Research

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12 pages, 2213 KiB

Open AccessArticle

Ten-Year Experience with Endomyocardial Biopsy after Orthotopic Heart Transplantation: Comparison between Trans-Jugular and Trans-Femoral Approach

by Antonella Galeone, Annalisa Bernabei, Gabriele Pesarini, Marcello Raimondi Lucchetti, Francesco Onorati and Giovanni Battista Luciani

J. Cardiovasc. Dev. Dis. 2024, 11(4), 115; https://doi.org/10.3390/jcdd11040115 - 03 Apr 2024

Viewed by 394

Abstract

Background: Endomyocardial biopsy (EMB) is considered the gold standard for monitoring allograft rejection after heart transplantation. EMB is an invasive procedure that may be performed via a trans-jugular or a trans-femoral approach with a complication rate reported as less than 6%. The aim [...] Read more.

Background: Endomyocardial biopsy (EMB) is considered the gold standard for monitoring allograft rejection after heart transplantation. EMB is an invasive procedure that may be performed via a trans-jugular or a trans-femoral approach with a complication rate reported as less than 6%. The aim of this study was to evaluate the complication rate after EMBs in heart recipients and to compare the results of EMBs performed via a trans-jugular or a trans-femoral approach. Methods: Medical records of heart recipients undergoing EMBs between January 2012 and December 2022 were retrospectively reviewed. EMB-related complications were classified as major (death, pericardial effusion, hemopericardium, cardiac tamponade requiring a pericardiocentesis or an urgent cardiac surgery, ventricular arrythmias, permanent atrio-ventricular block requiring permanent pacing, hemothorax, pneumothorax and retroperitoneal bleeding) and minor (de novo tricuspid regurgitation, arrhythmias, coronary artery fistula, vascular access site complications). Results: A total of 1698 EMBs were performed during the study period at our institution in 212 heart recipients. There were 927 (55%) EMBs performed through a trans-jugular approach (TJ group) and 771 (45%) EMBs performed through a trans-femoral approach (TF group). A total of 60 (3.5%) complications were recorded, including nine (0.5%) major complications (six cardiac tamponades, two pneumothorax and one retroperitoneal bleeding) and 51 (3%) minor complications (seven coronary fistulae, five de novo tricuspid regurgitation, four supraventricular arrythmias and thirty-five vascular access site complications). No difference was found in total (38 [4%] vs. 22 [3%]; p = 0.16) and major (6 [1%} vs. 3 [0.4%]; p = 0.65) complications (32 [3%] vs. 19 [2%]; p = 0.23) between the TJ group and the TF group. No difference was found in male sex, age at time of EMB and time from HT between complicated and not complicated EMBs. Conclusions: EMBs represent a safe procedure with a low risk of complications. In our experience, EMBs performed via a trans-jugular approach are as safe as the trans-femoral approach. Full article

(This article belongs to the Special Issue Current Challenges in Heart Failure and Cardiac Transplantation)

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14 pages, 1340 KiB

Open AccessArticle

One Year Outcomes Following Transplantation with COVID-19-Positive Donor Hearts: A National Database Cohort Study

by Stanley B. Wolfe, Ruby Singh, Dane C. Paneitz, Seyed Alireza Rabi, Chijioke C. Chukwudi, Richa Asija, Eriberto Michel, Asvin M. Ganapathi and Asishana A. Osho

J. Cardiovasc. Dev. Dis. 2024, 11(2), 46; https://doi.org/10.3390/jcdd11020046 - 31 Jan 2024

Viewed by 1079

Abstract

The current understanding of the safety of heart transplantation from COVID-19+ donors is uncertain. Preliminary studies suggest that heart transplants from these donors may be feasible. We analyzed 1-year outcomes in COVID-19+ donor heart recipients using 1:3 propensity matching. The OPTN database was [...] Read more.

