests in order to elucidate possible etiologies. Updated diagnostic algorithms for HFpEF have been recommended (H2FPEF, HFA-PEFF). New therapeutic options improve clinical outcomes as well as functional status in patients with HFrEF (e.g., sodium-glucose cotransporter-2 - SGLT2 inhibitors) and such progress in treatment of HFrEF patients resulted in new working definition of the term “HF with recovered left ventricular ejection fraction”. In line with rapid development of HF treatment, cardiac rehabilitation becomes an increasingly important part of overall approach to patients with chronic HF for it has been proven that exercise training can relieve symptoms, improve exercise capacity and quality of life as well as reduce disability and hospitalization rates. We gave an overview of latest insights in HF diagnosis and treatment with special emphasize on the important role of cardiac rehabilitation in such patients.
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Affiliation(s)
- Ivana Sopek Merkaš
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
| | - Ana Marija Slišković
- Department of Cardiology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Nenad Lakušić
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, Osijek 31000, Croatia
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine Osijek, Osijek 31000, Croatia
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15
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Sandal S, Chen T, Cantarovich M. Evaluation of Transplant Candidates With a History of Nonadherence: An Opinion Piece. Can J Kidney Health Dis 2021; 8:2054358121990137. [PMID: 33598301 PMCID: PMC7863559 DOI: 10.1177/2054358121990137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/03/2021] [Indexed: 12/18/2022] Open
Affiliation(s)
- Shaifali Sandal
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Tianyan Chen
- Division of Hepatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Marcelo Cantarovich
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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16
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Witkowski A, Szumowski Ł, Urbanek P, Jastrzębski J, Skowroński J, Sobieszczańska-Małek M, Hoffman P, Kowalik E, Wiśniewska J, Banasiak A, Parulski A, Zieliński T. Transcatheter pulmonary denervation in patients with left heart failure with reduced ejection fraction and combined precapillary and postcapillary pulmonary hypertension: A prospective single center experience. Catheter Cardiovasc Interv 2021; 98:588-594. [PMID: 33559279 DOI: 10.1002/ccd.29526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/05/2020] [Accepted: 01/17/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The present study was a prospective, single-center, single-arm study to investigate the efficacy of transcatheter pulmonary artery denervation (TPADN) in patients with combined postcapillary and precapillary PH (Cpc-PH) associated with left heart failure with reduced ejection fraction (HF-rEF). BACKGROUND Pulmonary hypertension (PH) in patients with left ventricular systolic dysfunction has a negative impact on outcome. METHODS The combination of pulmonary artery systolic pressure (PAPs) ≥60 mmHg, transpulmonary pressure gradient (TPG) ≥12 mmHg, nonreversible mean PAP, and pulmonary vascular resistance (PVR) ≥3.5 Wood Units was considered as too high risk for heart transplantation (HTx). The clinical efficacy endpoint was an improvement in 6-min walking test and the hemodynamic endpoints were changes in PAPs, PVR, and TPG between baseline and 6 months. Circumferential radiofrequency applications were delivered around distal main, left and right pulmonary arteries. At each ablation point temperature was 45°C and energy 10 W. RESULTS TPADN was performed in 10 patients. At 6-month in 5 patients we observed reduction in PAP, PVR, TPG, and DPG and then 1 had successful HTx, 2 are on HTx waiting list, 2 received LVADs, 2 patients did not improve, and 3 patients died. CONCLUSIONS TPADN may be beneficial in selected patients with HF-rEF and Cpc-PH.
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Affiliation(s)
- Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Łukasz Szumowski
- Department of Arrhythmia, National Institute of Cardiology, Warsaw, Poland
| | - Piotr Urbanek
- Department of Arrhythmia, National Institute of Cardiology, Warsaw, Poland
| | - Jan Jastrzębski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Jarosław Skowroński
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | | | - Piotr Hoffman
- Department of Congenital Heart Diseases, National Institute of Cardiology, Warsaw, Poland
| | - Ewa Kowalik
- Department of Congenital Heart Diseases, National Institute of Cardiology, Warsaw, Poland
| | - Joanna Wiśniewska
- Department of Heart Failure and Transplantology, National Institute of Cardiology, Warsaw, Poland
| | - Adam Banasiak
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Adam Parulski
- Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, Warsaw, Poland
| | - Tomasz Zieliński
- Department of Heart Failure and Transplantology, National Institute of Cardiology, Warsaw, Poland
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17
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Jawad K, Sipahi F, Koziarz A, Huhn S, Kalampokas N, Albert A, Borger MA, Lichtenberg A, Saeed D. Less-invasive ventricular assist device implantation: A multicenter study. J Thorac Cardiovasc Surg 2020; 164:1910-1918.e4. [PMID: 33487414 DOI: 10.1016/j.jtcvs.2020.12.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 11/27/2020] [Accepted: 12/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Left ventricular assist device has been shown to be a safe and effective treatment option for patients with end-stage heart failure. However, there is limited evidence showing the effect of the implantation approach on postoperative morbidities and mortality. We aimed to compare left ventricular assist device implantation using conventional sternotomy versus less-invasive surgery including hemi-sternotomy and the minithoracotomy approach. METHODS Between January 2014 and December 2018, 342 consecutive patients underwent left ventricular assist device implantation at 2 high-volume centers. Patient characteristics were prospectively collected. The propensity score method was used to create 2 groups in a 1:1 fashion. A competing risk regression model was used to evaluate time to death adjusting for competing risk of heart transplantation. RESULTS The unmatched cohort included 241 patients who underwent left ventricular assist device implantation with the conventional sternotomy technique and 101 patients who underwent left ventricular assist device implantation with the less-invasive surgery technique. Propensity matching produced 2 groups each including 73 patients. In the matched groups, reexploration rate for bleeding was necessary in 17.9% (12/67) in the conventional sternotomy group compared with 4.1% (3/73) the less-invasive surgery group (P = .018). Intensive care unit stay for the less-invasive surgery group was significantly lower than for the sternotomy group (10.5 [interquartile range, 2-25.75] days vs 4 [interquartile range, 2-9.25] days, P = .008), as was hospital length of stay (37 [interquartile range, 27-61] days vs 25.5 [interquartile range, 21-42] days, P = .007). Mortality cumulative incidence for conventional surgery was 24% (95% confidence interval, 14.3-34.8) at 1 year and 26% (95% confidence interval, 15.9-37.4) at 2 years for patients without heart transplantation. Mortality cumulative incidence for less-invasive surgery was 22.5% (95% confidence interval, 12.8-33.8) at 1 year and 25.2% (95% confidence interval, 14.5-37.4) at 2 years for patients without heart transplantation. There was no difference in cumulative mortality incidence when adjusting for competing risk of heart transplantation (subdistribution hazard, 0.904, 95% confidence interval, 0.45-1.80, P = .77). CONCLUSIONS The less-invasive surgery approach is a safe technique for left ventricular assist device implantation. Less-invasive surgery was associated with a significant reduction in the postoperative bleeding complications and duration of hospital stay, with no significant difference in mortality incidence.
