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Begot I, Gomes WJ, Rocco IS, Bublitz C, Gonzaga LRA, Bolzan DW, Santos VB, Moreira RSL, Breda JR, Almeida DRD, Arena R, Guizilini S. Inspiratory Muscle Weakness is Related to Poor Short-Term Outcomes for Heart Transplantation. Braz J Cardiovasc Surg 2021; 36:308-317. [PMID: 33438847 PMCID: PMC8357387 DOI: 10.21470/1678-9741-2020-0344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION In heart transplantation (HT) recipients, several factors are critical to promptly adopting appropriate rehabilitation strategies and may be important to predict outcomes way after surgery. This study aimed to determine preoperative patient-related risk factors that could adversely affect the postoperative clinical course of patients undergoing HT. METHODS Twenty-one hospitalized patients with heart failure undergoing HT were evaluated according to respiratory muscle strength and functional capacity before HT. Mechanical ventilation (MV) time, reintubation rate, and intensive care unit (ICU) length of stay were recorded, and assessed postoperatively. RESULTS Inspiratory muscle strength as absolute and percentpredicted values were strongly correlated with MV time (r=-0.61 and r=-0.70, respectively, at P<0.001). Concerning ICU length of stay, only maximal inspiratory pressure (MIP) absolute and percent-predicted values were significantly associated. The absolute |MIP| was significantly negatively correlated with ICU length of stay (r=-0.58 at P=0.006) and the percent-predicted MIP was also significantly negatively correlated with ICU length of stay (r=-0.68 at P=0.0007). No associations were observed between preoperative functional capacity, age, sex, and clinical characteristics and MV time and ICU length of stay in the cohort included in this study. Patients with respiratory muscle weakness had a higher prevalence of prolonged MV, reintubation, and delayed ICU length of stay. CONCLUSION An impairment of preoperative MIP was associated with poorer short-term outcomes following HT. As such, inspiratory muscle strength is an important clinical preoperative marker in patients undergoing HT.
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Affiliation(s)
- Isis Begot
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Walter J Gomes
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil.,Cardiology and Cardiovascular Surgery Disciplines, Sao Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Isadora S Rocco
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Caroline Bublitz
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil.,Cardiology and Cardiovascular Surgery Disciplines, Sao Paulo Hospital, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Laion R A Gonzaga
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Douglas W Bolzan
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | | | | | - João R Breda
- Cardiology Postgraduate Program, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | | | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Solange Guizilini
- Department of Human Motion Sciences, Federal University of Sao Paulo, São Paulo, Brazil
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Wajnsztajn Yungher F, Kim A, Boehme A, Kleyman I, Weimer LH, Maurer MS, Brannagan TH. Peripheral neuropathy symptoms in wild type transthyretin amyloidosis. J Peripher Nerv Syst 2020; 25:265-272. [PMID: 32627282 DOI: 10.1111/jns.12403] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/15/2020] [Accepted: 06/26/2020] [Indexed: 12/11/2022]
Abstract
To propose a correlation between polyneuropathy and ATTRwt based on retrospective analysis of patients with ATTRwt. We reviewed 151 ATTRwt patients followed by the amyloid cardiac clinic (group A) for symptoms of neuropathy and 12 patients with ATTRwt evaluated in the Neurology Department (group B) with objective measures of neuropathy. Medical history, electrodiagnosis, laboratory and skin biopsies were assessed; 30.5% of group A had neuropathy symptoms. Alternative explanations for neuropathy symptoms were explored, including, age, gender, BMI, diabetes mellitus, B12 deficiency. No difference was observed for BMI, age, gender and spine disease for those with and without neuropathic symptoms (P > .05). All of group B (n = 12) were diagnosed with neuropathy, confirmed by electrodiagnostic testing or skin biopsy, while two patients had not yet developed cardiac symptoms. We observe a higher prevalence of neuropathic symptoms in ATTRwt patients than previously believed. Neuropathic symptoms may precede cardiac symptoms. Our findings suggest a possible causative relationship that requires further investigation.