The current understanding of the safety of heart transplantation from COVID-19+ donors is uncertain. Preliminary studies suggest that heart transplants from these donors may be feasible. We analyzed 1-year outcomes in COVID-19+ donor heart recipients using 1:3 propensity matching. The OPTN database was queried for adult heart transplant recipients between 1 January 2020 and 30 September 2022. COVID-19+ donors were defined as those who tested positive on NATs or antigen tests within 21 days prior to procurement. Multiorgan transplants, retransplants, donors without COVID-19 testing, and recipients allocated under the old heart allocation system were excluded. A total of 7211 heart transplant recipients met the inclusion criteria, including 316 COVID-19+ donor heart recipients. Further, 290 COVID-19+ donor heart recipients were matched to 870 COVID-19− donor heart recipients. Survival was similar between the groups at 30 days (p = 0.46), 6 months (p = 0.17), and 1 year (p = 0.07). Recipients from COVID-19+ donors in the matched cohort were less likely to experience postoperative acute rejection prior to discharge (p = 0.01). National COVID-19+ donor heart usage varied by region: region 11 transplanted the most COVID-19+ hearts (15.8%), and region 6 transplanted the fewest (3.2%). Our findings indicate that COVID-19+ heart transplantation can be performed with safe early outcomes. Further analyses are needed to determine if long-term outcomes are equivalent between groups. Full article

(This article belongs to the Special Issue Current Challenges in Heart Failure and Cardiac Transplantation)

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10 pages, 2939 KiB

Open AccessArticle

Reference Values for Inward Displacement in the Normal Left Ventricle: A Novel Method of Regional Left Ventricular Function Assessment

by Romy R. M. J. J. Hegeman, Sean McManus, Attila Tóth, Ricardo Ladeiras-Lopes, Pieter Kitslaar, Viet Bui, Kayleigh Dukker, Serge C. Harb, Martin J. Swaans, Ori Ben-Yehuda, Patrick Klein and Rishi Puri

J. Cardiovasc. Dev. Dis. 2023, 10(12), 474; https://doi.org/10.3390/jcdd10120474 - 24 Nov 2023

Cited by 1 | Viewed by 1312

Abstract

Background: Regional functional left ventricular (LV) assessment using current imaging techniques remains limited. Inward displacement (InD) has been developed as a novel technique to assess regional LV function via measurement of the regional displacement of the LV endocardial border across each of the [...] Read more.

Background: Regional functional left ventricular (LV) assessment using current imaging techniques remains limited. Inward displacement (InD) has been developed as a novel technique to assess regional LV function via measurement of the regional displacement of the LV endocardial border across each of the 17 LV segments. Currently, normal ranges for InD are not available for clinical use. The aim of this study was to validate the normal reference limits of InD in healthy adults across all LV segments. Methods: InD was analyzed in 120 healthy subjects with a normal LV ejection fraction, using the three standard long-axis views obtained during cardiac MRI that quantified the degree of inward endocardial wall motion towards the true LV center of contraction. For all LV segments, InD was measured in mm and expressed as a percentage of the theoretical degree of maximal segment contraction towards the true LV centerline. The arithmetic average InD was obtained for each of the 17 segments. The LV was divided into three regions, obtaining average InD at the LV base (segments 1–6), mid-cavity (segments 7–12) and apex (segments 13–17). Results: Average InD was 33.4 ± 4.3%. InD was higher in basal and mid-cavity LV segments (32.8 ± 4.1% and 38.1 ± 5.8%) compared to apical LV segments (28.6 ± 7.7%). Interobserver variability correlations for InD were strong (R = 0.80, p < 0.0001). Conclusions: We provide clinically meaningful reference ranges for InD in subjects with normal LV function, which will emerge as an important screening and assessment imaging tool for a range of HFrEF therapies. Full article

(This article belongs to the Special Issue Current Challenges in Heart Failure and Cardiac Transplantation)

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12 pages, 1340 KiB

Open AccessArticle

Early versus Delayed Surgery in Patients with Left-Sided Infective Endocarditis and Stroke

by Jamila Kremer, Joshua Jahn, Sabrina Klein, Mina Farag, Tobias Borst and Matthias Karck

J. Cardiovasc. Dev. Dis. 2023, 10(8), 356; https://doi.org/10.3390/jcdd10080356 - 21 Aug 2023

Cited by 1 | Viewed by 2665

Abstract

Background: Timing of surgery remains controversial in patients with infective endocarditis and stroke. Guidelines on infective endocarditis suggest delaying surgery for up to 4 weeks. However, with early heart failure due to progression of the infection or recurrent septic embolism, urgent surgery becomes [...] Read more.

