Histomorphometric features predict 1-year outcome of patients with idiopathic dilated cardiomyopathy considered to be at low priority for cardiac transplantation (original) (raw)
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Discordance Between Pre and Post Cardiac Transplant Diagnosis
Cardiovascular Pathology, 1999
A correct clinical diagnosis in end-stage patients undergoing cardiac transplantation may have important prognostic and therapeutic implications. A retrospective clinico-pathologic study was carried out in 257 patients who had undergone cardiac transplantation at the University of Padua. A discrepancy between clinical and pathological diagnosis was found in 20 cases (8%). Among 126 patients with the clinical diagnosis of dilated cardiomyopathy, seven were found eventually to have ischemic heart disease (IHD), five myocarditis, one arrhythmogenic right ventricular cardiomyopathy (ARVC), and one non-compacted myocardium. Among the 87 patients with clinical diagnosis of IHD, three turned out to be dilated cardiomyopathy and one granulomatous myocarditis. Among the 10 patients with the clinical diagnosis of hypertrophic-restrictive cardiomyopathy, one had ARVC and one had cardiac fibroma. Altogether, only 24.5% underwent endomyocardial biopsy (EMB) and 75% coronary angiography before transplantation. Missed diagnosis of myocarditis occurred in patients in whom EMB was not carried out. EMB and coronary angiography might be indicated routinely in patients with apparent dilated cardiomyopathy, before proceeding to cardiectomy.
Revista Brasileira de Cirurgia Cardiovascular, 2012
Objective: To evaluate patient with cardiomyopathy's progress after cardiac transplant, by analyzing his survival, complications and cardiovascular responses after nearly four years of surgery. Methods: The survey was conducted from February to May 2011, with patients undergoing cardiac transplantation at Dr. Carlos Alberto Studart Gomes Hospital-Messejana Hospital (HDM). The sample consisted of all transplanted patients in 2007 in this hospital. Initially an evaluation form developed by the researchers, which was based on collected data from patients' medical records, was applied, about trans and postoperative period. After collecting these informations, patients underwent the six-minute walk test (6WT). The marks found in walking distance were compared with reference marks expected for this population by using Enright and Sherrill's equation. Results: From all the 24 patients who underwent cardiac transplantation in HDM in 2007, 14 were evaluated and 10 were excluded. Regarding the complications, in the transoperatory period, the most evident was the right ventricular dysfunction (64.3%) and tachycardia (64.3%) was more evident on the postoperative period. Analyzing the 6WT it was observed a decrease of 11.6% in walking distance when compared with the estimated distance (486 ± 55 m, 550 ± 59 m, respectively). Conclusion: Survival of heart transplant patients was equivalent to about 70%. The results of this study before the 6WT showed that patients' cardiovascular responses are below the estimated, nevertheless within the normal range established.
Myocyte nuclear area as a measure of left ventricular hypertrophy in transplant patients
1995
Transplanted hearts have been reported to increase in sire/weight in the first few months after transplant and to remain stable thereafter. An indirect way of assessing the changes in heart weight is through the changes in the area of the rnyocyte nucleus (MNA). We studied 20 patients who had undergone orthotopic heart transplantation more than 12 months previously; 10 had become hypertensive, and the remaining 10 were normotensive. Myocardial biopsies taken the first week after transplant and 6, 12,24, and 52 weeks after transplant were assessed. Myocyte nuclear area was measured in 200 myocytes/biopsy with an image analyzer. Individual measurements showed a wide variation in MNA, with significant overlaps among the different biopsies. Assessment of MNA at one year showed increased MNA in 4/10 patients in the hypertensive group and YlO in the normotensive group. The remaining patients showed either no statistically significant changes in MNA or a significant (p < 0.0001) decrease in MNA. The presence of systemic hypertension was not a predictive factor for significant hypertrophy and, in some cases, not even for hypertrophy itself. We conclude that although there is often an increase in MNA of the transplanted heart at one year posttransplant, this increase is not systematic, and isolated morphometric results should be viewed cautiously. Heart transplantation has become an accepted and worldwideused treatment for severe cardiac failure. Long-term results have improved significantly in the last 10 years, with a l-year survival of 90% and a 5-year survival of 70% (1). Systemic hypertension after cardiac transplantation is common, ranging from 40% to 100 % in different studies (l), depending on the diagnostic criteria used. Systemic hypertension and subsequent left ventricular hypertrophy may lead to decreased survival (2). Systemic hypertension after cardiac transplantation appears around the fourth to sixth week and remains stable through long-term follow-up (1). The mechanism by which transplanted patients become hypertensive has not been totally elucidated, but cyclosporine A seems to play a major role, both increasing afterload and leading to fine myocardial fibrosis, which could result in a restrictive physiology (3).
