Cardiac resynchronization defibrillator (CRT‐D) as primary prevention is known to reduce mortalit... more Cardiac resynchronization defibrillator (CRT‐D) as primary prevention is known to reduce mortality. At the time of replacement, higher age and comorbidities may attenuate the benefit of implantable cardioverter‐defibrillator (ICD) therapy. The purpose of this study was to evaluate the progression of comorbidities after implantation and their association with mortality following CRT‐D generator replacement. In addition, a risk score was developed to identify patients at high risk for mortality after replacement.
Background: Left ventricular assist devices (LVADs) improve quality of life and long-term surviva... more Background: Left ventricular assist devices (LVADs) improve quality of life and long-term survival in advanced heart failure, but device related infections (DRI) remain cumbersome. We evaluated the diagnostic capability of FDG-PET/CT and the additive value of semi-quantitative analysis for the diagnosis of DRI. Methods: LVAD recipients undergoing FDG-PET/CT between December 2012 and August 2020 for suspected DRI were retrospectively included. FDG-PET/CT was performed and evaluated according to EANM guidelines and assessors were blinded to the clinical context of included patients. Final clinical diagnosis of driveline infection and/or central device infection, based on multidisciplinary consensus and findings during surgery whenever performed, was used as the reference for the diagnosis. Results: 44 patients were evaluated for 62 episodes of suspected DRI. Clinical evaluation established driveline infection in 33 (54%) episodes, central device infection in 8 (14%) and combined infec...
Background: Our aim was to explore potential use of temporal profiles of seven emerging cardio-re... more Background: Our aim was to explore potential use of temporal profiles of seven emerging cardio-renal and two pulmonary candidate biomarkers for predicting future adverse clinical outcome in stable patients with chronic heart failure (CHF). Methods: In 263 CHF patients, we determined the risk of a composite endpoint of HF-hospitalization, cardiac death, LVAD-placement and heart transplantation in relation to repeatedly assessed (567 samples in total) blood biomarker levels, and slopes of their temporal trajectories (i.e., rate of biomarker change per year). In each patient, we estimated biomarker trajectories using repeatedly measured osteopontin (OPN), osteoprotegerin (OPG), epidermal growth factor receptor (EGFR), heparin-binding protein (HBP), trefoil factor-3 (TFF3), kallikrein-6 (KLK-6), matrix extracellular phosphoglycoprotein (MEPE), pulmonary surfactant-associated protein-D (PSP-D), and secretoglobulin family 3A-member-2 (SCGB3A2). Results: During 2.2 years of follow-up, OPN, OPG, and HBP levels predicted the composite endpoint (univariable hazard ratio [95% confidence interval] per 1SD increase: 2.31 [1.76-3.15], 2.23 [1.69-3.00], and 1.36[1.09-1.70]). Independently of the biomarkers' levels, the slopes of OPG, TFF-3, PSP-D trajectories were also strong clinical predictors (per 0.1SD increase: 1.24 [1.14-1.38], 1.31 [1.17-1.49], and 1.32 [1.21-1.47]). All associations persisted after multivariable adjustment for baseline characteristics, and repeatedly assessed CHF pharmacological treatment and cardiac biomarkers NT-proBNP and troponin T. Conclusions: Repeatedly-measured levels of OPN, OPG, and HBP, and slopes of OPG, TFF-3, and PSP-D strongly predict clinical outcome. These candidate biomarkers may be clinically relevant as they could further define a patient's risk and provide additional pathophysiological insights into CHF.
Neurologic events occur in up to 18% of patients with continuous-flow left ventricular assist dev... more Neurologic events occur in up to 18% of patients with continuous-flow left ventricular assist devices (LVAD) and is associated with significant morbidity and mortality. The current form of the LVAD equipment is not suited to serve patients who are impaired by a stroke. By creating an assistance device for the LVAD equipment, we have been able to greatly improve the quality of life and self-dependence of a hemiplegic LVAD patient.
ASAIO journal (American Society for Artificial Internal Organs : 1992), Jan 21, 2017
Implantable continuous flow left ventricular assist devices (LVAD's) are increasingly used in... more Implantable continuous flow left ventricular assist devices (LVAD's) are increasingly used in end-stage heart failure treatment as a bridge-to-transplant and destination therapy. However, LVAD's still have major drawbacks, such as infections that can cause morbidity and mortality. Unfortunately, appropriate diagnosis of LVAD-related and LVAD-specific infections can be very cumbersome. The differentiation between deep and superficial infections, is crucial in clinical decision-making. Despite a decade of experience in using fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) to diagnose various infections, its use in LVAD patients remains scarce. In this case series, we review the current evidence in literature and describe our single center experience using F-FDG PET/CT for the diagnosis and management of LVAD infections.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives ...
