Non-surgical bleeding (NSB) is one of the major clinical complications in patients under continuous-flow left ventricular assist device (LVAD) support. The increased shear stress leads to an altered ...platelet receptor composition. Whether these changes increase the risk for NSB is unclear. Thus, we compared the platelet receptor composition of patients with (bleeder group, n = 18) and without NSB (non-bleeder group, n = 18) prior to LVAD implantation. Blood samples were obtained prior to LVAD implantation and after bleeding complications in the post-implant period. Platelet receptor expression of GPIbα, GPIIb/IIIa, P-selectin and CD63 as well as intra-platelet oxidative stress levels were quantified by flow cytometry. Bleeders and non-bleeders were comparable regarding clinical characteristics, von Willebrand factor diagnostics and the aggregation capacity before and after LVAD implantation (p > 0.05). LVAD patients in the bleeder group suffered from gastrointestinal bleeding (33%; n = 6), epistaxis (22%; n = 4), hematuria or hematoma (17%; n = 3, respectively) and cerebral bleeding (11%; n = 2). Prior to LVAD implantation, a restricted surface expression of the platelet receptors P-selectin and GPIIb/IIIa was observed in the bleeder group (P-selectin: 7.2 ± 2.6%; GPIIb/IIIa: 26,900 ± 13,608 U) compared to non-bleeders (P-selectin: 12.4 ± 8.1%, p = 0.02; GPIIb/IIIa: 36,259 ± 9914 U; p = 0.02). We hypothesized that the reduced platelet receptor expression of P-selectin and GPIIb/IIIa prior to LVAD implantation may be linked to LVAD-related NSB.
Purpose
Infection is a common complication following left ventricular assist device (LVAD) implantation. Patients with obesity are particularly at risk due to their high percentage of adipose tissue ...and the resulting chronic inflammatory state and resulting immunological changes. This study investigated changes of immunological parameters in relation to body mass index (BMI) during the first year after LVAD implantation.
Methods
Blood samples were obtained prior to LVAD implantation and at 3 (1
st
FU), 6 (2
nd
FU) and 12 mo (3
rd
FU) after LVAD implantation. Patients were divided into three groups (normal weight: BMI of 18.5-24.9 kg/m
2
; n=12; pre-obesity: 25.0-29.9 kg/m
2
; n=15; obesity: ≥ 30.0 kg/m
2
; n=17) based on their BMI at the time of LVAD implantation. Flow cytometric analyses for CD4
+
and CD8
+
T cells, regulatory T cells (T
regs
), B cells as well as dendritic cells (DCs) were performed.
Results
After LVAD implantation, obese patients (0.51 ± 0.20%) showed a higher proportion of overall DCs than normal-weight (0.28 ± 0.10%) and pre-obese patients (0.32 ± 0.11%, p<0.01) at 3
rd
FU. The proportion of BDCA3
+
myeloid DCs was lower in obese patients (64.3 ± 26.5%) compared to normal-weight patients (82.7 ± 10.0%, p
normal-weight vs. obesity
=0.05) at 2
nd
FU after LVAD implantation. The analysis of BDCA4
+
plasmacytoid DCs revealed a reduced proportion in pre-obese (21.1 ± 9.8%, p
normal-weight vs. pre-obesity
=0.01) and obese patients (23.7 ± 10.6%, p
normal-weight vs. obesity
=0.05) compared to normal-weight patients (33.1 ± 8.2%) in the 1
st
FU. T cell analysis showed that CD4
+
T cells of obese patients (62.4 ± 9.0%) significantly increased in comparison to pre-obese patients (52.7 ± 10.0%, p
pre-obesity vs. obesity
=0.05) and CD8
+
T cells were lower in obese patients (31.8 ± 8.5%) than in normal-weight patients (42.4 ± 14.2%; p
normal-weight vs. obesity
=0.04) at the 3
rd
FU. Furthermore, we observed significantly reduced proportions of T
regs
in pre-obese patients compared to normal-weight and obese patients at 2
nd
FU (p=0.02) and 3
rd
FU (p=0.01) after LVAD implantation.
