JHLT Open最新文献

{"title":"Pediatric heart transplantation: Current status and perspectives","authors":"Estela Azeka MD, PhD ,&nbsp;Fabiane Hase ,&nbsp;Yoshihiro Tomimoto","doi":"10.1016/j.jhlto.2025.100353","DOIUrl":"10.1016/j.jhlto.2025.100353","url":null,"abstract":"<div><h3>Background</h3><div>Heart transplantation (HT) has been the treatment of choice for children with end-stage heart disease. Since the first transplant in 1967, almost 6 decades on, vast improvements have occurred, the number of transplants has increased over time, and post-transplant survival curve has progressively improved.</div></div><div><h3>Methods</h3><div>The purpose of this review is to analyze the current status of pediatric HT, including epidemiology of heart failure, number of ventricular assist devices, number of transplants, and outcomes. The pretransplant, contemporary issues of children with heart failure, the waiting list for transplant, the role of multidisciplinary team, perspectives to overcome the storage of donors with xenotransplantation, donation after circulatory death, and ABO-incompatible transplantation are discussed.</div></div><div><h3>Results</h3><div>The outcome of transplantation in children and the main post-transplant issues related to immunosuppression, transition, and adherence were addressed, as well as the use of telemedicine as an additional tool for surveillance.</div></div><div><h3>Conclusion</h3><div>HT in pediatric population is an established treatment for end-stage heart disease patients. The survival has increased over time, and there is a promising improvement in the care of these patients in relation to quality of life based on advances in the current researches and research and innovations in the future, improving life expectancy.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100353"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocarditis in children: diagnosis and management","authors":"Zachary Hutchinson,&nbsp;Yuk Law","doi":"10.1016/j.jhlto.2025.100332","DOIUrl":"10.1016/j.jhlto.2025.100332","url":null,"abstract":"<div><div>Historically, myocarditis was diagnosed by findings on endomyocardial biopsy. Although still considered to be the reference standard, this approach has become uncommon in pediatrics. Cardiac magnetic resonance imaging can also be used to make a diagnosis, but its use is also limited in pediatrics due to the frequent need for sedation among other logistical and technical requirements. In current practice, the diagnosis of myocarditis in children for the purpose of deciding whether to treat is largely clinical, guided by noninvasive clinical findings. Preceding fever, constitutional, respiratory, and gastrointestinal symptoms, and hepatomegaly are common presenting signs and symptoms that are frequently mistaken for non-cardiac issues. Arrythmias and specific ECG findings can also accompany myocarditis. Cardiac biomarkers including troponin and BNP are frequently elevated and can help provide prognostic information. Infectious workup is an important part of the diagnosis of myocarditis, and recent studies have shown Parvovirus B19 and HHV6 to be the most common causes of viral myocarditis in pediatrics. Echocardiography is key to the clinical diagnosis, yet findings of myocarditis can be quite variable. The hallmark of treatment for myocarditis in children is supportive care including ionotropic support and heart failure therapies, with prompt initiation of mechanical circulatory support for cardiogenic shock or compromising arrhythmias. Some combination of steroids and IVIG are also frequently used to slow the injurious inflammatory response involved with myocarditis, yet this remains an area of debate. Future treatments may include additional immunomodulatory therapies, but further studies are needed.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100332"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk prediction model for waitlist mortality in patients with left ventricular assist devices","authors":"Anjan Tibrewala MD, MS ,&nbsp;Duc Thinh Pham MD ,&nbsp;Mo Hu MS ,&nbsp;Lucia C. Petito PhD ,&nbsp;Jonathan D. Rich MD ,&nbsp;Finn Gustafsson MD, PhD ,&nbsp;Theo M.M.H. de By MBA, PhD ,&nbsp;Kevin Veen MD, PhD ,&nbsp;Donald M. Lloyd-Jones MD, ScM ,&nbsp;Sanjiv J. Shah MD","doi":"10.1016/j.jhlto.2025.100337","DOIUrl":"10.1016/j.jhlto.2025.100337","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular assist devices (LVAD) are a bridge to heart transplantation (HT). Given limited donor organs, assessment of risk of waitlist mortality is important for waitlist prioritization for HT. We sought to derive and validate a risk prediction model for waitlist mortality in LVAD patients.