A lower Hb threshold of 8 g per dL does not adversely affect patient outcome. Moreover, RBC resources can be saved without increased risk to the patient.

In this pilot study, the addition of photopheresis to triple-drug immunosuppressive therapy significantly decreased the risk of cardiac rejection without increasing the incidence of infection.

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The HeartMate VE LVAS provides adequate hemodynamic support, has an acceptably low incidence of adverse effects, and improves survival in heart transplant candidates both inside and outside the hospital. The studies of the HeartMate LVAS (both pneumatic and electric) for Food and Drug Administration approval are the only studies with a valid control group to show a survival benefit for cardiac transplantation.

Background-The role of QTc interval prolongation in heart failure remains poorly defined. To better understand it, we analyzed the QTc interval duration in patients with heart failure with high B-type natriuretic peptide (BNP) levels and analyzed the combined prognostic impact of prolonged QTc and elevated BNP. Methods and Results-QTc intervals were measured in 241 patients with heart failure who had BNP levels Ͼ400 pg/mL.QT interval duration was determined by averaging 3 consecutive beats through leads II and V 4 on a standard 12-lead ECG and corrected by using the Bazett formula. QTc intervals were prolonged (Ͼ440 ms) in 122 (51%) patients and normal in 119 (49%). The BNP levels in these 2 groups were not significantly different (786Ϯ321 pg/mL in the prolonged QTc group versus 733Ϯ274 pg/mL in the normal QTc group, Pϭ0.13). During 6 months of follow-up, 46 patients died, 9 underwent transplantation, and 17 underwent left ventricular assist device implantation. The deaths were attributed to pump failure (nϭ24, 52%), sudden cardiac death (nϭ18, 39%), or noncardiac causes (nϭ4, 9%). Kaplan-Meier survival rates were 3 times higher in the normal QTc group than in the prolonged QTc group (PϽ0.0001).On multivariate analysis, prolonged QTc interval was an independent predictor of all-cause death (Pϭ0.0001), cardiac death (Pϭ0.0001), sudden cardiac death (Pϭ0.004), and pump failure death (Pϭ0.0006). Conclusions-Prolonged QTc interval is a strong, independent predictor of adverse outcome in patients with heart failure with BNP levels Ͼ400 pg/mL.

Background-An increasing number of observations in patients with end-stage heart failure suggest that chronic ventricular unloading by mechanical circulatory support may lead to recovery of cardiac function. Tumor necrosis factor-␣ (TNF-␣) is a proinflammatory cytokine capable of producing pulmonary edema, dilated cardiomyopathy, and death. TNF-␣ is produced in the myocardium in response to volume overload; however, the effects of normalizing ventricular loading conditions on myocardial TNF-␣ expression are not known. We hypothesize that chronic ventricular unloading by the placement of a left ventricular assist device (LVAD) may eliminate the stress responsible for persistent TNF-␣ expression in human failing myocardium. Methods and Results-Myocardial tissue was obtained from normal hearts and from paired samples of 8 patients with nonischemic end-stage cardiomyopathy at the time of LVAD implantation and removal. Tissue sections were stained for TNF-␣, and quantitative analysis of the stained area was performed. We found that TNF-␣ content decreased significantly after LVAD support. Furthermore, the magnitude of the changes did not correlate with the length of LVAD support, although greater reductions in myocardial TNF-␣ content were found in patients who were successfully weaned off the LVAD who did not require transplantation. Conclusions-These data show for the first time that chronic mechanical circulatory assistance decreases TNF-␣ content in failing myocardium; furthermore, we suggest that the magnitude of the change may predict which patients will recover cardiac function.

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