Journal of Heart and Lung Transplantation最新文献

{"title":"Application of REVEAL Lite 2 and COMPERA 2.0 risk scores to patients with pulmonary arterial hypertension switching to riociguat in the REPLACE study","authors":"","doi":"10.1016/j.healun.2024.06.002","DOIUrl":"10.1016/j.healun.2024.06.002","url":null,"abstract":"<div><p>In Riociguat rEplacing PDE5i therapy evaLuated Against Continued PDE5i thErapy (REPLACE) (NCT02891850), improvements in risk status were observed in patients with pulmonary arterial hypertension (PAH) at intermediate risk switching to riociguat versus continuing phosphodiesterase-5 inhibitors (PDE5i). This post hoc study applied the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) Lite 2 and Comparative Prospective Registry of Newly Initiated Therapies for Pulmonary (COMPERA) 2.0 risk-assessment tools to REPLACE to investigate the impact of baseline risk status on clinical improvement. The proportions of riociguat- and PDE5i-treated patients achieving the primary end-point at REVEAL Lite 2 low, intermediate, and high baseline risk reflected the overall population. Proportions of riociguat-treated patients achieving the primary end-point were comparable between the COMPERA 2.0 intermediate-low risk (39%) and intermediate-high risk (43%) groups. Our findings show that patients in REPLACE achieved clinical improvement by switching from PDE5i to riociguat across all COMPERA 2.0 and most REVEAL Lite 2 baseline risk strata.</p></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1053249824016930/pdfft?md5=28d3d8cdfb1aafa7fe6ce26956f73659&pid=1-s2.0-S1053249824016930-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141296154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"VA-ECMO not a routine therapy for MI-related cardiogenic shock: Novel trial-driven realization or longstanding fundamental philosophy?","authors":"Jonathan R Dalzell, Jane A Cannon","doi":"10.1016/j.healun.2024.05.017","DOIUrl":"10.1016/j.healun.2024.05.017","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":8.9,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes among cardiogenic shock patients supported with high-capacity Impella axial flow pumps: A report from the Cardiogenic Shock Working Group","authors":"","doi":"10.1016/j.healun.2024.05.015","DOIUrl":"10.1016/j.healun.2024.05.015","url":null,"abstract":"<div><h3>Background</h3><p>The Impella 5.0 and 5.5 pumps (Abiomed, Danvers, MA) are large-bore transvalvular micro-axial assist devices used in cardiogenic shock<span> (CS) for patients requiring high-capacity flow. Despite their increasing use, real-world data regarding indications, rates of utilization and clinical outcomes with this therapy are limited. The objective of our study was to examine clinical profiles and outcomes of patients in a contemporary, real-world CS registry of patients who received an Impella 5.0/5.5 alone or in combination with other temporary mechanical circulatory support (tMCS) devices.</span></p></div><div><h3>Methods</h3><p><span>The CS Working Group (CSWG) Registry includes patients from 34 US hospitals. For this analysis, data from patients who received an Impella 5.0/5.5 between 2020–2023 were analyzed. Use of Impella 5.0/5.5 with or without additional tMCS therapies, duration of support, adverse events and outcomes at hospital discharge were studied. Adverse events including stroke, </span>limb ischemia<span>, bleeding<span> and hemolysis were not standardized by the registry but reported per individual CSWG Primary Investigator discretion. For those who survived, rates of native heart recovery (NHR) or heart replacement therapy (HRT) including heart transplant<span><span> (HT), or durable ventricular assist device (VAD) were recorded. We also assessed outcomes based on </span>shock etiology (acute myocardial infarction or MI-CS vs. heart failure-related CS or HF-CS).</span></span></span></p></div><div><h3>Results</h3><p>Among 6,205 patients, 754 received an Impella 5.0/5.5 (12.1%)<strong>,</strong><span> including 210 MI-CS (27.8%) and 484 HF-CS (64.1%) patients. Impella 5.0/5.5 was used as the sole tMCS device in 32% of patients, while 68% of patients received a combination of tMCS devices. Impella cannulation sites were available for 524/754 (69.4%) of patients, with 93.5% axillary configuration. Survival to hospital discharge for those supported with an Impella 5.0/5.5 was 67%, with 20.4% NHR and 45.5% HRT. Compared to HF-CS, patients with MI-CS supported on Impella 5.0/5.5 had higher in-hospital mortality (45.2% vs 26.2%, </span><em>p</em> &lt; 0.001) and were less likely to receive HRT (22.4% vs 56.6%, <em>p</em><span> &lt; 0.001. For patients receiving a combination of tMCS during hospitalization, this was associated with higher rates of limb ischemia (9% vs. 3%, </span><em>p</em> &lt; 0.01), bleeding (52% vs 33%, <em>p</em> &lt; 0.01), and mortality (38% vs 25%; <em>p</em> &lt; 0.001) compared to Impella 5.0/5.5 alone. Among Impella 5.0/5.5 recipients, the median duration of pump support was 12.9 days (IQR: 6.8–22.9) and longer in patients bridged to HRT (14 days; IQR: 7.7–28.4).