</div></div><div><h3>Methods</h3><div>Adult patients with a continuous-flow, centrifugal, durable LVAD listed or likely to be listed for HT in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) were included. The outcome was time to all-cause mortality within 2 years from implant. We considered 41 candidate predictors at 3 months post-implant. Univariate Fine-Gray models and 4 logistic regression techniques (logistic, LASSO, random forest, gradient boosting) were used to select variables for a final survival model using the Fine-Gray method. The model was validated in INTERMACS and in an independent cohort (European Registry for Patients with Mechanical Circulatory Support [EUROMACS]). Model discrimination and calibration were evaluated.</div></div><div><h3>Results</h3><div>The INTERMACS cohort included 2364 patients with 268 (11%) deaths. A risk prediction model for waitlist mortality at 2 years was derived with area-under-the-curve (AUC) of 0.72 (95% CI 0.67–0.77). The EUROMACS cohort included 577 patients with 70 (12%) deaths. The model AUC was 0.62 (95% CI 0.55–0.70). The model predicted waitlist mortality when divided into low-, medium-, or high-risk groups in the INTERMACS (p&lt;0.001) and EUROMACS (p=0.0099) cohorts.</div></div><div><h3>Conclusions</h3><div>We derived and validated a risk prediction model for waitlist mortality in LVAD patients using 2 independent cohorts. Our risk assessment model can inform HT prioritization in LVAD patents.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100337"},"PeriodicalIF":0.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detectability of subsegmental lesions in patients with inoperable CTEPH: Comparison between ultra-high-resolution vs. conventional CT","authors":"Satoshi Higuchi MD, PhD ,&nbsp;Taijyu Satoh MD, PhD ,&nbsp;Hidenobu Takagi MD, PhD ,&nbsp;Mitsuru Nakada RT ,&nbsp;Takuya Kawahara PhD, MPH ,&nbsp;Nobuhiro Yaoita MD, PhD ,&nbsp;Shuhei Sugiyama RT ,&nbsp;Tomoya Onuma RT ,&nbsp;Kenta Shirata RT ,&nbsp;Shingo Kayano RT ,&nbsp;Hideki Ota MD, PhD ,&nbsp;Satoshi Yasuda MD, PhD ,&nbsp;Kei Takase MD, PhD","doi":"10.1016/j.jhlto.2025.100344","DOIUrl":"10.1016/j.jhlto.2025.100344","url":null,"abstract":"<div><h3>Background</h3><div>CT pulmonary angiography (CTPA) plays a critical role in guiding balloon pulmonary angioplasty (BPA) for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, conventional CT (cCT) has limited sensitivity in detecting peripheral lesions, which is critical for avoiding complications. This study compared ultra-high-resolution CT (UHRCT; 0.25 mm detector elements) and conventional CT (cCT; 0.6 mm detector elements) in identifying and classifying segmental and subsegmental lesions, using invasive selective angiography during BPA as the reference standard.</div></div><div><h3>Methods</h3><div>This single-center retrospective study included 42 patients with newly diagnosed CTEPH who underwent CT pulmonary angiography (CTPA) with either cCT or UHRCT and subsequently completed BPA. The morphology and location of lesions were independently assessed using selective angiography and CTPA. Sensitivity, specificity, and lesion classification accuracy were assessed using selective angiography as the reference standard.</div></div><div><h3>Results</h3><div>A total of 1687 branches in 42 patients (male/female 11/31, mean age 66 years) were analyzed. The sensitivity and specificity of cCT were 54.6% (95% CI: 48.2–60.8) and 85.2% (95% CI: 75.6–91.4), respectively. In contrast, UHRCT demonstrated significantly higher sensitivity (94.3%, 95% CI: 91.9–96.1) but lower specificity (60.2%, 95% CI: 46.7–72.2). The sensitivity difference was more prominent in subsegmental branches (p for interaction = 0.11). UHRCT more accurately classified lesion types in 83.7% of cases (95% CI: 76.7–88.9), versus 69.1% (95% CI: 58.3–78.1) with cCT. Web lesions remained the most difficult to detect.