Background: Timing of surgery remains controversial in patients with infective endocarditis and stroke. Guidelines on infective endocarditis suggest delaying surgery for up to 4 weeks. However, with early heart failure due to progression of the infection or recurrent septic embolism, urgent surgery becomes imperative. Methods: Out of 688 patients who were surgically treated for left-sided infective endocarditis, 187 presented with preoperative neurological events. The date of cerebral stroke onset was documented in 147 patients. The patients were stratified according to timing of surgery: 61 in the early group (0–7 days) vs. 86 in the delayed group (>7 days). Postoperative neurological outcome was assessed by the modified Rankin Scale. Results: Preoperative sepsis was more prevalent in patients with preoperative neurological complications (46.0% vs. 29.5%, p < 0.001). Patients with haemorrhagic stroke were operated on later (19.8% vs. 3.3%, p = 0.003). Postoperative cerebrovascular accidents were comparable between both groups (p = 0.13). Overall, we observed good neurological outcomes (p = 0.80) and a high recovery rate, with only 5% of cases showing neurological deterioration after surgery (p = 0.29). In-hospital mortality and long-term survival were not significantly different in the early and delayed surgery groups (log-rank, p = 0.22). Conclusions: Early valve surgery in high-risk patients with infective endocarditis and stroke can be performed safely and is not associated with worse outcomes. Full article

(This article belongs to the Special Issue Current Challenges in Heart Failure and Cardiac Transplantation)

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10 pages, 1440 KiB

Open AccessArticle

Morbidity and Mortality of Heterotopic Partial Heart Transplantation in Rodent Models

by Savannah Skidmore, Morgan A. Hill, Katherine Bishara, Haley Konsek, Jennie H. Kwon, Kelvin G. M. Brockbank and Taufiek Konrad Rajab

J. Cardiovasc. Dev. Dis. 2023, 10(6), 234; https://doi.org/10.3390/jcdd10060234 - 26 May 2023

Cited by 3 | Viewed by 1312

Abstract

Unrepairable congenital heart valve disease is an unsolved problem in pediatric cardiac surgery because there are no growing heart valve implants. Partial heart transplantation is a new type of transplant that aims to solve this problem. In order to study the unique transplant [...] Read more.

Unrepairable congenital heart valve disease is an unsolved problem in pediatric cardiac surgery because there are no growing heart valve implants. Partial heart transplantation is a new type of transplant that aims to solve this problem. In order to study the unique transplant biology of partial heart transplantation, animal models are necessary. This study aimed to assess the morbidity and mortality of heterotopic partial heart transplantation in rodent models. This study assessed two models. The first model involved transplanting heart valves from donor animals into the abdominal aortic position in the recipient animals. The second model involved transplanting heart valve leaflets into the renal subcapsular position of the recipient animals. A total of 33 animals underwent heterotopic partial heart transplantation in the abdominal aortic position. The results of this model found a 60.61% (n = 20/33) intraoperative mortality rate and a 39.39% (n = 13/33) perioperative mortality rate. Intraoperative mortality was due to vascular complications from the procedure, and perioperative mortality was due to graft thrombosis. A total of 33 animals underwent heterotopic partial heart transplantation in the renal subcapsular position. The results of this model found a 3.03% (n = 1/33) intraoperative mortality rate, and the remaining 96.97% survived (n = 32/33). We conclude that the renal subcapsular model has a lower mortality rate and is technically more accessible than the abdominal aortic model. While the heterotopic transplantation of valves into the abdominal aortic position had significant morbidity and mortality in the rodent model, the renal subcapsular model provided evidence for successful heterotopic transplantation. Full article

(This article belongs to the Special Issue Current Challenges in Heart Failure and Cardiac Transplantation)

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13 pages, 891 KiB

Open AccessArticle

Elevated Levels of Neutrophil-to Monocyte Ratio Are Associated with the Initiation of Paroxysmal Documented Atrial Fibrillation in the First Two Months after Heart Transplantation: A Uni-Institutional Retrospective Study

by Dragos-Florin Baba, Horatiu Suciu, Calin Avram, Manuela Gyorgy, Alina Danilesco, Laurentiu Huma and Ileana Anca Sin

J. Cardiovasc. Dev. Dis. 2023, 10(2), 81; https://doi.org/10.3390/jcdd10020081 - 15 Feb 2023

Viewed by 2105

Abstract

Background: Heart transplantation represents the treatment for patients with end-stage heart failure (HF) being symptomatic despite optimal medical therapy. We investigated the role of NMR (neutrophil-to-monocyte ratio), NLR (neutrophil-to-lymphocyte ratio), NPR (neutrophil-to-platelet ratio), NWR (neutrophil-to-white cells ratio), MLR (monocyte-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio), [...] Read more.

