Prognostic value of pulmonary hemodynamic parameters in cardiac transplant candidates

Background: Pulmonary hypertension is a contradiction for heart transplantation (HTx). The aim of the study was to examine prognostic significance of pulmonary hemodynamic variables in patients with severe chronic heart failure (HF) considered for HTx.Methods: Patients with HF were qualified to HTx in Poland. We measured pulmonary artery systolic pressure (PASP), pulmonary capillary wedge pressure (PCWP), transpulmonary gradient (TPG), cardiac output (CO), pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR). We performed biochemical evaluation, 6-min walking test, VO2max. Death or emergency HTx were assumed as the endpoints in the follow-up. Death or any kind of HTx were considered an end of observation. Survival analysis was conducted using Kaplan-Meier curves (long rank test with strait defined by terciles of analyzed hemodynamic parameters).Results: Six hundred and fifty-eight patients were qualified to HTx between 2003 and 2007. The mean follow-up: 601 days. 87.8% male. Mean age was under 50, III and IV NYHA class. Mean PASP was 44.3 ± 16.9 mm Hg, TPG 10.0 ± 6.6 mm Hg and PVR 2.9 mm Hg, PCWP20.9 ± 9.3 mm Hg. PASP and PCWP had influence on survival or emergency HTx. There was a significant difference in survival between patients with PCWP > 25 mm Hg and PCWP < 25 mm Hg. The worst prognosis was with PASP higher than 50 mm Hg. One-, two-, and three-year survival was 75%, 58% and 48% compared to patients with PASP < 35 mm Hg (80%, 70%, and 68%, respectively).Conclusions: In patients qualified to HTx, pathological values of pulmonary hemodynamic parameters have a significant influence on survival. The worst prognosis have patients with PASP > 50 mm Hg, and PCWP > 25 mm Hg. Pulmonary hemodynamic parameters are important during allocation process to HTx

Recommendations for the prevention of Herpes zoster in solid organ transplant recipients in Poland

Herpes zoster (i.e. shingles) is a widespread and common infectious disease caused by reactivation of the varicella zoster virus. Although the cutaneous manifestation of the disease is the most common, shingles is also associated with numerous complications, such as neurological, including postherpetic neuralgia. It is estimated that one-third of general population will develop herpes zoster during their lifetime and the incidence in the solid organ recipients group is even higher. What is more the transplant recipients are more likely to suffer from severe complications of the disease. The most effective method of preventing herpes zoster is vaccination. The only available in Poland and recommended vaccine is the recombinant, adjuvanted zoster vaccine. Its safety and effectiveness was proven in both general, adult population and solid organ recipients. In this article, we present the position of experts in transplantation and infectious diseases on herpes zoster prevention in solid organ transplant recipients population. The group includes kidney, liver, lung and heart recipients

Management of hypertension in pregnancy — prevention, diagnosis, treatment and long-term prognosis. A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians

ADDITIONAL INFORMATION This article has been co‑published in Kardiologia Polska (doi:10.33963/KP.14904), Arterial Hypertension (doi:10.5603/AH.a2019.0011), and Ginekologia Polska (doi:10.5603/GP.2019.0074). The articles in Kardiologia Polska, Arterial Hypertension, and Ginekologia Polska are identical except for minor stylistic and spelling differences in keeping with each journal’s style. Any citation can be used when citing this article

Bilateral injury of deep peroneal nerve in the patient after heart transplant

In March 2015, a 62-year-old patient with advanced heart failure underwent a failed radiofrequency ablation, followed by paresis of muscles in the anterior compartment of the leg. After rehabilitation, partial recovery of the paresis was achieved. Orthotopic heart transplantation was performed 9 months after ablation at the at the Institute of Cardiology, followed by a bilateral paresis of muscles in the anterior leg compartment. Rehabilitation was implemented. The possible cause of paresis is most likely to be due to food shortages, mainly related to a folic acid deficiency

Znaczenie prognostyczne reaktywnego nadciśnienia płucnego u pacjentów z przewlekłą niewydolnością serca kwalifikowanych do transplantacji serca

