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Rahm AK, Helmschrott M, Darche FF, Thomas D, Bruckner T, Ehlermann P, Kreusser MM, Warnecke G, Frey N, Rivinius R. Newly acquired complete right bundle branch block early after heart transplantation is associated with lower survival. ESC Heart Fail 2021; 8:3737-3747. [PMID: 34213089 PMCID: PMC8497214 DOI: 10.1002/ehf2.13494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/24/2021] [Accepted: 06/15/2021] [Indexed: 01/06/2023] Open
Abstract
Aims Right bundle branch block (RBBB) after heart transplantation (HTX) is a common finding, but its impact on post‐transplant survival remains uncertain. This study investigated the post‐transplant outcomes of patients with complete RBBB (cRBBB) ≤ 30 days after HTX. Methods This registry study analysed 639 patients receiving HTX at Heidelberg Heart Center between 1989 and 2019. Patients were stratified by diagnosis of cRBBB ≤ 30 days after HTX. Analysis included recipient and donor data, medication, echocardiographic features, graft rejections, atrial fibrillation, heart rates, permanent pacemaker implantation and mortality after HTX including causes of death. Results One hundred thirty‐nine patients showed cRBBB ≤ 30 days after HTX (21.8%), 20 patients with pre‐existing cRBBB in the donor heart (3.2%) and 119 patients with newly acquired cRBBB (18.6%). Patients with newly acquired cRBBB had a worse 1‐year post‐transplant survival (36.1%, P < 0.01) compared with patients with pre‐existing cRBBB (85.0%) or without cRBBB (86.4%), along with a higher percentage of death due to graft failure (P < 0.01). Multivariate analysis indicated cRBBB ≤ 30 days after HTX as significant risk factor for 1‐year mortality after HTX (HR: 2.20; 95% CI: 1.68–2.87; P < 0.01). Secondary outcomes showed a higher rate of an enlarged right atrium (P = 0.01), enlarged right ventricle (P < 0.01), reduced right ventricular function (P < 0.01), 30‐day atrial fibrillation (P < 0.01) and 1‐year permanent pacemaker implantation (P = 0.02) in patients with cRBBB after HTX. Conclusions Newly acquired cRBBB early after HTX is associated with increased post‐transplant mortality.
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Affiliation(s)
- Ann-Kathrin Rahm
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Matthias Helmschrott
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Fabrice F Darche
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Dierk Thomas
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Tom Bruckner
- Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Philipp Ehlermann
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Rasmus Rivinius
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
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2
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Novel biomarkers useful in surveillance of graft rejection after heart transplantation. Transpl Immunol 2021; 67:101406. [PMID: 33975013 DOI: 10.1016/j.trim.2021.101406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/06/2021] [Indexed: 01/06/2023]
Abstract
Heart transplantation (HTx) is considered the gold-standard therapy for the treatment of advanced heart failure (HF). The long-term survival in HTx is hindered by graft failure which represents one of the major limitations of the long-term efficacy of HTx. Endomyocardial biopsy (EMB) and the evaluation of donor-specific antibodies (DSA) are currently considered the essential diagnostic tools for surveillance of graft rejection. Recently, new molecular biomarkers (including cell-free DeoxyriboNucleic Acid, exosomes, gene profiling microarray, nanostring, reverse transcriptase multiplex ligation-dependent probe amplification, proteomics and immune profiling by quantitative multiplex immunofluorescence) provide useful information on mechanisms of graft rejection. The ambitious role of a similar change of perspective is aimed at a better and longer graft preservation.