</p></div><div><h3>Conclusions</h3><p>In this multi-center cohort of patients with CS, use of Impella 5.0/5.5 was associated with an overall survival of 67.1% and high rates of HRT. Lower adverse event rates were observed when Imp","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statistical critique of GUARDIAN-heart registry trial.","authors":"Michael Bailey","doi":"10.1016/j.healun.2024.05.014","DOIUrl":"10.1016/j.healun.2024.05.014","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141237432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Information for Readers","authors":"","doi":"10.1016/S1053-2498(24)01675-9","DOIUrl":"https://doi.org/10.1016/S1053-2498(24)01675-9","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":8.9,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141242450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extra-cardiac management of cardiogenic shock in the intensive care unit","authors":"Varinder K. Randhawa MD PhD ,&nbsp;Ran Lee MD ,&nbsp;Carlos L. Alviar MD ,&nbsp;Aniket S. Rali MD ,&nbsp;Alexandra Arias MD ,&nbsp;Anjali Vaidya MD ,&nbsp;Emily K. Zern MD ,&nbsp;Andrew Fagan MD MEd ,&nbsp;Alastair G. Proudfoot MBChB PhD ,&nbsp;Jason N. Katz MD MHS","doi":"10.1016/j.healun.2024.03.017","DOIUrl":"10.1016/j.healun.2024.03.017","url":null,"abstract":"<div><p>Cardiogenic shock (CS) is a heterogeneous clinical syndrome characterized by low cardiac output leading to end-organ hypoperfusion. Organ dysoxia ranging from transient organ injury to irreversible organ failure and death occurs across all CS etiologies but differing by incidence and type. Herein, we review the recognition and management of respiratory, renal and hepatic failure complicating CS. We also discuss unmet needs in the CS care pathway and future research priorities for generating evidence-based best practices for the management of extra-cardiac sequelae. The complexity of CS admitted to the contemporary cardiac intensive care unit demands a workforce skilled to care for these extra-cardiac critical illness complications with an appreciation for how cardio-systemic interactions influence critical illness outcomes in afflicted patients.</p></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":8.9,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141185769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to ‘‘Cardiac donation after circulatory death utilizing normothermic regional perfusion: The three-year vanderbilt experience’’ [The Journal of Heart and Lung Transplantation 43 (2024) S121]","authors":"C. Pasrija ,&nbsp;A. DeBose-Scarlett ,&nbsp;M. Petrovic ,&nbsp;S. Bommareddi ,&nbsp;T. Absi ,&nbsp;H. Siddiqi ,&nbsp;K. Amancherla ,&nbsp;D. Brinkley ,&nbsp;J. Lindenfeld ,&nbsp;J. Menachem ,&nbsp;H. Ooi ,&nbsp;D. Pedrotty ,&nbsp;L. Punnoose ,&nbsp;A. Rali ,&nbsp;S. Sacks ,&nbsp;M. Wigger ,&nbsp;S. Zalawadiya ,&nbsp;S. DeVries ,&nbsp;C. Keck ,&nbsp;S. Scholl ,&nbsp;J. Trahanas","doi":"10.1016/j.healun.2024.05.001","DOIUrl":"https://doi.org/10.1016/j.healun.2024.05.001","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1053249824016528/pdfft?md5=1aa55e70f5f216fe5fc3a4cb7199736b&pid=1-s2.0-S1053249824016528-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141595986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “The effect of postoperative vasoplegia to the survival of LVAD recipients” [The Journal of Heart and Lung Transplantation, 38 (2019) S360–S360]","authors":"M. Kawabori MD ,&nbsp;J. Soffer ,&nbsp;M. Mastroianni ,&nbsp;Y. Zhan ,&nbsp;K.G. Warner ,&nbsp;H. Rastegar ,&nbsp;M.S. Kiernan ,&nbsp;D. Denofrio ,&nbsp;F.Y. Chen ,&nbsp;G.S. Couper","doi":"10.1016/j.healun.2024.04.061","DOIUrl":"10.1016/j.healun.2024.04.061","url":null,"abstract":"","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S105324982401636X/pdfft?md5=bae0ea1c76c3d0ff12c7811606caf271&pid=1-s2.0-S105324982401636X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141138467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Results from randomized trial of pirfenidone in patients with chronic rejection (STOP-CLAD study)","authors":"","doi":"10.1016/j.healun.2024.05.013","DOIUrl":"10.1016/j.healun.2024.05.013","url":null,"abstract":"<div><h3>Background</h3><p>Chronic lung allograft<span> dysfunction (CLAD) is the leading long-term cause of poor outcomes after transplant and manifests by fibrotic remodeling of small airways and/or pleuroparenchymal fibroelastosis. This study evaluated the effect of pirfenidone<span> on quantitative radiographic and pulmonary function assessment in patients with CLAD.