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Introduction: Over the last decades, several scores have been developed to aid clinicians in assessing prognosis in patients with heart failure (HF) based on clinical data, medications and, ultimately, biomarkers. Lung ultrasound (LUS) has emerged as a promising prognostic tool for patients when assessed at discharge after a HF hospitalization. We hypothesized that contemporary HF risk scores can be improved upon by the inclusion of the number of B-lines detected by LUS at discharge to predict death, urgent visit, or HF readmission at 6- month follow-up.Methods: We evaluated the discrimination improvement of adding the number of B-lines to 4 contemporary HF risk scores (Get with the Guidelines -GWTG-, MAGGIC, Redin-SCORE, and BCN Bio-HF) by comparing the change in the area under the receiver operating curve (AUC), the net reclassification index (NRI), and the integrated discrimination improvement (IDI). The population of the study was constituted by the 123 patients enrolled in the LUS-HF trial, adjusting the analyses by the intervention.Results: The AUC of the GWTG score increased from 0.682 to 0.789 (p = 0.02), resulting in a NRI of 0.608 and an IDI of 0.136 (p < 0.05). Similar results were observed when adding the number of B-lines to the MAGGIC score, with an AUC that increased from 0.705 to 0.787 (p < 0.05). This increase translated into a NRI of 0.608 and an IDI of 0.038 (p < 0.05). Regarding Redin-SCORE at 1-month and 1-year, the AUC increased from 0.714 to 0.773 and from 0.681 to 0.757, although it did not reach statistical significance (p = 0.08 and p = 0.06 respectively). Both IDI and NRI were significantly improved (0.093 and 0.509 in the 1-month score, p < 0.05; 0.056 and 0.111 in the 1-year score, p < 0.05). Lastly, the AUC for the BCN Bio-HF score increased from 0.733 to 0.772, which was statistically non-significant, with a NRI value of 0.363 (p = 0.06) and an IDI of 0.092 (p < 0.05).Conclusion: Adding the results of LUS evaluated at discharge improved the predictive value of most of the contemporary HF risk scores. As it is a simple, fast, and non-invasive test it may be recommended to assess prognosis at discharge in HF patients.

The article presents a case study of a 39-year-old man with the evaluation of dyspnea on exertion. Topics include patient developing symptoms of heart failure, documenting complete AVB, and severe left ventricular systolic dysfunction; and atrial and biventricular paced rhythm being observed after the effective shock therapy.

Thrombus formation as a complication of orthotopic heart transplantation (OHT) is considered uncommon and classically related to biatrial technique. Nevertheless, no studies have addressed this issue after the incorporation of bicaval technique. Multidetector computed tomography (MDCT) is a noninvasive technique that is used by some centers as a screening tool for cardiac allograft vasculopathy (CAV) in heart transplant recipients, which also allows to detect extracoronary associated pathology.Objective: We sought to determine the prevalence of AT detected by MDCT among a contemporary heart transplant cohort and to evaluate potential predictors for its development. We conducted a retrospective analysis including patients transplanted between 1989-2019 in which CAV monitoring was carried out using MDCT per protocol after the second year. Baseline characteristics and MDCT findings were retrospectively collected and patients were classified by the presence of AT. 114 heart transplant patients were included (mean age at transplantation 47 ± 15 years, 65% male), bicaval surgery was the most used method (88%, 100 patients). A total of 232 MDCT were performed, with a mean post-transplant follow-up of 9 ± 7 years.The prevalence of AT in our sample was 6% (N=7), with a female predominance (57%) and a mean follow-up from heart transplant until AT diagnosis of 10 ± 2 years. 6 patients were in sinus rhythm and non-anticoagulated at the moment of diagnosis, one patient had been diagnosed with atrial flutter. Recipients with AT were older (69 years vs 55 years; p<0.01) and had greater atrial enlargement (left atrial median volume 99.7ml vs 83.9 ml, p=0.02). HT recipients with AT had higher prevalence of hypertension (57% vs 24%, p=0.08), diabetes (14% vs 9%, p=0.51), post-transplant stroke (14% vs 5%, p=0.34) and standard surgery technique (14% vs 7%, p=0.46), although no statistical differences were found in the univariate analysis. Interestingly, a common heart disease that led to transplantation in the AT cohort group was rheumatic valve disease, with a higher proportion than the non-thrombosis cohort (29% vs 2%, p<0.01). Thrombus formation may not be as uncommon as it is believed, with up to 6% of heart transplant recipients with AT in our sample. MDCT in the follow-up of heart transplantation may supply additional information beyond CAV, with clinical implications. [ABSTRACT FROM AUTHOR]

There is a clear need for a non-invasive biomarker that could allow surveillance of acute cellular rejection (ACR) without the need of repeated endomyocardial biopsies (EMB) in heart transplant (HT) recipients. Donor-derived cell-free DNA (dd-cfDNA) is currently under study for this purpose. This was a multicenter, observational, prospective study. According to protocol, all patients included underwent surveillance EMB at 15 days, 1, 2, 3, 4, 6 and 12 months post-HT. Dd-cfDNA levels were determined prior to each EMB, using Next Generation Sequencing technology (Allonext® assay, Eurofins Genome). Primary end-point was the association between dd-cfDNA levels and the presence of ACR, as determined by ISHLT 2004 classification. We herein report the results of the first 848 pairs of EMB-dd-cfDNA determinations. The cohort included 206 recipients from 12 different centers (mean age 54 ± 11 years, 73% male). ACR, defined as grade ≥2R, was present in 35 EMB (4.1%), and AMR ≥1 in 14 EMB (1.7%). Median dd-cfDNA values for each ACR group were: 0R 0.088% (0.038-0.22), 1R 0.15% (0.056-0.4), 2R 0.23% (0.06-0.6) and 3R 0.6%. AMR0 median (IQR) values were 0.1% (0.04-0.24), and AMR≥1, 0.2% (0.075-0.7), respectively. In order to reduce the skewness, %ddcfDNA was logtransformed as log2(x+0.01) (Figure 1A). Using a GEE (generalized estimating equation) model, we found a statistically significant association between %dd-cfDNA and ACR ≥2R (OR 1.23, IQR 1.04-1.45), p <0.01 (Figure 1B). A 0.15% ddcf-DNA threshold revealed a negative predictive value of 97%, and could allow to save 57% of surveillance EMB. Dd-cfDNA appears to be an excellent biomarker for acute cellular rejection. Its high negative predictive value could allow to eliminate the need to perform a significant percentage of surveillance EMB currently performed in HT recipients. [ABSTRACT FROM AUTHOR]