</div></div><div><h3>Conclusion</h3><div>Higher-spatial-resolution CTPA provides a higher lesion detection sensitivity, particularly in subsegmental branches, and more accurately classified lesion type in patients with CTEPH treated with BPA, potentially aiding procedural planning and guidance.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100344"},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke in pediatric ventricular assist device support","authors":"Christina VanderPluym MD ,&nbsp;Ryan Kobayashi MD ,&nbsp;Michael Rivkin MD","doi":"10.1016/j.jhlto.2025.100348","DOIUrl":"10.1016/j.jhlto.2025.100348","url":null,"abstract":"<div><div>Stroke continues to be one of the most significant hemocompatibility related adverse event in pediatric ventricular assist device support. Tremendous gains have been made in reducing the incidence of stroke across all ages, diagnoses and device types. However there still remains noticeable differences in the hemocompatibility of device types, with paracorporeal continuous and pulsatile flow associated with higher rates of ischemic stroke as compared to intracorporeal devices. In this review article, we discuss the landscape of pediatric stroke in mechanical circulatory support focusing on; pathophysiology of stroke in this heightened risk population, past and present incidence of stroke, stroke diagnosis and acute stroke management.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100348"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac transplantation as resolution for Uhl's anomaly: A case report","authors":"Juan J. Bacigalupe MD ,&nbsp;Natalia Vensentini MD ,&nbsp;Santiago Torroba MD ,&nbsp;Javier A. Mariani MD ,&nbsp;Sandra Defelitto MD ,&nbsp;Norberto Blanco MD ,&nbsp;Fabian Paetz MD ,&nbsp;Julieta Ximena Saenz MD ,&nbsp;Marcelo Nahin MD ,&nbsp;Maximiliano de Abreu MD","doi":"10.1016/j.jhlto.2025.100343","DOIUrl":"10.1016/j.jhlto.2025.100343","url":null,"abstract":"<div><div>Uhl's anomaly is an extremely rare congenital cardiac defect characterized by the absence of myocardium in the right ventricle. It has a poor prognosis, typically fatal during the perinatal period, with very few patients reaching adulthood. We present the case of a 28-year-old woman with heart failure and ventricular arrhythmia associated with Uhl's anomaly, who required cardiac transplantation, with favorable postoperative outcomes. Uhl's anomaly represents an exceedingly rare cause of cardiac transplantation in adults.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100343"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144713649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impella 5.5 use in women: A multicenter study","authors":"Michaela Asher MPhil ,&nbsp;David Rekhtman MD ,&nbsp;Amit Iyengar MD, MSE ,&nbsp;John DePaolo MD, PhD ,&nbsp;Cindy Song MD ,&nbsp;Iris Feng MD ,&nbsp;Emma Morganroth BS ,&nbsp;Gabriel Dardik MD ,&nbsp;Max Shin MD ,&nbsp;Noah Weingarten MD ,&nbsp;Alyson Brown BS ,&nbsp;Joyce Wald DO ,&nbsp;Mauer Biscotti MD ,&nbsp;Koji Takeda MD, PhD ,&nbsp;Marisa Cevasco MD, MPH","doi":"10.1016/j.jhlto.2025.100341","DOIUrl":"10.1016/j.jhlto.2025.100341","url":null,"abstract":"<div><h3>Background</h3><div>We sought to compare the outcomes of Impella 5.5 use between sexes.</div></div><div><h3>Methods</h3><div>All adult patients who underwent Impella 5.5 implantation at the University of Pennsylvania and Columbia University between June 2020 and May 2024 were retrospectively reviewed. Demographics, baseline status, complications, and outcomes were compared between sexes. Laboratory values were examined with a linear mixed model, and a parsimonious multivariable logistic regression was developed to assess factors predictive of in-hospital mortality.