scholarly journals Selection Criteria for Heart Transplantation in Patients with End-Stage Heart Failure

2021 ◽  
pp. 8-16
Author(s):  
K. V. Rudenko ◽  
O. Yu. Dudnyk ◽  
M. I. Rzhanyi
Keyword(s):  
Heart Failure ◽  
Oxygen Consumption ◽  
Heart Transplantation ◽  
Left Ventricular ◽  
Waiting List ◽  
Left Ventricular Ejection ◽  
Maximum Oxygen Consumption ◽  
History Of ◽  
End Stage Heart Failure ◽  
End Stage

Today, heart transplantation remains the gold standard of treatment for patients with end-stage heart failure (HF). As the number of donors is limited and the risk of intervention is quite high, the key to achieving optimal outcomes and reducing the incidence of complications is the proper selection of patients who meet clearly defined criteria for inclusion in the waiting list for heart transplantation. This review presents the latest knowledge on indications and contraindications for inclusion recipients in the waiting list for heart transplantation, including the latest clinical guidelines of The International Society for Heart and Lung Transplantation (ISHLT) published in 2016. Thus, the absolute indications are dependence on intravenous inotropic and mechanical circulatory support; inoperable heart diseases or a history of volume reducing operations; refractory angina or life-threatening refractory arrhythmias despite maximal drug therapy and/or surgical correction; reduction of maximum oxygen consumption up to <12-14 ml/kg/min when performing the maximum cardiopulmonary exercise test. While including patients in the waiting list for heart transplantation, it should be noted that the low left ventricular ejection fraction <30%, a history of documented NYHA class III-IV HF, low maximum oxygen consumption as the only criterion of terminal HF and poor prognosis for annual survival in HF calculated on prognostic scales are not sufficient indications. Absolute contraindications include a systemic disease with a life expectancy of less than 2 years and irreversible pulmonary hypertension. The current procedure for the distribution of recipients by urgency status for heart transplantation is presented according to the updated recommendations of the United Network for Organ Sharing (UNOS) published in 2018 which consists of 6 degrees, compared with the 1999 edition which contained 3 degrees.

scholarly journals Changes in the SARS-CoV-2 cellular receptor ACE2 levels in cardiovascular patients: a potential biomarker for the stratification of COVID-19 patients

GeroScience ◽  
2021 ◽  
Author(s):  
Miklós Fagyas ◽  
Viktor Bánhegyi ◽  
Katalin Úri ◽  
Attila Enyedi ◽  
Erzsébet Lizanecz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Diseases ◽  
Thoracic Surgery ◽  
Heart Transplantation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cardiovascular Patients ◽  
End Stage Heart Failure ◽  
End Stage

AbstractAngiotensin-converting enzyme 2 (ACE2) is essential for SARS-CoV-2 cellular entry. Here we studied the effects of common comorbidities in severe COVID-19 on ACE2 expression. ACE2 levels (by enzyme activity and ELISA measurements) were determined in human serum, heart and lung samples from patients with hypertension (n = 540), heart transplantation (289) and thoracic surgery (n = 49). Healthy individuals (n = 46) represented the controls. Serum ACE2 activity was increased in hypertensive subjects (132%) and substantially elevated in end-stage heart failure patients (689%) and showed a strong negative correlation with the left ventricular ejection fraction. Serum ACE2 activity was higher in male (147%), overweight (122%), obese (126%) and elderly (115%) hypertensive patients. Primary lung cancer resulted in higher circulating ACE2 activity, without affecting ACE2 levels in the surrounding lung tissue. Male sex resulted in elevated serum ACE2 activities in patients with heart transplantation or thoracic surgery (146% and 150%, respectively). Left ventricular (tissular) ACE2 activity was unaffected by sex and was lower in overweight (67%), obese (62%) and older (73%) patients with end-stage heart failure. There was no correlation between serum and tissular (left ventricular or lung) ACE2 activities. Neither serum nor tissue (left ventricle or lung) ACE2 levels were affected by RAS inhibitory medications. Abandoning of ACEi treatment (non-compliance) resulted in elevated blood pressure without effects on circulating ACE2 activities. ACE2 levels associate with the severity of cardiovascular diseases, suggestive for a role of ACE2 in the pathomechanisms of cardiovascular diseases and providing a potential explanation for the higher mortality of COVID-19 among cardiovascular patients. Abandoning RAS inhibitory medication worsens the cardiovascular status without affecting circulating or tissue ACE2 levels.

