Study of the left ventricular function in pregnancy-induced hypertension

Left ventricular (LV) morphological and functional characteristics in 9 women suffering from pregnancy-induced hypertension (PIH) were studied by means of echocardiograms. In order to distinguish which changes depended on the pressure values and which were the result of pregnancy, 10 nonpregnant control women with no heart disease and 10 normal pregnant women (NP) were studied and the results of each of the groups compared. To evaluate the structure, left ventricular systodiastolic diameters and wall thickness were measured. The only statistically significant difference was in the diastolic diameters between the PIH (4:7±0.3 cm) and the control group (4.4±0.2 cm) p <0.01. Left ventricular mass was significantly increased (p<0.01) in the PIH patients (185±53.1 g) compared to the NP patients (161±29.6 g) and the control group (125±17.4 g). No statistically significant differences were found in the radius thickness ratio in the three groups. The systolic function assessed by the shortening percentage was significantly lower (p <0.05) in the control group (32.8±4.4%) and in the NP patients (37.8±5.2%) than in the PIH group (39±6.5 %). Afterload assessed by isovolumic period stress was significantly greater (p<0.01) in the PIH patients (157±10.6 dyne/cm²) compared with the NP group (118.9±7.01 dyne/cm²). There were no significant differences between the first group and the control group (134.09±8.7 dyne/cm²). As evidence of the diastolic function, analysis was made, on the one hand, of diastolic isovolumic period length (DIP). Values in the control group were 50±8.1 ms, in NP 54±14.2 ms, and in PIH 50±12.2 ms. There were no significant differences between the groups. On the other hand, peak velocity diameter diastolic changes were determined: that of the control group was 18±3.8 cm/s; forthe NP group, 18±5.9 cm/s; and for the PIH group, 21±5.3 cm/s. There were no statistically significant differences here either. The foregoing results lead us to the conclusion that PIH does not produce evident structural changes in the left ventricular cavity beyond those already caused by adaptation to pregnancy. The changes in systolic function may be secondary to the effects of an added adrenergic activity, suggested in turn as being responsible for this hypertension. Diastolic function is not altered despite the increase in the left ventricular mass in this group of patients.Facultad de Ciencias Médica

Molecular Identification of Trypanosma cruzi discrete Typing Units in end-Stage Chronic Chagas Heart Disease and Reactivation after Heart Transplantation

One hundred years after the discovery of Chagas disease, it remains a major neglected tropical disease. Chronic Chagas heart disease is the most severe manifestation. Heart trasplantation is the proper treatment for end-stage heart failure. T. cruzi strains cluster into 6 discrete typing units assosiated with different geographical distribution, transmission cycles and varying disease symptoms.In the southern cone of South America, T. cruzi II, V and VI popuations appear to be assosiated with Chagas disease and T. cruzi I with sylvatic cycles.Fil: Burgos, Juan Miguel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Instituto de Investigaciones Biotecnológicas. Instituto de Invest. Biotec. (subsede San Martin) | Universidad Nacional de San Martin. Instituto de Investigaciones Biotecnológicas. Instituto de Invest. Biotec. (subsede San Martin); Argentina. Laboratorio Biología Molecular de Enfermedad de Chagas; ArgentinaFil: Diez, Mirta. Universidad Favaloro; ArgentinaFil: Vigliano, Carlos. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Favaloro; ArgentinaFil: Bisio, Margarita María Catalina. Gobierno de la Ciudad de Buenos Aires. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas; ArgentinaFil: Risso, Marikena Guadalupe. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Bioquímicas de Buenos Aires. Fundación Instituto Leloir. Instituto de Investigaciones Bioquímicas de Buenos Aires; ArgentinaFil: Duffi, Tomas. Laboratorio Biología Molecular de Enfermedad de Chagas; ArgentinaFil: Cura, Carolina Inés. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigación en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres". Grupo Vinculado al INGEBI- Laboratorio de Biocatálisis y Biotransformaciones - LBB - UNQUI; ArgentinaFil: Brusés, Bettina Laura. Universidad Nacional del Nordeste. Instituto de Medicina Regional; ArgentinaFil: Favaloro, Liliana Ethel. Universidad Favaloro; ArgentinaFil: Leguizamon, María Susana. Dirección Nacional de Instituto de Investigación.Administración Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbrán"; ArgentinaFil: Lucero, Raúl Horacio. Universidad Nacional del Nordeste. Instituto de Medicina Regional; ArgentinaFil: Laguens, Rubén. Universidad Favaloro; ArgentinaFil: Levin, Mariano Jorge. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigación en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres". Grupo Vinculado al INGEBI- Laboratorio de Biocatálisis y Biotransformaciones - LBB - UNQUI; ArgentinaFil: Favaloro, Roberto René. Universidad Favaloro; ArgentinaFil: Schijman, Alejandro Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Laboratorio Biología Molecular de Enfermedad de Chagas; Argentin

Outcomes of heart transplantation based on recipient's clinical profile: 21-year experience

