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Retinal microvascular remodeling associates with adverse events in continuous-flow left ventricular assist device-supported patients 视网膜微血管重塑与持续流左心室辅助装置支持患者的不良事件有关。
IF 6.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-30 DOI: 10.1016/j.healun.2024.07.017
Sambavan Jeyakumar , Helen Nguyen BMedSci(Hons) , Desiree Robson RN , Nick Olsen PhD , Bruno Schnegg MD , Peter Macdonald MD, PhD , Clare L. Fraser MBBS , Gerald Liew MBBS, MMed, PhD , Jacky Jiang , Christopher Hayward MBBS, MD , Kavitha Muthiah MBChB, PhD

Background

Continuous-flow left ventricular assist device (cfLVAD) use is effective in supporting patients with end-stage heart failure (ESHF). Reduced flow pulsatility within the systemic circulation in cfLVAD-supported patients may lead to alterations within the microcirculation. Temporal changes in microvasculature in relation to adverse events in cfLVAD-supported patients have not been studied. We aimed to profile changes within retinal microvasculature and its association with adverse events.

Methods

Retinal photography was performed using Topcon TRC-NW8 nonmydriatic fundus camera in cfLVAD-supported patients and ESHF control patients. Specific retinal measurements were evaluated using a validated semiautomated program. Demographic and adverse event data were documented.

Results

Forty-eight patients were studied (n = 29 cfLVAD, n = 19 ESHF). There were significant trends in retinal arteriolar caliber (B = −0.53 µm, 95% confidence interval [CI]: −0.96 to −0.10, p = 0.016) and retinal fractal dimension parameters (B = 0.014, 95% CI: 0.001-0.002, p = 0.016) in linear mixed model regressions. Among cfLVAD patients, there was a significant association between the incidence of gastrointestinal bleeding and stepwise increases in retinal arteriolar-venular caliber ratio (hazard ratio: 3.03, 95% CI: 2.06-4.45, p = 0.005), a measure of arteriolar narrowing.

Conclusions

We have observed for the first time that alterations in retinal microvasculature in cfLVAD-supported patients may be associated with gastrointestinal bleeding. While understanding these temporal changes may predict future adverse events in cfLVAD-supported patients, further multicenter studies are required to confirm the associations observed.
背景:使用连续流左心室辅助装置(cfLVAD)可有效支持终末期心力衰竭(ESHF)患者。cfLVAD 支持的患者全身循环中的血流搏动性降低可能会导致微循环发生变化。目前尚未研究过微血管的时间变化与 cfLVAD 支持患者不良事件的关系。我们旨在分析视网膜微血管的变化及其与不良事件的关系:方法:使用拓普康 TRC-NW8 非眼底照相机对支持 cfLVAD 的患者和 ESHF 对照组患者进行视网膜摄影。使用经过验证的半自动程序评估视网膜测量结果,包括动静脉口径、分形维度、分支角和血管迂曲度。记录了人口统计学和不良事件数据:共记录了 48 名患者(n=29 cfLVAD,n=19 ESHF,平均年龄(54.2 ± 11.9))的 172 张图像。在线性混合模型回归中,视网膜动静脉口径(B = -0.53 µm,95% CI:-0.96 -0.10,p = 0.016)和视网膜分形维度参数(B = 0.014,95% CI:0.001 - 0.002,p = 0.016)呈显着趋势。在 cfLVAD 患者中,胃肠道出血的发生率与视网膜动脉-静脉口径比值的逐步增加之间存在显著关联(HR:3.03,95% CI:2.06 - 4.45,p = 0.005),动脉-静脉口径比值是衡量动脉狭窄程度的指标:我们首次观察到,cfLVAD 支持的患者视网膜微血管的改变可能与消化道出血有关。虽然了解这些时间变化可以预测 cfLVAD 支持患者未来的不良事件,但还需要进一步的多中心研究来证实所观察到的关联。
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引用次数: 0
Kidney function assessment using cystatin C and serum creatinine in heart transplantation recipients: Implications for valganciclovir dosing 使用胱抑素 C 和血清肌酐评估心脏移植受者的肾功能:缬更昔洛韦剂量的意义。
IF 6.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-26 DOI: 10.1016/j.healun.2024.07.015
Alberto Pinsino MD , Douglas L. Jennings PharmD , Annamaria Ladanyi MD , Phuong Duong MD , Austin O. Sweat MD , Ian Mahoney MD , Bruno Bohn MPH , Ryan T. Demmer MPH, PhD , Koji Takeda MD, PhD , Gabriel T. Sayer MD , Nir Uriel MD, MS , Jay S. Leb MD , Syed A. Husain MD , Sumit Mohan MD, MPH , Paolo C. Colombo MD , Melana Yuzefpolskaya MD