Background: Pulmonary hypertension (PH) is recognised in about 60% of patients referred for heart transplantation (HTx), and it influences the patient’s prognosis. Aim: To assess the prognostic value of reactive PH in patients listed for elective HTx. Methods: A total of 522 patients were enlisted from the Polish National Registry (POLKARD), listed for HTx, in whom complete haemodynamic data were reported. The endpoint was all-cause death before HTx. Heart transplantation, elective or urgent, was considered as an end of the follow-up (mean follow-up 1.47 ± 1.26 years). Patients were divided into three subgroups: no PH, passive PH, reactive PH taking into account mean pulmonary artery pressure (PAP) of 25 mm Hg, pulmonary capillary wedge pressure (PCWP) 15 mm Hg, and pulmonary vascular resistance (PVR) 3.0 Wood units. Haemodynamic, clinical, echocardiographic, and biochemical assessments (including NT-proBNP, hs-CRP) were performed. The Heart Failure Survival Score (HFSS) was calculated. Results: Estimated death rate was comparable between patients with no PH, passive PH, and reactive PH, despite the fact that the patients with reactive PH had the worst pulmonary haemodynamic scores (mean PAP 38.4 ± 7.8, PCWP 27 ± 7.4 mm Hg and PVR 4.8 ± 1.7 Wood units). In patients with reactive PH, in multifactor Cox analysis only the serum Na level influenced survival. According to the Kaplan-Meier method, patients with reactive PH, with mean PAP ≥ 41.4 mm Hg had the worst prognosis, estimated survival was: one year — 83%, two years — 65%. Conclusions: Reactive PH is common among patients with chronic HF listed to HTx (28%). It has no further influence on short-term prognosis as compared with patients with no PH and passive PH. Serum Na concentration and mean PAP ≥ 41.4 mm Hg influence the prognosis of patients with reactive PH.Wstęp: Nadciśnienie płucne (PH) rozpoznaje się u ok. 60% pacjentów rozpatrywanych jako kandydatów do transplantacji serca (HTx), co wpływa na przebieg kliniczny. Cel: Celem pracy było określenie wartości prognostycznej reaktywnego PH pacjentów kwalifikowanych w trybie planowym do HTx. Metody: Analizowano dane 522 pacjentów biorących udział w rejestrze POLKARD kwalifikowanych do HTx, u których wykonano cewnikowanie prawego serca. Punktem końcowym badania były wszystkie przypadki zgonu przed transplantacją serca. Przeprowadzenie HTx w trybie planowym lub pilnym uznano za koniec obserwacji (średni czas obserwacji 1,47 ± 1,26 roku). Pacjenci zostali podzieleni na trzy podgrupy: bez PH, z PH, z reaktywnym PH, a jako punkt odniensienia brano pod uwagę wartości średniego ciśnienia w tętnicy płucnej (PAP) 25 mm Hg, ciśnienia zaklinowania we włośniczkach płucnych (PCWP) 15 mm Hg i naczyniowego oporu płucnego (PVR) 3,0 j. Wooda. Przeprowadzano ocenę kliniczną oraz wykonywano badania hemodynamiczne, echokardiograficzne i biochemiczne krwi (m.in. NT-proBNP, hs-CRP). Wyliczano też wartość Heart Failure Survival Score (HFSS). Wyniki: Śmiertelność była porównywalna między grupami, mimo że w badaniach hemodynamicznych pacjentów z reaktywnym PH wyniki były najwyższe (średnie PAP 38,4 ± 7,8, PCWP 27 ± 7,4 mm Hg, PVR 4,8 ± 1,7 j. Wooda). W grupie pacjentów z reaktywnym PH w wieloczynnikowej analizie Coxa tylko stężenie sodu wpływało na przeżycie. Na podstawie analizy metodą Kaplana-Meiera stwierdzono, że pacjenci z reaktywnym PH, ze średnim PAP ≥ 41,4 mm Hg, charakteryzowali się najgorszym rokowaniem, a szacunkowe przeżycie jednoroczne i dwuletnie wynosiło odpowiednio 83% i 65%. Wnioski: Reaktywne PH jest częstym zjawiskiem u osob z przewlekłą niewydolnością serca kwalifikowanych do HTx. Nie ma to dalszego wpływu na krótkotrwałe rokowanie w porównaniu z pacjentami bez PH lub z PH. Stężenie sodu i średnie PAP ≥ 41,4 mm Hg wpływa na rokowanie pacjentów z reaktywnym nadciśnieniem płucnym