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Kakuda N, Amiya E, Hatano M, Tsuji M, Bujo C, Ishida J, Yagi H, Saito A, Narita K, Isotani Y, Fujita K, Ando M, Shimada S, Kinoshita O, Ono M, Komuro I. Residual Pulmonary Vascular Resistance Increase Under Left Ventricular Assist Device Support Predicts Long-Term Cardiac Function After Heart Transplantation. Front Cardiovasc Med 2022; 9:904350. [PMID: 35722119 PMCID: PMC9198244 DOI: 10.3389/fcvm.2022.904350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022] Open
Abstract
Aims We compared hemodynamics and clinical events after heart transplantation (HTx) in patients stratified by the severity of residual pulmonary vascular resistance (PVR) after left ventricular assist device (LVAD) implantation for bridge to transplantation. Methods We retrospectively analyzed patients who had undergone HTx at the University of Tokyo Hospital. We defined the high PVR group as patients with PVR of >3 Wood Units (WU) as measured by right heart catheterization performed 1 month after LVAD implantation. Results We included 85 consecutive HTx recipients, 20 of whom were classified in the high PVR group and 65 in the low PVR group. The difference in PVR between the two groups became apparent at 2 years after HTx (the high PVR group: 1.77 ± 0.41 WU, the low PVR group: 1.24 ± 0.59 WU, p = 0.0009). The differences in mean pulmonary artery pressure (mPAP), mean right arterial pressure (mRAP), and mean pulmonary capillary wedge pressure (mPCWP) tended to increase from the first year after HTx, and were all significantly higher in the high PVR group at 3 years after HTx (mPAP: 22.7 ± 9.0 mm Hg vs. 15.4 ± 4.3 mm Hg, p = 0.0009, mRAP: 7.2 ± 3.6 mm Hg vs. 4.1 ± 2.1 mm Hg, p = 0.0042, and mPCWP: 13.4 ± 4.5 mm Hg, 8.8 ± 3.3 mm Hg, p = 0.0040). In addition, pulmonary artery pulsatility index was significantly lower in the high PVR group than in the low PVR group at 3 years after HTx (2.51 ± 1.00 vs. 5.21 ± 3.23, p = 0.0033). The composite event including hospitalization for heart failure, diuretic use, and elevated intracardiac pressure (mRAP ≥ 12 mm Hg or mPCWP ≥ 18 mm Hg) between the two groups was significantly more common in the high PVR group. Residual high PVR was still an important predictor (hazard ratio 6.5, 95% confidence interval 2.0–21.6, and p = 0.0023) after multivariate Cox regression analysis. Conclusion Our study demonstrates that patients with residual high PVR under LVAD implantation showed the increase of right and left atrial pressure in the chronic phase after HTx.
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Affiliation(s)
- Nobutaka Kakuda
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Japan
- Department of Therapeutic Strategy for Heart Failure, University of Tokyo, Bunkyo-ku, Japan
- *Correspondence: Eisuke Amiya,
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Japan
- Advanced Medical Center for Heart Failure, University of Tokyo, Bunkyo-ku, Japan
| | - Masaki Tsuji
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - Chie Bujo
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - Junichi Ishida
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - Hiroki Yagi
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - Akihito Saito
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - Koichi Narita
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - Yoshitaka Isotani
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - Kanna Fujita
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Japan
- Department of Computational Radiology and Preventive Medicine, The University of Tokyo Hospital, Bunkyo-ku, Japan
| | - Masahiko Ando
- Department of Cardiac Surgery, University of Tokyo, Bunkyo-ku, Japan
| | - Shogo Shimada
- Department of Cardiac Surgery, University of Tokyo, Bunkyo-ku, Japan
| | - Osamu Kinoshita
- Department of Cardiac Surgery, University of Tokyo, Bunkyo-ku, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, University of Tokyo, Bunkyo-ku, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Japan
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Sonaglioni A, Cassandro R, Luisi F, Ferrante D, Nicolosi GL, Lombardo M, Anzà C, Harari S. Correlation Between Doppler Echocardiography and Right Heart Catheterisation-Derived Systolic and Mean Pulmonary Artery Pressures: Determinants of Discrepancies Between the Two Methods. Heart Lung Circ 2020; 30:656-664. [PMID: 33223493 DOI: 10.1016/j.hlc.2020.