Search

Right heart catheterization remains necessary for the diagnosis of pulmonary hypertension and, therefore, for the prognostic evaluation of patients with chronic heart failure. The non-invaSive Assessment of Pulmonary vasculoPathy in Heart failure (SAPPHIRE) study was designed to assess the feasibility and prognostic relevance of a non-invasive evaluation of the pulmonary artery vasculature in patients with heart failure and pulmonary hypertension. Patients will undergo a right heart catheterization, cardiac resonance imaging, and a pulmonary function test in order to identify structural and functional parameters allowing the identification of combined pre- and postcapillary pulmonary hypertension, and correlate these findings with the hemodynamic data.

Background: Osteoporosis is a prevalent complication in heart transplant population. Denosumab is a monoclonal antibody that inhibits bone resorption approved for the treatment of corticosteroid-induced osteoporosis and potentially useful in heart transplant recipients. Objective: To describe the metabolic and densitometric effects of denosumab in these patients, as well as the adverse effects observed. Methods: We performed a study of 9 transplant patients between 2014 and 2019 who were treated with denosumab for osteopenia or osteoporosis. All patients received postoperative calcium and vitamin D supplements. We measured the changes in densitometric and metabolic variables and compared them by Student's t-test. Results: After therapy, bone mineral density (BMD) and Tscore at lumbar spine improved a mean of 0.0458 and 0.5000, respectively (p

Telemonitoring through multiple variables measured on cardiac devices has the potential to improve the follow-up of patients with heart failure. The HeartLogic algorithm (Boston Scientific), implemented in some implantable cardiac defibrillators and cardiac resynchronisation therapy, allows monitoring of the nocturnal heart rate, respiratory movements, thoracic impedance, physical activity and the intensity of heart tones, with the aim of predicting major clinical events. Although HeartLogic has demonstrated high sensitivity for the detection of heart failure decompensations, its effects on hospitalisation and mortality in randomised clinical trials has not yet been corroborated. This review details how the HeartLogic algorithm works, compiles available evidence from clinical studies, and discusses its application in daily clinical practice.

To the Editor, Moderate-to-severe aortic regurgitation (AR) is a common complication of patients treated with continuous-flow left ventricular assist devices (CF-LVAD) that affects 35% of these patients at 5 years.1 The risk factors associated with its appearance are the absence of valvular opening, the time of progression, the presence of aortic or mitral regurgitation prior to implantation, and female sex.2 AR causes left ventricular overload and inefficient recirculation flow through the pump. Observational studies have reported that post-implantation AR is not associated with a higher mortality rate. However, it has been reported that the cardiac function deteriorates requiring some type of procedure in 33% of the patients who develop it.3 The implantation of percutaneous devices, in particular transcatheter aortic valve implantation (TAVI), has become the therapeutic alternative in this subgroup of patients in whom surgery is ill-advised because of their risk and possible future procedures.4 Although evidence is scarce on this regard, it has been described as an effective technique with disappearance of significant AR after the procedure and in the mid-term follow-up.5 This is the case of a 54-year-old woman with idiopathic dilated cardiomyopathy in situation of advanced heart failure who received the Heartmate III CF-LVAD (Abbot, Chicago, United States) as the...

La insuficiencia aórtica (IA) moderada-grave es una complicación frecuente en los pacientes tratados con dispositivos de asistencia ventricular de flujo continuo (DAVI-FC), que afecta al 35% de ellos a 5 años1. Los factores de riesgo para su aparición son la ausencia de apertura valvular, el tiempo de evolución, la presencia de IA o de insuficiencia mitral previa al implante y el sexo femenino2. La IA provoca sobrecarga del ventrículo izquierdo y flujo recirculante ineficiente a través de la bomba. Los estudios observacionales han descrito que la IA tras el implante no se asocia a mayor mortalidad. Sin embargo, se ha relacionado con un empeoramiento de la insuficiencia cardiaca y es preciso realizar alguna intervención en el 33% de los pacientes que la desarrollan3. El implante de dispositivos percutáneos, en concreto de prótesis valvulares aórticas transcatéter (TAVI), ha surgido como alternativa terapéutica en este subgrupo de pacientes en los que, por su riesgo y la posibilidad de futuras intervenciones, es recomendable evitar procedimientos quirúrgicos4. Pese a que la evidencia es limitada, se ha descrito como una técnica eficaz con desaparición de la IA significativa tras el procedimiento y en el seguimiento a medio plazo5. Presentamos el caso de una mujer de 54 años...

Introduction: Heart transplant (HT) survival has barely improved in the last decades, which is unsatisfactory for many HT recipients. The development of anti-human leukocyte antigen (anti-HLA) antibodies in HT patients is associated with a cardiac allograft dysfunction. The mechanisms leading to this damage are unclear. The Multimodality Evaluation Of Antibody-Mediated Injury In Heart Transplantation (LEONE-HT) study aimed to thoroughly describe the damage inflicted on the myocardium by anti-HLA antibodies. Methods and analysis: The LEONE-HT study is a cohort study with a cross-sectional approach in which HT patients with positive anti-HLA antibodies are compared with coetaneous HT patients with negative anti-HLA antibodies. All patients will undergo a state-of-the-art multimodal assessment, including imaging techniques, coronary anatomy and physiology evaluations and histological and immunological analyses. The individual and combined primary outcomes of structural graft injuries and longitudinal secondary outcomes are to be compared between the exposed and non-exposed groups with univariate and multivariable descriptive analyses. Ethics and dissemination: The LEONE-HT study is carried out in accordance with the principles set out in the Declaration of Helsinki and the International Conference on Harmonization guidelines for good clinical practice and following national laws and regulations. The study design, objectives and participant centers have been communicated to clinicaltrials.gov (NCT05184426). The LEONE-HT study counts on the support of patient associations to disseminate the objectives and results of the research. This study was funded by the Spanish Ministry of Science and Innovation and the Spanish Society of Cardiology.