Abstract
Background
Acute Cellular Rejection (ACR) remains a major complication in heart transplantation (HT). Since 1970, endomyocardial biopsy (EMB) has been the gold standard for ACR early ...detection. However, this invasive procedure has several limitations such as risk of complications, interobserver variability, false negative results and high cost. Therefore, a new non-invasive ACR biomarker is needed. Potential candidates could be microRNAs (miRs), small regulatory RNAs whose serum expression profiling could be modified in ACR patients. The aim of this study is the identification of differentially serum miRs expression patterns in ACR after HT.
Methods
Among HT performed in our Hospital (2013–2018), we selected patients with following criteria: i) “0R → 2R → 0R” EMB pattern for ACR (0R=no ACR, 2R=moderate ACR); ii) no antibody mediated rejection; iii) serum collected the same day as the EMBs. The 3 serum samples per patient matched in time with EMB were called “0Rs1 → 2Rs2 → 0Rs3”. In each of these serum samples, 179 miRs expression profile according manufacturer's instructions were analysed. Global Mean (GM) method was used to normalize our results expressed as miRs relative expression 2(–ΔCq). Expression pattern was defined as a 2 steps process: a significative rise (0Rs1 → 2Rs2) followed by a significative fall (2Rs2 → 0Rs3), or vice versa, in miR expression. Analysis of differences between 3 groups were calculated using one-way ANOVA with matched data and post-hoc Tukey test. ROC curve was generated for selected miRNA. A two-sided p<0.05 was considered statistically significant.
Results
21 patients and their serum “0Rs1 → 2Rs2 → 0Rs3” samples were included in the study. Among 179 miRs analysed, 5 miRs showed significative difference between 0Rs1 and 2Rs2, 3 miRs were over-expressed (miR-181a-5p, miR-339-3p, let-7f-5p) and 2 under-expressed (miR-505-3p, miR-2110). Only miR-181a-5p met significative difference between 2Rs2 and 0Rs3 showing a statistical significative rise/fall pattern. Serum miR-181a-5p ROC analysis demonstrated significant discrimination between biopsy proven ACR from no-ACR biopsy, AUC=0.692 (p=0.0335).
Differentially expressed miRs
Mean relative expression 2(–ΔCq) (95% CI)
Adjusted p-value (ANOVA)
AUC (95% CI)
0Rs1
2Rs2
0Rs3
0Rs1 vs 2Rs2
2Rs2 vs 0Rs3
0Rs1 vs 0Rs3
miR-181–5p
0.80 (0.60–1.02)
1.11 (0.90–1.31)
0.86 (0.71–1.01)
0.0194
0.0225
NS
0.692 (0.529–0,855)
Relative Expression 2(–ΔCq) and AUC expressed as mean (95% Confident Interval). NS: not significative.
Conclusion
Our findings suggest miR-181a-5p as a novel serological biomarker for detecting ACR after HT. After this preliminary discovery phase, miR-181a-5p is currently in a new validation phase to demonstrate its diagnostic performance.
Acknowledgement/Funding
This work was supported by a grant from isciii (PI15/02224) and it is part of the of the “CIBERCV”. Co-financed with FEDER Funds
Patients with heart failure are classified into three phenotypes based on left ventricular ejection fraction. This work aimed to compare the clinical profile, treatment, prognosis, and causes of ...death of patients with heart failure and reduced (<40%, HF-rEF), preserved (≥50%, HF-pEF), or mid-range (40–49%, HF-mrEF) left ventricular ejection fraction.
An analysis was conducted on the clinical data included in a prospective registry of patients with heart failure who were referred to a specific Cardiology unit from 2010 to 2019.
A total of 1404 patients with HF-rEF, 239 patients with HF-mrEF, and 266 patients with HF-pEF were analyzed. Significant differences were observed among the groups in regard to several clinical characteristics and the frequency of prescription of neurohormonal blocking drugs. A multivariate Cox regression revealed an increased risk of all-cause mortality in patients with HF-pEF (hazard ratio 1.36; 95% confidence interval 1.03–1.80; p = 0.028) and patients with HF-mrEF (hazard ratio 1.36; 95% confidence interval 1.03–1.78; p = 0.029) as compared to patients with HF-rEF. Heart failure was the most frequent cause of death in the three subgroups. A higher relative weight of sudden death as a cause of death was observed among patients with HF-rEF while the relative weight of non-cardiovascular causes of death was higher among patients with HF-pEF and HF-mrEF.