Background: Heart transplantation represents the treatment for patients with end-stage heart failure (HF) being symptomatic despite optimal medical therapy. We investigated the role of NMR (neutrophil-to-monocyte ratio), NLR (neutrophil-to-lymphocyte ratio), NPR (neutrophil-to-platelet ratio), NWR (neutrophil-to-white cells ratio), MLR (monocyte-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio), MWR (neutrophil-to-white cells ratio), and LWR (lymphocyte-to-white cells ratio) at the same cut-off values previously studied, to predict complications after heart transplant within 2 months after surgery. Methods: From May 2014 to January 2021, was included 38 patients in our study from the Cardiovascular and Transplant Emergency Institute of Târgu Mureș. Results: Preoperative NMR > 8.9 (OR: 70.71, 95% CI: 3.39–1473.64; p = 0.006) was a risk factor for the apparition of post-operative paroxysmal atrial fibrillation (Afib). In contrast, preoperative MWR > 0.09 (OR: 0.04, 95% CI: 0.003–0.58; p = 0.0182) represented a protective factor against AFib, but being the risk of complications of any cause (OR: 14.74, 95% CI: 1.05–206.59, p = 0.0458). Conclusion: Preoperative elevated levels of NMR were associated with the apparition of documented AFib, with high levels of MWR as a protective factor. High MWR was a risk factor in developing complications of any cause in the first 2 months after heart transplantation. Full article

(This article belongs to the Special Issue Current Challenges in Heart Failure and Cardiac Transplantation)

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10 pages, 1615 KiB

Open AccessArticle

New Wound Management of Driveline Infections with Cold Atmospheric Plasma

by Jamila Kremer, Étienne Fasolt Richard Corvin Meinert, Mina Farag, Florian Mueller, Jasmin Penelope Soethoff, Matthias Karck, Bastian Schmack, Anna Lassia Meyer and Gregor Warnecke

J. Cardiovasc. Dev. Dis. 2022, 9(11), 405; https://doi.org/10.3390/jcdd9110405 - 21 Nov 2022

Cited by 1 | Viewed by 2204

Abstract

The use of ventricular assist devices as a bridge to transplant or as destination therapy has increased. Wound complications increase morbidity in this cohort. Cold atmospheric plasma is a source of reactive oxygen and nitrogen species and can reduce the microbial load in [...] Read more.

The use of ventricular assist devices as a bridge to transplant or as destination therapy has increased. Wound complications increase morbidity in this cohort. Cold atmospheric plasma is a source of reactive oxygen and nitrogen species and can reduce the microbial load in skin wounds without negative effects on the surrounding tissue. We evaluated our cold atmospheric plasma treatment for LVAD driveline infections in a retrospective single-center study for peri- and postintervention outcome analysis. Between April 2019 and September 2019, 15 male patients were included (5 HVAD, 10 HeartMate III). The wounds were treated for a mean of 368.5 s with a reduction of bacterial load in treated wounds in 60% of patients, regardless of the pathogen. The most common pathogen was staphylococcus aureus (n = 8 patients). There was a significant reduction of the wound scale (scale 2.80 vs. 1.18; p < 0.001) plus a significant reduction in size (16.08 vs. 1.90 cm³; p = 0.047). Seven patients (46.6%) were free from any signs of local or systemic infection during 1-year follow-up. Five patients (33%) received a heart transplantation. Cold atmospheric plasma treatment is a potent, safe, and painless adjuvant technique for treating driveline infection without the need for repeating surgical interventions. Full article

(This article belongs to the Special Issue Current Challenges in Heart Failure and Cardiac Transplantation)

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11 pages, 3037 KiB

Open AccessArticle

Optimizing Anastomoses Technique in Orthotopic Heart Transplantation: Comparison of Biatrial, Bicaval and Modified Bicaval Technique

by Moritz Benjamin Immohr, Udo Boeken, Raphael Romano Bruno, Yukiharu Sugimura, Arash Mehdiani, Hug Aubin, Ralf Westenfeld, Igor Tudorache, Artur Lichtenberg and Payam Akhyari

J. Cardiovasc. Dev. Dis. 2022, 9(11), 404; https://doi.org/10.3390/jcdd9110404 - 20 Nov 2022

Cited by 1 | Viewed by 3407

Abstract

Implantation techniques for orthotopic heart transplantation (HTx) have evolved over the centuries. Recently new approaches of modified bicaval techniques to minimize warm ischemia are gaining popularity in the literature. Between 2010 and 2022 n = 238 patients underwent HTx in our department. The [...] Read more.