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Armstrong‐Jr R, Ricardo‐da‐Silva FY, Correia CJ, Vidal‐dos‐Santos M, Anunciação LF, Coutinho e Silva RS, Moreira LFP, Leuvenink HGD, Breithaupt‐Faloppa AC. Treatment with 17β‐estradiol protects donor heart against brain death effects in female rat. Transpl Int 2020; 33:1312-1321. [DOI: 10.1111/tri.13687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/05/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Roberto Armstrong‐Jr
- Laboratorio de Cirurgia Cardiovascular e Fisiopatologia da Circulação (LIM‐11) Instituto do Coração (InCor)Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Fernanda Yamamoto Ricardo‐da‐Silva
- Laboratorio de Cirurgia Cardiovascular e Fisiopatologia da Circulação (LIM‐11) Instituto do Coração (InCor)Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Cristiano Jesus Correia
- Laboratorio de Cirurgia Cardiovascular e Fisiopatologia da Circulação (LIM‐11) Instituto do Coração (InCor)Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Marina Vidal‐dos‐Santos
- Laboratorio de Cirurgia Cardiovascular e Fisiopatologia da Circulação (LIM‐11) Instituto do Coração (InCor)Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Lucas Ferreira Anunciação
- Laboratorio de Cirurgia Cardiovascular e Fisiopatologia da Circulação (LIM‐11) Instituto do Coração (InCor)Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Raphael Santos Coutinho e Silva
- Laboratorio de Cirurgia Cardiovascular e Fisiopatologia da Circulação (LIM‐11) Instituto do Coração (InCor)Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Luiz Felipe Pinho Moreira
- Laboratorio de Cirurgia Cardiovascular e Fisiopatologia da Circulação (LIM‐11) Instituto do Coração (InCor)Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | | | - Ana Cristina Breithaupt‐Faloppa
- Laboratorio de Cirurgia Cardiovascular e Fisiopatologia da Circulação (LIM‐11) Instituto do Coração (InCor)Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
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Nakamura Y, Saito S, Miyagawa S, Yoshikawa Y, Hata H, Yoshioka D, Toda K, Sawa Y. Perioperative ischaemic reperfusion injury and allograft function in the early post-transplantation period. Interact Cardiovasc Thorac Surg 2019; 29:230–236. [PMID: 30919896 DOI: 10.1093/icvts/ivz086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/08/2019] [Accepted: 02/21/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Ischaemic reperfusion injury (IRI) is an inevitable complication of heart transplantation (HTX) and is observed as a pathological finding in biopsies from transplanted allografts. The aim of this study was to evaluate the severity of IRI and determine the clinical outcomes of HTX in patients with severe IRI. METHODS We enrolled 74 consecutive patients who had undergone HTX since 2007. Endomyocardial biopsy samples were obtained from the right ventricle of the transplanted heart. IRI was graded as 'trivial', 'mild', 'moderate' or 'severe' according to the extent of IRI-specific findings in the samples. The cohort was divided into a moderate-to-severe IRI group with 21 patients [IRI(+)] and a low-grade group with 53 patients [IRI(-)]. RESULTS The frequency of mechanical circulatory support and duration of catecholamine dependence in the early postoperative period were significantly higher in the IRI(+) group compared to the IRI(-) group. However, overall survival after HTX and mid-term cardiac allograft function were not significantly different between the groups. Among perioperative factors, cardiac ischaemic time was significantly different between the groups [IRI(-) vs IRI(+), 199 ± 38 min vs 239 ± 39 min; P < 0.001]. Incremental increases in cardiac ischaemic time were correlated with increases in IRI severity. Serum troponin T levels 3 h after donor heart reperfusion was significantly correlated with cardiac ischaemic time (r = 0.418, P = 0.0007). CONCLUSIONS IRI is associated with a complicated clinical course in the early post-HTX period due to temporary deterioration of allograft function. This may be attributable to myocardial stunning caused by long donor heart ischaemic time during HTX.
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Affiliation(s)
- Yuki Nakamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shunsuke Saito
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Hata
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Nykänen AI, Holmström EJ, Tuuminen R, Krebs R, Dhaygude K, Kankainen M, Jokinen JJ, Lommi J, Helanterä I, Räisänen-Sokolowski A, Syrjälä SO, Lemström KB. Donor Simvastatin Treatment in Heart Transplantation. Circulation 2019; 140:627-640. [PMID: 31352795 DOI: 10.1161/circulationaha.119.039932] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Ischemia-reperfusion injury may compromise the short-term and long-term prognosis after heart transplantation. Experimental studies show that simvastatin administered to the organ donor is vasculoprotective and inhibits cardiac allograft ischemia-reperfusion injury. METHODS Eighty-four multiorgan donors were randomly assigned to receive 80 mg of simvastatin (42 donors) via nasogastric tube after declaration of brain death and upon acceptance as a cardiac donor, or to receive no simvastatin (42 donors). The primary efficacy end point was postoperative plasma troponin T and I levels during the first 24 hours after heart transplantation. Secondary end points included postoperative hemodynamics, inflammation, allograft function, rejections and rejection treatments, and mortality. Results: Organ donor simvastatin treatment significantly reduced the heart recipient plasma levels of troponin T by 34% (14 900 ± 12 100 ng/L to 9800 ± 7900 ng/L, P=0.047), and troponin I by 40% (171 000 ± 151 000 ng/L to 103 000 ± 109 000 ng/L, P=0.023) at 6 hours after reperfusion, the levels of NT-proBNP (N-terminal pro-B-type natriuretic peptide) by 36% (32 800 ± 24 300 ng/L to 20 900 ± 15 900 ng/L; P=0.011) at 1 week, and the number of rejection treatments with hemodynamic compromise by 53% within the first 30 days (P=0.046). Donor simvastatin treatment did not affect donor lipid levels but was associated with a specific transplant myocardial biopsy gene expression profile, and a decrease in recipient postoperative plasma levels of CXCL10 (C-X-C motif chemokine 10), interleukin-1α, placental growth factor, and platelet-derived growth factor-BB. Postoperative hemodynamics, biopsy-proven acute rejections, and mortality were similar. No adverse effects were seen in recipients receiving noncardiac solid organ transplants from simvastatin-treated donors. CONCLUSIONS Donor simvastatin treatment reduces biomarkers of myocardial injury after heart transplantation, and-also considering its documented general safety profile-may be used as a novel, safe, and inexpensive adjunct therapy in multiorgan donation. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01160978.
