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Burrage MK, Cheshire C, Hey CY, Azam S, Watson WD, Bhagra S, Berman M, D'Errico L, Jenkins DP, Kaul P, Large S, Lewis C, Martinez L, Messer S, Page A, Parameshwar J, Pettit S, Rafiq M, Tsui S, Tweed K, Weir-McCall JR, Kydd A. Comparing Cardiac Mechanics and Myocardial Fibrosis in DBD and DCD Heart Transplant Recipients. J Card Fail 2022; 29:834-840. [PMID: 36521726 DOI: 10.1016/j.cardfail.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/11/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Heart transplantation (HTx) after donation after circulatory death (DCD) is an expanding practice but is associated with increased warm ischemic time. The impact of DCD HTx on cardiac mechanics and myocardial fibrosis has not been reported. We aimed to compare cardiac mechanics and myocardial fibrosis using cardiovascular magnetic resonance (CMR) imaging in donation after brain death (DBD) and DCD HTx recipients and healthy controls. METHODS AND RESULTS Consecutive HTx recipients between March 2015 and March 2021 who underwent routine surveillance CMR imaging were included. Cardiac mechanics were assessed using CMR feature tracking to compute global longitudinal strain, global circumferential strain, and right ventricular free-wall longitudinal myocardial strain. Fibrosis was assessed using late gadolinium enhancement imaging and estimation of extracellular volume. There were 82 (DBD n = 42, DCD n = 40) HTx recipients (aged 53 years, interquartile range 41-59 years, 24% female) who underwent CMR imaging at median of 9 months (interquartile range 6-14 months) after transplantation. HTx recipients had increased extracellular volume (29.7 ± 3.6%) compared with normal ranges (25.9%, interquartile range 25.4-26.5). Myocardial strain was impaired after transplantation compared with controls (global longitudinal strain -12.6 ± 3.1% vs -17.2 ± 1.8%, P < .0001; global circumferential strain -16.9 ± 3.1% vs -19.2 ± 2.0%, P = .002; right ventricular free-wall longitudinal strain -15.7 ± 4.5% vs -21.6 ± 4.7%, P < .0001). There were no differences in fibrosis burden (extracellular volume 30.6 ± 4.4% vs 29.2 ± 3.2%; P = .39) or cardiac mechanics (global longitudinal strain -13.1 ± 3.0% vs -12.1 ± 3.1%, P = .14; global circumferential strain -17.3 ± 2.9% vs -16.6 ± 3.1%, P = .27; right ventricular free-wall longitudinal strain -15.9 ± 4.9% vs -15.5 ± 4.1%, P = .71) between DCD and DBD HTx. CONCLUSIONS HTx recipients have impaired cardiac mechanics compared with controls, with increased myocardial fibrosis. There were no differences in early CMR imaging characteristics between DBD and DCD heart transplants, providing further evidence that DCD and DBD HTx outcomes are comparable.
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Affiliation(s)
- Matthew K Burrage
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK; Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | | | - Cong Ying Hey
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Saima Azam
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - Sai Bhagra
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Marius Berman
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | | | - Pradeep Kaul
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Stephen Large
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Clive Lewis
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | - Luis Martinez
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - Aravinda Page
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | | | | | - Steven Tsui
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK
| | | | - Jonathan R Weir-McCall
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK; School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Anna Kydd
- Transplant Unit, Royal Papworth Hospital, Cambridge, UK.
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Hey CY. It's time to 'Build Back Fairer': what can we do to reduce health inequalities in cardiology? Br J Cardiol 2022; 29:27. [PMID: 36873718 PMCID: PMC9982665 DOI: 10.5837/bjc.2022.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Disparities in cardiovascular morbidity and mortality are among the leading health and social care concerns in the UK. The disruption of the COVID-19 pandemic to health services has further placed cardiovascular care and the respective patient communities at the sharp end, not least in exacerbating existing health inequalities across service interfaces and patients' health outcomes. While the pandemic engenders unprecedented constraints within established cardiology services, it conduces to a unique opportunity to embrace novel transformative approaches within the way we deliver patient care in maintaining best practices during and beyond the crisis. As the first step in navigating toward the 'new norm', a clear recognition of the challenges inherent in cardiovascular health inequalities is critical, primarily in preventing the widening of extant inequalities as cardiology workforces continue to build back fairer. We may consider the challenges through the lens of health services' diverse facets, including the aspects of universality, interconnectivity, adaptability, sustainability, and preventability. This article explores the pertinent challenges and provides a focused narration concerning potential measures to foster equitable and resilient cardiology services that are patient centred in the post-pandemic landscape.
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Affiliation(s)
- Cong Ying Hey
- Internal Medical Trainee Department of Cardiology, Royal Papworth Hospital, Papworth Road, Cambridge, CB2 0AY
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