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Affiliation(s)
- Khalil Jawad
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany; Cardiac Surgery, Peter Munk Cardiac Center, University of Toronto, Toronto, Ontario, Canada
| | - Firat Sipahi
- Cardiac Surgery, Düsseldorf University Hospital, Dusseldorf, Germany
| | - Alex Koziarz
- Cardiac Surgery, Peter Munk Cardiac Center, University of Toronto, Toronto, Ontario, Canada
| | - Simone Huhn
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Nikos Kalampokas
- Cardiac Surgery, Düsseldorf University Hospital, Dusseldorf, Germany
| | - Alexander Albert
- Cardiac Surgery, Düsseldorf University Hospital, Dusseldorf, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Artur Lichtenberg
- Cardiac Surgery, Düsseldorf University Hospital, Dusseldorf, Germany
| | - Diyar Saeed
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany; Cardiac Surgery, Düsseldorf University Hospital, Dusseldorf, Germany.
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18
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Merás P, Riesgo-Gil F, Rybicka J, Barradas-Pires A, Smith J, Kempny A, Brookes P, Simon A, Gatzoulis MA. Heart transplantation at a single tertiary adult congenital heart disease centre: Too little, too late? Int J Cardiol 2020; 322:107-113. [PMID: 32798622 DOI: 10.1016/j.ijcard.2020.08.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Heart failure (HF) is the leading cause of death in adults with congenital heart disease (ACHD). Heart transplantation can be an effective therapy for them, albeit unfavourable anatomy, end-organ damage, pulmonary vascular disease, HLA sensitization and lack of robust selection criteria currently limit its application. METHODS Consecutive CHD patients considered for heart or combined heart and lung transplantation at our tertiary ACHD centre between 2000 and 2018 constitute our study population. Baseline characteristics and outcome, including transplantation and death, were obtained for all patients from designated databases, medical records and the UK Office for National Statistics. RESULTS From a total of more than 9000 active ACHD patients under follow-up, 166 (median age 40.4 years) fulfilled inclusion criteria, with a broad spectrum of underlying diagnosis: univentricular heart 22.3%, systemic right ventricle 22.3%, systemic-to-pulmonary shunts and Eisenmenger syndrome 16.3%, left sided valvular lesions 14.5%, tetralogy of Fallot 12.7%, CHD associated with cardiomyopathy 4.8% and other 7.2%. There was a high overall mortality with 39.2% of patients dying over a median follow-up of 2.7 years. A minority of patients (22.9%) were eventually listed and only 13.3% from the 166 patients were actually transplanted. Survival at 1 year after transplantation was 81.8% and remained high long-term (65.5% at 15 years). We describe herewith in detail characteristics and outcome of our cohort and present the transplantation pathway followed. CONCLUSION Of the small number of patients with ACHD considered for heart transplantation at a large tertiary centre, there was high overall mortality, with only a fraction of patients being actually transplanted. Patients who received transplantation, however, had a good outcome. Better patient selection and timing are clearly warranted so that more ACHD patients are considered and potentially benefit from this effective form of therapy.
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Affiliation(s)
- Pablo Merás
- Royal Brompton & Harefield NHS Trust. London, UK.
| | | | | | | | - John Smith
- Royal Brompton & Harefield NHS Trust. London, UK
| | | | - Paul Brookes
- Royal Brompton & Harefield NHS Trust. London, UK
| | - Andre Simon
- Royal Brompton & Harefield NHS Trust. London, UK
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19
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Correale M, Monaco I, Tricarico L, Bottigliero D, Sicuranza M, Del Forno B, Godeas G, Teri A, Maiorano A, Perulli R, Centola A, De Bonis M, Di Biase M, Brunetti ND. Advanced heart failure: non-pharmacological approach. Heart Fail Rev 2020; 24:779-791. [PMID: 30972521 DOI: 10.1007/s10741-019-09786-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patients with advanced heart failure have poor prognosis despite traditional pharmacological therapies. The early identification of these subjects would allow them to be addressed on time in dedicated centers to select patients eligible for heart transplantation or ventricular assistance. In this article we will report the current management of these patients based on latest international guidelines, underlining some critical aspects, with reference to future perspectives.
