RESUMEN
Idiopathic dilated cardiomyopathy (IDC) is a structural heart disease with strong genetic background. The different single nucleotide polymorphisms (SNPs) that constitute mitochondrial haplogroups could play an important role in IDC progression. The aim of this study was to test frequencies of mitochondrial haplogroups in healthy controls (n=422) and IDC patients (n=304) of a Caucasian Spanish population. To achieve this, ten major European haplogroups were identified. Frequencies and Odds Ratios for the association between IDC and haplogroups were calculated in both groups. We found that compared to healthy controls, the prevalence of haplogroup H was significantly higher in IDC patients (40.0% vs 50.7%, p-value=0.040).
Asunto(s)
Cardiomiopatía Dilatada/epidemiología , Cardiomiopatía Dilatada/genética , ADN Mitocondrial/genética , Haplotipos , Adulto , Anciano , Femenino , Frecuencia de los Genes , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , España/epidemiologíaRESUMEN
BACKGROUND: It is uncertain whether donor-transmitted coronary artery disease (DTCAD) affects heart transplant (HT) recipients. METHODS: This retrospective analysis includes records of all patients who underwent a HT at our center over an 8-year period, who survived for at least 1 month, and who were examined by coronary angiography within 2 months post-HT. We distinguished angiographically from keep ultrasonography (IVUS) detected DTCAD. Major adverse cardiovascular events (MACE) comprised death, myocardial infarction, unstable angina, coronary revascularization, and admission because of heart failure not due to an acute rejection episode. RESULTS: Among the 171 patients of mean age 53±13 years and including 83% men, 65 (38%) were evaluated by IVUS. Donors were aged 40±14 years (range=14-73). Angiographic DTCAD affected seven patients (4.1%), and IVUS-detected DTCAD, 35 (53.8% of those examined by IVUS). DTCAD donors were older than non-DTCAD donors, by an average of 13 years (P=.001) for angiographic DTCAD and 18 years (P<.0001) for IVUS-detected DTCAD. Two patients underwent percutaneous revascularization upon detection of angiographic DTCAD. The angiographic- and IVUS-detected DTCAD groups did not differ significantly from the corresponding non-DTCAD groups as regards MACE incidence during 54±41 and 38±20 months follow-up, respectively. Cox regression analysis with adjustment for relevant confounders confirmed that IVUS-detected DTCAD was not a predictor of MACE (hazard ratio 1.2, 95% confidence interval 0.2-8.1). CONCLUSIONS: Among HT patients surviving≥1 month, angiographic- and IVUS-detected DTCAD showed prevalences of <10% and >50%, respectively. Neither detection method was associated with a greater long-term incidence of MACE.
Asunto(s)
Enfermedad de la Arteria Coronaria/epidemiología , Trasplante de Corazón , Donantes de Tejidos , Adulto , Anciano , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: Safety of treatment with mammalian target of rapamycin inhibitors (mTORi) in the postoperative period after heart transplantation (HT) is controversial. METHODS: We evaluated the incidence of postoperative complications (pericardial, pleural, and surgical wound complications) among nine de novo heart transplant recipients treated with mTORi compared with 19 patients who did not receive them during the same period (control group). RESULTS: No significant differences were observed between the two groups regarding sex, age, body mass index, pretransplant diagnosis, history of diabetes mellitus, prior cardiac surgery, or baseline renal function. The main laboratory parameters at 1 month were also similar. During the first 2 months after HT, four patients (44%) in the mTORi group developed severe pericardial effusions requiring drainage, compared to 1 (5%) in the control group (P = .026). All patients presenting this complication in the mTORi group received everolimus. In addition, two cases of sternal dehiscence were observed in the mTORi group, compared to none in the control group (P = .09); one patient on everolimus required sternal reopening and debridement for clinically suspected mediastinitis. Duration of chest tube drainage, quantity of collected pleural fluid, and need for thoracentesis were similar in both groups. CONCLUSIONS: In our series, patients receiving mTORi-particularly everolimus-during the postoperative period after HT showed a higher incidence of severe pericardial effusion requiring drainage, as well as a trend toward a higher incidence of sternal dehiscence, as compared to a group not receiving mTORi. The use of mTORi during the early postcardiac transplant period should be individualized.
