Pub Date : 2024-12-25DOI: 10.1016/j.healun.2024.12.022
C Baratto,C Dewachter,K Forton,D Muraru,M F Gagliardi,M Tomaselli,M Gavazzoni,G B Perego,M Senni,A Bondue,L P Badano,G Parati,J L Vachiéry,S Caravita
BACKGROUNDRV reserve has been linked to exercise capacity and prognosis in cardiopulmonary diseases. However, evidence in this setting is limited, due to the complex shape and load dependency of the RV. We sought to study right ventricular (RV) adaptation to exercise by simultaneous three-dimensional echocardiography (3DE) and right heart catheterization (RHC).METHODSPatients with heart failure with preserved ejection fraction (HFpEF) or pulmonary vascular disease (PVD) underwent simultaneous supine rest/exercise RHC-3DE. They were subdivided based on RV ejection fraction (EF) changes: 1)exhausted RV reserve, RVEF-; 2)preserved RV reserve, RVEF+.RESULTSSixty percent of patients were RVEF-. Distribution of HFpEF/PVD, as well as RV volumes and RVEF at rest were similar in the two groups. Hemodynamic metrics of RV afterload, as well as their exercise-induced changes, were similar in the two groups. During exercise, RV end-diastolic volume increased more in RVEF- than in RVEF+ (29±29 vs 7±25 mL,p<0.05). RV end-systolic volume increased by 21[12;31]mL in RVEF- and decreased by 8[-15;1]mL in RVEF+ (p<0.001). RV-pulmonary artery coupling was lower in RVEF- at peak exercise(p<0.05). Peak RVEF was associated with left ventricular preload (R2=0.14,p=0.011). Cardiac output increased less in RVEF- than in RVEF+ (+2.3±2.0 vs +4.0±2.4 L/min,p<0.05). Peak RVEF was associated with oxygen consumption(p<0.01).CONCLUSIONSExhausted RV reserve, as evaluated by 3DE, was frequent in HFpEF and PVD, was relatively independent from classical afterload parameters, was associated with RV-pulmonary artery decoupling, RV dilation, enhanced ventricular interdependence, and cardiac limitation to exercise. Intrinsic RV dysfunction may contribute to exhausted RV reserve.
{"title":"Right ventricular reserve in cardiopulmonary disease: a simultaneous hemodynamic and three-dimensional echocardiographic study.","authors":"C Baratto,C Dewachter,K Forton,D Muraru,M F Gagliardi,M Tomaselli,M Gavazzoni,G B Perego,M Senni,A Bondue,L P Badano,G Parati,J L Vachiéry,S Caravita","doi":"10.1016/j.healun.2024.12.022","DOIUrl":"https://doi.org/10.1016/j.healun.2024.12.022","url":null,"abstract":"BACKGROUNDRV reserve has been linked to exercise capacity and prognosis in cardiopulmonary diseases. However, evidence in this setting is limited, due to the complex shape and load dependency of the RV. We sought to study right ventricular (RV) adaptation to exercise by simultaneous three-dimensional echocardiography (3DE) and right heart catheterization (RHC).METHODSPatients with heart failure with preserved ejection fraction (HFpEF) or pulmonary vascular disease (PVD) underwent simultaneous supine rest/exercise RHC-3DE. They were subdivided based on RV ejection fraction (EF) changes: 1)exhausted RV reserve, RVEF-; 2)preserved RV reserve, RVEF+.RESULTSSixty percent of patients were RVEF-. Distribution of HFpEF/PVD, as well as RV volumes and RVEF at rest were similar in the two groups. Hemodynamic metrics of RV afterload, as well as their exercise-induced changes, were similar in the two groups. During exercise, RV end-diastolic volume increased more in RVEF- than in RVEF+ (29±29 vs 7±25 mL,p<0.05). RV end-systolic volume increased by 21[12;31]mL in RVEF- and decreased by 8[-15;1]mL in RVEF+ (p<0.001). RV-pulmonary artery coupling was lower in RVEF- at peak exercise(p<0.05). Peak RVEF was associated with left ventricular preload (R2=0.14,p=0.011). Cardiac output increased less in RVEF- than in RVEF+ (+2.3±2.0 vs +4.0±2.4 L/min,p<0.05). Peak RVEF was associated with oxygen consumption(p<0.01).CONCLUSIONSExhausted RV reserve, as evaluated by 3DE, was frequent in HFpEF and PVD, was relatively independent from classical afterload parameters, was associated with RV-pulmonary artery decoupling, RV dilation, enhanced ventricular interdependence, and cardiac limitation to exercise. Intrinsic RV dysfunction may contribute to exhausted RV reserve.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142887603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-25DOI: 10.1016/j.healun.2024.12.001
Amit H Alam,Candice Y Lee,Manreet K Kanwar,Yasbanoo Moayedi,Alexander M Bernhardt,Koji Takeda,Duc Thinh Pham,Christopher Salerno,Andreas Zuckermann,David D'Alessandro,Victor G Pretorius,John O Louca,Stephen Large,Dawn E Bowles,Scott C Silvestry,Nader Moazami
Heart transplantation remains a critical therapy for patients with end-stage heart failure, offering incremental survival and improved quality of life. One of the key components behind the success of heart transplantation is the condition and preservation of the donor heart. In this review, we provide a comprehensive overview of ischemic reperfusion injury, risk factors associated with primary graft dysfunction, current use of various preservation solutions for organ procurement and recent advancements in donor heart procurement technologies. This State-of-the-Art review will explore factors associated with bringing the "ideal" donor heart to the operating room in the contemporary era.