</div></div><div><h3>Results</h3><div>Of 254 patients, 41 (16%) were female and 213 (84%) were male. Before implant, females had lower hemoglobin levels (9.6 vs 11.2 g/dl, <em>p</em> &lt; 0.05), but similar cardiac risk factors (all <em>p</em> &gt; 0.05). The smaller size of females did not preclude device implantation (height: 1.7 vs 1.8 m; weight: 74.8 vs 88.0 kg, all <em>p</em> &lt; 0.05), and only 1 out of 41 (2.4%) females required direct aortic placement due to prohibitive anatomy. Preimplant mechanical circulatory support, duration of support, and postimplant rates of stroke, infection, and bleeding were similar (all <em>p</em> &gt; 0.05). In addition, laboratory biocompatability markers did not differ between sexes, nor did rates of successful bridging to durable therapies (all <em>p</em> &gt; 0.05). Finally, in-hospital and 1-year mortality were similar (all <em>p</em> &gt; 0.05), and female sex was not identified as a risk factor for in-hospital mortality (odds ratio 0.91, <em>p</em> &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>Females do not experience increased complications from the Impella 5.5, nor reduced device biocompatibility. Our data support greater consideration of device use in females.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100341"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144725088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential intermediate-term survival differences among heart transplant recipients from circulatory death vs brain death donors","authors":"Anh Nguyen MD, PhD ,&nbsp;Abbas Rana MD ,&nbsp;Alexis Shafii MD ,&nbsp;Gabriel Loor MD ,&nbsp;Andrew Civitello MD ,&nbsp;Jose Euberto Mendez Reyes MD, MPH ,&nbsp;O. Howard Frazier MD ,&nbsp;Todd Rosengart MD ,&nbsp;Kenneth Liao MD, PhD","doi":"10.1016/j.jhlto.2025.100342","DOIUrl":"10.1016/j.jhlto.2025.100342","url":null,"abstract":"<div><h3>Background</h3><div>This study builds upon previous analyses by examining heart transplant survival from donation after circulatory death (DCD) vs donation after brain death (DBD) using the United Network for Organ Sharing (UNOS) database, with follow-up extended to 3 years post-transplant.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 1,453 DCD and 16,561 DBD adult heart transplants from January 2019 to June 2024 using the UNOS database. Propensity scores were generated based on clinically relevant covariates, and 1-to-1 propensity-score matching was performed. Survival analysis was conducted using Cox proportional hazards regression and Kaplan-Meier curves, with the log-rank test comparing overall survival and the Wald test examining yearly survival rates between DCD and DBD groups.</div></div><div><h3>Results</h3><div>Mortality was not significantly different between DCD and DBD total cohorts (hazard ratio [HR] = 1.1, 95% confidence interval [CI] 0.9-1.3, <em>p</em> = 0.493). After propensity-score matching, balanced cohorts of 1,423 DCD and 1,423 DBD transplants were created with standardized mean difference among covariates well below 6%. In the matched cohort, DCD transplant mortality was 1.2 times higher than that of DBD transplants (HR 1.2, 95% CI 0.9-1.5). Kaplan-Meier curves revealed nonsignificantly lower overall survival for DCD recipients (log-rank <em>p</em> = 0.096). Survival rates were comparable in year 1: 91.6% vs 91.5%, <em>p</em> = 0.96, but significant differences emerged in subsequent years: 84.7% vs 89.4%, <em>p</em> = 0.007 in year 2; 80.3% vs 85.6%, <em>p</em> = 0.025 in year 3.</div></div><div><h3>Conclusions</h3><div>Intermediate-term survival following DCD heart transplantation may be lower compared to DBD transplantation. Further investigation is warranted to identify the underlying factors contributing to this potential disparity.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100342"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High profile transvalvular microaxial flow pump as a bridge to heart transplantation for amyloid cardiomyopathy: A case series","authors":"Pankaj Garg MBBS ,&nbsp;Mohammad Alomari MD ,&nbsp;Ishaq Wadiwala MBBS ,&nbsp;Melissa Lyle MD ,&nbsp;Si Pham MD ,&nbsp;Nafiye Busra Celik MD ,&nbsp;Juan C. Leoni Moreno MD ,&nbsp;Rohan Goswami MD ,&nbsp;Kevin Landolfo MD ,&nbsp;Jose Nativi-Nicolau MD ,&nbsp;Daniel Yip MD ,&nbsp;Parag C. Patel MD ,&nbsp;Basar Sareyyupoglu MD","doi":"10.1016/j.jhlto.2025.100340","DOIUrl":"10.1016/j.jhlto.2025.100340","url":null,"abstract":"<div><h3>Background</h3><div>The definitive treatment for end-stage heart failure (ESHF) due to amyloid cardiomyopathy (ACM) is an orthotopic heart transplant (OHT). However, associated pulmonary hypertension (PH) can present as a contraindication to OHT and be challenging to manage with conventional therapies. We herein reported the successful use of Impella 5.5 in a series of patients with ACM to improve PH and successfully bridge to OHT.