No abstract

To examine changes in left ventricular (LV) mass and function (diastolic and systolic) after successful renal allograft transplantation (RT), we prospectively studied 30 patients (19 men, 11 women, aged 37 ± 13 years) by M-mode, two-dimensional and pulsed Doppler echocardiography at the time of surgery and 10 ± 1.8 months later. At the time of transplantation all patients had been undergoing dialysis (4 peritoneal dialysis, 26 hemodialysis) for 2.5 ± 3.2 years. A hematocrit of ≤30% was present in 26 patients. After RT the mean hematocrit increased from 26 ± 4 to 40 ± 7 (p < 0.01), whereas systolic, diastolic and mean blood pressure (BP) remained unchanged. The LV mass index (LVMI) decreased from 201 ± 56 to 171 ± 41 g/m², (p < 0.01); LV diastolic diameter corrected by body surface area (LVDDI) decreased from 298 ± 38 to 279 ± 35 (p < 0.01) and the LV end-diastolic volume index (LVEDVI) from 72 ± 18 to 63 ± 15 (p < 0.01). There were no changes in LV fractional shortening or LV end systolic wall stress. Peak late transmitral velocity (A wave) decreased from 77 ± 16 to 68 ± 12 cm/s (p < 0.01) with no changes in other Doppler-derived indexes of diastolic function. No fistula patency influence on changes in LV mass and function was found. After RT, BP decreased in 21 patients from 150 ± 20 to 132 ± 15 (p < 0.001; group I) and increased in 9 patients from 130 ± 14 to 153 ± 16 (p < 0.05, group II). Patients in group I suffered a reduction in LVMI (p < 0.001), LV end-diastolic diameter (p < 0.05), LVDDI (p < 0.001); LV end-diastolic volume (p < 0.05); LVEDVI (p < 0.01); cardiac index (p < 0.05), and peak late transmitral velocity (p < 0.01), but no changes in group-II patients were observed. We concluded that BP is a major determining factor with regard to changes in LV hypertrophy and function following RT. LV mass and volumes can be expected to decrease after RT in patients with BP reduction.

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Beiras, en representación del grupo de estudio INCARGAL Resumen Antecedentes. La insuficiencia cardíaca es la enfermedad cardiológica de más crecimiento en las naciones desarrolladas, y supone ya la primera causa de ingreso en ancianos. No se ha estudiado bien la diferencia que el servicio de ingreso supone en cuanto al manejo de la insuficiencia cardíaca ni los factores que condicionan el servicio de ingreso. Objetivos. Establecer si existen diferencias de manejo pronóstico en función del servicio de ingreso (cardiología frente a medicina interna y geriatría) en pacientes con insuficiencia cardíaca. Pacientes y método. Estudio transversal en que 951 pacientes (505 varones y 446 mujeres) ingresados consecutivamente por insuficiencia cardíaca en los servicios de cardiología (n = 364), medicina interna y geriatría (n = 587) de 14 hospitales de Galicia fueron reclutados durante un período máximo de 6 meses, registrándose en el momento del ingreso las principales variables epidemiológicas y clínicas, complicaciones, tratamientos y situación en el momento del alta. Resultados. Los pacientes con insuficiencia cardíaca tenían una edad media de 75,5 ± 12,4 años (78,5 ± 10,6 en mujeres y 72,7 ± 13,5 en varones). La estancia media fue de 11 ± 8 días, con un 50,8% de primeros ingresos, siendo la mortalidad global hospitalaria del 6,8%. El 58,9% de los pacientes tenía hipertensión arterial, el 31,8% cardiopatía isquémiea, el 27,7% valvulopatía, el 28,4% diabetes mellitus y el 32,5% EPOC. Por servicios, los pacientes atendidos en servicios de cardiología son más jóvenes (72,5 ± 13,3 frente a 77,4 ± 11,4 años; p < 0,005), con más varones (51,9 frente a 3,7%; p < 0,01), mayor proporción de primeros ingresos (54,8 frente a 48,4; p < 0,05) Y de edema agudo de pulmón (22,8 frente a 9,2%; P < 0,001). Las odds ratio (y sus intervalos de confianza [IC] del 95%) de realización de procedimientos diagnósticos y terapéuticos en función del servicio de ingreso (el grupo de referencia es medicina interna-geriatría), ajustando por edad, sexo, función sistólica, número de ingresos y antecedentes personales de

A new cardiac transplantation technique that preserves the shape of the left atrium and leaves the right atrium intact has been introduced. To compare the new and the standard techniques, we studied cardiac physiology with Doppler echocardiography and catheterization in 26 patients who underwent operation with the standard technique (group A) and I1 who underwent operation with the new technique (group B). Right atrial dimensions were significantly lower in group B (right atrial area index 8.4 +/- 1.5 vs 14.5 +/- 1.9 cm2/m2, p < 0.001), whereas left atrial dimensions were slightly lower (left atrial area index 10.8 +/- 2.0 vs 16.4 +/- 7.0 cm2/m2, p = 0.07). Right atrial contraction, as reflected by peak late tricuspid velocity, was greater in group B (37 +/- 15 vs 30 +/- 10 cm/sec, p < 0.05). The subsequent systolic vena caval flow-velocity integral was also greater in group B at all respiratory phases (inspiration 10.0 +/- 4.0 vs 5.2 +/- 4.0 cm, p < 0.001; expiration 4.8 +/- 1.9 vs 2.9 +/- 1.4 cm, p < 0.001; apnea 5.3 +/- 2.0 vs 2.9 +/- 1.9 cm, p < 0.001) suggesting better atrial relaxation. Filling pressures on the right side of the heart were lower in group B (mean right atrial pressure 5.5 +/- 2.4 vs 6.6 +/- 2.8 mm Hg, p = 0.1; right atrial A wave 6.0 +/- 3.1 vs 8.3 +/- 3.2 mm Hg, p < 0.01; right atrial V wave 6.8 +/- 3.1 vs 9.2 +/- 3.2 mm Hg, p < 0.01; right ventricular end-diastolic pressure 5.6 +/- 3.2 vs 7.3 +/- 2.9 mm Hg, p < 0.05); however, no significant differences were found in left ventricular end-diastolic pressure or cardiac index. We conclude that patients undergoing the new technique exhibit cardiac physiologic improvements. Follow-up study is indicated to ascertain whether this finding implies improved long-term prognosis.