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This study aims to understand the role of Galectin-3 (Gal-3) before and after heart transplant (HTx), the relation between its serum concentration and that found on biopsies (performed every week for the first month after the transplant) and to specify the possible value of this marker to predict the various post-HTx outcomes with particular focus on renal disfunction. A concomitant evaluation of ST2 is obtained. Gal-3 is a novel biomarker reflecting cardiac remodeling and fibrosis. Elevated serum levels of Gal-3 are associated with poor prognosis in patients with heart failure. However, the meaning of the change in levels of Gal-3 following HTx and its relation to possible outcomes remains unknown. Serum Gal-3 levels were measured in 14 patients at the time of admission for HTx, on the 7th and 30th day after transplant. Heart tissue, taken during routine endomyocardial biopsies (EMB), was analyzed to evaluate the correlation between the levels of Gal-3 found on tissue samples and the serum levels. A significant correlation between pre-HTx Gal-3 levels and post-HTx eGFR values was found. In addition, there is a linear relation between post-HTx Gal-3 levels and post HTx-eGFR.No connection between Gal-3 serum level and HTx rejection was detected.The direct relation between the time between the diagnosis of heart failure and the date of transplantation and the levels of serum Gal-3 was also significant.Those results are comparable for ST2. The correlation between post-HTx serum Gal-3 and eGFR levels make Gal-3 a predictive marker of kidney damage which could be useful in the stratification of risk for renal dysfunction after HTx. However, Gal-3 cannot be regarded as a rejection marker. Moreover, the longer the time from diagnosis to transplant, the higher the Gal-3 levels. [ABSTRACT FROM AUTHOR]

As COVID-19 pandemic spread, cases of involvement of the heart have been reported. A 47-year-old woman was admitted to the ICU of our hospital for severe cardiogenic shock. She was pyretic, hypoxemic, tachycardic and with reduction of voltages at ECG. TTE showed severe biventricular impairment with an EF of 20 %. Chest X-ray revealed interstitial edema (Fig.1). Invasive mechanical ventilation and inotropic support and empiric antibiotic therapy were set up. High levels of IL-6, lactate, TpnI, and pro-BNP and WBC emerged from laboratory exams (Fig.2).Testing for cardiotropic viruses came back negative, as well as hemocultures. BAL PCR resulted positive for SARS-CoV2. COVID-19 myocarditis was therefore diagnosed. Due to severe hypotension irresponsive to noradrenaline and adrenaline, IABP was placed. The following day, a pericardiocentesis was carried out for cardiac tamponade. Due to worsening of the general conditions, V-A ECMO was implanted. Corticosteroids were administered at high dosage. As cardiac function steadily improved and pro BNP and troponins decreased, vasopressor and inotrope were stopped, V-A ECMO was removed and IABP support was interrupted. Improvement of biventricular function was observed (EF 55 %), after 15 days the patient was transferred to the ward and after 25 days was discharged with heart failure therapy. Currently, most of the ongoing research focuses on the respiratory complication of SARS-CoV2 and little is known about the management of COVID-19 myocarditis. In our experience, high dosage glucocorticoids, inotropes, and V-A ECMO improved the clinical conditions of the patient. [ABSTRACT FROM AUTHOR]

We report the case of a 61-year-old heart transplant patient who developed A. baumannii bilateral pneumonia (MDR-AB) which progressed into septic shock. The patient was treated with antibiotics and Polymyxin B Hemoperfusion resulting in complete resolution of the septic shock. A 61-year-old patient with idiopathic dilatated cardiomyopathy underwent heart transplantation with a regular post-operative course. Post-transplant echocardiogram showed satisfying biventricular contraction (EF 55 %, Tapse 23 mm) and normal pulmonary pressures (PAPs 29 mmHg). On the 15th day after surgery, he suffered from hyperpyrexia and marked hypotension. The chest X-ray revealed a bilateral pneumonia. He was transferred to the intensive care unit where he was treated with catecholaminergic therapy with IV norepinephrine (0,2 y/kg/min) and antibiotic therapy with meropenem, colistin and ampicillin/sulbactam. In the following 24 hours, we observed a worsening of the respiratory function and oliguria (10 ml/h); therefore, the patient was sedated and intubated and started dialytic treatment. Severe myelosuppression also occurred with a white blood cell count lower than 600 cells/mmc. The scoring systems for the evaluation of critical patients in the ICU were elevated (SOFA score 13; Apache II Score 21; MODS Score 13). The immunosuppressant therapy with tacrolimus was reduced in order to reach a range of serum levels of 5-7 ng/ml. Endotoxemia was 1172 pg/mL (EAA™ 1 0,63 EAA™ 2 0,66). A cycle of Polymyxin B Hemoperfusion connected to the dialysis circuit was performed. At the end of two treatments, with a pause of 22 hours in between, we witnessed a significant reduction of endotoxemia: 150 pg/mL (EAA™ 1 0,11 EAA™ 2 0,14). In the following days, inflammation indexes decreased (PCT 31 ng/mL→ 1,7 ng/mL), respiratory function recovered (p02 65 → 110), leading to extubation, hemodynamics improved and inotrope support was suspended, white blood cell count increased (WBC 600 cells/mmc → 3300 cells/mmc). In our experience, the prompt use of combined IV antibiotic therapy and Polymyxin B Hemoperfusion for septic shock with heart transplant patients has improved the outcome, thus reducing the duration of inotrope and antibiotic therapy and intubation. [ABSTRACT FROM AUTHOR]