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Affiliation(s)
- Michele Correale
- Cardiology Department, Ospedali Riuniti University Hospital, Viale Pinto 1, 71122, Foggia, Italy
| | - Ilenia Monaco
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Lucia Tricarico
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Dario Bottigliero
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Monica Sicuranza
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Benedetto Del Forno
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, San Raffaele Hospital, Milan, Italy
| | - Giulia Godeas
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonino Teri
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Annamaria Maiorano
- Nephrology Dialysis and Transplantation Unit, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Rossella Perulli
- Nephrology Dialysis and Transplantation Unit, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Antonio Centola
- Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, San Raffaele Hospital, Milan, Italy
| | - Matteo Di Biase
- Santa Maria Hospital, Gruppo Villa Maria Research and Care, Bari, Italy
| | - Natale Daniele Brunetti
- Cardiology Department, Ospedali Riuniti University Hospital, Viale Pinto 1, 71122, Foggia, Italy.
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20
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Mirza KK, Xie R, Cowger J, Kirklin JK, Meyns B, Gustafsson F, Shaw SM, Goldstein DJ. Comparative analysis of regional outcomes and adverse events after continuous-flow left ventricular assist device implantation: An IMACS analysis. J Heart Lung Transplant 2020; 39:904-914. [PMID: 32487472 DOI: 10.1016/j.healun.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 05/03/2020] [Accepted: 05/08/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Regional outcomes after implantation of continuous-flow left ventricular assist devices (LVADs) have not been described. We examined differences in patient selection, survival, and adverse events across 3 geographic regions of the world: the Americas, Asia-Pacific, and Europe. METHODS Using data from The International Society for Heart and Lung Transplantation Mechanically Assisted Circulatory Support registry, all adult patients implanted with a continuous-flow LVADs were included in this International Society for Heart and Lung Transplantation Mechanically Assisted Circulatory Support analysis (n = 15,560), of whom, 9,988 (64%) received axial-flow devices and 5,572 (36%) received centrifugal-flow devices. RESULTS There were significant interregional differences in the rate of implantation of patients aged >70 years (Americas: 14%, Asia-Pacific: 1%, Europe: 5%; p < 0.0001), morbidly obese (Americas: 5%, Asia-Pacific: 1%, Europe: 1%; p < 0.0001), male (Americas: 79%, Asia-Pacific: 77%, Europe: 85%; p < 0.0001), and implanted as destination therapy (Americas: 48%, Asia-Pacific: 4%, Europe: 22%; p < 0.0001). The rates of centrifugal pump usage varied by region (Americas: 30%, Asia-Pacific: 34%, Eu: 74%; p < 0.0001). Survival rates varied by region and the type of pump flow, with survival at 12 and 48 months (axial flow vs centrifugal flow) being 82% vs 82% and 52% vs 53 in Americas; 92% vs 86% and 83% vs 74% in Asia-Pacific; and 80% vs 75% and 69% vs 53% in Europe, respectively (regional survival p < 0.0001). CONCLUSION There are marked global differences in LVAD recipient characteristics, device utilization, and post-operative care. These heterogeneities along with differences in patient management and transplantation rates may impact long-term survival. Regional differences in adverse event incidence warrant further investigation.
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Affiliation(s)
- Kiran K Mirza
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
| | - Rongbing Xie
- Department of Surgery, University of Alabama, Birmingham, Alabama
| | - Jennifer Cowger
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan
| | - James K Kirklin
- Department of Surgery, University of Alabama, Birmingham, Alabama
| | - Bart Meyns
- Department of Clinical Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steven M Shaw
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Daniel J Goldstein
- Department of Cardiothoracic Surgery, Montefiore Medical Center, Bronx, New York
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21
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Abstract
Heart failure (HF) is a condition in which the heart is unable to pump enough blood to meet the body's needs for blood and oxygen. Thus, HF is a grave disease with high morbidity and mortality. Because the prevalence of and exposure to the risk factors for HF increase with age, the prevalence of HF has been increasing in an aging society, including Korea. The vast advancement of medical and device therapy has improved the outcomes of HF, but significant residual risk still exists, and the benefit is confined to patients with reduced ejection fraction. Finding effective treatment for HF with preserved ejection fraction and identification of groups who benefit from drug and device therapy remain challenging. In this review, we illustrate the epidemiology, temporal trends, and current status of medical and device therapy, including heart transplantation, as well as emerging treatments for HF in Korea and worldwide.
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Affiliation(s)
- Jin Joo Park
- Cardiovascular Center, Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong-Ju Choi
- Cardiovascular Center, Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
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22
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Cazzoli I, Gunturiz-Beltran C, Guarguagli S, Alonso-Gonzalez R, Babu-Narayan SV, Dimopoulos K, Swan L, Uebing A, Gatzoulis MA, Ernst S. Catheter ablation for patients with end-stage complex congenital heart disease or cardiomyopathy considered for transplantation: Trials and tribulations. Int J Cardiol 2020; 301:127-134. [PMID: 31604655 DOI: 10.1016/j.ijcard.2019.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/27/2019] [Accepted: 09/06/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Arrhythmia contributes significantly to morbidity and mortality of patients with congenital heart disease (CHD) or cardiomyopathy (CMP). It also has the potential to worsen symptoms and is particularly detrimental to patients with advanced heart failure awaiting cardiac transplantation. We report our experience using catheter ablation to treat recurrent arrhythmia in patients with CHD or CMP considered for transplantation. METHODS Five consecutive patients (3 female, mean age 47.8 ± 12.8 years) with complex CHD or CMP (tricuspid atresia, mitral atresia, double inlet left ventricle, arrhythmogenic right ventricular cardiomyopathy, left ventricular non-compaction) presented with either atrial (n = 3) or ventricular (n = 2) arrhythmias. All ablations were guided by three-dimensional (3D) electro-anatomical mapping, plus remote magnetic navigation in 3 patients. RESULTS Patients underwent a median of 2 ablation procedures for a total number of 26 tachycardias. None of the 5 patients experienced further arrhythmia at a median of 939 days (range 4-1375) from their last ablation. During a median follow up of 31 months (range 1-70), three patients underwent successful transplantation at 1375, 1062 and 321 days following their last ablation. One patient with a Fontan circulation died from hepatic cancer and one from end-stage heart failure despite urgent transplant listing. CONCLUSIONS Catheter ablation is feasible in complex cardiac patients considered for heart transplantation and should be offered for rhythm management and patient optimization until a suitable donor is found.