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Affiliation(s)
- Antti I Nykänen
- Transplantation Laboratory (A.I.N., E.J.H., R.T., R.K., K.D., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Department of Cardiothoracic Surgery (A.I.N., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Translational Immunology Program Research Programs Unit (A.I.N., E.J.H., R.T., R.K., K.D., M.K., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland
| | - Emil J Holmström
- Transplantation Laboratory (A.I.N., E.J.H., R.T., R.K., K.D., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Translational Immunology Program Research Programs Unit (A.I.N., E.J.H., R.T., R.K., K.D., M.K., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland
| | - Raimo Tuuminen
- Transplantation Laboratory (A.I.N., E.J.H., R.T., R.K., K.D., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Translational Immunology Program Research Programs Unit (A.I.N., E.J.H., R.T., R.K., K.D., M.K., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland
| | - Rainer Krebs
- Transplantation Laboratory (A.I.N., E.J.H., R.T., R.K., K.D., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Translational Immunology Program Research Programs Unit (A.I.N., E.J.H., R.T., R.K., K.D., M.K., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland
| | - Kishor Dhaygude
- Transplantation Laboratory (A.I.N., E.J.H., R.T., R.K., K.D., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Translational Immunology Program Research Programs Unit (A.I.N., E.J.H., R.T., R.K., K.D., M.K., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland
| | - Matti Kankainen
- Translational Immunology Program Research Programs Unit (A.I.N., E.J.H., R.T., R.K., K.D., M.K., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Medical and Clinical Genetics (M.K.), University of Helsinki and Helsinki University Hospital, Finland.,Institute for Molecular Medicine Finland, University of Helsinki (M.K.)
| | - Janne J Jokinen
- Department of Cardiology (J.L.), University of Helsinki and Helsinki University Hospital, Finland.,Päijät-Häme Central Hospital, Department of Surgery, Lahti, Finland (J.J.J.)
| | | | - Ilkka Helanterä
- Transplantation and Liver Surgery (I.H.), University of Helsinki and Helsinki University Hospital, Finland
| | | | - Simo O Syrjälä
- Transplantation Laboratory (A.I.N., E.J.H., R.T., R.K., K.D., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Department of Cardiothoracic Surgery (A.I.N., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Translational Immunology Program Research Programs Unit (A.I.N., E.J.H., R.T., R.K., K.D., M.K., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland
| | - Karl B Lemström
- Transplantation Laboratory (A.I.N., E.J.H., R.T., R.K., K.D., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Department of Cardiothoracic Surgery (A.I.N., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland.,Translational Immunology Program Research Programs Unit (A.I.N., E.J.H., R.T., R.K., K.D., M.K., S.O.S., K.B.L.), University of Helsinki and Helsinki University Hospital, Finland
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DeBerge M, Zhang S, Glinton K, Grigoryeva L, Hussein I, Vorovich E, Ho K, Luo X, Thorp EB. Efferocytosis and Outside-In Signaling by Cardiac Phagocytes. Links to Repair, Cellular Programming, and Intercellular Crosstalk in Heart. Front Immunol 2017; 8:1428. [PMID: 29163503 PMCID: PMC5671945 DOI: 10.3389/fimmu.2017.01428] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/13/2017] [Indexed: 12/24/2022] Open
Abstract
Phagocytic sensing and engulfment of dying cells and extracellular bodies initiate an intracellular signaling cascade within the phagocyte that can polarize cellular function and promote communication with neighboring non-phagocytes. Accumulating evidence links phagocytic signaling in the heart to cardiac development, adult myocardial homeostasis, and the resolution of cardiac inflammation of infectious, ischemic, and aging-associated etiology. Phagocytic clearance in the heart may be carried out by professional phagocytes, such as macrophages, and non-professional cells, including myofibrolasts and potentially epithelial cells. During cardiac development, phagocytosis initiates growth cues for early cardiac morphogenesis. In diseases of aging, including myocardial infarction, heightened levels of cell death require efficient phagocytic debridement to salvage further loss of terminally differentiated adult cardiomyocytes. Additional risk factors, including insulin resistance and other systemic risk factors, contribute to inefficient phagocytosis, altered phagocytic signaling, and delayed cardiac inflammation resolution. Under such conditions, inflammatory presentation of myocardial antigen may lead to autoimmunity and even possible rejection of transplanted heart allografts. Increased understanding of these basic mechanisms offers therapeutic opportunities.