Implantation techniques for orthotopic heart transplantation (HTx) have evolved over the centuries. Recently new approaches of modified bicaval techniques to minimize warm ischemia are gaining popularity in the literature. Between 2010 and 2022 n = 238 patients underwent HTx in our department. The recipients were retrospectively reviewed and divided regarding their anastomoses’ technique. Anastomoses were sutured either in biatrial (n = 37), bicaval (n = 191) or in a modified bicaval (n = 10) manner with suturing of the superior cava vein and A. pulmonalis anastomosis after removing the aortic cross-clamp during the reperfusion. Warm ischemia was 62 ± 11 min for biatrial, 66 ± 15 min for bicaval, but only 48 ± 10 min for modified bicaval technique (p < 0.001). The incidence of severe primary graft dysfunction (PGD) was comparable between biatrial (27.0%) and bicaval (28.8%) anastomoses. In contrast, in patients with modified bicaval technique PGD occurred only in a single patient (10.0%). The incidence of postoperative pacemaker implantation was 18.2% for biatrial compared to 3.0% for bicaval and 0.0% for modified bicaval technique (p = 0.01). The modified bicaval technique enables to decrease the crucial warm ischemia during HTx compared to both biatrial and regular bicaval techniques. Therefore, we strongly recommend bicaval anastomoses, ideally in a modified manner. Full article

(This article belongs to the Special Issue Current Challenges in Heart Failure and Cardiac Transplantation)

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17 pages, 952 KiB

Open AccessArticle

Frequency, Risk Factors, and Clinical Outcomes of Late-Onset Atrial Flutter in Patients after Heart Transplantation

by Ann-Kathrin Rahm, Susanne Reinhardt, Matthias Helmschrott, Fabrice F. Darche, Tom Bruckner, Patrick Lugenbiel, Dierk Thomas, Philipp Ehlermann, Wiebke Sommer, Gregor Warnecke, Norbert Frey and Rasmus Rivinius

J. Cardiovasc. Dev. Dis. 2022, 9(10), 337; https://doi.org/10.3390/jcdd9100337 - 03 Oct 2022

Cited by 1 | Viewed by 1498

Abstract

Aims: Atrial flutter (AFL) is a common late-onset complication after heart transplantation (HTX) and is associated with worse clinical outcomes. Methods: This study investigated the frequency, risk factors, and outcomes of late-onset post-transplant AFL. We analyzed 639 adult patients undergoing HTX at the [...] Read more.

Aims: Atrial flutter (AFL) is a common late-onset complication after heart transplantation (HTX) and is associated with worse clinical outcomes. Methods: This study investigated the frequency, risk factors, and outcomes of late-onset post-transplant AFL. We analyzed 639 adult patients undergoing HTX at the Heidelberg Heart Center between 1989 and 2019. Patients were stratified by diagnosis and type of late-onset post-transplant AFL (>90 days after HTX). Results: A total of 55 patients (8.6%) were diagnosed with late-onset post-transplant AFL, 30 had typical AFL (54.5%) and 25 had atypical AFL (45.5%). Patients with AFL were younger at HTX (p = 0.028), received more biatrial anastomosis (p = 0.001), and presented with moderate or severe tricuspid regurgitation (56.4%). Typical AFL was associated with graft rejection (p = 0.016), whereas atypical AFL was associated with coronary artery disease (p = 0.028) and stent implantation (p = 0.042). Patients with atypical AFL showed a higher all-cause 1-year mortality (p = 0.010) along with a higher rate of graft failure after diagnosis of AFL (p = 0.023). Recurrence of AFL was high (83.6%). Patients with catheter ablation after AFL recurrence had a higher 1-year freedom from AFL (p = 0.003). Conclusions: Patients with late-onset post-transplant AFL were younger at HTX, received more biatrial anastomosis, and showed a higher rate of moderate or severe tricuspid regurgitation. Typical AFL was associated with graft rejection, whereas atypical AFL was associated with myocardial ischemia, graft failure, and mortality. Catheter ablation represents a viable option to avoid further episodes of late-onset AFL after HTX. Full article

(This article belongs to the Special Issue Current Challenges in Heart Failure and Cardiac Transplantation)