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Affiliation(s)
- Ilaria Cazzoli
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, United Kingdom
| | - Clara Gunturiz-Beltran
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, United Kingdom; Electrophysiology Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Silvia Guarguagli
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, United Kingdom
| | - Rafael Alonso-Gonzalez
- Adult and Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Sonya V Babu-Narayan
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, United Kingdom; Cardiovascular Research Center, Royal Brompton and Harefield Hospital, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Konstantinos Dimopoulos
- Adult and Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Lorna Swan
- Adult and Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Anselm Uebing
- Electrophysiology Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Department of Paediatric Cardiology, University of Muenster, Muenster, Germany
| | - Michael A Gatzoulis
- Adult and Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospital, London, United Kingdom
| | - Sabine Ernst
- Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, United Kingdom.
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23
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Shaw SM, Venkateswaran R, Hogg R, Rushton S, Al-Attar N, Schueler S, Lim S, Parameshwar J, Banner NR. Durable left ventricular assist device support as a bridge to heart transplant candidacy†. Interact Cardiovasc Thorac Surg 2019; 28:594-601. [PMID: 30351360 DOI: 10.1093/icvts/ivy288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/16/2018] [Accepted: 08/28/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Left ventricular assist devices are funded in the UK exclusively as a bridge to transplant (BTT). However, patients who potentially could receive a transplant may develop reversible contraindications to transplant. Bridge to candidacy (BTC) has sometimes been controversial, given the uncertain clinical efficacy of BTC and the risk that reimbursement could be denied. We analysed the UK ventricular assist device database to understand how common BTC was and to assess patient survival rates and incidences of transplants. METHODS We identified BTC implants in patients with pulmonary hypertension, chronic kidney disease and obesity using the UK guidelines for heart transplants. RESULTS A total of 306 of 540 patients had complete data and 157 were identified as BTC (51%). Overall, there was no difference in survival rates between patients designated as BTC and those designated at BTT (71.9 vs 72.9% at 1 year, respectively; P = 0.82). However, the survival rate was lower at all time points in those with an estimated glomerular filtration rate (eGFR) <40 and in patients with a body mass index (BMI) >32 up to 1-year postimplant. There were no significant differences in the incidence of transplant between patients who were BTC and BTT or for any subgroup up to 5 years. However, we noted a diverging trend towards a lower cumulative incidence of transplant for patients with a BMI >32. CONCLUSIONS BTC is common in the UK and appears clinically effective, given that the survival rates and the incidence of transplants were comparable with those for BTT. Patients with a high BMI have a worse survival rate through to 1 year and a trend for a lower incidence of a transplant. Patients with a low eGFR also have a worse survival rate, but a similar proportion received transplants.
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Affiliation(s)
- Steven M Shaw
- Manchester University Foundation Trust, Wythenshawe Hospital, Manchester, UK.,Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Rajamiyer Venkateswaran
- Manchester University Foundation Trust, Wythenshawe Hospital, Manchester, UK.,Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Rachel Hogg
- Statistics and Clinical Studies, NHSBT, Bristol, UK
| | | | | | - Stephan Schueler
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Sern Lim
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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24
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Crossland DS, Jansen K, Parry G, Harper A, Perri G, Davidson A, De Rita F, Hermuzi A, Nassar M, Seller N, MacGowan GA, Hasan A, O'Sullivan JJ, Coats L. Outcome following heart transplant assessment in adults with congenital heart disease. Heart 2019; 105:1741-1747. [PMID: 31278142 PMCID: PMC6855839 DOI: 10.1136/heartjnl-2019-314711] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 05/04/2019] [Accepted: 05/16/2019] [Indexed: 01/06/2023] Open
Abstract
Objectives Adults with congenital heart disease (ACHD) are a growing group with end-stage heart failure. We aim to describe the outcomes of ACHD patients undergoing assessment for orthotopic heart transplant (OHT). Methods Case notes of consecutive ACHD patients (>16 years) assessed for OHT between 2000 and 2016 at our centre were reviewed. Decision and outcome were reported as of 2017. Data were analysed in three groups: systemic left ventricle (LV), systemic right ventricle (RV) and single ventricle (SV). Results 196 patients were assessed (31.8 years, 27% LV, 29% RV, 44% SV). 89 (45%) patients were listed for OHT and 67 (34%) were transplanted. 41 (21%) were unsuitable or too high risk and 36 (18%) were too well for listing. Conventional surgery was undertaken in 13 (7%) and ventricular assist device in 17 (9%) with 7 (4%) bridged to candidacy. Survival from assessment was 84.2% at 1 year and 69.7% at 5 years, with no difference between groups. Patients who were considered unsuitable for OHT (HR 11.199, p<0.001) and listed (HR 3.792, p=0.030) were more likely to die than those who were considered too well. Assessments increased over the study period. Conclusions The number of ACHD patients assessed for OHT is increasing. A third are transplanted with a small number receiving conventional surgery. Those who are unsuitable have a poor prognosis.
