mycophenolic-acid and Ventricular-Dysfunction--Left

With an increasing number of heart transplants being performed around the world and the improvement in survival rates, more transplant recipients may present to the emergency department with comorbidities unique to the transplanted heart and related immunosuppression, including heart failure. This article is aimed at enabling the emergency department physician identify and better manage this unique group of patients for whom time is life.

Topics: Arrhythmias, Cardiac; Contraindications; Coronary Artery Disease; Diagnosis, Differential; Dyspnea; Electrocardiography; Emergency Service, Hospital; Heart Failure; Heart Transplantation; Humans; Immunosuppressive Agents; Mycophenolic Acid; Myocardium; Natriuretic Peptides; Postoperative Complications; Transplantation, Homologous; Ventricular Dysfunction, Left

To assess the clinical characteristics, diagnosis, and outcome of cardiac sarcoidosis in a single institution sarcoidosis clinic.. Patients with cardiac sarcoidosis were identified using refined World Association of Sarcoidosis and Other Granulomatous Diseases (WASOG) criteria of highly probable and probable. Patient demographics, local and systemic treatments, and clinical outcome were collected.. Of the 1,815 patients evaluated over a 6-year period, 73 patients met the WASOG criteria for cardiac sarcoidosis. The median age at diagnosis was 46 years, with a median follow-up of 8.8 years. Reduced left ventricular ejection fraction (LVEF) was the most common manifestation (54.8%). Patients with arrhythmias experienced ventricular tachycardia or severe heart block, (35.6% and 19.2%, respectively) with or without reduced LVEF. A total of 45 (61.6%) patients underwent cardiac PET scan and/or MRI, with 41 (91.1%) having a positive study. During follow-up, 10 patients (13.7%) either underwent transplant (n = 3) or died (n = 7) from sarcoidosis. Kaplan-Meier survival curves revealed 5- and 10-year survival rates of 95.5% and 93.4%, respectively. Univariate factors of age at diagnosis < 46 years, implantation of pacemaker or defibrillator, mycophenolate treatment, or LVEF > 40% were associated with improved survival. Cox regression analysis demonstrated that age ≥ 46 years and lack of an implanted pacemaker or defibrillator were the only independent predictors of mortality.. The new WASOG criteria were able to characterize cardiac involvement in our sarcoidosis clinic. Age and lack of pacemaker or defibrillator were the significant predictors of mortality for cardiac sarcoidosis, and reduced LVEF < 40% was associated with worse prognosis.. ClinicalTrials.gov; No.: NCT02356445; URL: www.clinicaltrials.gov.

Topics: Adult; Antibiotics, Antineoplastic; Cardiomyopathies; China; Defibrillators, Implantable; Female; Follow-Up Studies; Heart Transplantation; Humans; Kaplan-Meier Estimate; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Mycophenolic Acid; Positron-Emission Tomography; Prognosis; Sarcoidosis; Stroke Volume; Tachycardia, Ventricular; Ventricular Dysfunction, Left

Calcineurin inhibitor (CNI)-based therapy is associated with adverse cardiovascular effects. We examined the effects of late CNI or mycophenolate mofetil (MMF) withdrawal on echocardiographic parameters.. This study was conducted as a substudy of a randomized trial in stable renal transplant recipients who were on a triple CNI-based regimen with prednisone and MMF that evaluated late concentration-controlled withdrawal of CNI or MMF on renal function. A total of 108 patients (age, 52.3±11.5 years; 67% male; at a median of 2.0 years post-transplantation, (interquartile range 1.3-3.3 years); estimated glomerular filtration rate, 57±16 mL/min/1.73 m; 66% on cyclosporine and 34% on tacrolimus) entered the cardiovascular substudy examining echocardiographic parameters at baseline and 2 years after randomization. In all patients, traditional cardiovascular risk factors were treated according to predefined targets.. Late CNI withdrawal prevented progressive development of left ventricular (LV) diastolic dysfunction, as assessed by markers of LV diastolic function (mitral deceleration time and mitral annular e' velocity). Conversely, in the MMF-withdrawal group, the left atrial volume index (an indicator of chronic LV diastolic dysfunction) was significantly increased at 2 years (from 24.1±6.7 to 27.0±7.0 mL/m, P<0.05). In addition, CNI withdrawal resulted in a higher proportion of patients achieving the predefined blood pressure targets (<130/85 mm Hg: 41.5% vs. 12.7%, P=0.001) at 2 years while requiring less antihypertensive drugs. Changes in the left atrial volume index were significantly associated with treatment arm (P=0.03) and changes in systolic (P=0.005) and diastolic (P=0.005) blood pressure.. Late CNI withdrawal, from a triple-drug regimen in stable renal transplant recipients, prevented progressive deterioration of LV diastolic function and facilitated better blood pressure control.

Topics: Adult; Antihypertensive Agents; Blood Pressure; Calcineurin Inhibitors; Chi-Square Distribution; Cyclosporine; Diastole; Drug Administration Schedule; Drug Therapy, Combination; Echocardiography, Doppler, Pulsed; Female; Heart Atria; Humans; Immunosuppressive Agents; Kidney Transplantation; Linear Models; Male; Middle Aged; Mitral Valve; Mycophenolic Acid; Netherlands; Predictive Value of Tests; Prednisone; Prospective Studies; Tacrolimus; Time Factors; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Function, Left