Survival after cardiac transplantation: influence of the previous cardiopathy in the recipient.

INTRODUCTION: Data from cardiac transplantation registries have demonstrated a gradual improvement in patient survival over the last decades. Nevertheless, 5-years mortality rates may reflect the multitude of physiologic processes. Registries offer valuable information regarding predictors of mortality that may help us to improve therapeutic strategies. OBJECTIVES: To determine the influence on long term recipient survival of the type of prior cardiopathy that led to cardiac transplantation. METHODS: Analysis of a 316 patient cohort who underwent heart transplantation since 1991 at a single center. RESULTS: We analyzed the main clinical variables among a cohort with a mean follow-up of 7.2 years (standard deviation [SD], 4.8). There were 84.2% men and the overall mean age of 50.06 years (SD 12.29) at the time of transplantation. We identified 11 cardiopathies as the leading causes for transplantation: severe ischemic cardiopathy (55.3%), dilated cardiomyopathy (29.1%), terminal valvular cardiopathy (5.4%), alcoholic cardiopathy (2.5%), congenital cardiopathy (1.6%), acute myocarditis (1.6%), hypertrophic cardiomyopathy (1.6%), endomyocardial fibrosis (1.3%), anthracyclin-related dilated cardiopathy (0.9%), peripartum cardiomyopathy (0.3%), and vascular allograft disease (0.3%). The mean global survival of the cohort was 4.1 years, which showed a significant increase in the recent 8 compared with the first 11 years (P=.03). Multivariate analysis only demonstrated worse survival rate among those with chronic ischemic compared with the other cardiopathies (HR 2.17; 1.21-6.2; P=.003). Nevertheless, the signification disappeared after adjusting the analysis for the presence of ≥2 classical cardiovascular risk factors. CONCLUSION: Patients with chronic ischemic cardiopathy showed the leading cause for a lower survival after cardiac transplantation compared with other cardiopathies, which seemed to be related to the cardiovascular risk factors that produced the cardiopathy.

Impact of overweight on survival and primary graft failure after heart transplantation.

BACKGROUND: Overweight influence on prognosis after heart transplantation remains controversial. The objective of this study was to determine the relationship between overweight and survival in this setting. METHODS: We evaluated 271 cardiac transplant recipients engrafted from 1991 to 2009 whose age was 50.3±12.1 (mean; SD) years. Their body mass index (BMI) was 25.7±3.9 kg/m2. Regarding gender, 85.2% were males. Patients were classified by pretransplantation BMI into group A (>25 kg/m2) and group B (<25 kg/m2). We analyzed the differences in mortality and related factors. RESULTS: One hundred fifty Group A patients (55.4%) showed a slightly lower median survival (7.35 vs 8.62 years; P=.152). Group A patients were at higher risk of death within 1 year of follow-up (HR, 1.71; confidence interval [CI], 0.996-2.939; P=.051). Overweight was associated with increased mortality at 1 year after adjustment for age, recipient gender, hypertension, diabetes mellitus, hypercholesterolemia, coronary artery disease, and donor-recipient heart size mismatch. The incidence of primary graft failure was also significantly increased in group A (HR, 2.74; CI, 1.17-6.40; P=.017) after adjustment for the same variables. There were no significant differences between the groups concerning surgical ischemic time, number of acute rejection episodes, and infections during the first year. CONCLUSION: In our sample, overweight was associated with increased mortality and an increased incidence of primary graft failure within 1 year after cardiac transplantation.

Safety and effectiveness of ivabradine after cardiac transplantation.