Purpose: Early repolarizations are been associated with malignant ventricular arrhythmias, includ... more Purpose: Early repolarizations are been associated with malignant ventricular arrhythmias, including idiopathic VF and sudden cardiac death (SCD). The possible mechanism include increased trabecula...
The Journal of Heart and Lung Transplantation, 2009
PRF increased the duration of hospital stay (pϭ0.001) and the incidence of chronic renal dysfunct... more PRF increased the duration of hospital stay (pϭ0.001) and the incidence of chronic renal dysfunction (p Ͻ0.001). The incidence of coronary artery disease (CAD) and acute rejection did not differ between the groups. Conclusions: PRF has a significant negative impact on pediatric heart transplant outcome. Specific characteristics identify patients at particularly high risk of developing PRF.
The Journal of Heart and Lung Transplantation, 2010
hypertension and right ventricular (RV) failure. The anatomic features and structural makeup of t... more hypertension and right ventricular (RV) failure. The anatomic features and structural makeup of the RV differentiate it from its left counterpart, so, often, qualities and tendencies of the left ventricle do not apply to the right and vice versa. Instead, the RV must be studied independently in order to describe its unique diagnostic and therapeutic features. With this in mind, we examined the predictive role of hyponatremia in pulmonary hypertension and RV failure. Methods and Materials: Using a retrospective cohort design, we identified all adult patients with pulmonary hypertension and RV failure who were admitted between 1999 and 2008. They were divided into 2 cohorts based on their initial serum sodium: hyponatremia (NaϽ135 mEq/L) and normonatremia (135-145 mEq/L). Patients with left ventricular dysfunction or hypernatremia (NaϾ145 mEq/L) were excluded. The primary endpoint was in-hospital length of stay. Results: Among 3502 hospitalized patients, 886 had an initial sodium concentration of less than 135 mEq/L and 2616 had a sodium concentration between 135 mEq/L and 145 mEq/L. Normonatremic patients had a shorter mean length of stay than hyponatremic patients (9.3 Ϯ 11.9 days vs 11.2 Ϯ 12.3 days, respectively, pϽ0.001).[figure1] Conclusions: Hyponatremia is associated with increased length of stay in patients with pulmonary hypertension and RV failure.
The aim of this study is to determine the clinical efficacy of rotavirus vaccine in Turkish infan... more The aim of this study is to determine the clinical efficacy of rotavirus vaccine in Turkish infants who attended to well child clinics of Gazi University Hospital between 01.05.2008 and 30.04.2009. The infants were randomly divided into two groups and 299 infants in group one received three doses of Rotateq ® vaccine at 2nd, 4th and 6th months while the remaining 251 infants who did not receive any Rotavirus vaccine served as control group. The infants were followed for one year to observe if they had any diarrhea episode In groups 1 and 2, 32 (10.7%) and 33 (13.1%) infants had diarrhea respectively and the difference was insignificant (p = 0.451). Stool samples were collected from 65 infants having diarrhea during the follow up. Six (9.2%) stool samples were positive for rotavirus by ELISA (Rotaclone, Meridian Bioscience Inc., Cincinnati, OH, USA), of which 3 (9.4%) from group one and 3 (9.1%) from group two (p = 1.000).
We describe a patient with acute cardiogenic shock due to cardiac involvement in idiopathic hyper... more We describe a patient with acute cardiogenic shock due to cardiac involvement in idiopathic hypereosinophilic syndrome (Löffler endocarditis). At the echocardiography, there was a huge mass in the left ventricular cavity, resulting in inflow-and outflow tract obstruction. The posterior leaflet of the mitral valve apparatus was completely embedded in a big (organized) thrombus mass. The patient was treated with high dose corticosteroids, however without effect. Partial remission was achieved after treatment with hydroxycarbamide. He was also treated with anticoagulants and high dose beta-blockers. The patient's condition improved remarkably after correction of the mitral valve insufficiency by a mitral valve bioprosthesis.