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/27/2020] [Accepted: 10/06/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND There is still controversy about whether transthoracic echocardiography (TTE) can provide reliable estimations of pulmonary artery pressures (PAP). The primary endpoint of this study was to evaluate the correlation between TTE and right heart catheterisation (RHC) in estimating systolic (SPAP) and mean (MPAP) pulmonary artery pressures. METHODS Between January 2011 and December 2018, 141 consecutive patients (average age 63.6±11.5 years; 84 women) with suspected or confirmed pulmonary hypertension (PH) were enrolled into this retrospective observational monocentric study. All patients underwent TTE and, within 3 hours, RHC. The correlation between TTE and RHC in estimating both SPAP and MPAP was retrospectively determined. RESULTS Seventeen (17) of the patients were excluded due to insufficient TTE signal quality. Of the remaining 124 patients, 18 had no PH. There was moderate correlation between both SPAP and MPAP estimated by TTE and those assessed by RHC (r=0.65 and r=0.60, respectively). Bland-Altman analysis revealed a bias of -11.9 mmHg (with the 95% limits of agreement ranging -45.4 to +21.5 mmHg) for SPAP estimation and -4.6 mmHg (with the 95% limits of agreement ranging -27.9 to +18.8 mmHg) for MPAP estimation, suggesting a general overestimation of PAP by TTE. The main factors responsible for discrepancies between TTE and RHC were: female gender, arrhythmic cardiac electrical activity, systemic arterial hypertension, and diuretic treatment. CONCLUSIONS Transthoracic echocardiography frequently overestimated PAP in comparison with RHC, especially in hypertensive women with arrhythmias and under diuretic treatment.
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Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Milan, Italy
| | - Roberto Cassandro
- Department of Pneumology, Semi-Intensive Care Unit, Department of Respiratory Physiopathology and Pulmonary Hemodynamics, Ospedale San Giuseppe MultiMedica IRCCS, Milan, Italy.
| | - Francesca Luisi
- Department of Pneumology, Semi-Intensive Care Unit, Department of Respiratory Physiopathology and Pulmonary Hemodynamics, Ospedale San Giuseppe MultiMedica IRCCS, Milan, Italy
| | - Daniela Ferrante
- Unit of Medical Statistics and Epidemiology, CPO Piemonte and University 'Amedeo Avogadro' of Piemonte Orientale, Novara, Italy
| | | | - Michele Lombardo
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Milan, Italy
| | - Claudio Anzà
- Cardiovascular Department, MultiMedica IRCCS, Sesto San Giovanni (MI), Italy
| | - Sergio Harari
- Department of Pneumology, Semi-Intensive Care Unit, Department of Respiratory Physiopathology and Pulmonary Hemodynamics, Ospedale San Giuseppe MultiMedica IRCCS, Milan, Italy; Department of Medical Sciences San Giuseppe Hospital MultiMedica IRCCS and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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3
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Ahmed A, Ahmed S, Arvidsson M, Bouzina H, Lundgren J, Rådegran G. Elevated plasma sRAGE and IGFBP7 in heart failure decrease after heart transplantation in association with haemodynamics. ESC Heart Fail 2020; 7:2340-2353. [PMID: 32548968 PMCID: PMC7524060 DOI: 10.1002/ehf2.12772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 12/26/2022] Open
Abstract
AIMS Metabolic derangement is implicated in the pathophysiology of heart failure (HF) and pulmonary hypertension (PH). We aimed to identify the dynamics of metabolic plasma proteins linked to end-stage HF and associated PH in relation to haemodynamics, before and after heart transplantation (HT). METHODS AND RESULTS Twenty-one metabolic plasma proteins were analysed with proximity extension assay in 20 controls and 26 patients before and 1 year after HT. Right heart catheterizations were performed in the HF patients pre-operatively and 1 year after HT. Plasma levels of soluble receptor for advanced glycation end products (sRAGE) and insulin-like growth factor-binding protein 7 (IGFBP7) were higher in HF patients compared with controls (P < 0.0001) and decreased after HT (P < 0.0001), matching controls' levels. The decrease in sRAGE after HT correlated with improved mean pulmonary arterial pressure (rs = 0.7; P < 0.0001), pulmonary arterial wedge pressure (rs = 0.73; P < 0.0001), pulmonary vascular resistance (rs = 0.65; P = 0.00062), and pulmonary arterial compliance (rs = -0.52; P = 0.0074). The change in plasma IGFBP7 after HT correlated with improved mean right atrial pressure (rs = 0.71; P = 0.00011) and N-terminal pro-brain natriuretic peptide (rs = 0.71; P < 0.0001). CONCLUSIONS Our results indicate that plasma sRAGE may reflect passive pulmonary vascular congestion and the 'mechanical' state of the pulmonary vasculature in HF patients with or without related PH. Furthermore, sRAGE and IGFBP7 may provide additional insight into the pathophysiological mechanisms in HF and associated PH. Their potential clinical and therapeutic relevance in HF and associated PH need further investigation.