Circulation, 2011
Background-Pediatric dilated cardiomyopathy (DCM) is the leading indication for heart transplantation after 1 year of age. Risk factors by etiology at clinical presentation have not been determined separately for death and transplantation in population-based studies. Competing risks analysis may inform patient prioritization for transplantation listing. Methods and Results-The Pediatric Cardiomyopathy Registry enrolled 1731 children diagnosed with DCM from 1990 to 2007. Etiologic, demographic, and echocardiographic data collected at diagnosis were analyzed with competing risks methods stratified by DCM etiology to identify predictors of death and transplantation. For idiopathic DCM (nϭ1192), diagnosis after 6 years of age, congestive heart failure, and lower left ventricular (LV) fractional shortening z score were independently associated with both death and transplantation equally. In contrast, increased LV end-diastolic dimension z score was associated only with transplantation, whereas lower height-for-age z score was associated only with death. For neuromuscular disease (nϭ139), lower LV fractional shortening was associated equally with both end points, but increased LV end-diastolic dimension was associated only with transplantation. The risks of death and transplantation were increased equally for older age at diagnosis, congestive heart failure, and increased LV end-diastolic dimension among those with myocarditis (nϭ272) and for congestive heart failure and decreased LV fractional shortening among those with familial DCM (nϭ79).
PLOS ONE, 2022
Background This study aimed to determine the etiology of stageD heart failure (HF) and the prevalence and prognosis of misdiagnosed cardiomyopathy in patients undergoing heart transplantation. Methods and results We retrospectively reviewed 127 consecutive patients (mean age, 42 years; 90 [71%], male) from February 1994 to September 2021 admitted for heart transplant in our tertiary center. Pre-transplant clinical diagnosis was compared with post-transplant pathological diagnosis. The most common misdiagnosed cardiomyopathy was nonischemic cardiomyopathy accounting for 6% (n = 8) of all patients. Histopathological examination of explanted hearts in misdiagnosed patients revealed 2 arrhythmogenic cardiomyopathy, 2 sarcoidosis, 1 hypertrophic cardiomyopathy, 1 hypersensitivity myocarditis, 1 noncompacted cardiomyopathy, and 1 ischemic cardiomyopathy. Pre-transplant cardiac MRI and endomyocardial biopsy (EMB) were performed in 33 (26%) and 6 (5%) patients, respectively, with both performed in 3 (3% of patients). None of the patients undergoing both cardiac tests were misdiagnosed. During the 5-years follow-up period, 2 (25%) and 44 (37%) patients with and without pretransplant misdiagnosed cardiomyopathy died. There was no difference in survival rate between the groups (hazard ratio: 0.52; 95% CI:0.11-2.93; P = 0.314). Conclusions The prevalence of misdiagnosed cardiomyopathy was 6% of patients with stageD HF undergoing heart transplantation, the misdiagnosis mostly occurred in nonischemic/dilated
Papel do ecocardiograma na avaliação ventricular do coração transplantado versus rejeição cardíaca
Arquivos Brasileiros de Cardiologia, 2012
Background: Heart transplantation is an alternative for individuals with end-stage heart disease. However, episodes of heart rejection (HR) are frequent and increase morbidity and mortality, requiring the use of an accurate non-invasive exam for their diagnosis, since endomyocardial biopsy (EMB) is not a complication-free procedure. Objective: To compare the parameters obtained by use of Doppler echocardiography in a group of transplanted patients with HR (TX1) and another group of transplanted patients without rejection (TX0), having as reference a control group (CG) and observing the behavior of the left ventricular systo-diastolic function expressed as the myocardial performance index (MPI) Methods: Transthoracic