Asunto(s)
Trasplante de Corazón/efectos adversos , Proteínas Quinasas/uso terapéutico , Adulto , Diabetes Mellitus/epidemiología , Femenino , Trasplante de Corazón/inmunología , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Selección de Paciente , Derrame Pericárdico/epidemiología , Derrame Pleural/epidemiología , Periodo Posoperatorio , Estudios Retrospectivos , Serina-Treonina Quinasas TORRESUMEN
INTRODUCTION: Statins, although the treatment of choice for dyslipidemia after heart transplantation (HT), are not always well tolerated or effective. In such cases, administration of ezetimibe may be useful. AIM: The aim of this study was to assess the efficacy and safety of ezetimibe, with or without statins, after HT. METHOD: Thirty-six HT patients, 97% of whom were males of overall mean age of 57 +/- 13 years, were all unable to reach target lipid levels with statins alone and/or were intolerant of statins. They were prescribed ezetimibe, with or without a statin. Efficacy and safety were evaluated after 1, 3, 6, and 12 months. RESULTS: Thirty-four patients were evaluated at 1 month and 12 months. Ezetimibe was prescribed to 27 patients (75%) because of statin inefficacy, and to 9 patients (25%) because of statin intolerance, manifested by myalgia in 4 cases (11%), hepatotoxicity in 2 cases (6%), and rhabdomyolysis in 3 cases (8%). Lipid levels (mg/dL; baseline vs 1 year) were as follows: cholesterol, 235 +/- 49 versus 167 +/- 32 (P = .013); LDL cholesterol, 137 +/- 47 versus 89 +/- 29 (P = .001); HDL cholesterol, 54 +/- 13 versus 51 +/- 10 (P = .235); and triglycerides, 243 +/- 187 versus 143 +/- 72 (P = .022). There were no cases of liver toxicity, renal dysfunction, or significant alteration of immunosuppressive pharmacokinetics. Ezetimibe was withdrawn from 2 patients because of hand edema or asymptomatic recurrence of rhabdomyolysis first caused by statins. CONCLUSIONS: With or without a statin, ezetimibe was generally well tolerated, reducing total cholesterol, LDL cholesterol, and triglyceride levels with no long-term alteration of HDL cholesterol levels. CPK surveillance is recommended because of a slight continued risk of adverse effects. Further studies should evaluate the benefit for survival.
Asunto(s)
Anticolesterolemiantes/uso terapéutico , Azetidinas/uso terapéutico , Dislipidemias/tratamiento farmacológico , Trasplante de Corazón/fisiología , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Complicaciones Posoperatorias/tratamiento farmacológico , Adulto , Anciano , Atorvastatina , Quimioterapia Combinada , Tolerancia a Medicamentos , Ezetimiba , Femenino , Trasplante de Corazón/inmunología , Ácidos Heptanoicos/uso terapéutico , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Inmunosupresores/uso terapéutico , Lípidos/sangre , Masculino , Persona de Mediana Edad , Pravastatina/uso terapéutico , Pirroles/uso terapéutico , Adulto JovenRESUMEN
Irreversible hepatic cirrhosis greatly increases the risks attending heart transplantation (HT), and is accordingly considered to be an absolute contraindication for HT unless combined heart and liver transplantation can be performed. It is now recognized that hepatic cirrhosis can undergo regression if the source of insult is removed, but no cases of post-HT regression of cirrhosis of cardiac origin have hitherto been reported. Here we report a case of cardiac cirrhosis that underwent complete regression following orthotopic HT, and we discuss the implications of this case.