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Affiliation(s)
- Abdulla Ahmed
- Department of Clinical Sciences, Lund, The Section for CardiologyLund UniversityLundSweden
- The Haemodynamic Lab, The Section for Heart Failure and Valvular Disease, VO Heart and Lung MedicineSkåne University HospitalLundSweden
| | - Salaheldin Ahmed
- Department of Clinical Sciences, Lund, The Section for CardiologyLund UniversityLundSweden
- The Haemodynamic Lab, The Section for Heart Failure and Valvular Disease, VO Heart and Lung MedicineSkåne University HospitalLundSweden
| | - Mattias Arvidsson
- Department of Clinical Sciences, Lund, The Section for CardiologyLund UniversityLundSweden
- The Haemodynamic Lab, The Section for Heart Failure and Valvular Disease, VO Heart and Lung MedicineSkåne University HospitalLundSweden
| | - Habib Bouzina
- Department of Clinical Sciences, Lund, The Section for CardiologyLund UniversityLundSweden
- The Haemodynamic Lab, The Section for Heart Failure and Valvular Disease, VO Heart and Lung MedicineSkåne University HospitalLundSweden
| | - Jakob Lundgren
- Department of Clinical Sciences, Lund, The Section for CardiologyLund UniversityLundSweden
- The Haemodynamic Lab, The Section for Heart Failure and Valvular Disease, VO Heart and Lung MedicineSkåne University HospitalLundSweden
| | - Göran Rådegran
- Department of Clinical Sciences, Lund, The Section for CardiologyLund UniversityLundSweden
- The Haemodynamic Lab, The Section for Heart Failure and Valvular Disease, VO Heart and Lung MedicineSkåne University HospitalLundSweden
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Abstract
PURPOSE OF REVIEW Antibody-mediated rejection (AMR) is a major contributor of impaired long-term survival after heart transplantation (HTx). The presence of circulating donor-specific antihuman leukocyte antigen (HLA) antibodies (DSAs) is considered as a mandatory criterion for AMR after HTx. DSA are known prognostic biomarkers of outcome, for example, recipients with de-novo DSA have a three-fold increased risk of mortality. RECENT FINDINGS Although the awareness of the impact and prognosis of DSA on the survival has been increased in the HTx community over the last decade, the management of DSA pre and posttransplant varies among centers and is mainly based on the experience of transplant physicians. Thus, firm consensus strategies for each HTx recipient should be established by a center advisory board of experts in the field of HLA genetics, transplantation immunology, and HTx to evaluate the immunological risk preoperatively and also continuously during the posttransplant course. Consequently, the recent advances of invasive and noninvasive diagnostic tools should be applied, according to the risk, laboratory findings, and clinical events of the recipient. Such individual strategy will result in tailored therapeutic options. SUMMARY Novel standards for the management of DSA in HTx recipients on the basis of an interdisciplinary approach of experts will improve diagnostics for personalized medicine.