Despite modern treatment modalities, cardiogenic shock is associated with a very high risk of mor... more Despite modern treatment modalities, cardiogenic shock is associated with a very high risk of mortality and morbidity. The short- and long-term survival in patients with cardiogenic shock or end-stage heart failure has improved considerably by recent technological advances in short and long-term mechanical circulatory support devices. For short-term mechanical support, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used as bridge-to-decision and bridge-to-recovery in cardiogenic shock patients. Long-term mechanical circulatory support devices such as left ventricular assist devices (LVADs) are widely available and play a central role in bridge-to-transplantation in those eligible for heart transplantation (HTX) and as destination therapy (DT) in those not eligible for heart transplantation. Nevertheless, patients with critical cardiogenic shock show a deleterious outcome after LVAD-implantation or HTX with higher mortality, more complications and higher burden on financial resources. These considerations underscore the importance of optimal timing and appropriate patient selection for eventual LVAD therapy. The current report will focus on the immediate management of patients with cardiogenic shock with inotropes, discuss the use of IABP and focus mainly on pivotal choices to be made in the period spanned by short term mechanical circulatory support in patients with refractory cardiogenic shock.
Beta-blockers improve the prognosis in heart failure (HF), but their introduction may seem imposs... more Beta-blockers improve the prognosis in heart failure (HF), but their introduction may seem impossible in patients dependent on inotropic support. However, many of these patients can be titrated on beta-blockers, but there is little evidence of successful clinical strategies. We analysed the records of inotropy-dependent patients referred for assessment for heart transplantation. Thirty-six patients (45%) could not be weaned (NW) and underwent left ventricular assist device (LVAD) implantation or transplantation, or died. However, 44 (55%) were successfully weaned (SW). Neither the aetiology (ischaemic vs. non-ischaemic) nor cardiac indexes were different in the SW as compared with the NW group (2.27±0.5 vs. 2.15±0.6 L/min/m2). The NW patients had lower LVEF (15±5% vs. 19±5%, P=0.001), higher right atrial pressure (12±6 vs. 8±6 mmHg, P=0.02), and more severe mitral regurgitation (P<0.001) than the SW patients. At discharge, 35 of 44 SW patients were receiving beta-blockers. In 29 of them, a beta-blocker could only be initiated or continued during concomitant support with i.v. enoximone for a duration of 14.1±7.2 days. Patients discharged on a beta-blocker had an LVAD/transplantation-free cumulative survival of 71% during a follow-up of 2074±201 days (confidence interval 1679–2470). It takes time to put severely ill HF patients on beta-blockers and it may require bridging with inotropes which are independent of beta-adrenergic receptors. Whether such a strategy may result in a better clinical outcome warrants further research.
The pathophysiologic mechanisms of left ventricular (LV) dysfunction in isolated ventricular nonc... more The pathophysiologic mechanisms of left ventricular (LV) dysfunction in isolated ventricular noncompaction (IVNC) remain unclear. Evaluating global and segmental systolic LV function in 65 patients with IVNC, this study found that normal wall motion was more common in noncompacted than in compacted segments. The number of noncompacted segments per patient correlated positively with the LV ejection fraction and negatively with LV end-diastolic volume index. These paradoxical findings support the concept that noncompaction represents a marker of a more generalized (cardio)myopathy rather than the direct pathophysiologic substrate of this still little-understood disease.
