Search

Patients with congenital cardiac defects often require multiple surgeries during childhood and sometimes cardiac transplantation (HTX) as adults. This represents a challenge from a surgical and an immunological point of view. At age 27, our patient was diagnosed with a bicuspid aortic valve and mechanical valve replacement was performed. Five years later, due to biventricular outflow tract obstruction and severe patient-prosthesis mismatch, a reoperation with enlargement of the LVOT and RVOT (Konno-Repair) was performed, followed by several revisions for an iatrogenic septal defect and sternum instability. In 2021, the patient was listed for HTX after continuous deterioration of exercising capacity and progression to severe diastolic heart failure. The patient was highly HLA-sensitized with a virtual Panel Reactive Antibody (vPRA) of 100%. An initial treatment with Rituximab followed by two immunoadsorption sessions (IA) led to adequate B lymphocyte depletion (Panel A, B, E); however, HLA antibodies remained high (Panel D). Escalation with an Anti-CD-38 antibody (Daratumumab) to eradicate the plasma cells, followed by another cycle of IA was effective. Under these conditions, an HLA-matched donor was found within three weeks of the last IA (Panel D, thick lines). On the day of transplantation, the patient received a final IA and a dose of Eculizumab (Anti-C5). To minimise the cold ischemic time (CIT), we use the Organ Care System (OCS) for the first time in Switzerland. The CIT during organ procurement was 88 min (30 min preparation for OCS and 58 min for implantation), while ex-vivo perfusion time was 4 hours. The immediate postoperative course was uneventful. However, the patient suffered an antibody-mediated rejection during the second postoperative week, and desensitisation therapy had to be restarted. In pre-operated, highly immuno-sensitized patients, monoclonal antibody therapy and OCS allowed transplant patients who, a few years prior, would not have been transplantable. [ABSTRACT FROM AUTHOR]

After a cardiac transplantation, the steering of immunosuppression requires an active search for acute cellular rejection (ACR). Surveillance with endomyocardial biopsy (EMB) is the gold standard. Given the costs and potential complications, there is growing interest in the use of non-invasive screening methods. Thus, we have conducted a systematic review and meta-analysis to evaluate the role of speckle-tracking echocardiography as a screening method for ACR. We searched PubMed (CENTRAL) and gray literature for studies presenting data on speckle tracking echocardiography in heart-transplant patients experiencing acute cellular rejection. The primary outcomes of the meta-analysis were left and right ventricular global longitudinal strain. We used random effects models for all our calculations. We pre-registered our meta-analysis with PROSPERO (CRD42024508654). By incorporating data from over 2000 biopsies included in 18 studies, we found that both left (LVGLS, MD -1.96, 95% CI -2.85 to -1.07, p < 0.0001), and right (RVGLS, MD -2.90, 95% CI -4.03 to -1.76, p < 0.00001) ventricular longitudinal strain were lower among patients without ACR. The change of LVGLS from baseline over time was also greater among patients experiencing ACR (MD -2.43, 95% CI -4.82 to -0.05, p = 0.045). Current data suggest that myocardial strain measured by speckle tracking echocardiography is affected in ACR and could potentially be used for early rejection detection as a rule-out strategy, leading to reduction of routine EMB in heart transplant follow-up., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Recent evidence underlined the importance of right (RV) involvement in suspected myocarditis. We aim to analyze the possible incremental prognostic value from RV global longitudinal strain (GLS) by CMR., Methods: Patients referred for CMR, meeting clinical criteria for suspected myocarditis and no other cardiomyopathy were enrolled in a dual-center register cohort study. Ejection fraction (EF), GLS and tissue characteristics were assessed in both ventricles to assess their association to first major adverse cardiovascular events (MACE) including hospitalization for heart failure (HF), ventricular tachycardia (VT), recurrent myocarditis and death., Results: Among 659 patients (62.8% male; 48.1 ± 16.1 years), RV GLS was impaired (> - 15.4%) in 144 (21.9%) individuals, of whom 76 (58%), 108 (77.1%), 27 (18.8%) and 40 (32.8%) had impaired right ventricular ejection fraction (RVEF), impaired left ventricular ejection fraction (LVEF), RV late gadolinium enhancement (LGE) or RV edema, respectively. After a median observation time of 3.7 years, 45 (6.8%) patients were hospitalized for HF, 42 (6.4%) patients died, 33 (5%) developed VT and 16 (2.4%) had recurrent myocarditis. Impaired RV GLS was associated with MACE (HR = 1.07, 95% CI 1.04-1.10; p < 0.001), HF hospitalization (HR = 1.17, 95% CI 1.12-1.23; p < 0.001), and death (HR = 1.07, 95% CI 1.02-1.12; p = 0.004), but not with VT and recurrent myocarditis in univariate analysis. RV GLS lost its association with outcomes, when adjusted for RVEF, LVEF, LV GLS and LV LGE extent., Conclusion: RV strain is associated with MACE, HF hospitalization and death but has neither independent nor incremental prognostic value after adjustment for RV and LV function and tissue characteristics. Therefore, assessing RV GLS in the setting of myocarditis has only limited value., (© 2023. Society for Cardiovascular Magnetic Resonance.)