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Affiliation(s)
- Matthew DeBerge
- Department of Pathology, Feinberg Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Shuang Zhang
- Department of Pathology, Feinberg Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kristofor Glinton
- Department of Pathology, Feinberg Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Luba Grigoryeva
- Department of Pathology, Feinberg Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Islam Hussein
- Department of Pathology, Feinberg Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Esther Vorovich
- Department of Pathology, Feinberg Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Karen Ho
- Department of Pathology, Feinberg Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Xunrong Luo
- Department of Pathology, Feinberg Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Edward B Thorp
- Department of Pathology, Feinberg Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Foroutan F, Alba AC, Guyatt G, Duero Posada J, Ng Fat Hing N, Arseneau E, Meade M, Hanna S, Badiwala M, Ross H. Predictors of 1-year mortality in heart transplant recipients: a systematic review and meta-analysis. Heart 2017; 104:151-160. [DOI: 10.1136/heartjnl-2017-311435] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/17/2017] [Accepted: 06/06/2017] [Indexed: 11/04/2022] Open
Abstract
ObjectiveA systematic summary of the observational studies informing heart transplant guideline recommendations for selection of candidates and donors has thus far been unavailable. We performed a meta-analysis to better understand the impact of such known risk factors.MethodsWe systematically searched and meta-analysed the association between known pretransplant factor and 1-year mortality identified by multivariable regression models. Our review used the Grading of Recommendations, Assessment, Development and Evaluation for assessing the quality of assessment. We pooled risk estimates by using random effects models.ResultsRecipient variables including age (HR 1.16 per 10-year increase, 95% CI 1.10–1.22, high quality), congenital aetiology (HR 2.35, 95% CI 1.62 to 3.41, moderate quality), diabetes (HR 1.37, 95% CI 1.15 to 1.62, high quality), creatinine (HR 1.11 per 1 mg/dL increase, 95% CI 1.06 to 1.16, high quality), mechanical ventilation (HR 2.46, 95% CI 1.48 to 4.09, low quality) and short-term mechanical circulatory support (MCS) (HR 2.47, 95% CI 1.04 to 5.87, low quality) were significantly associated with 1-year mortality. Donor age (HR 1.20 per 10-year increase, 95% CI 1.14 to 1.26, high quality) and female donor to male recipient sex mismatch (HR 1.38, 95% CI 1.06 to 1.80, high quality) were significantly associated with 1-year mortality. None of the operative factors proved significant predictors.ConclusionHigh-quality and moderate-quality evidence demonstrates that recipient age, congenital aetiology, creatinine, pulsatile MCS, donor age and female donor to male recipient sex mismatch are associated with 1-year mortality post heart transplant. The results of this study should inform future guideline and predictive model development.
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Fröhlich GM, Leistner DM. The relevance of periprocedural troponin rise: the never ending story! Open Heart 2017; 4:e000590. [PMID: 28766585 PMCID: PMC5515128 DOI: 10.1136/openhrt-2017-000590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2017] [Indexed: 11/04/2022] Open
Affiliation(s)
- Georg Marcus Fröhlich
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - David Manuel Leistner
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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9
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Martin AK, Malhotra AK, Sullivan BL, Ramakrishna H. Troponin elevations in patients with chronic cardiovascular disease: An analysis of current evidence and significance. Ann Card Anaesth 2016; 19:321-7. [PMID: 27052076 PMCID: PMC4900336 DOI: 10.4103/0971-9784.179638] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Serum troponin elevation above the 99th percentile of the upper reference limit in healthy subjects (<0.01 ng/ml measured using currently available high-sensitivity cardiac troponin laboratory assays) is required to establish the diagnosis the diagnosis of myocardial necrosis in acute cardiovascular syndromes, as well as guide prognosis and therapy. In the perioperative period, for patients with cardiac disease undergoing noncardiac surgery, it is a particularly critical biomarker universally used to assess the myocardial damage. The value of troponin testing and elevation (as well as its significance) in patients with chronic cardiac valvular, vascular, and renal disease is relatively less well understood. This evidence-based review seeks to examine the currently available data assessing the significance of troponin elevation in certain chronic valvular and other disease states.
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Affiliation(s)
| | | | | | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Arizona, AZ, USA
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