A 58-year-old male patient underwent aortic valve replacement surgery (On-X mechanical prosthesis... more A 58-year-old male patient underwent aortic valve replacement surgery (On-X mechanical prosthesis, ring size 23 mm) due to severe aortic valve stenosis with preserved LV function and normal coronary arteries. The postoperative period was complicated by third-degree AV block and sustained ventricular tachycardias and a DDD-ICD implantation was implanted. After 3 months of surgery, the patient presented with symptoms of progressive fatigue, dyspnoea on exertion and generalised peripheral oedema. No chest pain was reported. The patient had gained 30 kg in weight in 3 months. Physical examination revealed a raised jugular venous pressure with prominent vein pulsations, normal cardiac sounds with normal artificial valve clicks and no murmurs. Auscultation of the lungs was normal. The patient had a palpable liver of 4 cm, noticeable ascites, and extensive pitting oedema from ankle to hip. Laboratory results revealed elevated liver enzymes and moderately raised NT-proBNP (328 pmol/l) without other abnormalities. Electrocardiogram revealed a sinus rhythm with ventricular pacing. Chest X-ray demonstrated an enlarged heart but no pulmonary congestion. The echocardiogram was limited by severely impaired image quality. Left
Severe acute respiratory syndrome coronavirus 2 has rapidly spread worldwide and resulted in the ... more Severe acute respiratory syndrome coronavirus 2 has rapidly spread worldwide and resulted in the coronavirus disease 2019 (COVID-19) pandemic. The disease raised an unprecedented demand for intensive care support due to severe pulmonary dysfunction and multiorgan failure. Although the pulmonary system is the potential target of the COVID-19, recent reports have demonstrated that COVID-19 profoundly influences the cardiovascular system and the kidneys. Research studies on cadavers have shown that direct heart and kidney injury can be frequently seen in patients deceased due to COVID-19 infection. On the other hand, functional or structural dysfunction of the heart may deteriorate the renal function and vice versa. This concept is already known as the cardiorenal syndrome and may play a role in COVID-19. Proactive monitoring of micro- and macrohemodynamics could allow prompt correction of circulatory dysfunction and can be of pivotal importance in the prevention of acute kidney injury...
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, Jan 30, 2018
Decision-making when offered a donor heart for transplantation is complex, and supportive data de... more Decision-making when offered a donor heart for transplantation is complex, and supportive data describing outcomes according to acceptance or non-acceptance choices are sparse. Our aim was to analyze donor heart acceptance decisions and associated outcomes at a single center, and after subsequent acceptance elsewhere. This investigation was a retrospective analysis of data obtained from the University of Vienna Medical Center and Eurotransplant centers for the period 2001 to 2015. Our center accepted 31.8% (699 of 2,199) of donor hearts offered. Unlike other centers, the acceptance rate, with or without transplantation, did not increase over time. Of the donor hearts rejected by our center, 38.1% (572 of 1,500) were later accepted elsewhere. Acceptance rates were twice as high for donor hearts initially rejected for non-quality reasons (339 of 601, 56.4%) compared with initial rejection for quality reasons (233 of 899, 25.9%). Three-year patient survival rate was 79% at Vienna; for ...
Cardiac resynchronization defibrillator (CRT‐D) as primary prevention is known to reduce mortalit... more Cardiac resynchronization defibrillator (CRT‐D) as primary prevention is known to reduce mortality. At the time of replacement, higher age and comorbidities may attenuate the benefit of implantable cardioverter‐defibrillator (ICD) therapy. The purpose of this study was to evaluate the progression of comorbidities after implantation and their association with mortality following CRT‐D generator replacement. In addition, a risk score was developed to identify patients at high risk for mortality after replacement.
Background: Left ventricular assist devices (LVADs) improve quality of life and long-term surviva... more Background: Left ventricular assist devices (LVADs) improve quality of life and long-term survival in advanced heart failure, but device related infections (DRI) remain cumbersome. We evaluated the diagnostic capability of FDG-PET/CT and the additive value of semi-quantitative analysis for the diagnosis of DRI. Methods: LVAD recipients undergoing FDG-PET/CT between December 2012 and August 2020 for suspected DRI were retrospectively included. FDG-PET/CT was performed and evaluated according to EANM guidelines and assessors were blinded to the clinical context of included patients. Final clinical diagnosis of driveline infection and/or central device infection, based on multidisciplinary consensus and findings during surgery whenever performed, was used as the reference for the diagnosis. Results: 44 patients were evaluated for 62 episodes of suspected DRI. Clinical evaluation established driveline infection in 33 (54%) episodes, central device infection in 8 (14%) and combined infec...