echocardiographies were performed from January 2006 to January 2008 to prospectively assess 47 patients divided into three groups: CG (36.2%); TX0 (38.3%); and TX1 (25.5%). The MPI was compared between the groups, and data were analyzed by use of Fisher exact test and nonparametric Kruskal-Wallis test, both with significance level of 5%. Results: The groups did not differ regarding age, weight, height, and body surface. When compared to GC, TX0 and TX1 showed a change in the left ventricular systo-diastolic function, expressed as an increase in MPI, which was greater in TX1 [0.38 (0.29-0.44); 0.47 (0.43-0.56); 0.58 (0.52-0.74), respectively; p < 0.001]. Conclusion: Echocardiography was a very accurate test to detect changes in the systo-diastolic function of the transplanted heart; however, it did not prove to be reliable to replace BEM in the safe diagnosis of HR.
Heart transplant candidates at high risk can be identified at the time of initial evaluation
Transplant International, 1996
The increasing discrepancy between the numbers of patients selected for cardiac transplantation and the available donor organs requires validation of markers of high risk at the time of initial evaluation that may help to determine which patients profit from aggressive therapy We retrospectively examined the case records of 91 heart transplant candidates selected out of a total of 140 consecutive patients referred for evaluation. Of these 91 patients, 48 were transplanted during follow-up. Of the remaining 43 patients, 25 died after a mean survival time of 1.6 + 2.5 months. The causes of death were pump failure in 18 (72 %) and sudden cardiac death in 7 (28 %). Multivariate analysis identified 4 out of 26 parameters at initial evaluation that distinguished the 25 nonsurvivors from the 18 survivors. These were: mean arterial pressure (P = 0.03), pulmonary capillary wedge pressure (P = 0.002), mean pulmonary artery pressure (P = 0.001), and fractional shortening (P = 0.007). The mode of death could not be predicted. We conclude that there are prognostic markers at initial evaluation that allow more restrictive selection of patients for cardiac transplantation and mechanical bridging.
Myocardial Mechanisms Causing Heart Failure Early After Cardiac Transplantation
Transplantation Proceedings, 2006
Early after heart transplantation, some patients have heart failure (HF) with preserved left ventricular ejection fraction (LVEF), in the absence of rejection. The purpose of this study was to define the mechanisms causing HF early after transplantation and to determine whether these mechanisms involve changes that occur in active or passive myocardial properties. Eleven consecutive patients 1 week after heart transplantation underwent right heart catheterization and echocardiography with an endomyocardial biopsy. Hemodynamic measurements were obtained at spontaneous heart rate, and then were repeated at three atrially paced rates increased in 20-bpm increments above spontaneous heart rate. At baseline, 5 patients (group 1) had clinical HF and a pulmonary capillary wedge pressure (PCWP) Ն16 mmHg, and 6 patients (group 2) had no clinical evidence of HF and a PCWP Ͻ16 mmHg. LVEF was normal in all 11 patients. The relationships between cardiac index versus heart rate (HR) and PCWP versus HR were normal in all 11 patients. These normal function-versus-frequency relationships suggested that there were no significant abnormalities in the active myocardial processes of contraction or relaxation. In group 1 patients, the PCWP was significantly increased but the left ventricular end diastolic dimension was normal, suggestive of diastolic stiffness. Early after transplantation, there was a significant increase in LV wall thickness in group 1 patients as compared with preexplantation values despite myocardial biopsies in all 11 patients, showing no evidence of rejection, cardiomyocyte hypertrophy, or interstitial fibrosis thus suggestive of myocardial edema.