Deloading of the Left Ventricle by Ventricular Assist Device Normalizes Increased Expression of Endothelin ET A Receptors But Not Endothelin-Converting Enzyme-1 in Patients With End-Stage Heart Failure

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Henning Morawietz ◽  
Marten Szibor ◽  
Winfried Goettsch ◽  
Babett Bartling ◽  
Matthias Barton ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Ace Inhibitor ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Left Ventricular Myocardium ◽  
Converting Enzyme ◽  
Ventricular Assist ◽  
End Stage Heart Failure ◽  
End Stage

Background —Ventricular assist devices (VAD) are implanted in patients with end-stage heart failure for bridging the time until heart transplantation, resulting in hemodynamic unloading of the failing heart, improved cardiac contractile and mitochondrial function, and reversal of cardiac hypertrophy. It is unknown whether VAD unloading may affect the cardiac endothelin (ET) system, which has been proposed as one of the putative pathomechanisms of heart failure. Methods and Results —With the use of standard-calibrated, competitive reverse-transcription–polymerase chain reaction mRNA expression of components of the ET system was analyzed in left ventricular myocardium from nonfailing donor hearts, from failing hearts without and with ACE inhibitor therapy, and from patients with end-stage heart failure at the time of VAD implantation and 103±15 days after VAD implantation during removal with subsequent heart transplantation. ET receptor A (ET A ) was markedly upregulated in failing human myocardium. This increased ET A expression was not affected by ACE inhibitor treatment but was normalized by VAD unloading. ET A expression before or after VAD implantation did not correlate with duration of VAD implantation or suppression of Pro-ANP mRNA. ET B mRNA expression was unaffected by heart failure or VAD. In contrast, increased ET-converting enzyme-1 mRNA and ET-1 peptide levels in failing myocardium were partially normalized by ACE inhibition but not by VAD unloading. Conclusions —We conclude that VAD implantation normalizes ET A expression in failing human left ventricular myocardium, probably as the result of the beneficial effects of VAD unloading.

Features of the clinical picture and outcomes in patients from a heart transplantation waiting list with different causes of heart failure

Kardiologiia ◽  
2020 ◽  
Vol 60 (7) ◽  
pp. 15-19
Author(s):  
A. N. Kostomarov ◽  
M. A. Simonenko ◽  
M. A. Fedorova ◽  
P. A. Fedotov
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Death Rate ◽  
Left Ventricular ◽  
Waiting List ◽  
Left Ventricular Ejection ◽  
Circulatory Support ◽  
Ventricular Ejection Fraction ◽  
Group 2 ◽  
Group 1

Aim To identify clinical differences between patients on the heart transplant waiting list (HTWL) in the origin of chronic heart failure (CHF).Materials and methods From January 2010 through September 2019, 235 patients (age, 47+13 years (from 10 to 67 years); men, 79% (n=186)) were included in the HTWL. The patients were divided into two groups; group 1 (n=104, 44 %) consisted of patients with ischemic heart disease (IHD); group 2 (n=131, 56 %) included patients with noncoronarogenic CHF. Clinical and instrumental data and frequency of the mechanical circulatory support (MCS) as a “bridge” to heart transplantation (HT) were retrospectively evaluated.Results Group 1 included more male patients than group 2 [97 % (n=101) and 82 % (n=85), р<0.0001]; patients were older (54±8 and 42±14 years, р=0.0001). On inclusion into the HTWL, the CHF functional class was comparable in the groups, III [III;IV]; there were more patients of the UNOS 2 class in group 1 than in group 2 [75 % (n=78) and 57 % (n=75), р=0.005]. Patient distribution in UNOS 1B and 1A classes was comparable in the groups: 21% (n=22) and 3% (n=4) in group 1 and 33 % (n=43) and 10 % (n=13) in group 2. According to echocardiography patients of group 1 compared to group 2 showed a tendency towards higher values of left ventricular ejection fraction (Simpson method) [22 [18;26] % and 19 [15;24] %, р=0.37] and stroke volume [59 [44;72] % and 50 [36;67] %, р=0.07]. Numbers of patients with a cardioverter defibrillator or a cardiac resynchronization device with a defibrillator function were comparable in the groups [35 % (n=36) and 34 % (n=45)]. Comparison of comorbidities in groups 1 and 2 showed higher incidences of pulmonary hypertension [55 % (n=57) and 36 % (n=47), р=0.005], obesity [20 % (n=21) and 10 % (n=13), р=0.03], and type 2 diabetes mellitus [29 % (n=30) and 10 % (n=13), р=0.0004]. Rates of chronic obstructive lung disease, stroke, chronic kidney disease and other diseases were comparable. Duration of staying on the HTWL was comparable (104 [34; 179] and 108 [37; 229] days). During staying on the HTWL, patients of group 1 less frequently required MCS implantation [3 % (n=3) and 28 % (n=21), р=0.0009]. HT was performed for 59 % patients (n=61) in group 2 and 52 % (n=69) patients in group 2. Death rate in the HTWL was lower in group 1 [13 % (n=14) and 27 % (n=35), р<0.01].Conclusion On inclusion into the HTWL, patients with noncoronarogenic CHF had more pronounced CHF manifestations and a more severe UNOS class but fewer comorbidities than patients with CHF of ischemic origin. With a comparable duration of waiting for HT, patients with noncoronarogenic CHD more frequently required MCS implantation and had a higher death rate.