Background: Our aim was to explore potential use of temporal profiles of seven emerging cardio-re... more Background: Our aim was to explore potential use of temporal profiles of seven emerging cardio-renal and two pulmonary candidate biomarkers for predicting future adverse clinical outcome in stable patients with chronic heart failure (CHF). Methods: In 263 CHF patients, we determined the risk of a composite endpoint of HF-hospitalization, cardiac death, LVAD-placement and heart transplantation in relation to repeatedly assessed (567 samples in total) blood biomarker levels, and slopes of their temporal trajectories (i.e., rate of biomarker change per year). In each patient, we estimated biomarker trajectories using repeatedly measured osteopontin (OPN), osteoprotegerin (OPG), epidermal growth factor receptor (EGFR), heparin-binding protein (HBP), trefoil factor-3 (TFF3), kallikrein-6 (KLK-6), matrix extracellular phosphoglycoprotein (MEPE), pulmonary surfactant-associated protein-D (PSP-D), and secretoglobulin family 3A-member-2 (SCGB3A2). Results: During 2.2 years of follow-up, OPN, OPG, and HBP levels predicted the composite endpoint (univariable hazard ratio [95% confidence interval] per 1SD increase: 2.31 [1.76-3.15], 2.23 [1.69-3.00], and 1.36[1.09-1.70]). Independently of the biomarkers' levels, the slopes of OPG, TFF-3, PSP-D trajectories were also strong clinical predictors (per 0.1SD increase: 1.24 [1.14-1.38], 1.31 [1.17-1.49], and 1.32 [1.21-1.47]). All associations persisted after multivariable adjustment for baseline characteristics, and repeatedly assessed CHF pharmacological treatment and cardiac biomarkers NT-proBNP and troponin T. Conclusions: Repeatedly-measured levels of OPN, OPG, and HBP, and slopes of OPG, TFF-3, and PSP-D strongly predict clinical outcome. These candidate biomarkers may be clinically relevant as they could further define a patient's risk and provide additional pathophysiological insights into CHF.
Neurologic events occur in up to 18% of patients with continuous-flow left ventricular assist dev... more Neurologic events occur in up to 18% of patients with continuous-flow left ventricular assist devices (LVAD) and is associated with significant morbidity and mortality. The current form of the LVAD equipment is not suited to serve patients who are impaired by a stroke. By creating an assistance device for the LVAD equipment, we have been able to greatly improve the quality of life and self-dependence of a hemiplegic LVAD patient.
ASAIO journal (American Society for Artificial Internal Organs : 1992), Jan 21, 2017
Implantable continuous flow left ventricular assist devices (LVAD's) are increasingly used in... more Implantable continuous flow left ventricular assist devices (LVAD's) are increasingly used in end-stage heart failure treatment as a bridge-to-transplant and destination therapy. However, LVAD's still have major drawbacks, such as infections that can cause morbidity and mortality. Unfortunately, appropriate diagnosis of LVAD-related and LVAD-specific infections can be very cumbersome. The differentiation between deep and superficial infections, is crucial in clinical decision-making. Despite a decade of experience in using fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) to diagnose various infections, its use in LVAD patients remains scarce. In this case series, we review the current evidence in literature and describe our single center experience using F-FDG PET/CT for the diagnosis and management of LVAD infections.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives ...
Purpose: Early repolarizations are been associated with malignant ventricular arrhythmias, includ... more Purpose: Early repolarizations are been associated with malignant ventricular arrhythmias, including idiopathic VF and sudden cardiac death (SCD). The possible mechanism include increased trabecula...
The Journal of Heart and Lung Transplantation, 2009
PRF increased the duration of hospital stay (pϭ0.001) and the incidence of chronic renal dysfunct... more PRF increased the duration of hospital stay (pϭ0.001) and the incidence of chronic renal dysfunction (p Ͻ0.001). The incidence of coronary artery disease (CAD) and acute rejection did not differ between the groups. Conclusions: PRF has a significant negative impact on pediatric heart transplant outcome. Specific characteristics identify patients at particularly high risk of developing PRF.
The Journal of Heart and Lung Transplantation, 2010
hypertension and right ventricular (RV) failure. The anatomic features and structural makeup of t... more hypertension and right ventricular (RV) failure. The anatomic features and structural makeup of the RV differentiate it from its left counterpart, so, often, qualities and tendencies of the left ventricle do not apply to the right and vice versa. Instead, the RV must be studied independently in order to describe its unique diagnostic and therapeutic features. With this in mind, we examined the predictive role of hyponatremia in pulmonary hypertension and RV failure. Methods and Materials: Using a retrospective cohort design, we identified all adult patients with pulmonary hypertension and RV failure who were admitted between 1999 and 2008. They were divided into 2 cohorts based on their initial serum sodium: hyponatremia (NaϽ135 mEq/L) and normonatremia (135-145 mEq/L). Patients with left ventricular dysfunction or hypernatremia (NaϾ145 mEq/L) were excluded. The primary endpoint was in-hospital length of stay. Results: Among 3502 hospitalized patients, 886 had an initial sodium concentration of less than 135 mEq/L and 2616 had a sodium concentration between 135 mEq/L and 145 mEq/L. Normonatremic patients had a shorter mean length of stay than hyponatremic patients (9.3 Ϯ 11.9 days vs 11.2 Ϯ 12.3 days, respectively, pϽ0.001).[figure1] Conclusions: Hyponatremia is associated with increased length of stay in patients with pulmonary hypertension and RV failure.