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12 pages, 1203 KiB

Open AccessArticle

Long-Term Patency of Venous Conduits Targeting the Right Coronary Artery System—Single Is Superior to Sequential bypass Grafting

by Rawa Arif, Aglaia Warninck, Mina Farag, Wiebke Sommer, Florian Leuschner, Norbert Frey, Matthias Karck, Gregor Warnecke and Nicolas A. Geis

J. Cardiovasc. Dev. Dis. 2022, 9(9), 285; https://doi.org/10.3390/jcdd9090285 - 26 Aug 2022

Viewed by 1778

Abstract

Objective: Little is known about the fate of bypass grafts to the right coronary system. To investigate the long-term patency of venous bypass grafts directed to the right coronary artery (RCA) based on postoperative angiograms and to identify predictors of graft occlusion. Methods: [...] Read more.

Objective: Little is known about the fate of bypass grafts to the right coronary system. To investigate the long-term patency of venous bypass grafts directed to the right coronary artery (RCA) based on postoperative angiograms and to identify predictors of graft occlusion. Methods: In this single-center study, all patients who underwent coronary angiography from 2005 to 2021 after previously undergoing isolated coronary artery bypass grafting (CABG) were included. The primary endpoint was graft occlusion over a median follow-up of 9.1 years. Results: Among a total of 1106 patients (17.0% women, 64 (57–71) years median age), 289 (26.1%) received a sequential vein graft and 798 (72.2%) a single graft. Multivariate regression revealed age (HR 1.019, CI 95% 1.007–1.032), the urgency of CABG (HR 1.355, CI 95% 1.108–1.656), and severely impaired left ventricular function (HR 1.883, CI 95% 1.290–2.748), but not gender and chronic total occlusion (CTO) as predictive factors for graft occlusion. Single conduits were found to be a predictor of graft patency (HR 0.575 CI 95% 0.449–0.737). The angiographic outcome showed an overall 10-year freedom from graft occlusion of 73.4% ± 1.6%. The 5-year (10-year) freedom from graft occlusion was 76.9% ± 2.8% (57.8% ± 4.0%) for sequential grafts and 90.4% ± 1.1% (77.8% ± 1.7%) for single grafts (log-rank p < 0.001). Conclusions: In symptomatic patients with renewed angiography, venous bypass grafting of the RCA showed acceptable long-term patency rates. Single bypass grafting of the RCA was superior to sequential grafting, which needs to be further investigated. Full article

(This article belongs to the Special Issue Current Challenges in Heart Failure and Cardiac Transplantation)

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Review

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18 pages, 1293 KiB

Open AccessReview

Cardiopulmonary Exercise Testing in Heart Failure

by Michel Juarez, Cristian Castillo-Rodriguez, Dina Soliman, Gaspar Del Rio-Pertuz and Kenneth Nugent

J. Cardiovasc. Dev. Dis. 2024, 11(3), 70; https://doi.org/10.3390/jcdd11030070 - 20 Feb 2024

Viewed by 1272

Abstract

Cardiopulmonary exercise testing (CPET) provides important information for the assessment and management of patients with heart failure. This testing measures the respiratory and cardiac responses to exercise and allows measurement of the oxygen uptake (

\dot{V}

O₂) max and the [...] Read more.

Cardiopulmonary exercise testing (CPET) provides important information for the assessment and management of patients with heart failure. This testing measures the respiratory and cardiac responses to exercise and allows measurement of the oxygen uptake (

\dot{V}

O₂) max and the relationship between minute ventilation (

\dot{V}

E) and carbon dioxide excretion (

\dot{V}

CO₂). These two parameters help classify patients into categories that help predict prognosis, and patients with a

\dot{V}

O₂ < 14 mL/kg/min and

\dot{V}

E/

\dot{V}

CO₂ slope >35 have a poor prognosis. This testing has been used in drug trials to determine complex physiologic responses to medications, such as angiotensin-converting enzyme inhibitors. For example, a study with enalapril demonstrated that the peak

\dot{V}

O₂ was 14.6 ± 1.6 mL/kg/min on placebo and 15.8 ± 2.0 mL/kg/min on enalapril after 15 days of treatment. The

\dot{V}

E/

\dot{V}

CO₂ slopes were 43 ± 8 on placebo and 39 ± 7 on enalapril. Chronic heart failure and reduced physical activity measured by cardiopulmonary exercise testing are associated with increases in BNP, and several studies have demonstrated that cardiac rehabilitation is associated with reductions in BNP and increases in

