Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome characterized by decreased exercise capacity and fluid retention in the setting of preserved left ventricular systolic ...function and evidence of abnormal diastolic function. Therapeutic strategies include pharmacologic agents, pacing, baroreflex modification, diet, and exercise. Despite symptomatic and hemodynamic improvements with some therapies, large clinical trials have not demonstrated a clear improvement in clinical outcomes. The current management of patients with HFpEF is directed to symptomatic relief of congestion with diuretics and risk factor modification. In this article, we summarize the available evidence base for potential targets of therapy.
Background
The elevated baseline heart rate (HR) of a heart transplant recipient has previously been considered inconsequential. However, we hypothesized that a resting HR above 100 beats per minute ...(bpm) may be associated with morbidity and mortality.
Methods
The U.T.A.H. Cardiac Transplant Program studied patients who received a heart transplant between 2000 and 2011. Outpatient HR values for each patient were averaged during the first year post‐transplant. The study cohort was divided into two groups: the tachycardic (TC) (HR >100 bpm) and the non‐TC group (HR ≤100 bpm) in which mortality, incidence of rejection, and cardiac allograft vasculopathy were compared.
Results
Three hundred and ten patients were included as follows: 73 in the TC and 237 in the non‐TC group. The TC group had a higher risk of a 10‐yr all‐cause mortality (p = 0.004) and cardiovascular mortality (p = 0.044). After adjustment for donor and recipient characteristics in multivariable logistic regression analysis, the hazard ratio was 3.9, (p = 0.03, CI: 1.2–13.2) and 2.6 (p = 0.02, CI: 1.2–5.5) for cardiovascular mortality and all‐cause mortality, respectively.
Conclusion
Heart transplant recipients with elevated resting HR appear to have higher mortality than those with lower resting HR. Whether pharmacologically lowering the HR would result in better outcomes warrants further investigation.
IntroductionTafamidis meglumine, available as 20 mg capsules, is approved around the world for the treatment of transthyretin amyloidosis in early stage polyneuropathy (20 mg) and more recently in ...cardiomyopathy (80 mg). A new formulation, tafamidis free acid 61 mg (a single capsule bioequivalent to tafamidis meglumine 80 mg), was subsequently developed as a more convenient option for patients with transthyretin amyloid cardiomyopathy (ATTR-CM) and further characterization of its safety profile would be of value.MethodsPatients who completed the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT) were eligible to enroll in a long-term, extension study (LTE). The LTE was subsequently expanded to include ATTR-CM patients not previously enrolled in ATTR-ACT, with all patients receiving tafamidis free acid 61 mg (tafamidis 61 mg). As of 20 July, 2018, patients in the LTE were transitioned to tafamidis free acid 61 mg (data assessed for patients treated with tafamidis 80 mg in the LTE who transitioned to tafamidis free acid 61 mg tafamidis 80/61 mg). Adverse events (AEs) during the LTE are described (as of 1 Aug, 2019) and compared with AEs with tafamidis 80 mg in ATTR-ACT.ResultsThere were 164 patients treated with tafamidis 80/61 mg and 715 newly enrolled patients treated with tafamidis 61 mg; with 157 (95.7%) AEs with tafamidis 80/61 mg and 458 (64.1%) with tafamidis 61 mg. The most common AEs by system organ class were cardiac disorders (Table). AEs with tafamidis 80/61 mg were broadly similar to those with tafamidis 80 mg in ATTR-ACT (previously shown to be similar to placebo). While there were fewer AEs with tafamidis 61 mg, the notably shorter exposure time in this group limits direct comparisons. Nevertheless, no new safety concerns emerged in patients who transitioned to, or started, tafamidis 61 mg.ConclusionsFor patients with ATTR-CM, tafamidis free acid 61 mg is a safe treatment which also offers improved patient convenience.
Utility of Biomarkers in Cardiac Amyloidosis Pregenzer-Wenzler, Arianna; Abraham, Jo; Barrell, Kelsey ...
JACC. Heart failure,
September 2020, 2020-09-00, 20200901, Letnik:
8, Številka:
9
Journal Article
Recenzirano
Odprti dostop
Cardiac amyloidosis is a growing field, with advancements in diagnosis and management. Cardiac biomarkers are used to predict survival and to develop severity staging systems. Cardiac biomarkers are ...also used in clinical practice to stratify patients for treatment and to evaluate response to therapies. The current review summarizes the major clinical utility of current biomarkers in patients with cardiac amyloidosis and provides insights about future areas of investigation.