This study confirms the existence of significant differences among patients with HF-rEF, HF-mrEF, and HF-pEF with regard to their clinical profile, therapeutic management, prognosis, and causes of death.
Los pacientes con insuficiencia cardíaca se caracterizan en 3 fenotipos en función de su fracción de eyección ventricular izquierda. El propósito de este estudio fue comparar el perfil clínico, el tratamiento, el pronóstico y las causas de muerte de los pacientes con insuficiencia cardíaca y fracción de eyección ventricular izquierda reducida (<40%, IC-FEr), preservada (≥50%, IC-FEp) o en rango medio (40–49%, IC-FErm).
Análisis de la información clínica recogida en un registro prospectivo de pacientes con insuficiencia cardíaca remitidos a una consulta monográfica de Cardiología entre 2010 y 2019.
Se estudiaron 1.404 pacientes con IC-FEr, 239 pacientes con IC-FErm y 266 pacientes con IC-FEp. Se observaron diferencias significativas entre los 3 grupos en relación con diversas características clínicas, y en cuanto a la tasa de prescripción de fármacos moduladores de la respuesta neurohormonal. La regresión de Cox multivariante reveló un incremento del riesgo de muerte por cualquier causa en los pacientes con IC-FEp (hazard-ratio 1,36; intervalo de confianza al 95% 1,03–1,80; p = 0,028) e IC-FErm (hazard-ratio 1,36; intervalo de confianza al 95% 1,03–1,78; p = 0,029) en comparación con los pacientes con IC-FEr. La insuficiencia cardíaca fue la causa más frecuente de muerte en los 3 grupos; se observó un mayor peso relativo de la muerte súbita en los pacientes con IC-FEr, mientras que las causas no cardiovasculares de muerte tuvieron un peso relativo mayor en los pacientes con IC-FEp e IC-FErm.
El estudio confirma la existencia de diferencias significativas en el perfil clínico, manejo terapéutico, pronóstico y causas de muerte de los pacientes con IC-FEr, IC-FErm e IC-FEp.
The effect of four different enzymatic bioscouring systems for cotton have been compared in regard to the dyeability of reactive, cationic and acid dyes. The residual pectin content was determined ...and the results assessed in terms of dyeability against control samples prepared in the absence of enzyme. The capacity of a bifunctional reactive dye to cover the differences between fabrics treated with different bioscouring treatments was very good. Exhaustion of the cationic dye relative to alkaline scouring was increased by 27.5% and that of the acid dye decreased by 48.2%, indicating that pectin hydrolysis produced an increase in the negative charge on the fibre. The dye exhaustion differences between the four enzymatic systems studied were of significance and confirmed the hypothesis that each enzymatic system provides its own end‐groups, resulting in differences in the response of the fibre to dyeing. Enzymatic bioscouring reduces the pollution level of the effluent.
The resistance of 139 Mycobacterium tuberculosis (MTB) isolates from the city of Monterrey, Northeast Mexico, to first and second-line anti-TB drugs was analysed. A total of 73 isolates were ...susceptible and 66 were resistant to anti-TB drugs. Monoresistance to streptomycin, isoniazid (INH) and ethambutol was observed in 29 cases. Resistance to INH was found in 52 cases and in 29 cases INH resistance was combined with resistance to two or three drugs. A total of 24 isolates were multidrug-resistant (MDR) resistant to at least INH and rifampicin and 11 MDR cases were resistant to five drugs. The proportion of MDR-TB among new TB cases in our target population was 0.72% (1/139 cases). The proportion of MDR-TB among previously treated cases was 25.18% (35/139 cases). The 13 polyresistant and 24 MDR isolates were assayed against the following seven second-line drugs: amikacin (AMK), kanamycin (KAN), capreomycin (CAP), clofazimine (CLF), ethionamide (ETH), ofloxacin (OFL) and cycloserine (CLS). Resistance to CLF, OFL or CLS was not observed. Resistance was detected to ETH (10.80%) and to AMK (2.70%), KAN (2.70%) and CAP (2.70%). One isolate of MDR with primary resistance was also resistant to three second-line drugs. Monterrey has a high prevalence of MDR-TB among previously treated cases and extensively drug-resistant-MTB strains may soon appear.