The aim of this study is to determine the clinical efficacy of rotavirus vaccine in Turkish infan... more The aim of this study is to determine the clinical efficacy of rotavirus vaccine in Turkish infants who attended to well child clinics of Gazi University Hospital between 01.05.2008 and 30.04.2009. The infants were randomly divided into two groups and 299 infants in group one received three doses of Rotateq ® vaccine at 2nd, 4th and 6th months while the remaining 251 infants who did not receive any Rotavirus vaccine served as control group. The infants were followed for one year to observe if they had any diarrhea episode In groups 1 and 2, 32 (10.7%) and 33 (13.1%) infants had diarrhea respectively and the difference was insignificant (p = 0.451). Stool samples were collected from 65 infants having diarrhea during the follow up. Six (9.2%) stool samples were positive for rotavirus by ELISA (Rotaclone, Meridian Bioscience Inc., Cincinnati, OH, USA), of which 3 (9.4%) from group one and 3 (9.1%) from group two (p = 1.000).
We describe a patient with acute cardiogenic shock due to cardiac involvement in idiopathic hyper... more We describe a patient with acute cardiogenic shock due to cardiac involvement in idiopathic hypereosinophilic syndrome (Löffler endocarditis). At the echocardiography, there was a huge mass in the left ventricular cavity, resulting in inflow-and outflow tract obstruction. The posterior leaflet of the mitral valve apparatus was completely embedded in a big (organized) thrombus mass. The patient was treated with high dose corticosteroids, however without effect. Partial remission was achieved after treatment with hydroxycarbamide. He was also treated with anticoagulants and high dose beta-blockers. The patient's condition improved remarkably after correction of the mitral valve insufficiency by a mitral valve bioprosthesis.
Despite modern treatment modalities, cardiogenic shock is associated with a very high risk of mor... more Despite modern treatment modalities, cardiogenic shock is associated with a very high risk of mortality and morbidity. The short- and long-term survival in patients with cardiogenic shock or end-stage heart failure has improved considerably by recent technological advances in short and long-term mechanical circulatory support devices. For short-term mechanical support, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used as bridge-to-decision and bridge-to-recovery in cardiogenic shock patients. Long-term mechanical circulatory support devices such as left ventricular assist devices (LVADs) are widely available and play a central role in bridge-to-transplantation in those eligible for heart transplantation (HTX) and as destination therapy (DT) in those not eligible for heart transplantation. Nevertheless, patients with critical cardiogenic shock show a deleterious outcome after LVAD-implantation or HTX with higher mortality, more complications and higher burden on financial resources. These considerations underscore the importance of optimal timing and appropriate patient selection for eventual LVAD therapy. The current report will focus on the immediate management of patients with cardiogenic shock with inotropes, discuss the use of IABP and focus mainly on pivotal choices to be made in the period spanned by short term mechanical circulatory support in patients with refractory cardiogenic shock.
Beta-blockers improve the prognosis in heart failure (HF), but their introduction may seem imposs... more Beta-blockers improve the prognosis in heart failure (HF), but their introduction may seem impossible in patients dependent on inotropic support. However, many of these patients can be titrated on beta-blockers, but there is little evidence of successful clinical strategies. We analysed the records of inotropy-dependent patients referred for assessment for heart transplantation. Thirty-six patients (45%) could not be weaned (NW) and underwent left ventricular assist device (LVAD) implantation or transplantation, or died. However, 44 (55%) were successfully weaned (SW). Neither the aetiology (ischaemic vs. non-ischaemic) nor cardiac indexes were different in the SW as compared with the NW group (2.27±0.5 vs. 2.15±0.6 L/min/m2). The NW patients had lower LVEF (15±5% vs. 19±5%, P=0.001), higher right atrial pressure (12±6 vs. 8±6 mmHg, P=0.02), and more severe mitral regurgitation (P<0.001) than the SW patients. At discharge, 35 of 44 SW patients were receiving beta-blockers. In 29 of them, a beta-blocker could only be initiated or continued during concomitant support with i.v. enoximone for a duration of 14.1±7.2 days. Patients discharged on a beta-blocker had an LVAD/transplantation-free cumulative survival of 71% during a follow-up of 2074±201 days (confidence interval 1679–2470). It takes time to put severely ill HF patients on beta-blockers and it may require bridging with inotropes which are independent of beta-adrenergic receptors. Whether such a strategy may result in a better clinical outcome warrants further research.