Background

Among heart transplantation (HT) recipients, the accuracy of serum creatinine (sCr)-based estimated glomerular filtration rate (eGFR) may be limited by fluctuations in muscle mass. Cystatin C (cysC) is less influenced by muscle mass, but its levels may increase with obesity and steroid use. Herein, we (1) longitudinally compared eGFRcysC and eGFRsCr among HT recipients; (2) investigated the association of body mass index (BMI), steroid use, and muscle mass with discrepancies between eGFRs; and (3) explored the implications of eGFRcysC use on valganciclovir (VGC) dosing.

Methods

cysC and sCr were measured in 294 blood samples obtained from 80 subjects. Intraindividual differences between eGFRs (eGFRdiffcysC-sCr) were calculated with negative values corresponding to eGFRsCr > eGFRcysC and positive values to eGFRcysC > eGFRsCr. In a patient subset (n = 21), pectoralis muscle measures were obtained.

Results

Marked differences between eGFRcysC and eGFRsCr were observed, particularly early post-HT (1-week post-HT, median eGFRdiffcysC-sCr −28 ml/min/1.73 m2). eGFRcysC demonstrated stability following a transient postoperative decline, while eGFRsCr decreased in the first year post-HT. Lower BMI and higher prednisone dose displayed a modest association with more negative eGFRdiffcysC-sCr values. Pectoralis muscle measures indicative of greater muscle mass and better tissue quality exhibited a stronger association with more positive eGFRdiffcysC-sCr values. The use of eGFRcysC would have led to VGC dose adjustment in 46% of samples, predominantly resulting in dose reduction.

