Clinical characteristics of obstructive sleep apnea syndrome in heart transplant recipients.

AIM: We investigated the prevalence and clinical characteristics of obstructive sleep apnea syndrome (OSAS) among heart transplantation patients. METHODS: Among 86 surviving patients of mean age 43.07 ± 13.23 years including 35 men transplanted from April 1999 to November 2010, 43 (50%) agreed to participate in this study. Patients with apnea-hypopnea index (AHI) < 5 were labeled as "normal", with an AHI > 5, as obstructive surgeon (OSA). According to the AHI, subjects were classified as with OSA (group 1; n = 25 of mean age 49.0 ± 12.1 years and including 21 men versus non OSA group 2; n = 18) of mean age 34.8 ± 10.1 years with 14 men. We recorded patient demographic features, medications, polysomnographi observations, laboratory measurements, as well as echocardiographic and angiographic parameters. RESULTS: Prevalence of OSA (AHI > 5) was 58% (n = 25) with 30% (n = 14) as moderate or severe OSA (AHI > 15) OSA patients were significantly older, and showed a greater value of body mass index (BMI) and waist circumference. Echocardiographic findings revealed the only significant difference to be systolic arterial pressure. The apnea-hypopnea index showed significant correlation with age, BMI, waist circumference, neck circumference, Epworth score, duration of apnea episode, time of SaO(2) under 90% and systolic arterial pressure (SPAP). An inverse correlation was observed between AHI and sleep efficiency, oxygen saturation, and percentage of time in random eye movement (REM) sleep. Multivariate backward logistic regression analysis indicated waist circumference, sleep efficiency, percentage of time in REM sleeps and duration of apnea episode to be independent predictors of AHI. CONCLUSION: OSA is prevalent among heart transplantation patients. Obesity is a risk factor and waist circumference, and independent predictor for OSA.

Infective endocarditis and spondylodiscitis due to posterior nasal packing in a patient with a bioprosthetic aortic valve.

Infective endocarditis (IE) is a severe form of heart valve disease and is associated with a poor prognosis and high risk of mortality. We report the first known case of bioprosthetic aortic valve endocarditis associated with spondylodiscitis as a result of posterior nasal packing coated with antibiotics but without systemic antibiotic prophylaxis.

Comparison of heart transplantation patients with ischemic and idiopathic dilated cardiomyopathy.

OBJECTIVE: We retrospectively analyzed our data to compare preoperative demographic, laboratory, echocardiographic, hemodynamic findings mortality and survival rates of heart transplantation patients with ischemic (ICM) and idiopathic dilated (IDCM) cardiomyopathy. METHODS: The data of 144 patients transplanted from February 1998 to January 2011 were analyzed. 38 patients with ischemic ICM and 86 patients with IDCM were compared. RESULTS: Recipient age, preoperative creatinine, recipient body mass index, intraoperative cross-clamp time, donor male sex ratio, recipient male sex ratio, hyperlipidemia ratio, and previous nitrate use were significantly higher and left ventricular end systolic diameter significantly lower in patients with ICM. Major causes of death after heart transplantation were infections (31.9%), right ventricle failure (14.8%), and sudden cardiac death (14.8%). Causes of death were not different between the groups. Overall mortality in the entire population was 37.9% (47/124), and it was not different between the groups (39.5% vs 37.2%; P=.48). Early mortality (<30 days) rate was 11.2% (14/124), late mortality rate was 26.6% (33/124), and no statistically significant difference was observed between the groups. Survival analysis showed that ICM patients were not associated with worse survival compared with IDCM (71.1% vs 81.1% after 1 year, 68.1% vs 73.0% at 2 years, and 54.2% vs 62.3% at 5 years; log rank=0.57). Multivariate analysis showed that the only predictor of mortality was preoperative urea level and that heart failure etiology was not a predictor of this end point. CONCLUSIONS: Patients with ICM had similar survival and mortality rate compared with IDCM.