scholarly journals Resynchronization therapy in end-stage heart failure

2021 ◽  
Vol 5 (4) ◽  
pp. 206-211
Author(s):  
D.V. Shumakov ◽  
◽  
D.I. Zybin ◽  
M.A. Popov ◽  
V.V. Dontsov ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Heart Transplant ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
End Stage Heart Failure ◽  
End Stage

Heart failure (HF) is a common condition, and its overall prevalence is constantly growing. HF ultimately progresses to end-stage disease that is refractory to optimal medical therapy and requires implantable devices or heart transplant. In recent years, cardiac resynchronization therapy (CRT) has been generally accepted in patients with NYHA class III or IV, reduced left ventricular ejection fraction (less than 35%), and the wide QRS complex (>120 msec). CRT improves the efficacy of heart ventricle function and, as a result, physical performance and quality of life. Reverse cardiac remodeling occurs at a pathophysiological level that improves systolic function. Patients with end-stage HF who are on the heart transplant list are a specific group in whom CRT is considered a “bridge” to surgery. This review paper discusses state-of-the-art, advances, and unresolved issues in this area. KEYWORDS: cardiac resynchronization therapy, heart failure, left ventricular remodeling, ejection fraction, heart transplant. FOR CITATION: Shumakov D.V., Zybin D.I., Popov M.A. et al. Resynchronization therapy in end-stage heart failure. Russian Medical Inquiry. 2021;5(4):206–211 (in Russ.). DOI: 10.32364/2587-6821-2021-5-4-206-211.

Abstract P477: Clinical Outcomes In Individuals With And Without Heart Failure Presenting With Acute Coronary Syndromes

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Stephen Clarkson ◽  
Todd Brown ◽  
Nita Limdi ◽  
Chrisly Dillon ◽  
Mark Beasley
Keyword(s):  
Heart Failure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Clinical Characteristics ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Increased Risk ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage

Objective: To determine the risk for major adverse cardiovascular events (MACE) following acute coronary syndrome (ACS) in patients with and without heart failure (HF) and whether this risk varies by race and comorbidity. Methods: We studied adults with and without HF who underwent percutaneous coronary intervention (PCI) for the treatment of ACS in the Pharmacogenomic Resource to improve Medication Effectiveness Genotype Guided Antiplatelet Therapy study. ACS was defined by the presence of ≥2 of the following: ischemic symptoms, acutely elevated cardiac troponin, or ischemic electrocardiographic changes. HF was defined prior to PCI as a known history of HF, left ventricular ejection fraction <50%, or brain natriuretic peptide level >400 pg/mL. Demographic and clinical characteristics were collected prior to PCI. Race was self-reported. Participants were followed for up to 1 year for MACE. We constructed Cox proportional hazard models, adjusted for demographic and clinical characteristics, separately in those with and without HF to identify independent predictors of MACE. Results: Since 2014, 1,230 individuals have undergone PCI for ACS. Those with HF (n=419) were older and had more comorbidities than those without HF (n=811). The incidence of MACE per 100 person years was 40.4 in those with HF and 22.2 in those without HF (p<0.001). African American race was associated with increased risk for MACE following ACS in those without but not with a history of HF. Other clinical factors associated with MACE following ACS were older age and end stage renal disease in those with HF and diabetes, end stage renal disease, and peripheral arterial disease in those without HF (Table). Conclusions: Individuals with HF are at increased risk of MACE following ACS irrespective of race. However, in those without HF, African Americans have a higher risk of MACE following ACS relative to their white counterparts. Individuals with end stage renal disease are at high risk of MACE following ACS regardless of HF status.

scholarly journals End-stage heart failure patients should be treated instantly despite a pandemic with all-time available technology to ensure best outcomes

2020 ◽  
Vol 22 (Supplement_P) ◽  
pp. P33-P37
Author(s):  
Marie-Cécile Bories ◽  
Ramzi Abi Akar
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Care Delivery ◽  
Left Ventricular ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
End Stage Heart Failure ◽  
Available Technology ◽  
The Right ◽  
End Stage

Abstract Since the earliest cases of coronavirus disease 2019 (COVID-19) infection were reported, our care delivery systems have been reorganized and challenged in unprecedent ways, specifically the cardiovascular community. COVID-19 poses a challenge for heart transplantation, affecting donor selection, immunosuppression, and posttransplant management. Left Ventricular Assist Device (LVAD) therapy is currently a viable option for patients with end-stage heart failure as a bridge to heart transplantation or destination therapy. Here, we present a therapeutic strategy for the management of acute HF with Intermacs profiles from 1 to 4, with or without Covid-19 infection, exemplified by serie of patients presenting with severe HF and successfully treated by LVAD therapy during the spread of the Covid-19 pandemic and the French national lockdown. This experience has shown that we still have the capacity to provide the right therapy for the right disease to the right patient. LVAD implantation seems to be the treatment of choice for advanced HF due to the lack of healthy donor hearts for cardiac transplantation. Covid or non-Covid context, we have to take care of our patients with end-stage HF the best we can.

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