Conclusions

Among HT recipients, eGFRcysC and eGFRsCr markedly differ with implications for VGC dosing. The observed discrepancies may reflect changes in body composition and steroid use.
背景:在心脏移植(HT)受者中,基于血清肌酐(sCr)估计肾小球滤过率(eGFR)的准确性可能会受到肾外变量(如肌肉质量)波动的限制。胱抑素 C(cysC)受肌肉质量的影响较小;但是,肥胖和使用类固醇可能会增加 cysC 水平。在此,我们:i)纵向比较了 HT 受者中 eGFRcysC 和 eGFRsCr 的变化;ii)研究了体重指数(BMI)、类固醇使用和肌肉质量与 eGFRs 之间差异的关系;iii)探讨了 eGFRcysC 的使用对伐烷酸韦(VGC)剂量的影响。计算了不同 eGFR 之间的个体差异(eGFRdiffcysC-sCr)。eGFRdiffcysC-sCr 负值对应 eGFRsCr > eGFRcysC,正值对应 eGFRcysC > eGFRsCr。在一个患者子集中(n=21),胸肌测量值来自计算机断层扫描:观察到 eGFRcysC 和 eGFRsCr 之间存在明显差异,尤其是在 HT 术后早期(HT 术后 1 周,中位 eGFRdiffcysC-sCr -28 ml/min/1.73 m2)。eGFRcysC 在术后短暂下降后表现出稳定性,而 eGFRsCr 在 HT 术后第一年有所下降。较低的体重指数(BMI)和较高的泼尼松剂量与较负的 eGFRdiffcysC-sCr 值略有关联。相反,表明肌肉质量和组织质量更高的胸肌测量值与更多的 eGFRdiffcysC-sCr 正值有更强的关联。使用 eGFRcysC 将导致 46% 的样本进行 VGC 剂量调整,主要是导致剂量减少:结论:在高血压受者中,eGFRcysC 和 eGFRsCr 有明显差异,这对 VGC 剂量有影响。观察到的差异可能反映了身体成分和类固醇使用的变化。
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引用次数: 0
Comment on: Characteristics and outcomes of lung transplants performed with ex-situ lung perfusion 评论:使用原位肺灌注进行肺移植的特点和结果
IF 6.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-26 DOI: 10.1016/j.healun.2024.07.016
Yu Xia MD, MS , Abbas Ardehali MD
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引用次数: 0
Successful clinical transplantation of hearts donated after circulatory death using direct procurement followed by hypothermic oxygenated perfusion: A report of the first 3 cases 循环死亡后捐献的心脏通过直接采集和低温氧合灌注成功进行临床移植:首批 3 个病例的报告。
IF 6.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-26 DOI: 10.1016/j.healun.2024.07.018
Janne Brouckaert MD , Katrien Vandendriessche MD , Karlien Degezelle , Kristof Van de Voorde , Francis De Burghgraeve MD , Lars Desmet MD , Dirk Vlasselaers MD, PhD , Catherine Ingels MD, PhD , Dieter Dauwe MD, PhD , Erwin De Troy MD , Laurens J. Ceulemans MD, PhD , Dirk Van Raemdonck MD, PhD , Diethard Monbaliu MD, PhD , Bart Meyns MD, PhD , Raf Van den Eynde MD , Steffen Rex MD, PhD , Johan Van Cleemput MD, PhD , Filip Rega MD, PhD
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引用次数: 0
Aortic insufficiency in the patient on contemporary durable left ventricular assist device support: A state-of-the-art review on preoperative and postoperative assessment and management 当代耐用左心室辅助装置支持患者的主动脉瓣关闭不全:术前和术后评估与管理的最新回顾。
IF 6.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-26 DOI: 10.1016/j.healun.2024.06.018
Diyar Saeed MD, PhD , Jonathan Grinstein MD , Jamila Kremer MD , Jennifer A. Cowger MD, MS
The development of aortic insufficiency (AI) during HeartMate 3 durable left ventricular assist device (dLVAD) support can lead to ineffective pump output and recurrent heart failure symptoms. Progression of AI often comingles with the occurrence of other hemodynamic-related events encountered during LVAD support, including right heart failure, arrhythmias, and cardiorenal syndrome. While data on AI burdens and clinical impact are still insufficient in patients on HeartMate 3 support, moderate or worse AI occurs in approximately 8% of patients by 1 year and studies suggest AI continues to progress over time and is associated with increased frequency of right heart failure. The first line intervention for AI management is prevention, undertaking surgical intervention on the insufficient valve at the time of dLVAD implant and avoiding excessive device flows and hypertension during long-term support. Device speed augmentation may then be undertaken to try and overcome the insufficient lesion, but the progression of AI should be anticipated over the long term. Surgical or transcatheter aortic valve interventions may be considered in dLVAD patients with significant persistent AI despite medical management, but neither intervention is without risk. It is imperative that future studies of dLVAD support capture AI in clinical end-points using uniform assessment and grading of AI severity by individuals trained in AI assessment during dLVAD support.
在 HeartMate 3 耐用左心室辅助设备(dLVAD)支持过程中出现主动脉瓣关闭不全(AI)会导致泵输出无效和反复出现心衰症状。AI 的发展往往与 LVAD 支持期间遇到的其他血流动力学相关事件同时发生,包括右心衰竭、心律失常和心肾综合征。虽然有关使用 HeartMate 3 支持的患者的 AI 负担和临床影响的数据仍然不足,但约有 8% 的患者在使用 1 年后出现中度或更严重的 AI,而且研究表明 AI 会随着时间的推移继续发展,并与右心衰竭发生频率的增加有关。人工心肌缺血管理的一线干预措施是预防,在植入 dLVAD 时对瓣膜功能不全进行手术干预,并在长期支持期间避免设备流量过大和高血压。然后可以进行设备速度增强,尝试克服瓣膜功能不足的病变,但应预计到人工心肌缺血会长期发展。如果 dLVAD 患者尽管接受了药物治疗,但主动脉瓣仍存在严重的持续性缺血,则可考虑进行手术或经导管主动脉瓣介入治疗,但这两种介入治疗都没有风险。未来的 dLVAD 支持研究必须在 dLVAD 支持过程中,由接受过 AI 评估培训的人员对 AI 严重程度进行统一评估和分级,从而在临床终点中反映 AI 的情况。
