By the middle of 2021, the official global number of coronavirus disease 2019 (COVID-19) patients was close to 230 million, but the number accounting for asymptomatic patients was much higher. ...Consequences and rehabilitation after COVID-19 are of particular interest and raise many controversial and unresolved issues. On May 18, 2021, the Eurasian Association of Therapists organized an international panel of experts to analyze challenges associated with the post-COVID-19 period. This panel aimed to develop approaches to identify gaps in the discussed issues. This interdisciplinary team of leading experts reviewed the current literature and presented their data to formulate practical guidance on management of patients after COVID-19. The panel of experts also presented recommendations on how to implement the gained knowledge into health care practices.
Abstract Background We evaluated the potential effects of granulocyte colony-simulating factor (G- CSF) on the incidence of rejection and allograft vasculopathy in heart transplant recipients. ...Methods Of 247 patients undergoing heart transplantation from 2000 to 2007, 52 (21%) developed leukopenia (white blood cell WBC <2.5 × 109 cells/L) in the absence of active infection, rejection, or malignancy. In 24 (46%) patients a clinical decision was made to treat the leukopenia with G-CSF (G-CSF group), and 28 (54%) Patients received no G-CSF (non-GCSF group). Patients followed up for 1 year after the period of leukopenia were assessed for allograft vasculopathy and acute rejection incidence. Results At baseline, the G-CSF group and the non-GCSF group did not differ in age, gender, race, heart failure etiology, creatinine, left ventricular ejection fraction (LVEF) or immunosupressive regimen. During 1-year follow-up there were no deaths in the G-CSF group, and 1 death in the non-GCSF group ( P = .34). The incidence of rejection or progressive allograft vasculopathy was lower in the G-CSF group when compared with the non-GCSF group (2 8% vs 15 53%; P < .01). Multivariate analysis identified both prior rejection episodes and G-CSF therapy as factors associated with the combined end-point of rejection or progressive allograft vasculopathy (odds ratio OR = 7.89 1.67–37.2 and OR = 0.09 0.02–0.52, respectively). Conclusions G-CSF therapy appears to be associated with a decreased incidence of acute rejection episodes or allograft vasculopathy in heart transplant recipients, suggesting a potential immunomodulatory effect of G-CSF.
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Due to advances in surgical techniques and immunosuppression survival of heart transplant (HT) recipients has improved ...significantly, with that the prevalence of sustained atrial arrhythmias (SAA) in these patients is increasing. In HT recipients antiarrhythmic therapy options are limited. Radiofrequency ablation (RFA) represents a viable but underutilized option after other etiologies of SAA such as acute allograft rejection and vasculopathy are excluded. Limiting radiation exposure in HT recipients, who are exposed to 3,5 times (1) greater radiation dose compared to general population and are significantly more susceptible to develop malignancies, is essential.
Purpose
Our aim was to analyse prevalence and type of SAA in Slovenian orthotopic HT recipients and analyse feasibility and procedural outcomes of zero (ZF) or near zero fluoroscopy (NZF) RFA treatment approaches.
Methods
We performed a retrospective analysis of HT recipients between 2002 and 2022. We re-evaluated all available ECGs of suspected arrhythmias of included patients for presence and type of SAA. We further analysed HT patients that underwent RFA for SAA at our centre. All procedures were performed primarily with 3D electroanatomical mapping system and intracardiac echocardiography guidance. Either ZF or NZF approaches were used. The primary endpoint of all procedures was SAA termination and acute success was deemed when subsequent attempts to reinduce SAA failed. Long-term success was defined as the absence of any spontaneous SAA during 12-month follow-up.