Asunto(s)
Cardiomiopatía Dilatada/cirugía , Trasplante de Corazón/métodos , Cirrosis Hepática/etiología , Cardiomiopatía Dilatada/complicaciones , Femenino , Humanos , Cirrosis Hepática/fisiopatología , Persona de Mediana Edad , Inducción de RemisiónRESUMEN
BACKGROUND: Steroid withdrawal (SW) after heart transplantation (HT) reduces steroid-associated side effects, although it can increase acute rejection episodes (ARE). Patient selection criteria for SW and the time elapsed after HT for this maneuver are controversial issues. The objective of this study was to assess the safety of late SW after HT with regard to the occurrence of ARE and to analyze risk factors resulting in a poor evolution. METHODS: We studied a cohort of 24 patients who underwent SW late after HT. All of them had gone at least 4 years without any ARE. Independent variables were time after HT, general recipient and donor data, risk factors for ARE, and immunosuppression. The dependent variables were occurrence of ARE (proven or not proven with endomyocardial biopsy) and time and severity of ARE. RESULTS: Among 24 HT patients including 96% men with an overall mean age of 57 years who underwent SW, the mean follow-up was 2.32 +/- 0.86 years. Six patients (25%) displayed an ARE >or=2R according to the International Society for Heart and Lung Transplantation (ISHLT) at 5 +/- 3 months after SW. There were no deaths. Time from the last rejection episode to SW was 6.6 +/- 2 years. All ARE were treated with steroid boluses (mean total dose 1583 +/- 1044 mg). Among the HT patients with ARE, 5 (85%) had never experienced ARE after HT. Upon long-term follow-up, there were 2 deaths: 1 sudden death at 30 months after SW and 1 due to allograft vasculopathy at 20 months post-SW. Currently 92% are New York Heart Association (NYHA) functional class I with a mean left ventricular ejection fraction of 67% +/- 10%. CONCLUSIONS: In our series of HT with late SW after HT (even among an HT population with a low risk of rejection), there was a 25% rate of ARE. This study did not allow us to identify risk factors for ARE after SW. We believe that based upon these observations SW should be implemented with caution.
Asunto(s)
Corticoesteroides/administración & dosificación , Rechazo de Injerto/epidemiología , Trasplante de Corazón/fisiología , Esquema de Medicación , Femenino , Rechazo de Injerto/inmunología , Rechazo de Injerto/prevención & control , Trasplante de Corazón/inmunología , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Selección de Paciente , Estudios Retrospectivos , Factores de TiempoRESUMEN
In recent years, there has been a significant increase in the studies concerning brown seaweed as biosorbents for metal removal owing to their high binding ability and low cost. This work reports the results of a study regarding the cadmium binding equilibria of dead biomass from the seaweed Sargassum muticum; this alga is a pest fouling organism that competes with the local fucalean species and may also interfere with the "sea industry"; therefore, it would constitute an ideal material to be used as biosorbent. Seven different treatments were tested in order to obtain a stable biomass that could be suitable for industrial use under a broad range of operational conditions. The treatments employed were protonation, chemical cross-linking with formaldehyde, KOH, Ca(OH)(2) and CaCl(2) or physical treatments with acetone and methanol. The equilibrium adsorption isotherms of Langmuir, Freundlich, and Langmuir-Freundlich were obtained for the quantitative description of the cadmium uptake. The effect of pH on biosorption equilibrium was studied at values ranging from 1 to 6, demonstrating the importance of this parameter for an accurate evaluation of the biosorption process. Maximum biosorption was found pH higher than 4.5. The maximum biosorption uptake for the raw biomass was 65 mg g(-1), while for formaldehyde cross-linking biomass the uptake increases to 99 mg g(-1) and for protonated biomass to 95 mg g(-1). Potentiometric titrations were carried out to estimate the total number of weak acid groups and to obtain their apparent pK value, 3.85, using the Katchalsky model. Kinetic studies varying cadmium concentration, algal dose, and ionic strength were carried out. Over 95% of the maximum cadmium uptake was achieved within 45 min, so the process can be considered relatively fast. A pseudo-second-order model, for the kinetics of cadmium biosorption, was shown to be able to reproduce experimental data points with accuracy.