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引用次数: 0
Immunomodulatory soluble HLA-G and HLA-E are associated with rapidly deteriorating CLAD and HCMV viremia after lung transplantation 免疫调节可溶性 HLA-G 和 HLA-E 与肺移植后迅速恶化的 CLAD 和 HCMV 病毒血症有关。
IF 6.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-25 DOI: 10.1016/j.healun.2024.07.014
Laura M. Kühner BSc , Sarah M. Berger BSc , Mila Djinovic MD , Philippe L. Furlano BSc , Lisa M. Steininger BSc , Anna-Lena Pirker MSc , Peter Jaksch MD , Elisabeth Puchhammer-Stöckl MD , Hannes Vietzen PhD
Plasma-soluble (s)HLA-G and sHLA-E are immunoregulatory proteins that balance the activation of NKG2A+ immune cells. In lung-transplant recipients (LTRs), dysregulated NKG2A+ natural killer cell responses may result in high-level human cytomegalovirus (HCMV) replication as well as chronic lung allograft dysfunction (CLAD), and especially the development of rapidly deteriorating CLAD is associated with high mortality. We thus analyzed the kinetics and function of sHLA-G and sHLA-E in follow-up samples of N = 76 LTRs to evaluate whether these immunoregulatory proteins are associated with the risk for CLAD and high-level HCMV replication. Here, we demonstrate that rapidly deteriorating CLAD LTRs are hallmarked by continually low (<107 ng/ml) sHLA-G levels. In contrast, high sHLA-E levels were associated with the following development of high-level (>1,000 copies/ml) HCMV episodes. Thus, sHLA-G and sHLA-E may serve as novel biomarkers for the development of rapidly deteriorating CLAD and high-level HCMV replication in LTRs.
血浆可溶性(s)HLA-G 和 sHLA-E 是免疫调节蛋白,可平衡 NKG2A+ 免疫细胞的活化。在肺移植受者(LTR)中,NKG2A+ 自然杀伤细胞反应失调可能导致高水平的 HCMV 复制以及慢性肺移植功能障碍(CLAD),尤其是快速恶化的 CLAD 与高死亡率相关。因此,我们分析了 N=76 例 LTR 随访样本中 sHLA-G 和 sHLA-E 的动力学和功能,以评估这些免疫调节蛋白是否与 CLAD 和高水平 HCMV 复制的风险有关。在这里,我们证明了快速恶化的 CLAD LTR 的特征是持续的低水平(1000 拷贝/毫升)HCMV 发作。因此,sHLA-G 和 sHLA-E 可作为快速恶化的 CLAD 和高水平 HCMV 复制 LTR 的新型生物标志物。
{"title":"Immunomodulatory soluble HLA-G and HLA-E are associated with rapidly deteriorating CLAD and HCMV viremia after lung transplantation","authors":"Laura M. Kühner BSc ,&nbsp;Sarah M. Berger BSc ,&nbsp;Mila Djinovic MD ,&nbsp;Philippe L. Furlano BSc ,&nbsp;Lisa M. Steininger BSc ,&nbsp;Anna-Lena Pirker MSc ,&nbsp;Peter Jaksch MD ,&nbsp;Elisabeth Puchhammer-Stöckl MD ,&nbsp;Hannes Vietzen PhD","doi":"10.1016/j.healun.2024.07.014","DOIUrl":"10.1016/j.healun.2024.07.014","url":null,"abstract":"<div><div>Plasma-soluble (s)HLA-G and sHLA-E are immunoregulatory proteins that balance the activation of NKG2A<sup>+</sup> immune cells. In lung-transplant recipients (LTRs), dysregulated NKG2A<sup>+</sup> natural killer cell responses may result in high-level human cytomegalovirus (HCMV) replication as well as chronic lung allograft dysfunction (CLAD), and especially the development of rapidly deteriorating CLAD is associated with high mortality. We thus analyzed the kinetics and function of sHLA-G and sHLA-E in follow-up samples of N = 76 LTRs to evaluate whether these immunoregulatory proteins are associated with the risk for CLAD and high-level HCMV replication. Here, we demonstrate that rapidly deteriorating CLAD LTRs are hallmarked by continually low (&lt;107 ng/ml) sHLA-G levels. In contrast, high sHLA-E levels were associated with the following development of high-level (&gt;1,000 copies/ml) HCMV episodes. Thus, sHLA-G and sHLA-E may serve as novel biomarkers for the development of rapidly deteriorating CLAD and high-level HCMV replication in LTRs.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"43 12","pages":"Pages 2036-2041"},"PeriodicalIF":6.4,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141766236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Small airway brush gene expression predicts chronic lung allograft dysfunction and mortality 小气道刷基因表达可预测慢性肺移植功能障碍和死亡率
IF 6.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-24 DOI: 10.1016/j.healun.2024.07.010
Rashmi Prava Mohanty PhD , Kaveh Moghbeli MD , Jonathan P. Singer MD, MS , Daniel R. Calabrese MD , Steven R. Hays MD , Carlo Iasella PharmD, MPH , Sophia Lieber BS , Lorriana E. Leard MD , Rupal J. Shah MD , Aida Venado MD , Mary E. Kleinhenz MD , Jeffery A. Golden MD , Tereza Martinu MD , Christina Love BA , Ryan Ward BS , Charles R. Langelier MD , John McDyer MD , John R. Greenland MD, PhD

