ABSTRACT
BACKGROUND: Heart transplantation (HT) is the reference treatment for patients with terminal heart failure. In recent years there has been a progressive increase in HT procedures in patients who have a circulatory support (CS). METHODS: This is a retrospective single-center study of 293 consecutive patients who underwent HT from 2009 to 2018, analyzing the evolution of the 2 cohorts: patients with and without CS as a bridge to HT. Baseline and evolutionary clinical data collected following the usual follow-up protocol were recorded, including clinical events observed during the follow-up 1 year after the procedure. RESULTS: The subgroup of patients transplanted with CS showed a higher incidence of primary graft failure, frequent infection, and mortality. A tendency toward lower cardiac allograft vasculopathy was observed in this subgroup. Mechanical ventilation added to the CS resulted in a higher incidence of primary graft failure, infection, and renal dysfunction. The CS variable as a bridge to HT was shown to be predictive of 1-year mortality in both univariate (odds ratio, 1.84; 95% confidence interval, 1.03-3.3; P = .038) and multivariate (odds ratio, 2.1; 95% confidence interval, 1.01-4.3; P = .047) analyses. CONCLUSIONS: In our experience, CS as a bridge to HT results in a higher incidence of primary graft failure, frequent infection, and mortality at 1-year follow-up. Mechanical ventilation added to CS has a clear unfavorable prognostic impact. CS as a bridge to HT was shown to be predictive of 1-year mortality in both univariate and multivariate analyses.
Subject(s)
Heart Failure , Heart Transplantation , Follow-Up Studies , Heart Failure/surgery , Heart Transplantation/adverse effects , Humans , Prognosis , Retrospective StudiesABSTRACT
Cardiac resynchronization therapy (CRT) is an effective treatment for those patients with severe heart failure. Regrettably, there are about one third of CRT "non-responders", i.e. patients who have undergone this form of device therapy but do not respond to it, which adversely affects the utility and cost-effectiveness of CRT. In this paper, we assess the ability of a novel surface ECG marker to predict CRT response. We performed a retrospective exploratory study of the ECG previous to CRT implantation in 43 consecutive patients with ischemic (17) or non-ischemic (26) cardiomyopathy. We extracted the QRST complexes (consisting of the QRS complex, the S-T segment, and the T wave) and obtained a measure of their energy by means of spectral analysis. This ECG marker showed statistically significant lower values for non-responder patients and, joint with the duration of QRS complexes (the current gold-standard to predict CRT response), the following performances: 86% accuracy, 88% sensitivity, and 80% specificity. In this manner, the proposed ECG marker may help clinicians to predict positive response to CRT in a non-invasive way, in order to minimize unsuccessful procedures.
Subject(s)
Cardiac Resynchronization Therapy/adverse effects , Cardiac Resynchronization Therapy/statistics & numerical data , Cardiomyopathies/epidemiology , Cardiomyopathies/therapy , Electrocardiography , Adult , Aged , Aged, 80 and over , Female , Heart Failure/epidemiology , Humans , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Treatment OutcomeABSTRACT
Se realiza una investigación acerca del uso del recurso agua en el ámbito del ejido municipal de Cinco Saltos tanto en el ámbito urbano como rural. El ámbito de estudio y desarrollo de la experiencia, se localiza en la cuenca baja del Río Neuquén, entre los límites NO y SE de la localidad antes mencionada, abarcando una franja que a modo de transecta toma un área desde la planicie o meseta y sus cauces aluvionales, la bajada aluvio-coluvial, y el piso del valle con sus distintos escalones o terrazas - antiguas y recientes - y la planicie de inundación del Río Neuquén. Se estudia el comportamiento del hombre en relación con el recurso natural agua, los usos que de ella hace, consumo, riego, recreación y, como a partir de esos usos se generan desechos o efluentes tanto industriales como cloacales, como de drenaje y desag³e de las tierras irrigadas
Subject(s)
Sustainable Development , Sewage , Water Resources , Rivers , Environmental Health , Water UseABSTRACT
Se realiza una investigación acerca del uso del recurso agua en el ámbito del ejido municipal de Cinco Saltos tanto en el ámbito urbano como rural. El ámbito de estudio y desarrollo de la experiencia, se localiza en la cuenca baja del Río Neuquén, entre los límites NO y SE de la localidad antes mencionada, abarcando una franja que a modo de transecta toma un área desde la planicie o meseta y sus cauces aluvionales, la bajada aluvio-coluvial, y el piso del valle con sus distintos escalones o terrazas - antiguas y recientes - y la planicie de inundación del Río Neuquén. Se estudia el comportamiento del hombre en relación con el recurso natural agua, los usos que de ella hace, consumo, riego, recreación y, como a partir de esos usos se generan desechos o efluentes tanto industriales como cloacales, como de drenaje y desag³e de las tierras irrigadas