Background: Risk-stratification of myocarditis is based on functional parameters and tissue characterization of the left ventricle (LV), whereas right ventricular (RV) involvement remains mostly unrecognized., Objectives: In this study, the authors sought to analyze the prognostic value of RV involvement in myocarditis by cardiac magnetic resonance (CMR)., Methods: Patients meeting the recommended clinical criteria for suspected myocarditis were enrolled at 2 centers. Exclusion criteria were the evidence of coronary artery disease, pulmonary artery hypertension or structural cardiomyopathy. Biventricular ejection fraction, edema according to T2-weighted images, and late gadolinium enhancement (LGE) were linked to a composite end point of major adverse cardiovascular events (MACE), including heart failure hospitalization, ventricular arrhythmia, recurrent myocarditis, and death., Results: Among 1,125 consecutive patients, 736 (mean age: 47.8 ± 16.1 years) met the clinical diagnosis of suspected myocarditis and were followed for 3.7 years. Signs of RV involvement (abnormal right ventricular ejection fraction [RVEF], RV edema, and RV-LGE) were present in 188 (25.6%), 158 (21.5%), and 92 (12.5%) patients, respectively. MACE occurred in 122 patients (16.6%) and was univariably associated with left ventricular ejection fraction (LVEF), LV edema, LV-LGE, RV-LGE, RV edema, and RVEF. In a series of nesting multivariable Cox regression models, the addition of RVEF (HR adj : 0.974 [95% CI: 0.956-0.993]; P = 0.006) improved prognostication (chi-square test = 89.5; P = 0.001 vs model 1; P = 0.006 vs model 2) compared with model 1 including only clinical variables (chi-square test = 28.54) and model 2 based on clinical parameters, LVEF, and LV-LGE extent (chi-square test = 78.93)., Conclusions: This study emphasizes the role of RV involvement in myocarditis and demonstrates the independent and incremental prognostic value of RVEF beyond clinical variables, CMR tissue characterization, and LV function. (Inflammatory Cardiomyopathy Bern Registry [FlamBER]; NCT04774549; CMR Features in Patients With Suspected Myocarditis [CMRMyo]; NCT03470571)., Competing Interests: Funding Support and Author Disclosures Dr Bernhard has received career development grants from the Swiss National Science Foundation. Dr Safarkhanlo has received research funding from the Center for Artificial Intelligence in Medicine Research Project Fund, University Bern, outside of the submitted work. Dr Benz has received career development grants from the Swiss National Science Foundation and reimbursement of travel expenses by Philips Healthcare and Amgen. Dr Gräni has received research funding from the Swiss National Science Foundation and Innosuisse, the Center for Artificial Intelligence in Medicine Research Project Fund University Bern, and the GAMBIT foundation, outside of the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Cough from a cardiologic perspective Abstract. A cough is at the efferent end of a complex reflex arc and, due to its well-known mechanical respiratory cleaning function, usually the first symptom prompting a pneumological clarification. However, the chemical and mechanical afferent neuronal parts of the reflex, the cough receptors, are distributed over a variety of organ systems, some of which directly and indirectly affect the heart. Cardiology therefore plays a central role in the clarification of coughs. In cardiology, a cough is most frequently caused by acute and chronic heart failure resulting from different types of cardiomyopathies. It can, however, be caused by other pathologies as well. The connection between cough and cardiac arrhythmia is interesting, although cough can be cause, consequence and therapy. Last but not least, almost all drugs frequently prescribed in cardiology can cause cough in one way or another. In addition, a cough is the current number 1 warning sign when it comes to COVID-19 infection. On the one hand, it must be differentiated from cardiac-induced coughs, but on the other hand it can also be closely related to them.

An increasing number of mechanical assist devices, especially left ventricular assist devices (VADs), are being implanted for prolonged periods and as destination therapy. Some VAD patients require radiotherapy due to concomitant oncologic morbidities, including thoracic malignancies. This raises the potential of VAD malfunction via radiation-induced damage. So far, only case reports and small case series on radiotherapy have been published, most of them on HeartMate II (HMII, Abbott, North Chicago, IL, USA). Significantly, the effects of irradiation on the HeartMate 3 (HM3, Abbott) remain undefined, despite the presence of controller components engineered within the pump itself. We report the first case of a patient with a HM3 who successfully underwent stereotactic hypofractionated radiotherapy due to an early-stage non-small-cell lung cancer. The patient did not suffer from any complications, including toxicity or VAD malfunction. Based on this case report and on published literature, we think that performing radiotherapy after VAD implantation with the aid of a multidisciplinary team could be performed, but more in vitro studies and cases series are needed to reinforce this statement., (© 2019 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)