</div></div><div><h3>Methods</h3><div>Five patients with ACM associated ESHF were analyzed. All patients had moderate to severe PH on admission. As a bridge to transplant, Impella 5.5 was inserted through the axillary artery, and continued until OHT.</div></div><div><h3>Results</h3><div>All patients were male, and mean age was 62.2 ± 1.3 years. One patient had light chain associated amyloid cardiomyopathy (AL-CM), 2 had wild-type transthyretin associated amyloid cardiomyopathy (ATTRwt-CM), and 2 had variant transthyretin amyloid cardiomyopathy (ATTRv-CM). Indication for Impella 5.5 was to support acute on chronic heart failure and improve elevated PA pressures. Mean support time was 34.4 ± 11.97 days. Mean PA pressures decreased from 38.2 ± 4.43 mm<!--> <!-->Hg to 27 ± 4.24 mm<!--> <!-->Hg, and cardiac index increased from 1.58 ± 0.44 liter/min/m² to 2.46 ± 0.43 liter/min/m². No major adverse events related to Impella insertion occurred. All patients were successfully transplanted and doing well after OHT with no mortality after a mean follow-up of 13 ± 10.88 months.</div></div><div><h3>Conclusion</h3><div>Bridging patients with ACM to OHT remains challenging due to small left ventricular cavity and associated PH. Temporary mechanical circulatory support with Impella 5.5 helps reduce PA pressures and improve cardiac index. Impella 5.5 can be safe and feasible option to bridge patients with ACM to OHT.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"10 ","pages":"Article 100340"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased arterial stiffness and heart rate variability over time in heart transplant recipients: A cross-sectional study using peripheral arterial tonometry","authors":"Juliana Andrade Ferreira de Souza PhD ,&nbsp;Daniella Cunha Brandão PhD ,&nbsp;Maria da Glória Rodrigues-Machado PhD ,&nbsp;Bruna T.S. Araújo PhD ,&nbsp;Caio Morais PhD ,&nbsp;Alice Miranda dos Santos MSc ,&nbsp;Antônio Christian Evangelista Gonçalves PhD ,&nbsp;Maria Inês Remígio de Aguiar PhD ,&nbsp;Shirley Lima Campos PhD ,&nbsp;Armèle Dornelas de Andrade PhD","doi":"10.1016/j.jhlto.2025.100339","DOIUrl":"10.1016/j.jhlto.2025.100339","url":null,"abstract":"<div><h3>Background</h3><div>Arterial stiffness represented by Augmentation index (AIx) and heart rate variability (HRV) are established predictors of cardiovascular risk in heart transplant (HTx) recipients. However, the relationship between AIx and HRV in this population remains insufficiently explored, and factors such as time after transplantation may influence both metrics.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate vascular function through Aix and HRV parameters in HTx patients, both assessed by peripheral arterial tonometry (PAT).</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted with 35 adults aged 18 to 65 years, HTx ≥ 6 months after surgery, with stable clinical condition and no changes over the last 3 months of immunosuppressive treatment. AIx and HRV were assessed using PAT.</div></div><div><h3>Results</h3><div>Participants were categorized into 2 groups based on AIx values: high AIx (<em>n</em> = 19, AIx &gt; −5%) and low AIx (<em>n</em> = 16, AIx ≤ −5%). The high AIx group had a significantly longer time after transplantation (<em>p</em> = 0.00). HRV analysis revealed that the standard deviation of all normal NN intervals (SDNN, <em>p</em> = 0.044), and lower frequency to high-frequency ratio (LF/HF, <em>p</em> = 0.034) were significantly higher (<em>p</em> = 0.03) and HR was significantly lower (<em>p</em> = 0.04) in the high AIx group compared to low AIx.</div></div><div><h3>Conclusions</h3><div>Arterial stiffness assessed by PAT was higher in patients with a longer time after heart transplantation. Similarly, HRV indices, which reflect several cardiovascular health conditions, such as SDNN and sympathovagal balance (LF/HF ratio) were higher in the group with higher arterial stiffness in individuals after heart transplantation.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100339"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}