Conversion from cyclosporine to tacrolimus improves renal function and lipid profile after cardiac transplantation.

BACKGROUND: Calcineurin inhibitors (CNIs) have become the cornerstone of immunosuppressive regimens following heart transplantation, but their use is associated with nephrotoxicity. The impact on renal function after conversion from cyclosporine (CsA) to tacrolimus (TAC) is reported. PATIENTS AND METHODS: Fifteen patients (men age 42 +/- 11 years) after cardiac transplantation (HTX) were switched from CsA to TAC (mean time after HTX 21 +/- 6 months). There were 13 male and 2 female patients. Mean cholesterol and LDL level at the time of conversion were 217 +/- 65 ml/dl and and 136 +/- 51 mg/100 ml respectively. Indication for HTX was ischemic cardiomyopathy (CMP) in 8, congenital in 3 and dilatative CMP in the remaining 4 patients. RESULTS: Mean tacrolimus level (microg/dl) at 1, 3, 6 and 12 months were 8.6 +/- 3.3, 8.6 +/- 1.4, 9.2 +/- 2.8 and 9.8 +/- 2.5 respectively. There was a statistically significant improvement in creatinine levels at 1, 3, 6 and 12 months after conversion from baseline 1.9 +/- 0.7 mg/dl to 1.4 +/- 0.5 mg/dl, 1.4 +/- 0.4 mg/dl, 1.3 +/- 0.4 mg/dl and 1.2 +/- 0.4 mg/dl, respectively (p < 0.05). Furthermore, TAC decreased cholesterol as well as LDL-levels during this one-year time frame. CONCLUSION: This study shows that conversion from CsA to tacrolimus after orthotopic heart transplantation improves renal function.

One-year clinical outcome after emergency hospitalisation for suspected acute coronary syndrome -- a comparative analysis with respect to angiographic findings.

INTRODUCTION: Among patients with suspected acute coronary syndromes (ACS) referred for urgent coronary angiography there are some with normal angiograms. AIM: To compare, with respect to angiographic findings, one-year clinical outcomes in patients hospitalised for suspected ACS. METHOD: Between January 2001 and December 2003 emergency angiography was performed in 1169 patients. It revealed no significant coronary lesions in 97 (8.3%) cases, of these 40 being women and 57 men with a mean age of 55+/-15 yrs (Group 1). Sixty consecutive patients with ACS (20 women and 40 men with a mean age of 54+/-9 yrs) and significant coronary artery disease (CAD) confirmed by angiography were the study controls (Group 2). Demographic data, CAD risk factors, angiographic findings, ECG and echocardiographic data as well as laboratory test results were analysed. In a long-term follow-up, the prevalence of recurrent angina and all-cause mortality were assessed. RESULTS: There were no significant differences in patients' demographics between the two groups with the exception of arterial hypertension, which was more frequent in group 1. In group 1 the diagnosis of ACS was established in 14.5% cases, X syndrome in 14.4%, Prinzmetal angina in 4.1%, myocarditis in 6.1% and pulmonary thromboembolization in 5.1%. A definite diagnosis was not related to the cardiovascular disease in 36%. No complications were observed in the late follow-up of group 1 patients. CONCLUSIONS: Apparently normal angiograms are relatively common in patients referred for emergency coronary angiography. In patients without significant CAD on their angiograms the clinical outcome is favourable, without major adverse cardiovascular events in the long-term follow-up.

[Left ventricular function in gated single photon emission computed tomography (GSPET) in patients with myocardial infarction subjected to thrombolysis or primary PTCA]. / Ocena czynnosci lewej komory serca za pomoca bramkowanej tomografii emisyjnej pojedynczego fotonu (GSPET) u chorych z zawalem leczonych fibrynolitycznie lub pierwotna angioplastyka naczyn wienicowych.

Primary Percutaneous Transluminal Coronary Angioplasty (PTCA) is increasingly common method of treatment patients with acute myocardial infarction. The aim of the study was to assess the left ventricular function in patients with myocardial infarction subjected to thrombolysis or primary PTCA. Gated Single Photon Emission Computed Tomography was performed in 40 patients 6 months after myocardial infarction treated either with thrombolysis or primary PTCA. Left ventricular ejection fraction (LVEF), left ventricular enddiastolic (LVED) and systolic (LVES) volumes were analysed both at rest and after stress. Six months after myocardial infarction LVEF was significantly greater and LVED, LVES volumes smaller in patients treated with primary PTCA in comparison to patients treated with thrombolysis. The above observation suggests that patients subjected to primary PTCA might have better functional outcome in comparison to matched patients treated with thrombolysis after 6 months post myocardial infarction.