ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant

Francis, Gary S.; Greenberg, Barry; Hsu, Daphne T.; Jaski, Brian E.; Jessup, Mariell; LeWinter, Martin M.; Pagani, Francis D.; Piña, Ileana L.; Semigran, Marc J.; Walsh, Mary Norine; Wiener, David; Yancy, Clyde W.

doi:10.1016/j.jacc.2010.04.014

Cited by 75 publications

(27 citation statements)

References 135 publications

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“…The study population consisted of 23 patients with HF and end-stage DCM ( n = 11) or ICM ( n = 12) eligible for and undergoing heart transplantation (HT) according to recent guidelines [15]. Patients with arterial hypertension, recent myocardial infarction (≤6 months before surgery) or myocarditis, diabetes or evidence of valve disease were excluded from the study.…”

Section: Methodsmentioning

confidence: 99%

Regional mapping of myocardial hibernation phenotype in idiopathic end‐stage dilated cardiomyopathy

Lionetti

Matteucci

Ribezzo

et al. 2014

J Cellular Molecular Medi

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Myocardial hibernation (MH) is a well-known feature of human ischaemic cardiomyopathy (ICM), whereas its presence in human idiopathic dilated cardiomyopathy (DCM) is still controversial. We investigated the histological and molecular features of MH in left ventricle (LV) regions of failing DCM or ICM hearts. We examined failing hearts from DCM (n = 11; 41.9 ± 5.45 years; left ventricle-ejection fraction (LV-EF), 18 ± 3.16%) and ICM patients (n = 12; 58.08 ± 1.7 years; LVEF, 21.5 ± 6.08%) undergoing cardiac transplantation, and normal donor hearts (N, n = 8). LV inter-ventricular septum (IVS) and antero-lateral free wall (FW) were transmurally (i.e. sub-epicardial, mesocardial and sub-endocardial layers) analysed. LV glycogen content was shown to be increased in both DCM and ICM as compared with N hearts (P < 0.001), with a U-shaped transmural distribution (lower values in mesocardium). Capillary density was homogenously reduced in both DCM and ICM as compared with N (P < 0.05 versus N), with a lower decrease independent of the extent of fibrosis in sub-endocardial and sub-epicardial layers of DCM as compared with ICM. HIF1-α and nestin, recognized ischaemic molecular hallmarks, were similarly expressed in DCM-LV and ICM-LV myocardium. The proteomic profile was overlapping by ˜50% in DCM and ICM groups. Morphological and molecular features of MH were detected in end-stage ICM as well as in end-stage DCM LV, despite epicardial coronary artery patency and lower fibrosis in DCM hearts. Unravelling the presence of MH in the absence of coronary stenosis may be helpful to design a novel approach in the clinical management of DCM.

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Section: Methodsmentioning

confidence: 99%

Regional mapping of myocardial hibernation phenotype in idiopathic end‐stage dilated cardiomyopathy

Lionetti

Matteucci

Ribezzo

et al. 2014

J Cellular Molecular Medi

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“…Some patients may require short-term bridging with inotropes and inhaled nitric oxide to provide optimal medical support to both ventricles after device explantation. The patient should also be treated with neurohormonal blockade, as recommended by the American College of Cardiology Foundation/American Heart Association heart failure guidelines, 14 once pressors are no longer needed. Dr Uriel: Although there is a large body of evidence supporting internal cardioverter-defibrillator placement in chronic cardiomyopathy, 15 there are minimal data on patients with preserved ejection fraction with myocarditis who have ventricular arrhythmias during the recovery period.…”

Section: 10mentioning

confidence: 99%

A Cold Taken to Heart

Mody

Lyons

Jorde³

et al. 2015

Circulation

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A 35-year-old woman with no past medical history presented to her local emergency room with 2 days of fevers, chills, and myalgias. She was febrile with a temperature of 102°F, blood pressure of 95/60 (72) mm Hg, heart rate of 110 bpm, respiratory rate of 20 breaths per minute, and an oxygen saturation of 100% on 2 L oxygen. The physical examination was notable for cool extremities, clear lungs, and tachycardic heart sounds with no s3, s4, or friction rub. The patient decompensated quickly and developed hypotension, requiring rapid uptitration of norepinephrine to 12 μg·kg Dr Uriel: Interpretation of the clinical course so far: A young woman with no medical history presents with an infectious syndrome and rapidly deteriorates. At this point, one must consider the different processes that would result in such a dramatic clinical picture. It is important to begin to rapidly rule out life-threatening processes and to perform the appropriate clinical testing in a manner that will not delay treatment. Given the increasing hypoxia, an assessment of the lung parenchyma would be beneficial at this point. A computed tomographic angiogram may be considered to simultaneously examine for an infectious process, pulmonary edema, and pulmonary embolism. In addition, cardiac assessment would also be important at this point, particularly in the setting of hypotension and hypoxia. Hypotension can be divided into different types: secondary to systolic dysfunction, vasodilation, or hypovolemia. A transthoracic echocardiogram would help further elucidate the cardiac process, particularly with the assessment of ventricular function and size. Left ventricular (LV) dysfunction would be expected if there was direct cardiac involvement such as coronary disease or myocardial inflammation, whereas a hyperdynamic ventricle would be expected in a state of vasodilation or hypovolemia. Given the abnormal cardiac troponin, it is important to rule out epicardial coronary ischemia. A coronary angiogram should be performed to rule out an acute coronary syndrome, which, in this age group, would most likely be related to spontaneous coronary artery dissection or thrombosis resulting from a hypercoagulable state. Myocarditis should also be considered, particularly in the setting of a prodrome of fevers and myalgias. Patient presentation (continued):A computed tomographic angiogram was performed that was negative for pulmonary embolism and showed small bilateral pleural effusions. A bedside transthoracic echocardiogram showed a large pericardial effusion, a dilated inferior vena cava, and right atrial and right ventricular (RV) diastolic collapse. The LV ejection fraction was visually estimated to be 45% to 50%.Simultaneous right and left heart catheterization showed elevated filling pressures and is summarized in Table 1. The coronary angiogram was normal.Dr Uriel: With a negative coronary angiogram and negative computed tomographic angiogram, the catheterization of the right side of the heart and echocardiogram should be further evaluated. With a la...

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“…124 Table 4 shows the treatment schedule for diastolic HF. 13,30,34,46,48 As yet, no treatment has been shown conclusively to reduce morbidity and mortality in HF patients with preserved LVEF. Diuretics are used to control sodium and water retention and reduce dyspnoea and oedema, as in HF with depressed LVEF.…”

Section: Alpha-2 Agonistsmentioning

confidence: 99%

Clinical Practice Guideline (CPG). Recommendations on strategy for reducing risk of heart failure patients requiring noncardiac surgery

Escudero¹,

Vecino²,

Baluja³

et al. 2015

Revista Española de Anestesiología y Reanimación (English Editi

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ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant

Cited by 75 publications

References 135 publications

Regional mapping of myocardial hibernation phenotype in idiopathic end‐stage dilated cardiomyopathy

Regional mapping of myocardial hibernation phenotype in idiopathic end‐stage dilated cardiomyopathy

A Cold Taken to Heart

Clinical Practice Guideline (CPG). Recommendations on strategy for reducing risk of heart failure patients requiring noncardiac surgery

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