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Affiliation(s)
- Fernanda Wajnsztajn Yungher
- Department of Neurology, Neurological Institute, Columbia University Irving Medical Center, New York, New York, USA.,Department of Neurology, UConn Health, Farmington, Connecticut, USA
| | - Arreum Kim
- Department of Neurology, Neurological Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Amelia Boehme
- Department of Neurology, Neurological Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Inna Kleyman
- Department of Neurology, Neurological Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Louis H Weimer
- Department of Neurology, Neurological Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Mathew S Maurer
- Department of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Thomas H Brannagan
- Department of Neurology, Neurological Institute, Columbia University Irving Medical Center, New York, New York, USA
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Minà C, Bagnato S, Sant'Angelo A, Falletta C, Gesaro GD, Agnese V, Tuzzolino F, Galardi G, Clemenza F. Risk Factors Associated With Peripheral Neuropathy in Heart Failure Patients Candidates for Transplantation. Prog Transplant 2019; 28:36-42. [PMID: 29592634 DOI: 10.1177/1526924818765091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Peripheral neuropathy can affect patients with heart failure, though its prevalence is unknown. After heart transplantation, it can influence the postoperative course and quality of life, but screening for neuromuscular disease is not routinely performed. OBJECTIVE The aim of this study was to identify the factors associated with neuropathy in a population of patients with heart failure who are candidates for heart transplantation. STUDY DESIGN Data regarding patients' clinical history, including recent hospitalizations, were collected. All patients underwent a complete neurological examination and a neurophysiological protocol including nerve conduction studies and concentric needle electromyography. RESULTS Thirty-two patients were included in the study, and neuropathy was diagnosed in 10 (31.3%). Neuropathy was associated with the number of admissions ( P = .023; odds ratio [OR]: 1.96) and the total number of days of hospitalization in the year prior to inclusion in the study ( P = .010; OR: 1.03). The majority of hospitalizations occurred in the step-down unit (85%), with acute heart failure the leading cause of admission (42%). CONCLUSIONS This study shows that neuropathy is frequent in patients with advanced heart failure and that hospitalization for cardiac care, also in the absence of intensive care, is a marker of high risk of neurologic damage. These data can help physicians in selecting and managing candidates for transplantation and can guide decisions on the best immunosuppressive regimen or rehabilitation strategy.
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Affiliation(s)
- Chiara Minà
- 1 Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Sergio Bagnato
- 2 Unit of Neurophysiology and Rehabilitation Department, Foundation Institute G. Giglio, Cefalù, Italy
| | - Antonino Sant'Angelo
- 2 Unit of Neurophysiology and Rehabilitation Department, Foundation Institute G. Giglio, Cefalù, Italy
| | - Calogero Falletta
- 1 Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Gabriele Di Gesaro
- 1 Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Valentina Agnese
- 1 Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Fabio Tuzzolino
- 3 Research Office, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Giuseppe Galardi
- 2 Unit of Neurophysiology and Rehabilitation Department, Foundation Institute G. Giglio, Cefalù, Italy
| | - Francesco Clemenza
- 1 Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
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McCartney SL, Patel C, Del Rio JM. Long-term outcomes and management of the heart transplant recipient. Best Pract Res Clin Anaesthesiol 2017; 31:237-248. [PMID: 29110796 DOI: 10.1016/j.bpa.2017.06.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/01/2017] [Accepted: 06/16/2017] [Indexed: 01/02/2023]
Abstract
Cardiac transplantation remains the gold standard in the treatment of advanced heart failure. With advances in immunosuppression, long-term outcomes continue to improve despite older and higher risk recipients. The median survival of the adult after heart transplantation is currently 10.7 years. While early graft failure and multiorgan system dysfunction are the most important causes of early mortality, malignancy, rejection, infection, and cardiac allograft vasculopathy contribute to late mortality. Chronic renal dysfunction is common after heart transplantation and occurs in up to 68% of patients by year 10, with 6.2% of patients requiring dialysis and 3.7% undergoing renal transplant. Functional outcomes after heart transplantation remain an area for improvement, with only 26% of patients working at 1-year post-transplantation, and are likely related to the high incidence of depression after cardiac transplantation. Areas of future research include understanding and managing primary graft dysfunction and reducing immunosuppression-related complications.
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Affiliation(s)
- Sharon L McCartney
- Divisions of Cardiothoracic and Critical Care Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
| | - Chetan Patel
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.
| | - J Mauricio Del Rio
- Divisions of Cardiothoracic and Critical Care Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
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