Background

Chronic lung allograft dysfunction (CLAD) limits survival following lung transplant, but substantial lung damage occurs before diagnosis by traditional methods. We hypothesized that small airway gene expression patterns could identify CLAD risk before spirometric diagnosis and predict subsequent graft failure.

Methods

Candidate genes from 4 rejection-associated transcript sets were assessed for associations with CLAD or graft failure in a derivation cohort of 156 small airway brushes from 45 CLAD cases and 37 time-matched controls with >1-year stable lung function. Candidate genes not associated with CLAD and time to graft failure were excluded, yielding the Airway Inflammation 2 (AI2) gene set. Area under the receiver operating curve (AUC) for CLAD and competing risks of death or graft failure were assessed in an independent validation cohort of 37 CLAD cases and 37 controls.

Results

Thirty-two candidate genes were associated with CLAD and graft failure, comprising the AI2 score, which clustered into 3 subcomponents. The AI2 score identified CLAD before its onset, in early and late post-CLAD brushes, as well as in the validation cohort (AUC 0.69-0.88). The AI2 score association with CLAD was independent of positive microbiology, CLAD stage, or CLAD subtype. However, transcripts most associated with CLAD evolved over time from CLAD onset. The AI2 score predicted time to graft failure and retransplant-free survival in both cohorts (p ≤ 0.03).