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Affiliation(s)
- David Steven Crossland
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.,Cardiovascular Research Centre, Institute of Genetic Medicine Newcastle University, Newcastle upon Tyne, UK
| | - Katrijn Jansen
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Gareth Parry
- Cardiac Transplantation, Freeman Hospital Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Harper
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Oxford, UK
| | - Gianluigi Perri
- Pediatric Cardiology and Cardiac Surgery, Ospedale Pediatrico Bambino Gesu, Roma, Italy.,Universita Cattolica del Sacro Cuore Sede di Roma, Rome, UK
| | - Alison Davidson
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Fabrizio De Rita
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Antony Hermuzi
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Mohamed Nassar
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.,Cardiodiothoracic Surgery Unit, Alexandria University, Alexandria, Egypt
| | - Neil Seller
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Guy A MacGowan
- Cardiovascular Research Centre, Institute of Genetic Medicine Newcastle University, Newcastle upon Tyne, UK.,Cardiology, Freeman Hospital Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Asif Hasan
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - John J O'Sullivan
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.,Cardiovascular Research Centre, Institute of Genetic Medicine Newcastle University, Newcastle upon Tyne, UK
| | - Louise Coats
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.,Cardiovascular Research Centre, Institute of Genetic Medicine Newcastle University, Newcastle upon Tyne, UK
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25
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Chaggar PS, McKay EJ, Foden P, Williams SG, Barnard J, Yonan N, Venkateswaran R, Shaw SM. Clinical characteristics and survival in cardiogenic shock admissions to a UK heart transplant unit. Future Cardiol 2018; 14:397-406. [PMID: 30232901 DOI: 10.2217/fca-2017-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM We describe the characteristics and outcomes of cardiogenic shock (CS) admissions to a UK transplant unit, which is previously unreported. PATIENTS & METHODS Fifty-nine unselected, consecutive patients over a 38-month period in CS (INTERMACS ≤2) and potentially eligible for transplant were retrospectively reviewed. RESULTS Patients were predominantly male (76.3%), young (mean age 42.2 years) and with severe end-organ dysfunction (acute liver/kidney injury 83%, mean lactate 3.5 mmol/l). 57.6% required mechanical support and 28.8% cardiac transplant. 30 days, discharge and 1-year survival were 78, 68 and 63%, respectively. Predictors of death included no transplant, increasing age and increasing creatinine. CONCLUSION Patients with CS and potential for transplant require significant resource input but demonstrate favorable outcomes in our experience.
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Affiliation(s)
| | - Ewan J McKay
- Department of Cardiology, The Countess of Chester NHS Trust, Chester, CH2 1UL, UK
| | - Philip Foden
- Medical Statistics, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK
| | - Simon G Williams
- The Transplant Unit, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK
| | - Jim Barnard
- The Transplant Unit, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK
| | - Nizar Yonan
- The Transplant Unit, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK
| | - Rajamiyer Venkateswaran
- The Transplant Unit, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK
| | - Steven M Shaw
- The Transplant Unit, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK
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26
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Bhagra SK, Pettit S, Parameshwar J. Cardiac transplantation: indications, eligibility and current outcomes. Heart 2018; 105:252-260. [DOI: 10.1136/heartjnl-2018-313103] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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27
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Bekfani T, Westphal F, Schulze PC. Therapeutic options in advanced heart failure. Clin Res Cardiol 2018; 107:114-119. [PMID: 29987596 DOI: 10.1007/s00392-018-1318-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Florian Westphal
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
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28
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Chan JL, Miller JG, Singh AK, Horvath KA, Corcoran PC, Mohiuddin MM. Consideration of appropriate clinical applications for cardiac xenotransplantation. Clin Transplant 2018; 32:e13330. [DOI: 10.1111/ctr.13330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Joshua L. Chan
- Cardiothoracic Surgery Research Program/National Heart; Lung and Blood Institute; National Institutes of Health; Bethesda MD USA
| | - Justin G. Miller
- Cardiothoracic Surgery Research Program/National Heart; Lung and Blood Institute; National Institutes of Health; Bethesda MD USA
| | - Avneesh K. Singh
- Cardiothoracic Surgery Research Program/National Heart; Lung and Blood Institute; National Institutes of Health; Bethesda MD USA
| | - Keith A. Horvath
- Cardiothoracic Surgery Research Program/National Heart; Lung and Blood Institute; National Institutes of Health; Bethesda MD USA
| | - Philip C. Corcoran
- Cardiothoracic Surgery Research Program/National Heart; Lung and Blood Institute; National Institutes of Health; Bethesda MD USA
| | - Muhammad M. Mohiuddin
- Cardiothoracic Surgery Research Program/National Heart; Lung and Blood Institute; National Institutes of Health; Bethesda MD USA
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29
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Cuthbert JJ, Pellicori P, Rigby A, Pan D, Kazmi S, Shah P, Clark AL. Low serum chloride in patients with chronic heart failure: clinical associations and prognostic significance. Eur J Heart Fail 2018; 20:1426-1435. [PMID: 29943886 DOI: 10.1002/ejhf.1247] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/19/2018] [Accepted: 05/23/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Low serum chloride is common in patients with chronic heart failure (CHF) and is associated with worse outcomes. We investigated the clinical and prognostic associations, including cause of death associations, of low serum chloride in patients referred to a secondary care clinic with suspected heart failure. METHODS AND RESULTS Patients with echocardiogram and serum chloride were evaluated (n = 5613). CHF was defined as signs and symptoms of the disease and either left ventricular systolic dysfunction (LVSD) worse than mild [heart failure with reduced ejection fraction (HFrEF)] or LVSD mild or better and raised amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (>125 ng/L) [heart failure with preserved ejection fraction (HFpEF)]. Hypochloraemia was defined as greater than two standard deviations below the mean in the local normal distribution (<96 mmol/L). Of the 5613 patients referred, 908 patients did not have CHF, 1988 had HFrEF, and 2717 had HFpEF. Compared to patients in the fourth quartile (median chloride 106 mmol/L), patients in the first quartile (median chloride 96 mmol/L) had more severe symptoms (38% New York Heart Association class III or IV vs. 25%, P < 0.001) and were more likely to take loop diuretics (79% vs. 55%, P < 0.001). The annual mortality rate for patients with CHF was 11%. Hypochloraemia was associated with an increased risk of death independent of NT-proBNP. Patients in the first quartile had a two-fold increased risk of death compared to patients in the fourth quartile (P < 0.001). Sudden death was a common mode of death amongst patients with hypochloraemia. CONCLUSIONS Hypochloraemia is strongly related to an adverse prognosis and may be a therapeutic target in patients with CHF.