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5
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Bergh N, Gude E, Bartfay S, K Andreassen A, Arora S, Dahlberg P, Dellgren G, Gullestad L, Gustafsson F, Karasson K, Rådegran G, Bollano E, Andersson B. Invasive haemodynamics in de novo everolimus vs. calcineurin inhibitor heart transplant recipients. ESC Heart Fail 2020; 7:567-576. [PMID: 32059083 PMCID: PMC7160471 DOI: 10.1002/ehf2.12608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 12/21/2022] Open
Abstract
Aims Invasive haemodynamic profiles at rest and during exercise after heart transplantation (HTx) have never been described in a randomized trial where de novo everolimus (EVR)‐based therapy with early calcineurin inhibitor (CNI) withdrawal has been compared with conventional CNI treatment. We report central invasive haemodynamic parameters at rest and exercise during a 3 year follow‐up after HTx in a sub‐study of the SCandiavian Heart transplant Everolimus De novo stUdy with earLy calcineurin inhibitor avoidancE trial. We hypothesized that the nephroprotective properties, the less development of cardiac allograft vasculopathy (CAV), and the antifibrotic properties of EVR, in comparison with CNI‐based immunosuppression, would demonstrate favourable invasive haemodynamic profiles in patients at rest and during exercise. Methods and results Ninety of 115 HTx recipients randomized to EVR or CNI treatment performed right heart catheterization at rest and 68 performed right heart catheterization at exercise up to 3 years after HTx. Haemodynamic profiles were compared between EVR and CNI treatment groups. Resting haemodynamics improved in both groups from pre‐HTx to the first follow‐up at 7–11 weeks post‐HTx and thereafter remained unchanged up to 3 years of follow‐up. During follow‐up, cardiac reserve during exercise increased with higher levels of maximum heart rate (118 to 148 b.p.m., P < 0.001), mean arterial pressure (103 to 128 mmHg, P < 0.001), and cardiac output (10.3 to 12.2 l/min, P < 0.001). No significant differences in haemodynamic parameters were observed between the EVR and CNI groups at rest or exercise. Isolated post‐capillary pulmonary hypertension (mean pulmonary arterial pressure > 20 mmHg, pulmonary arterial wedge pressure ≥ 15 mmHg, and pulmonary vascular resistance <3) were measured in 11% of the patients at 7–11 weeks, 5% at 12 months, and 6% at 36 months after HTx. The EVR group had significantly better kidney function (76 mL/min/1 vs. 60 mL/min/1, P < 0.001) and reduced CAV (P < 0.01) but an increased rate of early biopsy‐proven treated rejections (21.2% vs 5.7%, P < 0.01) compared with the CNI group at any time point. The differences in renal function, CAV, or early biopsy‐proven treated acute rejections were not associated with altered haemodynamics. Conclusions De novo EVR treatment with early CNI withdrawal compared with conventional CNI therapy did not result in differences in haemodynamics at rest or during exercise up to 3 years after HTx despite significant differences in renal function, reduced CAV, and number of early biopsy‐proven treated rejections.
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Affiliation(s)
- Niklas Bergh
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
- Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Einar Gude
- Department of CardiologyOslo University Hospital RikshospitaletOsloNorway
| | - Sven‐Erik Bartfay
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
- Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Arne K Andreassen
- Department of CardiologyOslo University Hospital RikshospitaletOsloNorway
- KG Jebsen Center for Cardiac ResearchUniversity of OsloOsloNorway
- Center for Heart Failure ResearchOslo University HospitalOsloNorway
| | - Satish Arora
- Department of CardiologyOslo University Hospital RikshospitaletOsloNorway
- KG Jebsen Center for Cardiac ResearchUniversity of OsloOsloNorway