\dot{V}

O₂. Therefore, BNP measurements can help determine the benefits of cardiac rehabilitation and provide indirect estimates of changes in

\dot{V}

O₂. In addition, measurement of microRNAs can determine the status of skeletal muscle used during physical activity and the changes associated with rehabilitation. However, CPET requires complicated technology, and simpler methods to measure physical activity could help clinicians to manage their patients. Recent advances in technology have led to the development of portable cardiopulmonary exercise testing equipment, which can be used in various routine physical activities, such as walking upstairs, sweeping the floor, and making the bed, to provide patients and clinicians a better understanding of the patient’s current symptoms. Finally, current smart watches can provide important information about the cardiorespiratory system, identify unexpected clinical problems, and help monitor the response to treatment. The organized use of these devices could contribute to the management of certain aspects of these patients’ care, such as monitoring the treatment of atrial fibrillation. This review article provides a comprehensive overview of the current use of CPET in heart failure patients and discusses exercise principles, methods, clinical applications, and prognostic implications. Full article

(This article belongs to the Special Issue Current Challenges in Heart Failure and Cardiac Transplantation)

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19 pages, 266 KiB

Open AccessReview

Developments and Challenges in Durable Ventricular Assist Device Technology: A Comprehensive Review with a Focus on Advancements in China

by Jingrong Tu, Li Xu, Fei Li and Nianguo Dong

J. Cardiovasc. Dev. Dis. 2024, 11(1), 29; https://doi.org/10.3390/jcdd11010029 - 18 Jan 2024

Viewed by 1660

Abstract

Heart transplantation is currently the most effective treatment for end-stage heart failure; however, the shortage in donor hearts constrains the undertaking of transplantation. Mechanical circulatory support (MCS) technology has made rapid progress in recent years, providing diverse therapeutic options and alleviating the dilemma [...] Read more.

Heart transplantation is currently the most effective treatment for end-stage heart failure; however, the shortage in donor hearts constrains the undertaking of transplantation. Mechanical circulatory support (MCS) technology has made rapid progress in recent years, providing diverse therapeutic options and alleviating the dilemma of donor heart shortage. The ventricular assist device (VAD), as an important category of MCS, demonstrates promising applications in bridging heart transplantation, destination therapy, and bridge-to-decision. VADs can be categorized as durable VADs (dVADs) and temporary VADs (tVADs), according to the duration of assistance. With the technological advancement and clinical application experience accumulated, VADs have been developed in biocompatible, lightweight, bionic, and intelligent ways. In this review, we summarize the development history of VADs, focusing on the mechanism and application status of dVADs in detail, and further discuss the research progress and use of VADs in China. Full article

(This article belongs to the Special Issue Current Challenges in Heart Failure and Cardiac Transplantation)

12 pages, 1008 KiB

Open AccessReview

Practical Pharmacological Treatment of Heart Failure: Does Ejection Fraction Matter Anymore?

by Jonathan C. H. Chan, Emily Cowley and Michael Chan

J. Cardiovasc. Dev. Dis. 2023, 10(3), 114; https://doi.org/10.3390/jcdd10030114 - 09 Mar 2023

Cited by 1 | Viewed by 4295

Abstract

Heart failure (HF) is a complex clinical syndrome involving structural and/or functional abnormalities of the heart. Heart failure is often classified based on left ventricular ejection fraction, which serves as a predictor of mortality. The majority of the data supporting disease-modifying pharmacological therapies [...] Read more.

Heart failure (HF) is a complex clinical syndrome involving structural and/or functional abnormalities of the heart. Heart failure is often classified based on left ventricular ejection fraction, which serves as a predictor of mortality. The majority of the data supporting disease-modifying pharmacological therapies are from patients with reduced ejection fraction (less than 40%). However, with the recent results from the sodium glucose cotransporter-2 inhibitor trials, there is renewed interest in identifying potential beneficial pharmacological therapies. This review focuses on and includes pharmacological HF therapies across the spectrum of ejection fraction, providing an overview of the novel trials. We also examined the effects of the treatments on mortality, hospitalization, functional status, and biomarker levels to further investigate the interplay between ejection fraction and HF. Full article

(This article belongs to the Special Issue Current Challenges in Heart Failure and Cardiac Transplantation)

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