Prevalence of donor-transmitted atherosclerosis—Clinical utility of intracoronary ultrasound early after heart transplantation. A single-center study

AbstractIntroductionCoronary allograft vasculopathy (CAV) is one of the main factors limiting long-term survival following orthotopic heart transplantation (HTx). Whether or not and, if so, how donor-transmitted atherosclerosis (DCA) affects the post-transplant course of the allograft recipient is still unclear. Conventional coronary angiography is a moderately accurate technique for DCA detection as it will reveal only the more gross morphological lesions. By contrast, intravascular ultrasound (IVUS) has been shown to be a much more sensitive technique for CAV and DCA detection. In our study we sought to determine the prevalence of DCA in our HTx patient population and identify main risk factors of DCA based on donor characteristics.Patients and methodsWe performed a retrospective analysis of data of 119 patients (92 men, 27 women) undergoing transplantation in our center from August 2006 through September 2012, who had survived their first post-transplant month and had coronary angiography and IVUS.ResultsDCA was present in 39 patients, and not documented in 80 patients. The main risk factors for DCA included donor age, cigarette smoking, and hypertension; the other parameters were not shown to be statistically significant. In-hospital mortality was low in both groups (DCA positive and DCA negative), with one patient dying in either group. One-year mortality rates post-HTx were likewise almost identical in both groups (15.4% and 15% in DCA positive and negative, respectively).ConclusionThe prevalence of DCA in our patients was 32.8%, with major risk factors for DCA including donor age, cigarette smoking, and hypertension. As age seems to be the strongest predictor, coronary angiography should be a routine examination in individuals aged over 40 years; the examination should be considered in younger individuals with a cluster of several of risk factors. The 1-year survival in this selected patient population was identical in both groups, the implication being that the diagnosis of DCA had no effect on 1-year survival post-HTx

Indukcni imunosupresivni terapie u pacientu po ortotopicke transplantaci srdce daclizumabem - monoklonalni protilatkou proti IL-2 receptoru.

Available from STL Prague, CZ / NTK - National Technical LibrarySIGLECZCzech Republi

Iron Deficiency in Patients with Advanced Heart Failure

Background and Objectives: Iron deficiency (ID) is a common comorbidity in patients with heart failure. It is associated with reduced physical performance, frequent hospitalisations for heart failure decompensation, and high cardiovascular and overall mortality. The aim was to determine the prevalence of ID in patients with advanced heart failure on the waiting list for heart transplantation. Methods and Materials: We included 52 patients placed on the waiting list for heart transplantation in 2021 at our centre. The cohort included seven patients with LVAD (left ventricle assist device) as a bridge to transplantation implanted before the time of results collection. In addition to standard tests, the parameters of iron metabolism were monitored. ID was defined as a ferritin value <100 µg/L, or 100–299 µg/L if transferrin saturation (T-sat) is <20%. Results: ID was present in 79% of all subjects, but only in 35% of these patients anaemia was expressed. In the group without LVAD, ID was present in 82%, a median (lower–upper quartile) of ferritin level was 95.4 (62.2–152.1) µg/mL and mean T-sat was 0.18 ± 0.09. In LVAD group, ID was present in 57%, ferritin level was 268 (106–368) µg/mL and mean T-sat was 0.14 ± 0.04. Haemoglobin concentration was the same in patients with or without ID (133 ± 16) vs. (133 ± 23). ID was not associated with anaemia defined with regard to patient’s gender. In 40.5% of cases, iron deficiency was accompanied by chronic renal insufficiency, compared to 12.5% of the patients without ID. In the patients with LVAD, ID was present in four out of seven patients, but the group was too small for reliable statistical testing due to low statistical power. Conclusions: ID was present in the majority of patients with advanced heart failure and was not always accompanied by anaemia and renal insufficiency. Research on optimal markers for the diagnosis of iron deficiency, especially for specific groups of patients with heart failure, is still ongoing