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Affiliation(s)
- Joseph J Cuthbert
- Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK
| | - Pierpaolo Pellicori
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Alan Rigby
- Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK
| | - Daniel Pan
- Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK
| | - Syed Kazmi
- Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK
| | - Parin Shah
- Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK
| | - Andrew L Clark
- Department of Academic Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK
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30
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Roscoe A, Tomey MI, Torregrossa G, Galhardo C, Parhar K, Zochios V. Chagas Cardiomyopathy: A Comprehensive Perioperative Review. J Cardiothorac Vasc Anesth 2018; 32:2780-2788. [PMID: 29803311 DOI: 10.1053/j.jvca.2018.04.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Andrew Roscoe
- Department of Cardiothoracic Anesthesia and Critical Care Medicine, Papworth Hospital, Cambridge, United Kingdom
| | - Matthew I Tomey
- Cardiovascular Institute and Institute for Critical Care Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, Mount Sinai Saint Luke, Mount Sinai Health System, New York, NY
| | - Carlos Galhardo
- Department of Anesthesia, National Institute of Cardiology, Rio de Janeiro, Brazil
| | - Ken Parhar
- Department of Critical Care Medicine, University of Calgary, Calgary, Canada
| | - Vasileios Zochios
- University Hospitals Birmingham NHS Foundation Trust, Department of Critical Care Medicine, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, United Kingdom; Perioperative Critical Care and Trauma Trials Group, Institute of Inflammation and Ageing, Centre of Translational Inflammation Research, University of Birmingham, Birmingham, United Kingdom.
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31
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Ameri P, Canepa M, Anker MS, Belenkov Y, Bergler-Klein J, Cohen-Solal A, Farmakis D, López-Fernández T, Lainscak M, Pudil R, Ruschitska F, Seferovic P, Filippatos G, Coats A, Suter T, Von Haehling S, Ciardiello F, de Boer RA, Lyon AR, Tocchetti CG. Cancer diagnosis in patients with heart failure: epidemiology, clinical implications and gaps in knowledge. Eur J Heart Fail 2018; 20:879-887. [PMID: 29464808 DOI: 10.1002/ejhf.1165] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/24/2017] [Accepted: 01/24/2018] [Indexed: 12/15/2022] Open
Abstract
Cancer and heart failure (HF) are common medical conditions with a steadily rising prevalence in industrialized countries, particularly in the elderly, and they both potentially carry a poor prognosis. A new diagnosis of malignancy in subjects with pre-existing HF is not infrequent, and challenges HF specialists as well as oncologists with complex questions relating to both HF and cancer management. An increased incidence of cancer in patients with established HF has also been suggested. This review paper summarizes the epidemiology and the prognostic implications of cancer occurrence in HF, the impact of pre-existing HF on cancer treatment decisions and the impact of cancer on HF therapeutic options, while providing some practical suggestions regarding patient care and highlighting gaps in knowledge.
