Long-term outcomes of light chain amyloidosis patients receiving heart transplant: A single-center experience.

Background: Cardiac amyloidosis is a less common indication for orthotopic heart transplantation (OHT). Light chain (AL) amyloidosis specifically poses challenges. While previous small studies have established the validity of OHT for AL amyloidosis, we present experience from a large contemporary series at a single center.

Differences in wait-list mortality: Temporary vs durable circulatory support devices.

Background: In 2018, changes in the United Network for Organ Sharing (UNOS) allocation system led to a shift in practices, making durable left ventricular assist devices less desirable as a bridge to transplantation compared to temporary mechanical circulatory support. This study compares the composite outcome of waitlist mortality and delisting incidence at 1 year between these two support types.

Methods: All actively listed adult patients on mechanical circulatory support listed for heart transplantation under the current UNOS system from October 2018 to October 2021 were included, excluding those with right ventricular devices, biventricular devices, total artificial hearts, and extracorporeal membrane oxygenators.

Pulmonary hypertension: diagnostic aspects-what is the role of imaging?

Purpose Of Review: The role of imaging in diagnosis of pulmonary hypertension is multifaceted, spanning from estimation of pulmonary arterial pressures, understanding pulmonary artery-right ventricular interaction, and identification of the cause. The purpose of this review is to provide a comprehensive overview of multimodality imaging in evaluation of pulmonary hypertension as well as the novel applications of imaging techniques that have improved our detection and understanding of pulmonary hypertension.

Recent Findings: There are diverse imaging modalities available for comprehensive assessment of pulmonary hypertension that are expanding with new tracers (e.

Utilizing cardiac magnetic resonance to assess the sequelae of prior rejection episodes on myocardium and correlation with clinical outcomes.

This study compared structural and functional alterations using cardiac MRI (CMR) in heart transplant recipients with and without acute cellular rejection (ACR) and analyzed their association with clinical outcomes. ACR patients showed reduced left ventricular global longitudinal strain (LV GLS) (10% vs 12%;  = 0.03), reduced right ventricular global longitudinal strain (16% vs 18%;  = 0.

History of Heart Transplant: Setting the Stage.

Heart transplantation is a marvel of modern medicine for patients with end-stage heart failure. Decades of research and surgical innovation have overcome challenges in immunology, organ preservation, and patient care. From the earliest heart transplants on canines and primates, the field evolved through immunosuppressive therapies, development of the bioptome for endomyocardial biopsy and, recently, the use of cell free DNA and molecular microscopy for assessing rejection.

Impact of Natriuretic Peptide and Prior Hospitalization in Patients With Severe Mitral Regurgitation: COAPT Trial.

Background: The clinical significance of elevated baseline natriuretic peptide level and prior heart failure hospitalization (HFH) within the prior year in mitral transcatheter edge-to-edge repair outcomes is unclear. This analysis examined the impact of BNP (B-type natriuretic peptide) or NT-proBNP (N-terminal pro-B-type natriuretic peptide) and prior HFH on outcomes in patients with severe secondary mitral regurgitation.

Methods: The COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) was a randomized controlled trial of subjects assigned to mitral valve transcatheter edge-to-edge repair with the MitraClip device versus guideline-directed medical therapy alone.

Role for inflammatory markers in predicting right ventricular failure in mechanical assist device recipients.

Right ventricular failure (RVF) is a common complication following left ventricular assist device (LVAD) implantation and increases patient morbidity and mortality. Due to the complex and limited understanding of RVF pathophysiology, efforts to prognosticate RVF after LVAD have been challenging. To fill the gaps, current efforts have been focused on identifying molecular drivers and physiological mechanisms of right ventricular dysfunction in this population.

Corrigendum to ''Outcomes related to hospital characteristics of heart transplant centers: A national readmission database analysis'' [JHLT Open (2024) 100085].

[This corrects the article DOI: 10.1016/j.jhlto.

Outcomes related to hospital characteristics of heart transplant centers: A National Readmission Database analysis.

Background: This study showcases an analysis performed using the National Readmission Database (NRD) from 2016 to 2019 to analyze the impact of ownership, location, size, and teaching status of transplant centers on cardiac transplant outcomes.

Methods: Demographic variables and hospital characteristics were identified using NRD data and International Classification of Diseases,10th revision codes. Comorbidities were assessed using the Elixhauser comorbidity index.

Terbutaline for Management of Relative Bradycardia Post-Orthotopic Heart Transplant: A Single Center Experience.

Background: Vagal nerve denervation during the heart transplant procedure results in higher resting heart rates in these recipients compared to the general population. Relative bradycardia (RB) is a common and often temporary post-operative complication that can be managed with agents like terbutaline; however, little data exist on the efficacy, safety, and necessity of long-term terbutaline use post-heart transplant.

Methods: This was a single-center, retrospective, descriptive study conducted at a large academic medical center investigating oral terbutaline use for RB management in heart transplant recipients.

Early detection of pulmonary arterial hypertension through [F] positron emission tomography imaging with a vascular endothelial receptor small molecule.

The objective of this study is to provide a positron emission tomography (PET) imaging modality targeting vascular endothelial growth factor receptors (VEGFR) for the early noninvasive detection and assessment of pulmonary arterial hypertension (PAH) severity. To validate the effectiveness of the [F]VEGFR PET tracer, we utilized a monocrotaline (MCT)-induced PAH rat model. Molecular optical imaging, using a Cy5.