Introducción: El trasplante cardíaco continúa siendo el tratamiento de elección en pacientes con miocardiopatías graves sin otras opciones terapéuticas. Los resultados alentadores del trasplante cardíaco en términos de supervivencia han permitido ampliar los criterios de selección del receptor, lo que ha llevado a la inclusión de pacientes de mayor complejidad en lista de espera. Objetivo: Analizar los resultados del trasplante cardíaco del Hospital Universitario Fundación Favaloro a lo largo de 21 años de seguimiento. Material y métodos: Entre febrero de 1993 y diciembre de 2014 se realizaron 442 trasplantes cardíacos ortotópicos en un único centro. Se analizaron en forma retrospectiva las historias clínicas de los pacientes, excluyéndose los pediátricos y protegiendo la confidencialidad de los datos. Para el análisis se dividió la serie en período 1 (febrero 1993 - agosto 2003) y período 2 (septiembre 2003 - diciembre 2014). Resultados: Se observó durante el segundo período una prevalencia mayor de candidatos con miocardiopatía dilatada no coronaria versus coronaria y un incremento significativo de la indicación de trasplante cardíaco en la miocardiopatía dilatada chagásica. La prevalencia de hipertensión pulmonar aumentó, realizándose un número mayor de trasplantes cardíacos en condición de emergencia, con requerimiento de inotrópicos y soporte circulatorio mecánico con balón de contrapulsación intraaórtico. Conclusiones: Se han observado cambios en el perfil clínico de los receptores de trasplante cardíaco, ingresando en lista de espera pacientes con un número mayor de comorbilidades. La cuidadosa elección de candidatos a trasplante requiere una revisión continua y un análisis individualizado de los diferentes factores que determinan la supervivencia de los pacientes y su impacto en los resultados de los programas de trasplante.Background: Heart transplantation is still the treatment of choice in patients with severe cardiomyopathies that do not have any therapeutic options. The promising results of heart transplantation in terms of survival have modified the criteria of recipients’ selection, including more complex patients on the waiting list. Objective: The aim of this report is to analyze the outcomes of heart transplantation performed at the Hospital Universitario Fundación Favaloro after 21 years of follow-up. Methods: Between February 1993 and December 2014, 442 orthotopic heart transplantations were performed at a single center. The clinical records of the recipients, excluding pediatric patients, were retrospectively analyzed, ensuring the confidentiality of the information. Two periods were considered: period 1 (from February 1993 to August 2003) and period 2 (from September 2003 to December 2014). Results: During the second period, the prevalence of recipients with non ischemic versus ischemic dilated cardiomyopathy was higher, and the indication of heart transplantation in Chagas dilated cardiomyopathy showed a significant increase. The prevalence of pulmonary hypertension increased and more emergency heart transplantations were performed, with requirements of inotropic agents and mechanical circulatory support with intraaortic balloon pump. Conclusions: The clinical profile of heart transplantation recipients has changed and more patients on the waiting list have a greater number of comorbidities. The careful selection of candidates for transplantation needs continuous revision and an individual analysis of the different factors that determine patients’ survival and its impact on the outcomes of transplantation programs.Fil: Peradejordi Lastras, Margarita Ana. Universidad Favaloro; ArgentinaFil: Favaloro, Liliana Ethel. Universidad Favaloro; ArgentinaFil: Vigliano, Carlos. Universidad Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Renedo, María F.. Universidad Favaloro; ArgentinaFil: Martínez, Liliana. Universidad Favaloro; ArgentinaFil: Moscoloni, Silvia E.. Universidad Favaloro; ArgentinaFil: Abud, José. Universidad Favaloro; ArgentinaFil: Absi, Daniel O.. Universidad Favaloro; ArgentinaFil: Favaloro, Roberto René. Universidad Favaloro; ArgentinaFil: Bertolotti, Alejandro Mario. Universidad Favaloro; Argentin

Combined cardiorenal transplant in heart and advanced renal disease

Introduction: Renal failure (RF) is a post cardiac transplantation predictor of morbimortality. The combined cardiorenal transplant (CCRTx) in cardiac transplantation (CTx) candidates with chronic renal disease is a therapeutic option. Our aim was to evaluate the CCRTx follow up outcomes in a single Centre. Methods: Between 2/1993 and 12/2014 we performed 442 CTx. Since 2006, 20 patients (p) underwent CCRTx using allografts from the same donor. The inclusion criteria were: RF with CrCl ≤ 40 mil/min or dialysis requirement in CTx candidates. All p received Thymoglobulin and immunosuppression with tacrolimus, mycophenolate mofetil and steroids.Median follow up: 46 months (7-96). Results: Mean age: 58±7 years, 85% were male. Mean Creatinine (Cr): 3,1±2,5 mg/dl and ClCr 27,5+10 mil/min. Three p required dialysis during the pre-transplantation phase and 4 p were under chronic dialysis. Etiologies: cardiomyopathies: coronary 10 p, noncoronary 9 p and re CTx, 1 p; nephropathies: nephroangiosclerosis 5 p, cardiorenal syndrome 10 p, diabetes 2 p, glomerulopathy 1 p, polycystosis 1 p and toxic nephritis 1 p. At 30 days and 1 year post CCRTx, Cr was 1,2±0,4 mg/dl and 1,1±0,2 mg/dl respectively. In-hospital mortality was 3/20 p (15%), 2 p due to sepsis and 1 p due to cardiac graft failure. Late mortality 5/17 p (29 %), 4p due to sepsis and 1 p due to liver sarcoma. Survival at 1 and 3 years was 76 and 72%, respectively. Conclusions: In our series CCRTx was a safe and effective treatment for CTx candidates with CrCl < 40 ml/min