ABSTRACT
Vasoplegic syndrome (VS) is associated with poor outcomes after heart transplantation (HT). Our aim was to determine whether SAC/VALS is associated with VS after HT. We retrospectively analyzed all consecutive HT performed in three centers between January 2017 and August 2018. VS was defined as vasopressor need (norepinephrine or epinephrine >.5 mcg/kg/min or vasopressin) for more than 24 hours to maintain a mean arterial pressure >70 mm Hg. Ninety-six recipients underwent HT in the study period: 60 elective HT with no LVAD, 5 elective HT on long term LVAD, and 31 emergent HT: 3 on long-term LVAD and 28 on temporary mechanical circulatory support. Fourteen patients were on SAC/VALS treatment at the time of transplant, and 82 were not. The global incidence of VS was 15.6%, with no significant differences between the groups (7.14% in with SAC/VALS vs 17.07% in no-SAC/VALS). In conclusion, in our small cohort SAC/VALS was not associated with VS development.
Subject(s)
Heart Transplantation , Heart-Assist Devices , Vasoplegia , Aminobutyrates , Biphenyl Compounds , Drug Combinations , Heart Transplantation/adverse effects , Humans , Incidence , Retrospective Studies , Valsartan , Vasoplegia/drug therapy , Vasoplegia/epidemiology , Vasoplegia/etiologySubject(s)
Betacoronavirus , Coronavirus Infections/complications , Myocarditis/etiology , Pneumonia, Viral/complications , Ventricular Function, Left/physiology , Acute Disease , COVID-19 , Echocardiography , Electrocardiography , Female , Humans , Middle Aged , Myocarditis/diagnosis , Myocarditis/physiopathology , Pandemics , Radiography, Thoracic , SARS-CoV-2 , Stroke Volume/physiologyABSTRACT
Our aim was to describe the clinical profile of patients presenting sustained ventricular arrhythmias after sacubitril/valsartan (SV) initiation. All cases of sustained ventricular arrhythmias in patients receiving SV were consecutively recorded in two centers. Nineteen patients had sustained ventricular arrhythmias after SV. All were men and were previously receiving angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers before SV initiation. Fifteen patients (78.9%) had electrical stability in the previous 6 months. Nine patients (47.4%) initiated SV at the lowest available dose (24/26 mg). Globally, in all but five patients alive at discharge, SV was discontinued after the event. Six patients presented new arrhythmic events after discontinuation of SV. Two deaths and three heart transplants occurred (one due to heart failure and the other two due to persistent ventricular arrhythmias). All patients had a high arrhythmic risk, and 17 (89.5%) had an implanted cardioverter defibrillator. No specific triggers for the arrhythmic event were found. Male sex and previous episodes of ventricular arrhythmias could be associated with an increased risk of sustained ventricular tachycardia after SV initiation. Discontinuation of the drug might be an additional approach to enable a better control of ventricular arrhythmias in some patients.
Subject(s)
Aminobutyrates/adverse effects , Angiotensin II Type 1 Receptor Blockers/adverse effects , Heart Failure/drug therapy , Heart Rate/drug effects , Protease Inhibitors/adverse effects , Tachycardia, Ventricular/chemically induced , Tetrazoles/adverse effects , Aged , Aged, 80 and over , Biphenyl Compounds , Drug Combinations , Heart Failure/complications , Heart Failure/diagnosis , Heart Failure/physiopathology , Humans , Male , Middle Aged , Neprilysin/antagonists & inhibitors , Risk Assessment , Risk Factors , Spain , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/physiopathology , Time Factors , Treatment Outcome , ValsartanABSTRACT
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