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Affiliation(s)
- Pietro Ameri
- Department of Internal Medicine, University of Genova; and Cardiology Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
| | - Marco Canepa
- Department of Internal Medicine, University of Genova; and Cardiology Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
| | - Markus S Anker
- Department of Cardiology (CBF), Charité University Medicine, Berlin, Germany; AND Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia; Department of Internal Medicine & Cardiology; and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), at Charité University Medicine, Berlin, Germany
| | | | | | - Alain Cohen-Solal
- Department of Cardiology, Lariboisière Hospital, Paris, France; U942 INSERM, BIOCANVAS (Biomarqueurs Cardiovasculaires), Paris, France;, Department of Cardiology, University of Paris VII Denis Diderot, Paris, France
| | - Dimitrios Farmakis
- Cardio-Oncology Clinic, Heart Failure Unit, Department of Cardiology, Athens University Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Teresa López-Fernández
- Cardio-Oncology Unit, Cardiac Imaging Unit, Department of Cardiology, La Paz University Hospital, IdiPAz, Madrid, Spain
| | - Mitja Lainscak
- Department of Cardiology, Department of Research and Education, General Hospital Celje, Celje, Slovenia, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Radek Pudil
- 1st Department of Medicine - Cardioangiology, Medical Faculty and University Hospital Hradec Kralove, Czech Republic
| | - Frank Ruschitska
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Gerasimos Filippatos
- Cardio-Oncology Clinic, Heart Failure Unit, Department of Cardiology, Athens University Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Andrew Coats
- Monash University, Australia and University of Warwick, UK
| | - Thomas Suter
- Department of Cardiology, Cardio-Oncology, Bern University Hospital, Bern, Switzerland
| | - Stephan Von Haehling
- Klinik für Kardiologie und Pneumologie, Herzzentrum Göttingen, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Germany;, Deutsches Zentrum für Herz- und Kreislaufforschung, Standort Göttingen, Göttingen, Germany
| | - Fortunato Ciardiello
- Department of Clinical and Experimental Medicine "Flaviano Magrassi", Luigi Vanvitelli University of Campania, Naples, Italy
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Carlo G Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
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Roos JCP, Daniels MJ, Morris E, Hyry HI, Cox TM. Heterogeneity in a large pedigree with Danon disease: Implications for pathogenesis and management. Mol Genet Metab 2018; 123:177-183. [PMID: 28822614 PMCID: PMC6588538 DOI: 10.1016/j.ymgme.2017.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Danon disease is an X-linked disturbance of autophagy manifesting with cognitive impairment and disordered heart and skeletal muscle. After a period of relative stability, patients deteriorate rapidly and may quickly become ineligible for elective heart transplantation - the only life-saving therapy. METHODS We report a large pedigree with diverse manifestations of Danon disease in hemizygotes and female heterozygotes. RESULTS Malignant cardiac arrhythmias requiring amiodarone treatment induced thyroid disease in two patients; intractable thyrotoxicosis, which enhances autophagy, caused the death of a 21year-old man. Our patients also had striking elevation of serum troponin I during the accelerated phase of their illness (p<0.01) and rising concentrations heralded cardiac decompensation. We argue for changes to cardiac transplantation eligibility criteria. CONCLUSION Danon disease causes hypertrophic cardiomyopathy - here we propose a common pathophysiological basis for the metabolic and structural effects of this descriptive class of heart disorders. We also contend that troponin I may have prognostic value and merits exploration for clinical decision-making including health warning bracelets. Rapamycin (Sirolimus®), an approved immunosuppressant which also influences autophagy, may prove beneficial. In the interim, while new treatments are developed, a revaluation of cardiac transplantation eligibility criteria is warranted.
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Affiliation(s)
| | | | | | - Hanna I Hyry
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Cambridge, UK.
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33
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Sullivan T, Taimur S, Rana M, Patel G, Pinney S, Anyanwu A, Huprikar S. Successful heart transplantation in patients with active Staphylococcus bloodstream infection and suspected mechanical circulatory support device infection. Transpl Infect Dis 2017; 20. [PMID: 29139180 DOI: 10.1111/tid.12812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/18/2017] [Accepted: 08/07/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND An active bloodstream infection (BSI) is typically considered a contraindication to heart transplantation (HT). However, in some patients with Staphylococcus bacteremia and mechanical circulatory support device infection, positive blood cultures may persist until removal of the infected device, and eradicating the infection prior to HT may not be possible. We report the outcomes of six patients with active Staphylococcus BSI at the time of HT. METHODS All cases of HT performed at The Mount Sinai Hospital from 2009 through 2015 were reviewed. All patients with a mechanical circulatory support device and an active Staphylococcus BSI at the time of HT were included. RESULTS Six patients with active Staphylococcus bacteremia and suspected mechanical circulatory support device infection underwent HT. All patients were bacteremic with Staphylococcus species at the time of HT. All were managed with antimicrobial therapy, radical debridement at the time of HT, and limited use of immunosuppression, and all survived until hospital discharge with no evidence of relapsed Staphylococcus infection. CONCLUSION These results suggest that some carefully selected patients with active Staphylococcus bacteremia and suspected mechanical circulatory support device infection may safely undergo HT, and that HT may effectively eliminate the underlying infection.
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Affiliation(s)
- Timothy Sullivan
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah Taimur
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meenakshi Rana
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gopi Patel
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sean Pinney
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anelechi Anyanwu
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shirish Huprikar
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Schmidhauser M, Regamey J, Pilon N, Pascual M, Rotman S, Banfi C, Prêtre R, Meyer P, Antonietti JP, Hullin R. The impact of multidisciplinary care on early morbidity and mortality after heart transplantation. Interact Cardiovasc Thorac Surg 2017; 25:384-390. [DOI: 10.1093/icvts/ivx151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 04/14/2017] [Indexed: 11/13/2022] Open
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35
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Affiliation(s)
| | - Daniele Masarone
- Second University of Naples-AORN Colli, Ospedale Monaldi, Naples, Italy
| | - Giuseppe Pacileo
- Second University of Naples-AORN Colli, Ospedale Monaldi, Naples, Italy
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36
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Evans JD, Kaptoge S, Caleyachetty R, Di Angelantonio E, Lewis C, Parameshwar KJ, Pettit SJ. Socioeconomic Deprivation and Survival After Heart Transplantation in England. Circ Cardiovasc Qual Outcomes 2016; 9:695-703. [DOI: 10.1161/circoutcomes.116.002652] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022]
Abstract
Background—
Socioeconomic deprivation (SED) is associated with shorter survival across a range of cardiovascular and noncardiovascular diseases. The association of SED with survival after heart transplantation in England, where there is universal healthcare provision, is unknown.