Determinar el riesgo quirúrgico en pacientes de alto riesgo en nuestro hospital para la toma de decisiones sobre diferentes alternativas terapéuticas de la estenosis valvular aórtica grave.
Pacientes ...sometidos a sustitución valvular aórtica por estenosis grave aislada en el periodo 2003-2010.
Tras estratificar el riesgo quirúrgico según EuroSCORE logístico, estudiamos el punto de inflexión de la mortalidad en este grupo de pacientes.
–Aquellos pacientes con una mortalidad esperada inferior al 10% presentaron una mortalidad observada del 1,6%.–Aquellos pacientes con una mortalidad esperada superior al 10% presentaron una mortalidad observada del 25,8%.
–En nuestro medio hospitalario se observa un punto de corte para la toma de decisiones cuando el EuroSCORE logístico es superior al 10%.–Ante estos resultados sería recomendable decidir otras alternativas terapéuticas en pacientes con EuroSCORE logístico superior al 10%.–Así pues, teniendo en cuenta las discrepancias actuales entre los distintos estratificadores de riesgo quirúrgico, cada centro debería considerar su propia estrategia de acuerdo con el tipo de población intervenida.
La sustitución valvular mitral es el tratamiento estandarizado en caso de endocarditis mitral, pero no son pocos los inconvenientes de las prótesis valvulares como reinfección, trombosis o ...degeneración. Presentamos nuestra serie de pacientes con endocarditis en los cuales se reparó la válvula mitral en los últimos 5 años.
Ciento cinco pacientes intervenidos de endocarditis de los cuales 63 presentaban infección mitral; en 15 pacientes (24%), tras resecar todo el tejido infectado, se reparó la válvula mitral mediante resección cuadrangular del velo posterior, comisuroplastia, parche de pericardio o implante de neocuerdas. Edad media: 64,9±17,3. Varones: 57%. Hipertensión pulmonar: 2 (13%). Insuficiencia renal: 3 (20%). Disfunción ventricular: 2 (13%). EuroSCORE medio: 26%.
Mortalidad hospitalaria: 1 (6,5%). Seguimiento: 100% de los pacientes. Seguimiento medio: 27±15meses. Endocarditis recurrente: 1 (6,5%). Sustitución valvular por disfunción de la plastia: 1 (6,5%). Mortalidad en el seguimiento: 1 paciente de causa no cardíaca ni infecciosa. Pacientes libres de endocarditis e insuficiencia mitral: 85,7%. Pacientes no anticoagulados: 92,9%.
Con la suficiente experiencia en reparación mitral, la reparación de la válvula mitral con endocarditis se puede realizar con una baja mortalidad quirúrgica además de aportar las ventajas de conservar la válvula nativa con una baja tasa de reoperación.
En la actualidad existe controversia acerca del tipo adecuado de canulación para los dispositivos de asistencia circulatoria izquierda. Algunos autores defienden la superioridad de la canulación ...apical, en cuanto a la optimización de flujos medios del dispositivo y sangrado perioperatorio1,2.
En los últimos 2 años se han implantado en nuestro centro un total de 22 dispositivos Abiomed BVS 5000, 18 de ellos fueron canulados por el ápex del ventrículo izquierdo (grupo I), mientras que 4 fueron canulados por la aurícula izquierda (grupo II). Del total de enfermos, el 59,09% llegaron al trasplante cardíaco, falleciendo el 30% de los trasplantados; la mortalidad global fue del 54,55%.
Analizando comparativamente las cifras de sangrado medio en 24 h y el flujo medio del dispositivo en nuestra serie, el grupo I presentó unas cifras de flujo medio significativamente mayores (4,8 1/min en el grupo I frente a 4,1 1/min en el grupo II), así como menos sangrado 24 h.
La mortalidad del grupo I fue del 50% (9 de 18), frente al 75% del grupo II (1 de 4).
A pesar del reducido número de enfermos, los datos obtenidos en nuestro centro insinúan mejores parámetros hemodinámicos usando la canulación apical. Sería necesario realizar estudios posteriores con un mayor tamaño muestral para obtener conclusiones definitivas.
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