The pathophysiologic mechanisms of left ventricular (LV) dysfunction in isolated ventricular nonc... more The pathophysiologic mechanisms of left ventricular (LV) dysfunction in isolated ventricular noncompaction (IVNC) remain unclear. Evaluating global and segmental systolic LV function in 65 patients with IVNC, this study found that normal wall motion was more common in noncompacted than in compacted segments. The number of noncompacted segments per patient correlated positively with the LV ejection fraction and negatively with LV end-diastolic volume index. These paradoxical findings support the concept that noncompaction represents a marker of a more generalized (cardio)myopathy rather than the direct pathophysiologic substrate of this still little-understood disease.
A 58-year-old male patient underwent aortic valve replacement surgery (On-X mechanical prosthesis... more A 58-year-old male patient underwent aortic valve replacement surgery (On-X mechanical prosthesis, ring size 23 mm) due to severe aortic valve stenosis with preserved LV function and normal coronary arteries. The postoperative period was complicated by third-degree AV block and sustained ventricular tachycardias and a DDD-ICD implantation was implanted. After 3 months of surgery, the patient presented with symptoms of progressive fatigue, dyspnoea on exertion and generalised peripheral oedema. No chest pain was reported. The patient had gained 30 kg in weight in 3 months. Physical examination revealed a raised jugular venous pressure with prominent vein pulsations, normal cardiac sounds with normal artificial valve clicks and no murmurs. Auscultation of the lungs was normal. The patient had a palpable liver of 4 cm, noticeable ascites, and extensive pitting oedema from ankle to hip. Laboratory results revealed elevated liver enzymes and moderately raised NT-proBNP (328 pmol/l) without other abnormalities. Electrocardiogram revealed a sinus rhythm with ventricular pacing. Chest X-ray demonstrated an enlarged heart but no pulmonary congestion. The echocardiogram was limited by severely impaired image quality. Left
Severe acute respiratory syndrome coronavirus 2 has rapidly spread worldwide and resulted in the ... more Severe acute respiratory syndrome coronavirus 2 has rapidly spread worldwide and resulted in the coronavirus disease 2019 (COVID-19) pandemic. The disease raised an unprecedented demand for intensive care support due to severe pulmonary dysfunction and multiorgan failure. Although the pulmonary system is the potential target of the COVID-19, recent reports have demonstrated that COVID-19 profoundly influences the cardiovascular system and the kidneys. Research studies on cadavers have shown that direct heart and kidney injury can be frequently seen in patients deceased due to COVID-19 infection. On the other hand, functional or structural dysfunction of the heart may deteriorate the renal function and vice versa. This concept is already known as the cardiorenal syndrome and may play a role in COVID-19. Proactive monitoring of micro- and macrohemodynamics could allow prompt correction of circulatory dysfunction and can be of pivotal importance in the prevention of acute kidney injury...
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, Jan 30, 2018
Decision-making when offered a donor heart for transplantation is complex, and supportive data de... more Decision-making when offered a donor heart for transplantation is complex, and supportive data describing outcomes according to acceptance or non-acceptance choices are sparse. Our aim was to analyze donor heart acceptance decisions and associated outcomes at a single center, and after subsequent acceptance elsewhere. This investigation was a retrospective analysis of data obtained from the University of Vienna Medical Center and Eurotransplant centers for the period 2001 to 2015. Our center accepted 31.8% (699 of 2,199) of donor hearts offered. Unlike other centers, the acceptance rate, with or without transplantation, did not increase over time. Of the donor hearts rejected by our center, 38.1% (572 of 1,500) were later accepted elsewhere. Acceptance rates were twice as high for donor hearts initially rejected for non-quality reasons (339 of 601, 56.4%) compared with initial rejection for quality reasons (233 of 899, 25.9%). Three-year patient survival rate was 79% at Vienna; for ...
Uploads
Papers by Kadir Caliskan