BACKGROUND: Heart denervation is the primary cause of sinus tachycardia in transplant recipients. Drugs are usually needed to treat associated symptoms. OBJECTIVE: To evaluate the safety and effectiveness of the novel I(f) channel antagonist ivabradine to control heart rate after transplantation. METHODS: Of 316 heart transplant recipients at a single center since 1991, ivabradine was administered in 15 patients, in addition to ß-blockers in 4 patients and contraindication to use of ß-blocker therapy in the others. A prospective follow-up study was conducted to identify possible adverse effects, tolerance, and drug effects on heart rate and control of symptoms. RESULTS: Of the 15 patients, 13 were men; overall mean (SD) patient age was 46 (4.6) years. In all patients, treatment was begun after verification of basal heart rate greater than 100 bpm and after other causes of sinus tachycardia had been ruled out. During follow-up of 1.13 (0.3) years, no substantial adverse effects were observed. It was possible to reach the maximum drug dosage in all patients, achieving a reduction in basal heart rate of 33 (6.2) bpm. All patients reported substantial clinical improvement, and demonstrated an increase in functional class. CONCLUSION: Ivabradine is safe, well tolerated, and effective in heart transplant recipients.

[Ischemic stroke secondary to left atrial myxoma]. / Ictus isquémico secundario a mixoma auricular izquierdo.

We present the case of a 43-year-old-woman with history of ictal episodes who was admitted to the hospital after suffering a stroke affecting the left middle cerebral artery territory. After initial evaluation, an echocardiography identified a left atrial myxoma as aetiology of the stroke. In view of the surgical need, we asked for a cardiac magnetic resonance in order to obtain further anatomical information about the atrial mass. In the present article we review the neurological manifestations of the cardiac myxoma, considering the ischemic cerebrovascular disease as the most frequent presentation, just as this case illustrates.

Ictus isquémico secundario a mixoma auricular izquierdo / Ischemic stroke secondary to left atrial myxoma

Presentamos el caso de una mujer de 43 años, ingresada por infarto isquémico en el territorio de la arteria cerebral media izquierda y con antecedentes de episodios ictales. Tras una serie de pruebas se realiza una ecocardiografía que muestra un mixoma auricular izquierdo como etiología del ictus. Ante la necesidad de exéresis quirúrgica, se solicita una resonancia magnética (RNM) cardiaca para obtener información adicional sobre la anatomía y morfología de la masa auricular. Se exponen las manifestaciones neurológicas del mixoma cardiaco, siendo el accidente cerebrovascular la presentación más frecuente, tal y como ilustra el caso clínico

We present the case of a 43-year-old-woman with history of ictal episodes who was admitted to the hospital after suffering a stroke affecting the left middle cerebral artery territory. After initial evaluation, an echocardiography identified a left atrial myxoma as aetiology of the stroke. In view of the surgical need, we asked for a cardiac magnetic resonance in order to obtain further anatomical information about the atrial mass. In the present article we review the neurological manifestations of the cardiac myxoma, considering the ischemic cerebrovascular disease as the most frequent presentation, just as this case illustrates

[Mitral prosthetic valve and presyncope]. / Prótesis mecánica mitral y cuadros presincopales.

The incidence of mitral prosthetic valve thrombosis is low and generally dependent on low levels of anticoagulation. The clinical presentation is highly variable and ranges from asymptomatic patient though to arterial embolism or hemodynamic symptoms of valve obstruction. We report a case of a patient with presyncope and prosthetic mitral valve dysfunction with intermittent flow obstruction.

Prótesis mecánica mitral y cuadros presincopales / Mitral prosthetic valve and presyncope

La trombosis protésica mitral es una entidad poco frecuente, cuya incidencia se relaciona habitualmente con niveles bajos de anticoagulación. La presentación clínica varía desde pacientes asintomáticos, embolismo arterial o compromiso hemodinámico por obstrucción. Presentamos el caso de una disfunción protésica mitral con cuadros presincopales por obstrucción intermitente al flujo

The incidence of mitral prosthetic valve thrombosis is low and generally dependent on low levels of anticoagulation. The clinical presentation is highly variable and range from asintomatic patient though to arterial embolism or hemodinamic symptoms of valve obstruction. We report a case of a patient with presyncope and prosthetic mitral valve dysfunction with intermitent flow obstruction