Conclusion
This study reported changes of the innate and adaptive immune system of pre-obese and obese compared to normal-weight patients one year after LVAD implantation. DCs and their subsets, CD8
+
T cells and T
regs
were affected immune cell populations that indicate immunological changes which might increase the incidence of postoperative infection.
استهدف البحث تعرُف أثر الاستعمال التكاملي لاستراتيجيتى تسلق الهضبة و العصف الذهنى فى تحصيل طلبة كلية الاساسية بجامعة دهوك فى مادة مناهج البحث العلمي .
اعتمد الباحثون التصميم التجريبي ذا المجموعتين ...المُتكافئتين ذواتا الاختبار البعدي، مجموعة تجريبية دُرٌست على وفق الاستعمال التكاملي لاستراتيجيتي تسلق الهضبة و العصف الذهني، و أخرى ضابطة دُرٌست بحسب طريقة الاعتيادية. و اختار الباحثون عشوائيا شعبتين من بين شعب المرحلة الثالثة فى قسم التربية و علم النفس بكلية التربية الاساسية، وتم توزيع المجموعتين بالأسلوب نفسه، فمثلُت شعبة (ب) البالغ عدد طلبتها (32) طالباً و طالبةً المجموعة التجريبية، فى حين مثُلت شعبة(ج) البالغ عدد طلبتها (34) طالباً و طالبةً المجموعة الضابطة. وتم اجراء التكافؤ بين المجموعتين في متغيرات عدة .
و اعد الباحثون اختباراً تحصيلياً اشتمل (40) فقرة من نوع الاختيار من متعدد، و استخرجه له الخصائص السيكومترية من صدق و تمييز و ثبات .
و بعد الانتهاء من التجربة، و تطبيق الاختبار، و إجراء التعامل الإحصائي مع البيانات باستعمال الاختبار التائي (t.test) لعينتين مستقلتين، أضهرت النتائج: وجود فرق ذي دلالة احصائية عند مستوى (0.05) بين مُتوسط درجات تحصيل طلبة المجموعتين التجريبية و الضابطة، ولصالح المجموعة التجريبية. و استنتج الباحثون استنتاجاُ عاماً مفاده انّ للاستعمال التكاملي لاستراتيجيتي تسلق الهضبة و العصف الذهنى أثر فعال في تحصيل طلبة عينة البحث فى مادة مناهج البحث العلمي، و أوصيو توصيات عدة أكدت على اهمية استعمال التكامل بين الاستراتيجيات و الطرائق التدريسية، و اقترحو دراسات في هذا المجال لإجرائها مستقبلاً.
Background Extracorporeal membrane oxygenation (ECMO) has been increasingly used for postcardiotomy cardiogenic shock, but without a concomitant reduction in observed in-hospital mortality. Long-term ...outcomes are unknown. This study describes patients' characteristics, in-hospital outcome, and 10-year survival after postcardiotomy ECMO. Variables associated with in-hospital and postdischarge mortality are investigated and reported. Methods and Results The retrospective international multicenter observational PELS-1 (Postcardiotomy Extracorporeal Life Support) study includes data on adults requiring ECMO for postcardiotomy cardiogenic shock between 2000 and 2020 from 34 centers. Variables associated with mortality were estimated preoperatively, intraoperatively, during ECMO, and after the occurrence of any complications, and then analyzed at different time points during a patient's clinical course, through mixed Cox proportional hazards models containing fixed and random effects. Follow-up was established by institutional chart review or contacting patients. This analysis included 2058 patients (59% were men; median interquartile range age, 65.0 55.0-72.0 years). In-hospital mortality was 60.5%. Independent variables associated with in-hospital mortality were age (hazard ratio HR, 1.02 95% CI, 1.01-1.02) and preoperative cardiac arrest (HR, 1.41 95% CI, 1.15-1.73). In the subgroup of hospital survivors, the overall 1-, 2-, 5-, and 10-year survival rates were 89.5% (95% CI, 87.0%-92.0%), 85.4% (95% CI, 82.5%-88.3%), 76.4% (95% CI, 72.5%-80.5%), and 65.9% (95% CI, 60.3%-72.0%), respectively. Variables associated with postdischarge mortality included older age, atrial fibrillation, emergency surgery, type of surgery, postoperative acute kidney injury, and postoperative septic shock. Conclusions In adults, in-hospital mortality after postcardiotomy ECMO remains high; however, two-thirds of those who are discharged from hospital survive up to 10 years. Patient selection, intraoperative decisions, and ECMO management remain key variables associated with survival in this cohort. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03857217.