{"title":"Current Approaches to Optimize Donor Heart for Transplantation.","authors":"Amit H Alam,Candice Y Lee,Manreet K Kanwar,Yasbanoo Moayedi,Alexander M Bernhardt,Koji Takeda,Duc Thinh Pham,Christopher Salerno,Andreas Zuckermann,David D'Alessandro,Victor G Pretorius,John O Louca,Stephen Large,Dawn E Bowles,Scott C Silvestry,Nader Moazami","doi":"10.1016/j.healun.2024.12.001","DOIUrl":"https://doi.org/10.1016/j.healun.2024.12.001","url":null,"abstract":"Heart transplantation remains a critical therapy for patients with end-stage heart failure, offering incremental survival and improved quality of life. One of the key components behind the success of heart transplantation is the condition and preservation of the donor heart. In this review, we provide a comprehensive overview of ischemic reperfusion injury, risk factors associated with primary graft dysfunction, current use of various preservation solutions for organ procurement and recent advancements in donor heart procurement technologies. This State-of-the-Art review will explore factors associated with bringing the \"ideal\" donor heart to the operating room in the contemporary era.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142887597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-22DOI: 10.1016/j.healun.2024.10.014
Jamie L Todd,Jeremy M Weber,Francine L Kelly,Andrew Nagler,Patrick McArthur,Lerin Eason,Jeeyon G Rim,Courtney W Frankel,John A Belperio,Marie Budev,Tereza Martinu,Kunal Patel,John M Reynolds,Pali D Shah,Lianne G Singer,Laurie D Snyder,Wayne Tsuang,S Sam Weigt,Megan L Neely,Scott M Palmer
BACKGROUNDFew tools exist for early identification of patients at risk for chronic lung allograft dysfunction (CLAD). We previously showed hyaluronan (HA), a matrix molecule that regulates lung inflammation and fibrosis, accumulates in bronchoalveolar lavage fluid (BALF) and blood in CLAD. We aimed to determine if early posttransplant HA elevations inform CLAD risk.METHODSHA was quantified in 3080 BALF and 1323 blood samples collected over the first posttransplant year in 743 adult lung recipients at 5 centers. The relationship between BALF or blood HA and CLAD was assessed using Cox models with a time-dependent binary covariate for "elevated" HA. Potential thresholds for elevated HA were examined using a grid search between the 50th and 85th percentile. The optimal threshold was identified using fit statistics, and the association between the selected threshold and CLAD was internally validated through iterative resampling. A multivariable Cox model using the selected threshold was performed to evaluate the association of elevated HA with CLAD considering other factors that may influence CLAD risk.RESULTSBALF HA levels >19.1ng/mL (65th percentile), had the largest hazard ratio for CLAD (HR 1.70, 95% CI 1.25-1.31; p<0.001), optimized fit statistics, and demonstrated robust reproducibility. In a multivariable model, the occurrence of BALF HA >19.1 ng/mL in the first posttransplant year conferred a 66% increase in the hazards for CLAD (adjusted HR 1.66, 95% CI 1.19-2.32; p=0.003). Blood HA was not significantly associated with CLAD.CONCLUSIONSWe identified and validated a precise threshold for BALF HA in the first posttransplant year that distinguishes patients at increased CLAD risk.