- Center for Heart Failure ResearchOslo University HospitalOsloNorway
| | - Pia Dahlberg
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
- Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Göran Dellgren
- Department of Clinical SciencesLund University, Lund, SwedenTransplant Institute, Sahlgrenska University HospitalGothenburgSweden
| | - Lars Gullestad
- Department of CardiologyOslo University Hospital RikshospitaletOsloNorway
- KG Jebsen Center for Cardiac ResearchUniversity of OsloOsloNorway
- Center for Heart Failure ResearchOslo University HospitalOsloNorway
- Faculty of MedicineUniversity of OsloOsloNorway
| | - Finn Gustafsson
- Department of Cardiology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Kristjan Karasson
- Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Göran Rådegran
- The Section for Heart Failure and Valvular Disease, VO Heart and Lung MedicineSkåne University HospitalLundSweden
- Department of Clinical SciencesLund University, Lund, SwedenTransplant Institute, Sahlgrenska University HospitalGothenburgSweden
| | - Entela Bollano
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
- Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Bert Andersson
- Department of CardiologySahlgrenska University HospitalGothenburgSweden
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6
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Impaired Exercise Tolerance Early After Heart Transplantation Is Associated With Development of Cardiac Allograft Vasculopathy. Transplantation 2020; 104:2196-2203. [DOI: 10.1097/tp.0000000000003110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ahmed A, Ahmed S, Arvidsson M, Bouzina H, Lundgren J, Rådegran G. Prolargin and matrix metalloproteinase-2 in heart failure after heart transplantation and their association with haemodynamics. ESC Heart Fail 2019; 7:223-234. [PMID: 31858729 PMCID: PMC7083509 DOI: 10.1002/ehf2.12560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/28/2019] [Accepted: 10/25/2019] [Indexed: 02/06/2023] Open
Abstract
Aims Remodelling of the extracellular matrix (ECM) is a key mechanism involved in the development and progression of heart failure (HF) but also functional in associated pulmonary hypertension (PH). Our aim was to identify plasma ECM proteins associated to end‐stage HF and secondary PH in relation to haemodynamics, before and after heart transplantation (HT). Methods and results Twenty ECM plasma proteins were analysed with proximity extension assay in 20 controls and 26 HF patients pre‐HT and 1 year post‐HT. Right heart catherization haemodynamics were assessed in the patients during the preoperative evaluation and at the 1 year follow‐up post‐HT. Plasma levels of prolargin and matrix metalloproteinase‐2 (MMP‐2) were elevated (P < 0.0001) in HF patients compared with controls and decreased (P < 0.0001) post‐HT towards controls' levels. The decrease in prolargin post‐HT correlated with improved mean right atrial pressure (rs = 0.63; P = 0.00091), stroke volume index (rs = −0.73; P < 0.0001), cardiac index (rs = −0.64; P = 0.00057), left ventricular stroke work index (rs = −0.49; P = 0.015), and N‐terminal pro brain natriuretic peptide (rs = 0.7; P < 0.0001). The decrease in MMP‐2 post‐HT correlated with improved mean pulmonary artery pressure (rs = 0.58; P = 0.0025), mean right atrial pressure (rs = 0.56; P = 0.0046), pulmonary artery wedge pressure (rs = 0.48; P = 0.016), and N‐terminal pro brain natriuretic peptide (rs = 0.56; P = 0.0029). Conclusions The normalization pattern in HF patients of plasma prolargin and MMP‐2 post‐HT towards controls' levels and their associations with improved haemodynamics indicate that prolargin and MMP‐2 may reflect, in part, the aberrant ECM remodelling involved in the pathophysiology of HF and associated PH. Their potential clinical use as biomarkers or targets for future therapy in HF and related PH remains to be investigated.