Results
Among 364 consecutive HT recipients 19 patients (5,2%) were evaluated for SAA. Of those 7 (37%) presented as typical atrial flutters (AFL), 9 (47%) as atypical AFL, 2 (11%) as focal atrial tachycardia (FAT) and 1 (5%) as slow-fast atrioventricular nodal reentry tachycardia. In 2 (11%) patients with AFL, SAA was a result of acute allograft rejection. In 10 (53%) patients SAA occurred in first 3 months after HT. In the remaining 9 patients SAA occurred late, median 6,6 years after HT (25th-75th IQR: 7,7 years). RFA was performed in 7 (37%) patients. In all patients procedures were acutely successful however in 2 patients additional RFA procedures were needed for long-term success. All in all, 10 RFA procedures were performed (Table 1). All cases had macro or micro reentrant AFL with a median of 2,0 re-entry circuits mapped (25th-75th IQR: 3,3 re-entry circuits) during the procedure – that included typical cavotricuspid isthmus AFL, perimitral AFL, and several right atrium (RA) scar-related or incision related AFL. In 2 cases additional RA FAT were ablated. Five (50%) procedures were performed with ZF. No major procedure related complications were observed.
Conclusion
In HT recipients ZF or NZF RFA of SAA appears to be feasible and safe, but still underutilised, treatment option. Our case series demonstrates favourable acute and long-term outcomes however larger data is needed to support these results.
Abstract Objective To analyze the relationship between QTc interval and cardiovascular risk factors in women with polycystic ovary syndrome (PCOS). Methods Study group included 119 PCOS women (age: ...32.2 ±5.2 years) and the control group 64 age-matched healthy women; they all underwent QT interval measurement, and plasma levels of high-sensitivity CRP (hsCRP), endothelin-1 (ET1), insulin, and testosterone determinations. Results In PCOS women hsCRP (2.35 ± 2.14 mg/L vs. 1.01 ± 1.28 mg/L; P = 0.04), ET1 (23.6 ± 10.3 ng/L vs. 7.7 ± 15.9 ng/L; P = 0.01), and insulin (16.5 ± 7.8 mIU/L vs. 11.8 ±10.7 mIU/L; P = 0.03) levels were significantly higher, and QTc interval significantly shorter than in controls (401 ± 61 ms vs. 467 ± 61 ms; P = 0.007). In 67 (56%) PCOS patients with a short QTc interval (< 400 ms), plasma testosterone levels were significantly higher than in PCOS women with normal QTc interval (2.3 ± 2.1 nmol/L vs. 1.4 ± 1.7 nmol/L; P = 0.02). Conclusions In patients with polycystic ovary syndrome increased testosterone levels may attenuate the effects of coronary risk factors.
Abstract Background The presentation, mechanisms, and incidence of ST elevation myocardial infarction (STEMI) in heart transplant recipients have been characterized only to a limited degree in the ...current literature. Herein, we present a unique case of STEMI years after heart transplantation with a focus on the salient features of its diagnosis and interventions. We also provide a review of the epidemiology of this phenomenon. Case Report A 33-year-old woman who was status post cardiac transplantation for dilated cardiomyopathy presented to the clinic with mild nonspecific fatigue and concern after having noticed relative bradycardia compared with her posttransplantation baseline heart rate. Electrocardiogram (ECG) showed junctional rhythm and inferior ST elevations, likely reflecting nodal ischemia. Troponins were grossly positive and echocardiogram showed marked right ventricular dysfunction. Results Successful percutaneous coronary intervention (PCI) with aspiration thrombectomy and drug-eluting stent placement was emergently performed. The heart's rhythm soon returned to sinus tachycardia. Right ventricular wall-motion abnormalities resolved. The patient suffered no clinical sequelae of her STEMI. Conclusion This case illustrated that “classic” symptoms of STEMI may not occur at all in the setting of heart transplantation. To our knowledge, this is the first case of posttransplantation STEMI presenting as asymptomatic bradycardia, and highlights the importance of maintaining high clinical suspicion for ischemia in transplant recipients with subtle changes. In reviewing the epidemiology of this case, we locate and bundle different types of studies that have directly or indirectly looked at STEMI in heart transplantation. For a variety of putative pathophysiological reasons, STEMI is indeed a rare manifestation of the common transplant phenomenon of coronary artery vasculopathy (CAV).
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