背景很少有工具可用于早期识别有慢性肺移植功能障碍（CLAD）风险的患者。我们以前研究发现，透明质酸（HA）是一种调节肺部炎症和纤维化的基质分子，会在 CLAD 患者的支气管肺泡灌洗液（BALF）和血液中蓄积。我们的目的是确定移植后早期 HA 升高是否可为 CLAD 风险提供信息。方法对 5 个中心的 743 名成年肺部受者在移植后第一年内采集的 3080 份 BALF 和 1323 份血液样本中的 HA 进行量化。使用Cox模型评估了BALF或血液HA与CLAD之间的关系，HA "升高 "的二元协变量与时间相关。在第 50 个百分位数和第 85 个百分位数之间进行网格搜索，检查了 HA 升高的潜在阈值。使用拟合统计量确定了最佳阈值，并通过迭代重采样对所选阈值与 CLAD 之间的关联进行了内部验证。考虑到可能影响 CLAD 风险的其他因素，使用选定阈值的多变量 Cox 模型评估 HA 升高与 CLAD 的关联。1ng/mL（第 65 百分位数），CLAD 的危险比最大（HR 1.70，95% CI 1.25-1.31；p19.1 ng/mL 在移植后第一年，CLAD 的危险增加 66%（调整后 HR 1.66，95% CI 1.19-2.32；p=0.003）。结论我们确定并验证了移植后第一年BALF HA的精确阈值，该阈值可将CLAD风险增加的患者区分开来。
{"title":"Identification and Validation of a Threshold for Early Posttransplant Bronchoalveolar Fluid Hyaluronan that Distinguishes Lung Recipients at Risk for CLAD.","authors":"Jamie L Todd,Jeremy M Weber,Francine L Kelly,Andrew Nagler,Patrick McArthur,Lerin Eason,Jeeyon G Rim,Courtney W Frankel,John A Belperio,Marie Budev,Tereza Martinu,Kunal Patel,John M Reynolds,Pali D Shah,Lianne G Singer,Laurie D Snyder,Wayne Tsuang,S Sam Weigt,Megan L Neely,Scott M Palmer","doi":"10.1016/j.healun.2024.10.014","DOIUrl":"https://doi.org/10.1016/j.healun.2024.10.014","url":null,"abstract":"BACKGROUNDFew tools exist for early identification of patients at risk for chronic lung allograft dysfunction (CLAD). We previously showed hyaluronan (HA), a matrix molecule that regulates lung inflammation and fibrosis, accumulates in bronchoalveolar lavage fluid (BALF) and blood in CLAD. We aimed to determine if early posttransplant HA elevations inform CLAD risk.METHODSHA was quantified in 3080 BALF and 1323 blood samples collected over the first posttransplant year in 743 adult lung recipients at 5 centers. The relationship between BALF or blood HA and CLAD was assessed using Cox models with a time-dependent binary covariate for \"elevated\" HA. Potential thresholds for elevated HA were examined using a grid search between the 50th and 85th percentile. The optimal threshold was identified using fit statistics, and the association between the selected threshold and CLAD was internally validated through iterative resampling. A multivariable Cox model using the selected threshold was performed to evaluate the association of elevated HA with CLAD considering other factors that may influence CLAD risk.RESULTSBALF HA levels >19.1ng/mL (65th percentile), had the largest hazard ratio for CLAD (HR 1.70, 95% CI 1.25-1.31; p<0.001), optimized fit statistics, and demonstrated robust reproducibility. In a multivariable model, the occurrence of BALF HA >19.1 ng/mL in the first posttransplant year conferred a 66% increase in the hazards for CLAD (adjusted HR 1.66, 95% CI 1.19-2.32; p=0.003). Blood HA was not significantly associated with CLAD.CONCLUSIONSWe identified and validated a precise threshold for BALF HA in the first posttransplant year that distinguishes patients at increased CLAD risk.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"96 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-20DOI: 10.1016/j.healun.2024.10.015
Ye In Christopher Kwon,Elizabeth Bashian,Arman Kilic,Zubair A Hashmi
{"title":"Impact of Procurement Methods on Organ Rejection in Donation After Circulatory Death Heart Transplantation.","authors":"Ye In Christopher Kwon,Elizabeth Bashian,Arman Kilic,Zubair A Hashmi","doi":"10.1016/j.healun.2024.10.015","DOIUrl":"https://doi.org/10.1016/j.healun.2024.10.015","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-20DOI: 10.1016/j.healun.2024.10.012
Gaurav Sharma,Michael E Jessen,Matthias Peltz
{"title":"iPhone or Blackberry? The unsure future of Ex-Vivo Lung Perfusion: A Commentary on Ex-Vivo Lung Perfusion National Trends and Post-Transplant Outcomes.","authors":"Gaurav Sharma,Michael E Jessen,Matthias Peltz","doi":"10.1016/j.healun.2024.10.012","DOIUrl":"https://doi.org/10.1016/j.healun.2024.10.012","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-20DOI: 10.1016/j.healun.2024.10.013
Michael P Combs,Krysta Walter,Haley Hixson,Elizabeth A Belloli,Matthew S Najor,Kevin M Chan,Andrew C Chang,Dennis M Lyu