Methods and Results—
Long-term follow-up data were obtained for all patients in England who underwent heart transplantation between 1995 and 2014. We used the United Kingdom Index of Multiple Deprivation (UK IMD), a neighborhood level measure of SED, to estimate the relative degree of deprivation for each recipient. Cox proportional hazard models were used to examine the association between SED and overall survival and conditional survival (dependant on survival at 1 year after transplantation) during follow-up. Models were stratified by transplant center and adjusted for donor and recipient age and sex, ethnicity, serum creatinine, diabetes mellitus, and heart failure cause. A total of 2384 patients underwent heart transplantation. There were 1101 deaths during 17 040 patient-year follow-up. Median overall survival was 12.6 years, and conditional survival was 15.6 years. Comparing the most deprived with the least deprived quintile, adjusted hazard ratios for all-cause mortality were 1.27 (1.04–1.55;
P
=0.021) and 1.59 (1.22–2.09;
P
=0.001) in the overall and conditional models, respectively. Median overall survival and conditional survival were 3.4 years shorter in the most deprived quintile than in the least deprived.
Conclusions—
Higher SED is associated with shorter survival in heart transplant recipients in England and should be considered when comparing outcomes between centers. Future research should seek to identify modifiable mediators of this association.
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Affiliation(s)
- Jonathan D.W. Evans
- From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.)
| | - Stephen Kaptoge
- From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.)
| | - Rishi Caleyachetty
- From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.)
| | - Emanuele Di Angelantonio
- From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.)
| | - Clive Lewis
- From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.)
| | - K. Jayan Parameshwar
- From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.)
| | - Stephen J. Pettit
- From the Transplant Unit, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, United Kingdom (J.D.W.E., C.L., K.J.P., S.J.P.); Department of Public Health and Primary Care, University of Cambridge, United Kingdom (J.D.W.E., S.K., E.D.A.); and The Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, United Kingdom (R.C.)
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37
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DePasquale EC, Kobashigawa JA. Socioeconomic Disparities in Heart Transplantation: A Universal Fix? Circ Cardiovasc Qual Outcomes 2016; 9:693-694. [PMID: 27803092 DOI: 10.1161/circoutcomes.116.003210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eugene C DePasquale
- From the Advanced Heart Failure Program, David Geffen School of Medicine, University of California, Los Angeles (E.C.D.); and Advanced Heart Disease Section, Cedars-Sinai Heart Institute, Los Angeles, CA (J.A.K.).
| | - Jon A Kobashigawa
- From the Advanced Heart Failure Program, David Geffen School of Medicine, University of California, Los Angeles (E.C.D.); and Advanced Heart Disease Section, Cedars-Sinai Heart Institute, Los Angeles, CA (J.A.K.)
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38
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Impact of Heart Transplantation on Survival in Patients on Venoarterial Extracorporeal Membrane Oxygenation at Listing in France. Transplantation 2016; 100:1979-87. [DOI: 10.1097/tp.0000000000001265] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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39
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Briceno N, Kapur NK, Perera D. Percutaneous mechanical circulatory support: current concepts and future directions. Heart 2016; 102:1494-507. [DOI: 10.1136/heartjnl-2015-308562] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37:2129-2200. [PMID: 27206819 DOI: 10.1093/eurheartj/ehw128] [Citation(s) in RCA: 8971] [Impact Index Per Article: 1121.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 and 1880=1880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- gadu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Chaggar PS, Williams SG, Yonan N, Fildes J, Venkateswaran R, Shaw SM. Myocardial recovery with mechanical circulatory support. Eur J Heart Fail 2016; 18:1220-1227. [DOI: 10.1002/ejhf.575] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/24/2016] [Accepted: 04/28/2016] [Indexed: 01/18/2023] Open
Affiliation(s)
- Parminder S. Chaggar
- The Transplant Unit; University Hospital of South Manchester; Southmoor Road Manchester M23 9LT UK
- The Manchester Collaborative Centre for Inflammation Research; University of Manchester; Manchester UK
| | - Simon G. Williams
- The Transplant Unit; University Hospital of South Manchester; Southmoor Road Manchester M23 9LT UK
| | - Nizar Yonan
- The Transplant Unit; University Hospital of South Manchester; Southmoor Road Manchester M23 9LT UK
| | - James Fildes
- The Transplant Unit; University Hospital of South Manchester; Southmoor Road Manchester M23 9LT UK
- The Manchester Collaborative Centre for Inflammation Research; University of Manchester; Manchester UK
| | - Rajamiyer Venkateswaran
- The Transplant Unit; University Hospital of South Manchester; Southmoor Road Manchester M23 9LT UK
| | - Steven M. Shaw
- The Transplant Unit; University Hospital of South Manchester; Southmoor Road Manchester M23 9LT UK
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail 2016; 18:891-975. [DOI: 10.1002/ejhf.592] [Citation(s) in RCA: 4631] [Impact Index Per Article: 578.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Abstract
The British Society of Heart Failure (BSH) meetings highlight the latest advancements within the field of heart failure (HF) and provide education for training and revalidation for cardiologists and general physicians. This article reviews take-home messages from the 7th BSH HF revalidation and training meeting. It emphasises what every physician needs to know about the latest acute HF guidelines, diagnostics in HF, management strategies (including pharmacotherapeutics and device therapy), and when to consider referring to a transplant centre for mechanical circulatory support or transplantation. It describes the practical challenges faced and provides clinicians with a framework to assist with service development and commissioning of resources to deliver optimal, integrated services that meet the ever-advancing needs of our HF communities.
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Affiliation(s)
- Eleanor C Wicks
- Department of Cardiology, Bart's Heart Centre, St Bartholomew's Hospital, London, UK, and PhD, University College London, London, UK
| | - Lewis C Davies
- Department of Cardiology, and honorary senior lecturer, Cardiovascular Biomedical Research Unit, Bart's Heart Centre, St Bartholomew's Hospital, London, UK
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