Introduction: Infections are a major problem after left ventricular assist device (LVAD) implantation that affects morbidity, mortality, and the quality of life. Obesity often increases the risk for ...infection. In the cohort of LVAD patients, it is unknown if obesity affects the immunological parameters involved in viral defense. Therefore, this study investigated whether overweight or obesity affects immunological parameters such as CD8 + T cells and natural killer (NK) cells. Methods: Immune cell subsets of CD8 + T cells and NK cells were compared between normal-weight (BMI 18.5–24.9 kg/m 2 , n = 17), pre-obese (BMI 25.0–29.9 kg/m 2 , n = 24), and obese (BMI ≥30 kg/m 2 , n = 27) patients. Cell subsets and cytokine serum levels were quantified prior to LVAD implantation and at 3, 6, and 12 months after LVAD implantation. Results: At the end of the first postoperative year, obese patients (31.8% ± 2.1%) had a lower proportion of CD8 + T cells than normal-weight patients (42.4% ± 4.1%; p = 0.04), and the percentage of CD8 + T cells was negatively correlated with BMI (p = 0.03; r = −0.329). The proportion of circulating NK cells increased after LVAD implantation patients in normal-weight (p = 0.01) and obese patients (p < 0.01). Patients with pre-obesity showed a delayed increase (p < 0.01) 12 months after LVAD implantation. Further, obese patients showed an increase in the percentage of CD57 + NK cells after 6 and 12 months (p = 0.01) of treatment, higher proportions of CD56 bright NK cells (p = 0.01), and lower proportions of CD56 dim/neg NK cells (p = 0.03) 3 months after LVAD implantation than normal-weight patients. The proportion of CD56 bright NK cells positively correlated with BMI (p < 0.01, r = 0.403) 1 year after LVAD implantation. Conclusions: This study documented that obesity affects CD8 + T cells and subsets of NK cells in patients with LVAD in the first year after LVAD implantation. Lower proportions of CD8 + T cells and CD56 dim/neg NK cells and higher proportion of CD56 bright NK cells were detected in obese but not in pre-obese and normal-weight LVAD patients during the first year after LVAD implantation. The induced immunological imbalance and phenotypic changes of T and NK cells may influence viral and bacterial immunoreactivity.
We evaluated critically ill patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) due to cardiac arrest (CA) with respect to baseline characteristics and laboratory assessments, ...including lactate and lactate clearance for prognostic relevance.
The primary endpoint was 30-day mortality. The impact on 30-day mortality was assessed by uni- and multivariable Cox regression analyses. Neurological outcome assessed by Glasgow Outcome Scale (GOS) was pooled into two groups: scores of 1⁻3 (bad GOS score) and scores of 4⁻5 (good GOS score).
A total of 93 patients were included in the study. Serum lactate concentration (hazard ratio (HR) 1.09; 95% confidence interval (CI) 1.04⁻1.13;
< 0.001), hemoglobin, (Hb; HR 0.87; 95% CI 0.79⁻0.96;
= 0.004), and catecholamine use were associated with 30-day-mortality. In a multivariable model, only lactate clearance (after 6 h; OR 0.97; 95% CI 0.94⁻0.997;
= 0.03) was associated with a good GOS score. The optimal cut-off of lactate clearance at 6 h for the prediction of a bad GOS score was at ≤13%. Patients with a lactate clearance at 6 h ≤13% evidenced higher rates of bad GOS scores (97% vs. 73%;
= 0.01).