PURPOSEThe ScanCLAD study reported a lower incidence of CLAD with the use of once-daily tacrolimus vs. twice-daily cyclosporine. Using the ISHLT Thoracic Organ Transplant (TTX) Registry data, we evaluated the hypothesis that tacrolimus is superior to cyclosporine in real world clinical practice.METHODSThis study is a retrospective cohort study of adult lung transplant recipients in the ISHLT Registry from January 1, 2000 through June 30, 2018 with known CLAD status. The primary exposure variable was patients' maintenance calcineurin inhibitor (CNI) regimen captured at post-transplant discharge. The primary outcome variables were time to CLAD development (with death/retransplantation analyzed as a competing risk) and allograft survival (i.e., time to death/retransplant).RESULTSOf the 57,403 adult lung transplant recipients in the registry, 22,222 had both CNI and CLAD data available. Of these, 19,698 (88.6%) received tacrolimus immediate release (IR), 2,477 (11.2%) received cyclosporine, and 47 (0.2%) received tacrolimus extended release (XR) for maintenance CNI. Receiving cyclosporine for maintenance immunosuppression (vs. tacrolimus IR) was associated with an increased risk of developing CLAD (HR 1.16, 95% CI 1.08-1.23, p<0.001) and with an increased overall risk for death/retransplant (HR 1.16, 95% CI 1.09-1.23, p<0.001). Receiving tacrolimus XR vs. tacrolimus IR was not associated with differences in long-term post-transplant outcomes, although these analyses were limited by a small sample size.CONCLUSIONSPatients receiving cyclosporine vs. tacrolimus IR for maintenance calcineurin inhibition had an increased risk of CLAD and decreased overall allograft survival in the ISHLT TTX registry.
{"title":"Impact of Tacrolimus vs. Cyclosporine on CLAD Incidence and Allograft Survival in the ISHLT Registry.","authors":"Michael P Combs,Krysta Walter,Haley Hixson,Elizabeth A Belloli,Matthew S Najor,Kevin M Chan,Andrew C Chang,Dennis M Lyu","doi":"10.1016/j.healun.2024.10.013","DOIUrl":"https://doi.org/10.1016/j.healun.2024.10.013","url":null,"abstract":"PURPOSEThe ScanCLAD study reported a lower incidence of CLAD with the use of once-daily tacrolimus vs. twice-daily cyclosporine. Using the ISHLT Thoracic Organ Transplant (TTX) Registry data, we evaluated the hypothesis that tacrolimus is superior to cyclosporine in real world clinical practice.METHODSThis study is a retrospective cohort study of adult lung transplant recipients in the ISHLT Registry from January 1, 2000 through June 30, 2018 with known CLAD status. The primary exposure variable was patients' maintenance calcineurin inhibitor (CNI) regimen captured at post-transplant discharge. The primary outcome variables were time to CLAD development (with death/retransplantation analyzed as a competing risk) and allograft survival (i.e., time to death/retransplant).RESULTSOf the 57,403 adult lung transplant recipients in the registry, 22,222 had both CNI and CLAD data available. Of these, 19,698 (88.6%) received tacrolimus immediate release (IR), 2,477 (11.2%) received cyclosporine, and 47 (0.2%) received tacrolimus extended release (XR) for maintenance CNI. Receiving cyclosporine for maintenance immunosuppression (vs. tacrolimus IR) was associated with an increased risk of developing CLAD (HR 1.16, 95% CI 1.08-1.23, p<0.001) and with an increased overall risk for death/retransplant (HR 1.16, 95% CI 1.09-1.23, p<0.001). Receiving tacrolimus XR vs. tacrolimus IR was not associated with differences in long-term post-transplant outcomes, although these analyses were limited by a small sample size.CONCLUSIONSPatients receiving cyclosporine vs. tacrolimus IR for maintenance calcineurin inhibition had an increased risk of CLAD and decreased overall allograft survival in the ISHLT TTX registry.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.healun.2024.10.009
Oliver J F Weiner,Moloy Das,Richard H Clayton,Janet M McComb,Alan Murray,Gareth Parry,Stephen W Lord