Association of secondary mitral regurgitation and right ventricular dysfunction among patients with non-ischaemic cardiomyopathy.

Aims: The association between secondary mitral regurgitation (MR) and right ventricular (RV) dysfunction in heart failure patients with non-ischaemic cardiomyopathy (NICM) is unclear. Hence, our objective was to study the association between secondary MR and the occurrence of RV dysfunction among patients with NICM using cardiac magnetic resonance (CMR).

Methods And Results: Patients with NICM were enrolled in a prospective observational registry between 2008 and 2019.

Prognostic Value of Right Ventricular Afterload in Patients Undergoing Mitral Transcatheter Edge-to-Edge Repair.

Background: Pulmonary hypertension (PH) and secondary mitral regurgitation (MR) are associated with adverse outcomes after mitral transcatheter edge-to-edge repair. We aim to study the prognostic value of invasively measured right ventricular afterload in patients undergoing mitral transcatheter edge-to-edge repair.

Methods And Results: We identified patients who underwent right heart catheterization ≤1 month before transcatheter edge-to-edge repair.

Effectiveness of combined plasma cell therapy and costimulation blockade based desensitization regimen in heart transplant candidates.

Background: Desensitization is one of the strategies to reduce antibodies and facilitate heart transplantation in highly sensitized patients. We describe our center's desensitization experience with combination of plasma cell (PC) depletion therapy (with proteasome inhibitor or daratumumab) and costimulation blockade (with belatacept).

Methods: We reviewed five highly sensitized patients who underwent desensitization therapy with plasma cell depletion and costimulation blockade.

Repeat left ventricular-assisted device exchange and upgrade from second- to third-generation devices in a high-volume single center.

Background: Pump exchange is an established strategy to treat LVAD-related complications such as thrombosis, infection, and driveline failure. Pump upgrades with an exchange to newer generation devices are being performed to the advantage of the patient on long-term support. The safety and efficacy of a repeat LVAD exchange with a concomitant upgrade to a third-generation pump have not been reported.

Multicenter registry and test bed for extended outpatient hemodynamic monitoring: the hemodynamic frontiers in heart failure (HF) initiative.

Background: Hemodynamic Frontiers in Heart Failure (HF) is a multicenter academic research consortium comprised of 14 US institutions with mature remote monitoring programs for ambulatory patients with heart failure (HF). The consortium developed a retrospective and prospective registry of patients implanted with a wireless pulmonary artery pressure (PAP) sensor.

Goals/aims: HF registry collects demographic, clinical, laboratory, echocardiographic (ECHO), and hemodynamic data from patients with PAP sensors.

Bloodstream infections in prolonged use of axillary-placed, intra-aortic balloon-pump support: A single-center study.

Infections from prolonged use of axillary intra-aortic balloon pumps (IABPs) have not been well studied. Bloodstream infection (BSI) occurred in 13% of our patients; however, no difference in outcome was noted between those with BSI and those without. Further studies regarding protocol developments that minimize BSI risk are needed.

Management of pulmonary hypertension associated with valvular heart disease with angiotensin-receptor neprilysin inhibitor.

Pulmonary hypertension secondary to left-sided valvular disease (VHD-PH) is associated with high morbidity and mortality. Angiotensin-receptor neprilysin inhibitor (ARNI) is a novel pharmacotherapy, which reduces afterload with natriuresis and peripheral vasodilation. Our cases demonstrate that ARNI may also have a role in the treatment of combined pre- and postcapillary pulmonary hypertension that is independent of its effect on pulmonary capillary wedge pressure and cardiac output.

Translating Pressure Into Practice: Operational Characteristics of Ambulatory Hemodynamic Monitoring Program in the United States.

Background: Ambulatory hemodynamic monitoring (AHM) using an implantable pulmonary artery pressure sensor (CardioMEMS) is effective in improving outcomes for patients with heart failure. The operations of AHM programs are crucial to clinical efficacy of AHM yet have not been described.

Methods And Results: An anonymous, voluntary, web-based survey was developed and emailed to clinicians at AHM centers in the United States.

Destination LVAD therapy in the current era of the heart transplant allocation system.

Purpose Of Review: This article aims to shed light on the major implications of the new allocation system by discussing the observed outcomes and complications and suggesting a few steps to prevent and manage those potential challenges.

Recent Findings: The new allocation system implemented in 2018 aimed to prioritize high-risk patients and provide a better equitable opportunity for heart transplantation. However, despite the success in reducing wait-list mortality, this change brought up many direct and indirect challenges to patient care, such as worsening ischemic time and an increase in the use of temporary mechanical support at the expense of durable LVADs.

Impact of exercise on pulmonary artery pressure in patients with heart failure using an ambulatory pulmonary artery pressure monitor.

Background: In this multicenter prospective study, we explored the relationship between pulmonary artery pressure (PAP) at rest and in response to a 6-min walk test (6MWT) in ambulatory patients with heart failure (HF) with an implantable PAP sensor (CardioMEMS, Abbott).

Methods: Between 5/2019 and 2/2021, HF patients with a CardioMEMS sensor were recruited from seven sites. PAP was recorded in the supine and seated position at rest and in the seated position immediately post-exercise.