Conclusions

This airway inflammation gene score is associated with CLAD development, graft failure, and death. Future studies defining the molecular heterogeneity of airway inflammation could lead to endotype-targeted therapies.
背景慢性肺移植功能障碍(CLAD)限制了肺移植后的存活率,但在用传统方法诊断之前就已经出现了严重的肺损伤。我们假设,小气道基因表达模式可以在肺功能诊断之前识别 CLAD 风险,并预测随后的移植物失败。方法在一个衍生队列中评估了来自 4 个排斥相关转录本集的候选基因与 CLAD 或移植物失败的相关性,该衍生队列包括来自 45 例 CLAD 病例和 37 例具有 >1年稳定肺功能的时间匹配对照的 156 个小气道刷。排除了与 CLAD 和移植物失败时间无关的候选基因,得出了气道炎症 2 (AI2) 基因集。结果32个候选基因与CLAD和移植失败相关,组成了AI2评分,该评分分为3个子成分。AI2 评分可在 CLAD 发病前、CLAD 刷片后早期和晚期以及验证队列中识别 CLAD(AUC 0.69-0.88)。AI2 评分与 CLAD 的关系与微生物学阳性、CLAD 分期或 CLAD 亚型无关。然而,与 CLAD 最相关的转录本会随着 CLAD 发病时间的推移而变化。结论这种气道炎症基因评分与 CLAD 的发生、移植失败和死亡有关。定义气道炎症分子异质性的未来研究可能会带来内型靶向疗法。
{"title":"Small airway brush gene expression predicts chronic lung allograft dysfunction and mortality","authors":"Rashmi Prava Mohanty PhD ,&nbsp;Kaveh Moghbeli MD ,&nbsp;Jonathan P. Singer MD, MS ,&nbsp;Daniel R. Calabrese MD ,&nbsp;Steven R. Hays MD ,&nbsp;Carlo Iasella PharmD, MPH ,&nbsp;Sophia Lieber BS ,&nbsp;Lorriana E. Leard MD ,&nbsp;Rupal J. Shah MD ,&nbsp;Aida Venado MD ,&nbsp;Mary E. Kleinhenz MD ,&nbsp;Jeffery A. Golden MD ,&nbsp;Tereza Martinu MD ,&nbsp;Christina Love BA ,&nbsp;Ryan Ward BS ,&nbsp;Charles R. Langelier MD ,&nbsp;John McDyer MD ,&nbsp;John R. Greenland MD, PhD","doi":"10.1016/j.healun.2024.07.010","DOIUrl":"10.1016/j.healun.2024.07.010","url":null,"abstract":"<div><h3>Background</h3><div>Chronic lung allograft dysfunction (CLAD) limits survival following lung transplant, but substantial lung damage occurs before diagnosis by traditional methods. We hypothesized that small airway gene expression patterns could identify CLAD risk before spirometric diagnosis and predict subsequent graft failure.</div></div><div><h3>Methods</h3><div>Candidate genes from 4 rejection-associated transcript sets were assessed for associations with CLAD or graft failure in a derivation cohort of 156 small airway brushes from 45 CLAD cases and 37 time-matched controls with &gt;1-year stable lung function. Candidate genes not associated with CLAD and time to graft failure were excluded, yielding the Airway Inflammation 2 (AI2) gene set. Area under the receiver operating curve (AUC) for CLAD and competing risks of death or graft failure were assessed in an independent validation cohort of 37 CLAD cases and 37 controls.</div></div><div><h3>Results</h3><div>Thirty-two candidate genes were associated with CLAD and graft failure, comprising the AI2 score, which clustered into 3 subcomponents. The AI2 score identified CLAD before its onset, in early and late post-CLAD brushes, as well as in the validation cohort (AUC 0.69-0.88). The AI2 score association with CLAD was independent of positive microbiology, CLAD stage, or CLAD subtype. However, transcripts most associated with CLAD evolved over time from CLAD onset. The AI2 score predicted time to graft failure and retransplant-free survival in both cohorts (<em>p</em> ≤ 0.03).</div></div><div><h3>Conclusions</h3><div>This airway inflammation gene score is associated with CLAD development, graft failure, and death. Future studies defining the molecular heterogeneity of airway inflammation could lead to endotype-targeted therapies.</div></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":"43 11","pages":"Pages 1820-1832"},"PeriodicalIF":6.4,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pragmatic approach to temporary mechanical circulatory support in acute right ventricular failure 在急性右心室衰竭中采用临时机械循环支持的实用方法。
IF 6.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-24 DOI: 10.1016/j.healun.2024.07.006
Anthony P. Carnicelli MD (Assistant Professor of Medicine/Cardiology) , Sean van Diepen MD , Ann Gage MD , Alexander M. Bernhardt MD , Jennifer Cowger MD , Brian A. Houston MD , Matt T. Siuba DO , Rachna Kataria MD , Craig J. Beavers PharmD , Kevin J. John MD , Bart Meyns MD PhD , Navin K. Kapur MD , Ryan J. Tedford MD , Manreet Kanwar MD
Acute right ventricular failure (RVF) is prevalent in multiple disease states and is associated with poor clinical outcomes. Right-sided temporary mechanical circulatory support (tMCS) devices are used to unload RV congestion and increase cardiac output in cardiogenic shock (CS) with hemodynamically significant RVF. Several RV-tMCS device platforms are available; however consensus is lacking on patient selection, timing of escalation to RV-tMCS, device management, and device weaning. The purposes of this review are to 1) describe the current state of tMCS device therapies for acute RVF with CS, 2) discuss principles of escalation to RV-tMCS device therapy, 3) examine important aspects of clinical management for patients supported by RV-tMCS devices including volume management, anticoagulation, and positive pressure ventilation, and 4) provide a framework for RV-tMCS weaning.
急性右心室功能衰竭(RVF)普遍存在于多种疾病状态中,并与不良的临床预后有关。右侧临时机械循环支持(tMCS)装置用于为血流动力学上有明显 RVF 的心源性休克(CS)患者解除 RV 充血负荷并增加心输出量。目前有多种 RV-tMCS 设备平台可供选择,但在患者选择、升级到 RV-tMCS 的时机、设备管理和设备断奶方面缺乏共识。本综述的目的是:1)描述治疗伴有 CS 的急性 RVF 的 tMCS 设备疗法的现状;2)讨论升级到 RV-tMCS 设备疗法的原则;3)研究 RV-tMCS 设备支持的患者临床管理的重要方面,包括容量管理、抗凝和正压通气;4)提供 RV-tMCS 断流的框架。
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引用次数: 0
Why VA-ECMO should not be used routinely in AMI-cardiogenic shock 为什么不应在急性心肌梗死-心源性休克中常规使用 VA-ECMO 评论和意见。
IF 6.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-21 DOI: 10.1016/j.healun.2024.07.013
Holger Thiele MD , Steffen Desch MD , Anne Freund MD , Uwe Zeymer MD
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引用次数: 0
Long-term follow-up of the randomized, prospective Scandinavian heart transplant everolimus de novo study with early calcineurin inhibitors avoidance (SCHEDULE) trial 斯堪的纳维亚心脏移植依维莫司从头开始研究与早期避免使用钙神经蛋白抑制剂(SCHEDULE)随机前瞻性试验的长期随访。
IF 6.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-20 DOI: 10.1016/j.healun.2024.07.002
Entela Bollano , Arne K. Andreassen , Hans Eiskjaer , Finn Gustafsson , Göran Rådegran , Einar Gude , Lars Gullestad , Kaspar Broch , Thea A.S. Halden , Kristjan Karason , Sven-Erik Bartfay , Niklas Bergh , on behalf of the SCHEDULE (Scandinavian heart transplant everolimus de novo study with early calcineurin inhibitors avoidance) investigators