BACKGROUNDPartial cardiac sympathetic reinnervation after cardiac transplant has been extensively investigated and evidenced. However, there have been no large-scale, long-term studies evaluating the prevalence, time-course, and association with long-term survival of sympathetic reinnervation of the heart.METHODSCardiac transplant recipients (n=232) were recruited from outpatient clinic at a single transplant centre in the United Kingdom. Participants were each tested once for the presence of sympathetic reinnervation of the sinus node using the low frequency component of power spectral analysis of heart rate variability, with a cut-off defined as 2 standard deviations above the mean for denervated participants (those tested <56 days post-transplant). Time-course was calculated based on the timing of testing post-transplant. Patients were then followed-up over a period of up to 27 years after transplant for survival analysis.RESULTSThe overall prevalence of cardiac sympathetic reinnervation in the 225 patients tested >56 days post-transplant was 64.9%. Sympathetic reinnervation primarily occurred in the first 18 months after transplant, with a plateau thereafter. The prevalence in participants tested >18 months post-transplant was 69.6%. In Kaplan-Meier survival analysis, sympathetic reinnervation was associated with significantly improved survival (Log-rank P=0.019), with a median survival time for reinnervated patients of 19.9 years compared to 14.4 years for the denervated group.CONCLUSIONSSympathetic reinnervation of the sinus node occurs mostly within 18 months of transplant, is found in 70% of cardiac transplant recipients tested >18 months post-transplant, and is associated with significantly improved long-term survival.
{"title":"Sympathetic reinnervation in cardiac transplant recipients: Prevalence, time course and association with long-term survival.","authors":"Oliver J F Weiner,Moloy Das,Richard H Clayton,Janet M McComb,Alan Murray,Gareth Parry,Stephen W Lord","doi":"10.1016/j.healun.2024.10.009","DOIUrl":"https://doi.org/10.1016/j.healun.2024.10.009","url":null,"abstract":"BACKGROUNDPartial cardiac sympathetic reinnervation after cardiac transplant has been extensively investigated and evidenced. However, there have been no large-scale, long-term studies evaluating the prevalence, time-course, and association with long-term survival of sympathetic reinnervation of the heart.METHODSCardiac transplant recipients (n=232) were recruited from outpatient clinic at a single transplant centre in the United Kingdom. Participants were each tested once for the presence of sympathetic reinnervation of the sinus node using the low frequency component of power spectral analysis of heart rate variability, with a cut-off defined as 2 standard deviations above the mean for denervated participants (those tested <56 days post-transplant). Time-course was calculated based on the timing of testing post-transplant. Patients were then followed-up over a period of up to 27 years after transplant for survival analysis.RESULTSThe overall prevalence of cardiac sympathetic reinnervation in the 225 patients tested >56 days post-transplant was 64.9%. Sympathetic reinnervation primarily occurred in the first 18 months after transplant, with a plateau thereafter. The prevalence in participants tested >18 months post-transplant was 69.6%. In Kaplan-Meier survival analysis, sympathetic reinnervation was associated with significantly improved survival (Log-rank P=0.019), with a median survival time for reinnervated patients of 19.9 years compared to 14.4 years for the denervated group.CONCLUSIONSSympathetic reinnervation of the sinus node occurs mostly within 18 months of transplant, is found in 70% of cardiac transplant recipients tested >18 months post-transplant, and is associated with significantly improved long-term survival.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.healun.2024.10.008
Ankit Bharat
{"title":"Bridging Gaps in Lung Allocation: A Data-Driven Approach to Overcome Biological Disparities.","authors":"Ankit Bharat","doi":"10.1016/j.healun.2024.10.008","DOIUrl":"https://doi.org/10.1016/j.healun.2024.10.008","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.healun.2024.10.010
Sanjay Dutta,Peter S Macdonald
{"title":"Severe primary graft dysfunction after heart transplantation - Defining the Subtypes.","authors":"Sanjay Dutta,Peter S Macdonald","doi":"10.1016/j.healun.2024.10.010","DOIUrl":"https://doi.org/10.1016/j.healun.2024.10.010","url":null,"abstract":"","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142486279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-17DOI: 10.1016/j.healun.2024.10.003