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Affiliation(s)
- Abdulla Ahmed
- Department of Clinical Sciences Lund, CardiologyLund UniversityLundSweden
- The Haemodynamic Lab, The Section for Heart Failure and Valvular Disease, VO Heart and Lung MedicineSkåne University HospitalLundSweden
| | - Salaheldin Ahmed
- Department of Clinical Sciences Lund, CardiologyLund UniversityLundSweden
- The Haemodynamic Lab, The Section for Heart Failure and Valvular Disease, VO Heart and Lung MedicineSkåne University HospitalLundSweden
| | - Mattias Arvidsson
- Department of Clinical Sciences Lund, CardiologyLund UniversityLundSweden
- The Haemodynamic Lab, The Section for Heart Failure and Valvular Disease, VO Heart and Lung MedicineSkåne University HospitalLundSweden
| | - Habib Bouzina
- Department of Clinical Sciences Lund, CardiologyLund UniversityLundSweden
- The Haemodynamic Lab, The Section for Heart Failure and Valvular Disease, VO Heart and Lung MedicineSkåne University HospitalLundSweden
| | - Jakob Lundgren
- Department of Clinical Sciences Lund, CardiologyLund UniversityLundSweden
- The Haemodynamic Lab, The Section for Heart Failure and Valvular Disease, VO Heart and Lung MedicineSkåne University HospitalLundSweden
| | - Göran Rådegran
- Department of Clinical Sciences Lund, CardiologyLund UniversityLundSweden
- The Haemodynamic Lab, The Section for Heart Failure and Valvular Disease, VO Heart and Lung MedicineSkåne University HospitalLundSweden
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8
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Clemmensen TS, Eiskjær H, Løgstrup BB, Valen KPB, Mellemkjær S, Poulsen SH. Prognostic value of exercise myocardial deformation and haemodynamics in long-term heart-transplanted patients. ESC Heart Fail 2019; 6:629-639. [PMID: 31025819 PMCID: PMC6676272 DOI: 10.1002/ehf2.12438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/06/2019] [Indexed: 11/14/2022] Open
Abstract
Aims The study evaluated exercise left ventricular global longitudinal strain (LVGLS) and invasive haemodynamics for major adverse cardiac events (MACE) prediction in heart‐transplanted (HTx) patients. Methods and results The study comprised 74 stable consecutive HTx patients who were followed at the Department of Cardiology, Aarhus University Hospital, Denmark, from August 2013 to January 2017. All patients were transplanted a minimum of 12 months before study entry and were included at the time of their routine annual coronary angiography. A symptom‐limited haemodynamic exercise test with simultaneous echocardiographic study was performed. The primary endpoint was MACE during follow‐up defined as heart failure hospitalization, treated rejection episodes, coronary event, or cardiac death. The median time since transplant was 5 years [1:12] and the median follow‐up was 1095 days [391;1506]. Thirty patients (41%) experienced MACE during follow‐up. Patients who suffered MACE had an impaired resting and peak exercise systolic function in form of a lower LV ejection fraction (Rest: 56 ± 12% vs. 65 ± 7%, P < 0.001; Peak 64 ± 13% vs. 72 ± 6%, P < 0.01) and LVGLS (Rest: 13 ± 4% vs. 16 ± 2%, P < 0.01; Peak: 15 ± 6% vs. 20 ± 4%, P = 0.0001) than patients without MACE episodes. In contrast, resting diastolic filling patterns were comparable between patients suffering from MACE and patients without MACE. At rest, pulmonary capillary wedge pressure (mPCWP) and cardiac index did not predict MACE, whereas increased right atrial pressure (mRAP) was associated with increased MACE risk. Patients with peak exercise mPCWP >23 mmHg [hazard ratio (HR) 2.5, 95% confidence interval (CI): 1.2–5.4], cardiac index <5.9 L/min/m2 (HR 2.7, 95% CI: 1.0–6.3), or mRAP >13 mmHg (HR 2.7, 95% CI: 1.1–6.3) had increased MACE risk. Patients with exercise‐induced LVGLS increase <3.5% and peak exercise cardiac index <5.9 L/min/m2 [HR 6.1 (95% CI: 2.2–17.1)] or mPCWP >23 mmHg [HR 6.1 (95% CI: 2.1–17.5)] or mRAP >13 mmHg [HR 7.5 (95% CI: 2.3–23.9)] had the highest MACE risk. Conclusions Resting haemodynamic parameters were poor MACE predictors in long‐term HTx patients. In contrast, peak exercise mPCWP, mRAP, and CI were significant MACE predictors. LVGLS both at rest and during exercise were significant MACE predictors, and the combined model with peak exercise LVGLS and peak exercise mPCWP, mRAP, and CI clearly identified high‐risk HTx patients in relation cardiovascular endpoints independently of time since HTx.