Background

Early substitution of calcineurin inhibitor (CNI) with mammalian target of rapamycin inhibitors has been shown to improve kidney function and reduce intimal hyperplasia in heart transplant (HTx) recipients but data on long-term outcome of such a regime are still sparse.

Methods

In the SCHEDULE trial, 115 de novo HTx recipients were randomized to (1) everolimus with reduced exposure of CNI followed by CNI withdrawal at week 7–11 post-transplant or (2) standard-exposure with CNI. Both groups received mycophenolate mofetil and corticosteroids. Herein we report on the 10–12-year long-term follow-up of the study.

Results

A total of 78 patients attended the follow-up visit at a median time of 11 years post-transplant. In the everolimus intention to treat (ITT) group 87.5% (35/40 patients) still received everolimus and in the CNI ITT group 86.8% (33/38) still received CNI. Estimated glomerular filtration rate (eGFR) (least square mean (95% CI)) at the 10–12 years visit was 82.7 (74.2–91.1) ml/min/1.73 m2 and 61.0 (52.3–69.7) ml/min/1.73 m2 in the everolimus and CNI group, respectively (p < 0.001). Graft function measured by ejection fraction, ECG, NT-proBNP and drug safety were comparable between groups. During the study period there was a total of 28 deaths, but there was no difference in survival between the everolimus and the CNI group (aHR 0.61 (95% CI 0.29–1.30) p = 0.20). For the composite endpoint of death, re-transplantation, myocardial infarction, PCI, dialysis, kidney transplantation or cancer no between group differences were found (aHR 1.0 (95% CI 0.57–1.77) p = 0.99).

Conclusions

De novo HTx patients randomized to everolimus and low dose CNI followed by CNI free therapy sustained significantly better long-term kidney function than patients randomized to standard therapy. The graft function at 10–12 years was similar in both groups and there was no difference in survival.
导言:有研究表明,早期用哺乳动物雷帕霉素靶点抑制剂替代钙神经蛋白抑制剂(CNI)可改善心脏移植(HTx)受者的肾功能并减少内膜增生,但有关这种疗法长期效果的数据仍然很少:在SCHEDULE试验中,115名心脏移植受者被随机分为两组:a)依维莫司组,减少CNI暴露,移植后第7-11周停用CNI;b)标准CNI暴露组。两组患者均接受霉酚酸酯和皮质类固醇治疗。我们在此报告该研究10-12年的长期随访结果:结果:共有 78 名患者参加了移植后 11 年的中位随访。在依维莫司意向治疗(ITT)组中,87.5%的患者(35/40)仍在接受依维莫司治疗;在氯化萘意向治疗(ITT)组中,86.8%的患者(33/38)仍在接受氯化萘意向治疗。依维莫司组和 CNI 组在 10-12 年访视时的估计肾小球滤过率(eGFR)(最小平方均值(95% CI))分别为 82.7 (74.2-91.1) ml/min/1.73m2 和 61.0 (52.3-69.7) ml/min/1.73m2 (p结论:随机接受依维莫司和小剂量氯化萘治疗后再接受无氯化萘治疗的新生肝移植患者的长期肾功能明显优于随机接受标准治疗的患者。两组患者10-12年后的移植物功能相似,存活率也没有差异。
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引用次数: 0
期刊
Journal of Heart and Lung Transplantation
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