</span></span></p></div><div><h3>Methods</h3><p><span><span><span>We performed a single-center, 6-month, randomized, placebo-controlled trial of pirfenidone in patients with CLAD. Randomization was stratified by CLAD phenotype. The primary outcome for this study was change in radiographic assessment of </span>small airways disease, quantified as percentage of lung volume using parametric response mapping analysis of </span>computed tomography scans (PRM</span>^fSAD<span>); secondary outcomes included change in forced expiratory volume in 1 second (FEV</span>₁<span>), change in forced vital capacity (FVC), and change in radiographic quantification of parenchymal disease (PRM</span>^PD). Linear mixed models were used to evaluate the treatment effect on outcome measures.</p></div><div><h3>Results</h3><p><span>The goal enrollment of 60 patients was not met due to the coronavirus disease of 2019 pandemic, with 23 patients included in the analysis. There was no significant difference over the study period between the pirfenidone vs placebo groups with regards to the observed change in PRM</span>^fSAD (+4.2% vs −0.4%; <em>p</em> = 0.22), FEV₁ (−3.5% vs −3.6%; <em>p</em> = 0.97), FVC (−1.9% vs −4.6%; <em>p</em> = 0.41), or PRM^PD (−0.6% vs −2.5%; <em>p</em><span> = 0.30). The study treatment tolerance and adverse events were generally similar between the pirfenidone and placebo groups.</span></p></div><div><h3>Conclusions</h3><p>Pirfenidone had no apparent impact on radiographic evidence of allograft dysfunction or pulmonary function decline in a single-center randomized trial of CLAD patients that did not meet enrollment goals but had an acceptable tolerance and side-effect profile.</p></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141144627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome-based Risk Assessment of Non-HLA Antibodies in Heart Transplantation: A Systematic Review","authors":"","doi":"10.1016/j.healun.2024.05.012","DOIUrl":"10.1016/j.healun.2024.05.012","url":null,"abstract":"<div><h3>Background</h3><p>Current monitoring after heart transplantation (HT) employs repeated invasive endomyocardial biopsies (EMB). Although positive EMB confirms rejection, EMB fails to predict impending, subclinical, or EMB-negative rejection events. While non-human leukocyte antigen (non-HLA) antibodies have emerged as important risk factors for antibody-mediated rejection after HT, their use in clinical risk stratification has been limited. A systematic review of the role of non-HLA antibodies in rejection pathologies has the potential to guide efforts to overcome deficiencies of EMB in rejection monitoring.</p></div><div><h3>Methods</h3><p>Databases were searched to include studies on non-HLA antibodies in HT recipients. Data collected included the number of patients, type of rejection, non-HLA antigen studied, association of non-HLA antibodies with rejection, and evidence for synergistic interaction between non-HLA antibodies and donor-specific anti-human leukocyte antigen antibody (HLA-DSA) responses.</p></div><div><h3>Results</h3><p>A total of 56 studies met the inclusion criteria. Strength of evidence for each non-HLA antibody was evaluated based on the number of articles and patients in support versus against their role in mediating rejection. Importantly, despite previous intense focus on the role of anti-major histocompatibility complex class I chain-related gene A (MICA) and anti-angiotensin II type I receptor antibodies (AT1R) in HT rejection, evidence for their involvement was equivocal. Conversely, the strength of evidence for other non-HLA antibodies supports that differing rejection pathologies are driven by differing non-HLA antibodies.</p></div><div><h3>Conclusions</h3><p>This systematic review underscores the importance of identifying peri-HT non-HLA antibodies. Current evidence supports the role of non-HLA antibodies in all forms of HT rejection. Further investigations are required to define the mechanisms of action of non-HLA antibodies in HT rejection.</p></div>","PeriodicalId":15900,"journal":{"name":"Journal of Heart and Lung Transplantation","volume":null,"pages":null},"PeriodicalIF":6.4,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141137786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}