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Affiliation(s)
| | - Hans Eiskjær
- Department of CardiologyAarhus University HospitalAarhusDenmark
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9
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Sanz-de la Garza M, Iannino N, Finnerty V, Mansour A, Blondeau L, Gayda M, Chaar D, Sirois MG, Racine N, de Denus S, Harel F, White M. Cardiopulmonary, biomarkers, and vascular responses to acute hypoxia following cardiac transplantation. Clin Transplant 2018; 32:e13352. [PMID: 30047602 DOI: 10.1111/ctr.13352] [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: 02/21/2018] [Revised: 07/05/2018] [Accepted: 07/15/2018] [Indexed: 11/27/2022]
Abstract
Previous studies have suggested good adaptation of cardiac transplant (CTx) recipients to exposure to a high altitude. No studies have investigated the cardiopulmonary and biomarker responses to acute hypoxic challenges following CTx. Thirty-six CTx recipients and 17 age-matched healthy controls (HC) were recruited. Sixteen (16) patients (42%) had cardiac allograft vasculopathy (CAV). Cardiopulmonary responses to maximal and submaximal exercise at 21% O2 , 20-minutes hypoxia (11.5% O2 ), and following a 10-minute exposure to 11.5% O2 using 30% of peak power output were completed. Vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), suppression of tumorigenicity 2 (ST2) were measured at baseline and at peak stress. Endothelial peripheral function was assessed using near-infrared spectroscopy. Compared with HC, CTx presented a lesser O2 desaturation both at rest (-19.4 ± 6.8 [CTx] vs -24.2 ± 6.0% O2 [HC], P < 0.05) and following exercise (-23.2 ± 4.9 [CTx] vs -26.2 ± 4.7% O2 [HC], P < 0.05). CTx patients exhibited a significant decrease in peak oxygen uptake. IL-6 and VEGF levels were significantly higher in CTx recipients in basal conditions but did not change in response to acute stress. CTx patients exhibit a favorable ventilatory and overall response to hypoxic stress. These data provide further insights on the good adaptability of CTx to exposure to high altitude.
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Affiliation(s)
- Maria Sanz-de la Garza
- Cardiology Department, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.,Cardiology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Nadia Iannino
- Cardiology Department, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Vincent Finnerty
- Cardiology Department, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Asmaa Mansour
- Division of the Montreal Heart Institute, Montreal Health Innovations Coordinating Center (MHICC), Montreal, Quebec, Canada
| | - Lucie Blondeau
- Division of the Montreal Heart Institute, Montreal Health Innovations Coordinating Center (MHICC), Montreal, Quebec, Canada
| | - Mathieu Gayda
- Cardiology Department, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.,Cardiovascular Prevention and Rehabilitation Center (ÉPIC), Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Diana Chaar
- Cardiology Department, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Martin G Sirois
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Normand Racine
- Cardiology Department, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Simon de Denus
- Research Center, Montreal Heart Institute, Université de Montréal Beaulieu-Saucier Pharmacogenomics Center and Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - François Harel
- Cardiology Department, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Michel White
- Cardiology Department, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
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10
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Lundgren J, Sandqvist A, Hedeland M, Bondesson U, Wikström G, Rådegran G. Alterations in plasma L-arginine and methylarginines in heart failure and after heart transplantation. SCAND CARDIOVASC J 2018; 52:196-204. [PMID: 29648475 DOI: 10.1080/14017431.2018.1459823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Endothelial function, including the nitric oxide (NO)-pathway, has previously been extensively investigated in heart failure (HF). In contrast, studies are lacking on the NO pathway after heart transplantation (HT). We therefore investigated substances in the NO pathway prior to and after HT in relation to hemodynamic parameters. DESIGN 12 patients (median age 50.0 yrs, 2 females), heart transplanted between June 2012 and February 2014, evaluated at our hemodynamic lab, at rest, prior to HT, as well as four weeks and six months after HT were included. All patients had normal left ventricular function post-operatively and none had post-operative pulmonary hypertension or acute cellular rejection requiring therapy at the evaluations. Plasma concentrations of ADMA, SDMA, L-Arginine, L-Ornithine and L-Citrulline were analyzed at each evaluation. RESULTS In comparison to controls, the plasma L-Arginine concentration was low and ADMA high in HF patients, resulting in low L-Arginine/ADMA-ratio pre-HT. Already four weeks after HT L-Arginine was normalized whereas ADMA remained high. Consequently the L-Arginine/ADMA-ratio improved, but did not normalize. The biomarkers remained unchanged at the six-month evaluation and the L-Arginine/ADMA-ratio correlated inversely to pulmonary vascular resistance (PVR) six months post-HT. CONCLUSIONS Plasma L-Arginine concentrations normalize after HT. However, as ADMA is unchanged, the L-Arginine/ADMA-ratio remained low and correlated inversely to PVR. Together these findings suggest that (i) the L-Arginine/ADMA-ratio may be an indicator of pulmonary vascular tone after HT, and that (ii) NO-dependent endothelial function is partly restored after HT. Considering the good postoperative outcome, the biomarker levels may be considered "normal" after HT.