Whereas lactate clearance does not predict mortality, it was the sole predictor of good neurological outcomes and might therefore guide clinicians when to stop ECPR.
Disturbances in the ubiquitin proteasome system, and especially changes of the E3 ligases, are subjects of interest when searching for causes and therapies for cardiomyopathies. The aim of this study ...was to clarify whether the myostatin/AKT/forkhead box O (FOXO) pathway, which regulates the expression of the E3 ligases muscle atrophy F-box gene (MAFbx) and muscle ring-finger protein-1 (MuRF1), is changed in dilated cardiomyopathy of ischemic origin (IDCM) and dilated cardiomyopathy of non-ischemic origin (NIDCM). The mRNA and protein expression of myostatin, AKT, FOXO1, FOXO3, MAFbx and MuRF1 were quantified by real-time polymerase chain reaction and ELISA, respectively, in myocardial tissue from 26 IDCM and 23 NIDCM patients. Septal tissue from 17 patients undergoing Morrow resection served as a control. MAFbx and FOXO1 mRNA and protein expression (all p < 0.05), AKT mRNA (p < 0.01) and myostatin protein expression (p = 0.02) were decreased in NIDCM patients compared to the control group. Apart from decreases of AKT and MAFbx mRNA expression (both p < 0.01), no significant differences were detected in IDCM patients compared to the control group. Our results demonstrate that the myostatin/AKT/FOXO pathway is altered in NIDCM but not in IDCM patients. FOXO1 seems to be an important drug target for regulating the expression of MAFbx in NIDCM patients.
Mechanical circulatory support has proven effective in managing postcardiotomy cardiogenic shock by stabilizing patients’ hemodynamics and ensuring adequate organ perfusion. Among the available ...device modalities, the combination of extracorporeal life support and a microaxial flow pump for left ventricular unloading has emerged as a valuable tool in the surgical armamentarium. In this publication, we provide recommendations for the application and weaning of temporary mechanical circulatory support in cardiogenic shock patients, derived from a consensus among leading cardiac centers in German-speaking countries.
Chronic stable heart failure model in ovine species Torregroza, Carolin; Sadat, Najla; Gomez Hamacher, Claudio J. R. ...
Artificial organs,
September 2020, 2020-09-00, 20200901, Letnik:
44, Številka:
9
Journal Article
Recenzirano
Establishing a chronic heart failure (HF) model is challenging, particularly in the ovine model. The aim of this study was to establish a reproducible model of HF in an ovine model. Seventeen sheep ...were operated using the left thoracotomy approach. Chronic HF was induced through ligation of the diagonal and marginal branches only. Perioperative hemodynamic and echocardiographic parameters were compared. A total of (3 ± 1) coronary ligations were used. Thirteen animals survived the procedure and were followed up for (15 ± 5) days. The mean arterial pressure, heart rate (HR), mean pulmonary artery pressure (mPAP), central venous pressure, and cardiac output at baseline and prior to animal sacrifice was (75 ± 14 mmHg) and (68 ± 16 mmHg) P = .261; (72 ± 9 bpm), (100 ± 28 bpm) P = .01; (15 ± 4 mmHg) and (18 ± 5 mmHg) P = .034; (10 ± 6 mmHg) and (8 ± 4 mmHg) P = .326; (3.4 ± 1 L/min) and (3.9 ± 1 L/min) P = .286, respectively. The LVEF at baseline and prior to animal sacrifice was (63 ± 13%) and (43 ± 6%) P = .012. Twelve surviving animals were supported with LVAD in a follow‐up procedure. Chronic stable HF in sheep was successively established. Clinical symptoms and drastic increase in the mPAP and HR as well as echo findings were the most sensitive parameters of HF. This reproducible ovine model has proven to be highly promising for research regarding HF.
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