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•Biomarkers can be used for patients with light chain amyloidosis and transthyretin amyloidosis for staging and prognosis.•Biomarkers can be used for patients with light chain amyloidosis to determine disease progression and response to therapies.•The role of biomarkers to determine disease progression and response to therapies in patient with transthyretin amyloidosis is an active area of investigation.
Heart transplant recipients are at a high risk of complications from the coronavirus-2019 (COVID-19) infection. Heart transplant recipients are a special group of persistently immunosuppressed ...people, and COVID-19 may cause them to experience an unpredictable course of infection, with a risk of hospitalization occurring well beyond their initial infection period. The seriousness of COVID-19 disease in heart transplant recipients emphasizes how vital it is to refer patients promptly and early to specialized heart transplant centers.
We retrospectively reviewed all heart transplant recipients at a single center between March 2019 and October 2021. All recipients with positive nasopharyngeal reverse transcriptase-polymerase chain reaction tests for COVID-19 were included in this study. After IRB approval, we obtained medical records and patient data from electronic medical records.
This study followed 126 heart transplant patients from March 2019 to October 2021, of which only 49 had COVID-19 infections. The median age at infection was 58 years (49 - 65), with 41% female. Race distribution was as follows: 59% Caucasian and 39% African American. The median time from transplant to infection was 384 days (237 - 677). All infected patients had a 50% dose reduction in mycophenolate mofetil per institutional protocol. The majority of symptoms were cough, fatigue, shortness of breath, and fever. Among all patients with COVID-19, 45 (92%) were vaccinated. Of those vaccinated, 27 (60%) patients received Pfizer initial and booster doses, whereas 18 (40%) received Moderna initial and booster doses. Twelve patients (24%) were hospitalized within 90 days of infection, with only two requiring ICU level of care. The median duration of hospitalization was 5 days (4 - 9). Of the hospitalized patients, 11 (92%) were discharged, and 1 (8%) died in the hospital. Three of the four unvaccinated patients were hospitalized, and one died while hospitalized. The remaining 37 patients were managed as outpatients.
Heart transplant recipients have an increased risk of contracting COVID-19 and developing severe symptoms due to multiple healthcare contacts, pre-existing health conditions, and weakened immune systems. Our data highlight that most vaccinated patients do not require hospitalization within 90 days of infection, and those hospitalized have a high likelihood of survival without needing ICU care.
Cardiac amyloidosis (CA) is characterized by the deposition of insoluble amyloid fibrils in the extracellular space of the heart. Infiltration of amyloid into the heart valves can compromise their ...integrity and predispose to regurgitation. Although mitral valve (MV) involvement in CA has been described in case reports, the natural history of mitral regurgitation (MR) in CA remains under studied.
The study cohort included patients with functional moderate, moderate-to-severe, or severe MR and CA evaluated within the Mayo Clinic enterprise between 2012 to 2022. Demographic information, type of amyloidosis, diagnostic data, imaging results, mortality outcomes, and procedural data were retrospectively extracted from medical charts. Lastly, a Kaplan-Meier approach was taken to generate a product-limit failure curve.
72 patients with cardiac amyloidosis and moderate or more severe MR were identified. The average age of the subjects was 69.9 ±8.04 years. Table 1 depicts the baseline demographics, comorbidities, MR severity, therapies, and mean echocardiographic parameters of the cohort. Of the 72 subjects, 4.17% underwent transcatheter edge-to-edge repair (TEER) of the MV, 2.82% had MV replacement, and 1.41% had MV repair. Stroke volume index (SVI) and TAPSE were found to be predictors of mortality (p<0.005, Table 2). Five-year mortality of our cohort was 48% (Figure 1).
As amyloidosis-specific pharmacotherapies continue to advance, ongoing studies to determine mortality risk will be crucial. We demonstrate a five-year mortality of 48% associated with moderate, moderate-to-severe, or severe MR, with SVI and TAPSE being significant prognostic indicators. The minority of patients underwent interventional mitral valve procedures. Further investigation is needed to determine the role of MV interventions in CA patients.
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