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Affiliation(s)
- Jakob Lundgren
- a Department of Clinical Sciences Lund, Cardiology , Lund University , Lund , Sweden.,b The Hemodynamic Lab, The Section for Heart Failure and Valvular Disease, The Heart and Lung Clinic , Skåne University Hospital , Lund , Sweden
| | - Anna Sandqvist
- c Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology , Umeå University , Umeå , Sweden
| | - Mikael Hedeland
- d Department of Chemistry, Environment and Feed Hygiene , National Veterinary Institute (SVA) , Uppsala , Sweden.,e Department of Medicinal Chemistry, Analytical Pharmaceutical Chemistry , Uppsala University , Uppsala , Sweden
| | - Ulf Bondesson
- d Department of Chemistry, Environment and Feed Hygiene , National Veterinary Institute (SVA) , Uppsala , Sweden.,e Department of Medicinal Chemistry, Analytical Pharmaceutical Chemistry , Uppsala University , Uppsala , Sweden
| | - Gerhard Wikström
- f Department of Medical Sciences, Cardiology , Uppsala University, Uppsala University Hospital , Uppsala , Sweden
| | - Göran Rådegran
- a Department of Clinical Sciences Lund, Cardiology , Lund University , Lund , Sweden.,b The Hemodynamic Lab, The Section for Heart Failure and Valvular Disease, The Heart and Lung Clinic , Skåne University Hospital , Lund , Sweden
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11
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Li Y, Wang Y, Li H, Zhu W, Meng X, Lu X. Evaluation of the hemodynamics and right ventricular function in pulmonary hypertension by echocardiography compared with right-sided heart catheterization. Exp Ther Med 2017; 14:3616-3622. [PMID: 29042956 PMCID: PMC5639404 DOI: 10.3892/etm.2017.4953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 03/17/2017] [Indexed: 11/24/2022] Open
Abstract
The present study aimed to evaluate hemodynamics and right ventricular function in patients with pulmonary hypertension (PH) using transthoracic echocardiography and to compare these results with measurements obtained using right-sided heart catheterization (RHC). A total of 75 patients with PH were examined using echocardiography and RHC. Patients were divided into the following two groups according to their difference between SPAPecho and SPAPRHC measurement: The overestimated group and underestimated group. The overestimated group included the subgroups groupover-A (difference <20 mmHg) and groupover-B (difference ≥20 mmHg), and the underestimated group included groupunder-A (absolute value of the difference <20 mmHg) and groupunder-B (absolute value of the difference ≥20 mmHg). SPAPecho measurements were revealed to be significantly positively correlated with SPAPRHC measurements (r=0.794; P<0.01). Among all echocardiographic measurements, only tricuspid annular plane systolic excursion (TAPSE) was significantly different between groups; it was increased in groupover-A and groupunder-A compared with groupover-B (P<0.01). Although SPAP measurements obtained using echocardiography were significantly positively correlated with those obtained using RHC, a high proportion of overestimation or underestimation of SPAP by echocardiography remained.
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Affiliation(s)
- Yidan Li
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Yidan Wang
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Hong Li
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Weiwei Zhu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Xiangli Meng
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Xiuzhang Lu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
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12
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Rieth A, Richter MJ, Gall H, Seeger W, Ghofrani HA, Mitrovic V, Hamm CW. Hemodynamic phenotyping based on exercise catheterization predicts outcome in patients with heart failure and reduced ejection fraction. J Heart Lung Transplant 2017; 36:880-889. [DOI: 10.1016/j.healun.2017.02.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/20/2017] [Accepted: 02/24/2017] [Indexed: 12/31/2022] Open
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