Value of SERCA2a as a Biomarker for the Identification of Patients with Heart Failure Requiring Circulatory Support

Background: Heart failure (HF) alters the nucleo-cytoplasmic transport of cardiomyocytes and reduces SERCA2a levels, essential for intracellular calcium homeostasis. We consider in this study whether the molecules involved in these processes can differentiate those patients with advanced HF and the need for mechanical circulatory support (MCS) as a bridge to recovery or urgent heart transplantation from those who are clinically stable and who are transplanted in an elective code. Material and method: Blood samples from 29 patients with advanced HF were analysed by ELISA, and the plasma levels of Importin5, Nucleoporin153 kDa, RanGTPase-Activating Protein 1 and sarcoplasmic reticulum Ca2+ ATPase were compared between patients requiring MCS and those patients without a MCS need prior to heart transplantation. Results: SERCA2a showed significantly lower levels in patients who had MCS compared to those who did not require it (0.501 ± 0.530 ng/mL vs. 1.123 ± 0.661 ng/mL; p = 0.01). A SERCA2a cut-off point of 0.84 ng/mL (AUC 0.812 ± 0.085, 95% CI: 0.646–0.979; p = 0.004) provided a 92% sensitivity, 62% specificity, 91% negative predictive value and 67% positive predictive value. Conclusions: In this cohort, patients with advanced HF and a need for MCS have shown significantly lower levels of SERCA2a as compared to stable patients without a need for MCS prior to heart transplantation. This is a small study with preliminary findings, and larger-powered dedicated studies are required to confirm and validate these results.

Case report: successful emergent transcatheter pulmonary valve replacement within failing pulmonary artery conduit in the setting of cardiogenic shock with extracorporeal membrane oxygenation support

Background To the best of our knowledge, this is the first reported case of transcatheter pulmonary valve replacement (TPVR) with extracorporeal membrane oxygenation (ECMO) support with successful decannulation as a bridge to recovery in a young adult with complex congenital heart disease. Case summary We describe a 24-year-old male patient with a history of D-transposition of the great arteries with ventricular septal defect status post-Rastelli repair at age three lost to follow-up and presenting with severe biventricular failure, left ventricular thrombus, and critical pulmonary conduit stenosis, deemed non-surgical and non-transplant candidate, who underwent conduit stenting and TPVR in the setting of cardiogenic shock. Upon intubation for general anaesthesia, the patient suffered from ventricular tachycardia arrest requiring cardiopulmonary resuscitation and veno-arterial ECMO. Once stabilized, conduit stenting and TPVR was performed with significant haemodynamic improvement and immediate ECMO decannulation with subsequent biventricular function improvement. Discussion In critically ill patients with complex congenital heart disease that are neither surgical nor transplant candidates, ECMO support can be used as a means of support during a transcatheter intervention to improve haemodynamics and a bridge to recovery, allowing time for future potential candidacy for surgery or transplantation as indicated. Patients with congenital heart disease need regular follow-up in specialty clinics to prevent the development of such critical illness.

Coronary Artery Reimplantation and Berlin Heart EXCOR Rescue for Left Coronary Artery Atresia With Severe Ischemic Cardiomyopathy

We describe a successful bridge to recovery by coronary reimplantation and Berlin Heart EXCOR left ventricular assist device in a child with left main coronary artery ostial atresia and severe ischemic cardiomyopathy.

The Influence Of Culture On The Process Of Recovery From A First Episode Schizophrenia

The literature indicates that aspects of culture have the potential to influence recovery from first episode schizophrenia (FES). The purpose of this study was to describe the infl uence of culture on the process of recovery for individuals with first episode schizophrenia. This study employed a qualitative descriptive methodology and elicited the experience of five male participants, who self-identified that culture influenced their recovery from FES. The three categories that emerged from the data are: ‘Emerging Cultural Identity,’ ‘Cultural Identity and Describing the Illness Experience,’ and ‘Cultural Identity: A Bridge to Recovery.’ A distinctive feature of this study is that participants turned toward their cultural identity to facilitate their process of recovery from a FES and maintain a positive sense of self. This study offers a preliminary understanding of the role of culture in recovery from FES and suggests implications for clinical practice, future research and theory.

The Influence Of Culture On The Process Of Recovery From A First Episode Schizophrenia

The literature indicates that aspects of culture have the potential to influence recovery from first episode schizophrenia (FES). The purpose of this study was to describe the infl uence of culture on the process of recovery for individuals with first episode schizophrenia. This study employed a qualitative descriptive methodology and elicited the experience of five male participants, who self-identified that culture influenced their recovery from FES. The three categories that emerged from the data are: ‘Emerging Cultural Identity,’ ‘Cultural Identity and Describing the Illness Experience,’ and ‘Cultural Identity: A Bridge to Recovery.’ A distinctive feature of this study is that participants turned toward their cultural identity to facilitate their process of recovery from a FES and maintain a positive sense of self. This study offers a preliminary understanding of the role of culture in recovery from FES and suggests implications for clinical practice, future research and theory.