Profile of Heart Transplant Recipients in a Brazilian Center: Comparison With International Registry

Seguro, Luis Fernando Bernal da Costa; Braga, Fabiana Goulart Marcondes; Avila, M.S.; Mangini, Sandrigo; Franco, Gabriel; Lima, Carla; Santos, Renato Hideo Nakagawa; Filho, Domingos D. Lourenço; Gaiotto, Fábio Antônio; Bacal, Fernando

doi:10.1016/j.healun.2014.01.695

Cited by 3 publications

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“…Heart transplant (HT) is the treatment of choice for patients with advanced heart failure (HF), who are refractory to optimal guideline-directed medical therapy because it significantly improves their survival outcome and quality of life (1). However, its use is limited by the low availability of organs and the resulting medical complications, such as primary graft dysfunction, right ventricular (RV) dysfunction, and acute rejection and infection (1)(2)(3)(4).…”

Section: ' Introductionmentioning

confidence: 99%

“…Acute cellular rejection (ACR), which occurs in more than 30% of patients in the first year following HT, is characterized by an autoimmune response mediated by T cells with lymphocyte and macrophage infiltration, resulting in cardiomyocyte inflammation and necrosis (2,5,6). Because ACR can be asymptomatic, its early detection requires active monitoring with serial endomyocardial biopsy (EMB), the gold standard for its diagnosis (7,8).…”

Section: ' Introductionmentioning

confidence: 99%

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C-Reactive protein level and left ventricular mass are associated with acute cellular rejection after heart transplant

Bacal¹,

Fernandes-Silva²,

Mangini³

et al. 2021

Clinics

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Acute cellular rejection (ACR) remains a major complication of heart transplant (HT). The gold standard for its diagnosis is endomyocardial biopsy (EMB), whereas the role of non-invasive biomarkers for detecting ACR is unclear. This study aimed to identify non-invasive biomarkers for the diagnosis of ACR in patients undergoing HT and presenting with normal left ventricular function. METHODS: We evaluated patients who underwent HT at a single center between January 2010 and June 2019. Patients were enrolled after HT, and those with left ventricular (LV) systolic dysfunction before EMB were excluded. We included only the results of the first EMB performed at least 30 days after HT (median, 90 days). Troponin, B-type natriuretic peptide (BNP), and C-reactive protein (CRP) levels were measured and echocardiography was performed up to 7 days before EMB. ACR was defined as International Society for Heart and Lung Transplantation grade 2R or 3R on EMB. We performed logistic regression analysis to identify the non-invasive predictors of ACR (2R or 3R) and evaluated the accuracy of each using area under the receiver operator characteristic curve analysis. RESULTS: We analyzed 72 patients after HT (51.31±13.63 years; 25 [34.7%] women); of them, 9 (12.5%) developed ACR. Based on multivariate logistic regression analysis, we performed forward stepwise selection (entry criteria, po0.05). The only independent predictors that remained in the model were CRP level and LV mass index. The optimal cut-off point for CRP level was X15.9 mg/L (odds ratio [OR], 11.7; p=0.007) and that for LV mass index was X111 g/m 2 (OR, 13.6; p=0.003). The area under the receiver operating characteristic curve derived from this model was 0.87 (95% confidence interval [CI], 0.75-0.99), with sensitivity of 85.7% (95% CI, 42.1%-99.6%), specificity of 78.4% (95% CI, 64.7%-88.7%), positive predictive value of 35.3% (95% CI, 14.3%-61.7%), and negative predictive value of 97.6% (95% CI, 87.1%-99.9%). CONCLUSIONS: Among patients undergoing HT, CRP level and LV mass were directly associated with ACR, but troponin and BNP levels were not.

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Section: ' Introductionmentioning

confidence: 99%

Section: ' Introductionmentioning

confidence: 99%

C-Reactive protein level and left ventricular mass are associated with acute cellular rejection after heart transplant

Bacal¹,

Fernandes-Silva²,

Mangini³

et al. 2021

Clinics

View full text Add to dashboard Cite

show abstract

“…Chagas cardiomyopathy is the indication for heart transplantation in 35% of patients in Brazil and 13% of patients in Argentina [3,16]. In the United States, testing of patients with dilated (nonischemic) cardiomyopathy who were born and lived for more than 1 year in a Chagas disease endemic country showed a seroprevalence of 13% in New York and 19% in Los Angeles [17 & ,18].…”

Section: Introductionmentioning

confidence: 99%