William Herrik Nielsen,Mariusz K Szymanski,Kiran K Mirza,Linda W Van Laake,Thomas Schmidt,Darshan H Brahmbhatt,Filio Billia,Steven Hsu,Guy MacGowan,Djordje G Jakovljevic,Piergiuseppe Agostoni,Filippo Trombara,Ulrich P Jorde,Yogita Rochlani,Katrien Vandersmissen,Nils Reiss,Stuart D Russell,Bart Meyns,Finn Gustafsson
BACKGROUNDPeak oxygen uptake (pVO2) predicts mortality in heart failure patients on left ventricular assist device (LVAD) support. This follow-up of the PRO-VAD study examines the prognostic value of repeated pVO2 measurements during long-term follow-up.METHODSThis multicenter follow-up study included patients from the original PRO-VAD cohort who performed a cardiopulmonary exercise test (CPET) twice. Patients were categorized into four groups based on pVO2 levels at the two CPETs: Low at both tests, Low at the first and High at the second test, High at the first and Low at the second test, and High at both tests. Low pVO2 was defined as ≤14 mL/kg/min (or ≤12 mL/kg/min if beta-blocker tolerant), while values above these thresholds were considered High. Survival outcomes were analyzed using the Kaplan-Meier method and cause-specific Cox analysis.RESULTSThe study included 152 patients with repeated CPETs at approximately 6 and 12 months following LVAD implantation. The cohort showed slight but significant pVO2 improvement (median change: 0.4 mL/kg/min, P = 0.04). Persistently High pVO2 (76 patients) was associated with a fivefold reduction in mortality hazard (HR 0.20, P = 0.002), compared to persistently Low pVO2 (46 patients). Improvement from Low to High pVO2 (21 patients) displayed similar benefits (HR 0.21, P = 0.02).CONCLUSIONpVO2 measurements remain predictive of mortality upon reiteration in LVAD patients, with changes in pVO2 providing additional prognostic value in identifying patients with an excellent outcome on ongoing LVAD support and in identifying patients requiring further interventions.
{"title":"Prognostic Value of Repeated Peak Oxygen Uptake Measurements in LVAD Patients.","authors":"William Herrik Nielsen,Mariusz K Szymanski,Kiran K Mirza,Linda W Van Laake,Thomas Schmidt,Darshan H Brahmbhatt,Filio Billia,Steven Hsu,Guy MacGowan,Djordje G Jakovljevic,Piergiuseppe Agostoni,Filippo Trombara,Ulrich P Jorde,Yogita Rochlani,Katrien Vandersmissen,Nils Reiss,Stuart D Russell,Bart Meyns,Finn Gustafsson","doi":"10.1016/j.healun.2024.10.003","DOIUrl":"https://doi.org/10.1016/j.healun.2024.10.003","url":null,"abstract":"BACKGROUNDPeak oxygen uptake (pVO2) predicts mortality in heart failure patients on left ventricular assist device (LVAD) support. This follow-up of the PRO-VAD study examines the prognostic value of repeated pVO2 measurements during long-term follow-up.METHODSThis multicenter follow-up study included patients from the original PRO-VAD cohort who performed a cardiopulmonary exercise test (CPET) twice. Patients were categorized into four groups based on pVO2 levels at the two CPETs: Low at both tests, Low at the first and High at the second test, High at the first and Low at the second test, and High at both tests. Low pVO2 was defined as ≤14 mL/kg/min (or ≤12 mL/kg/min if beta-blocker tolerant), while values above these thresholds were considered High. Survival outcomes were analyzed using the Kaplan-Meier method and cause-specific Cox analysis.RESULTSThe study included 152 patients with repeated CPETs at approximately 6 and 12 months following LVAD implantation. The cohort showed slight but significant pVO2 improvement (median change: 0.4 mL/kg/min, P = 0.04). Persistently High pVO2 (76 patients) was associated with a fivefold reduction in mortality hazard (HR 0.20, P = 0.002), compared to persistently Low pVO2 (46 patients). Improvement from Low to High pVO2 (21 patients) displayed similar benefits (HR 0.21, P = 0.02).CONCLUSIONpVO2 measurements remain predictive of mortality upon reiteration in LVAD patients, with changes in pVO2 providing additional prognostic value in identifying patients with an excellent outcome on ongoing LVAD support and in identifying patients requiring further interventions.","PeriodicalId":22654,"journal":{"name":"The Journal of Heart and Lung Transplantation","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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