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This study research the anatomopathological injuries and the number of mast cells in 51 confiscated calf livers in a major slaughterhouse in the south-east of Spain. The microscopic analysis was realized with hematoxylin-eosin (H-E) and Masson's Trichrome (CRT) stains. Furthermore, the number of mast cells was determined based on their pathologies, using toluidine blue staining, counting in 10 fields of 348 x 263 µm at 40x in each of the samples and with the SPSS statistical program and the Kolmogorov-Smirnov and Mann-Whitney tests compared with 5 control livers. The pathological lesions of confiscation were: abscesses (47%), cholangiohepatitis (31%), fibrosis (8%), steatosis (6%), atrophy (2%), necrosis (2%), congestion (2%) and cyst (2%). Classifying into inflammatory lesions (49%), parasitic lesions (33%) and degenerative-metabolic lesions (18%). The results conclude that there are significant differences in the number of mast cells in livers with cholangiohepatitis (p 0,001) compared with control livers and there are no significant differences in livers with abscesses (p 0,227). When classifying the pathological alterations by families, there are no significant differences in the inflammatory alterations when compared them with the control group and there are differences in the parasitic alterations. Degenerative alterations show significative differences, but the number of samples collected is scarce. Este estudio aborda las alteraciones anatomopatológicas y el número de mastocitos en 51 hígados de ternero decomisados en un matadero importante del sur-este de España. El análisis microscópico se ha realizado con las tinciones hematoxilina-eosina (H-E) y Tricrómico de Masson (TRC). Además, se determinó el número de mastocitos en función de sus patologías, mediante la tinción azul de toluidina, haciendo un conteo en 10 campos de 348 x 263 µm a 40x en cada una de las muestras. Con el programa estadístico SPSS y las pruebas estadísticas Kolmogorov-Smirnov y Mann-Whitney se ha hecho una comparación con 5 hígados control. Las lesiones anatomopatológicas causantes de decomiso han sido: abscesos (47%), colangiohepatitis (31%), fibrosis (8%), esteatosis (6%), atrofia (2%), necrosis (2%), congestión (2%) y quiste (2%). Clasificándose en lesiones inflamatorias (49%), lesiones parasitarias (33%) y lesiones degenerativo-metabólicas (18%). Los resultados del conteo de mastocitos muestran que hay diferencias significativas en el número de mastocitos de los hígados con colangiohepatitis (p 0,001), respecto a los hígados control y no hay diferencias significativas en los hígados con abscesos (p 0,227). Al hacer una clasificación por familias de las alteraciones anatomopatológicas estudiadas se ha llegado a la conclusión de que no hay diferencias significativas en las alteraciones inflamatorias al compararlas con el grupo control y sí las hay en las alteraciones parasitarias. Las alteraciones degenerativas también muestran diferencias significativas, pero el número de muestras recogidas es bajo.

The Antarctic Peninsula is a region of the world where drastic impacts of climate change have been observed over the past few years, leading the communities inhabiting this area to adapt to new conditions. This is reflected in changes to the composition and abundance of pelagic species, especially zooplankton, which constitute the main food source for the trophic web supporting the ecosystem in this region. In this study, we compared the composition, abundance, and spatial distribution of meso- and macro-zooplankton and how they relate to the oceanographic conditions of the Bransfield Strait and the area surrounding Elephant Island, Antarctic Peninsula, during the 2019–2020 austral summer. The community was represented by three groups: small-sized copepods such as Oithona similis and Ctenocalanus citer, salps such as Salpa thompsoni, and the Euphausiacea. Euphausiacea showed an important decrease in composition and abundance and was only represented by Euphausia superba and Thysanoessa macrura. An increase in the abundance and distribution of S. thompsoni was observed over the entire study area, as well as positive SST anomalies, which possibly favored the increase in the S. thompsoni population, as well as the decrease and displacement of Euphausiacea adults and juveniles. If, as climate models predict, increases in temperatures keep occurring, our results reflect the scenario that will prevail for zooplankton in the Antarctic Peninsula, with effects on distribution and abundance that will lead to the dominance of species that are more successful in warmer conditions.

Resumen La hipertension pulmonar es un trastorno hemodinamico definido por el aumento anomalo de la presion arterial pulmonar, que puede presentarse en numerosas enfermedades y situaciones clinicas. Las causas de hipertension pulmonar se clasifican en 5 grandes grupos: arterial, debida a cardiopatia izquierda, debida a enfermedad pulmonar y/o hipoxemia, tromboembolica cronica y de mecanismo no establecido y/o multifactorial. El presente documento expone de forma resumida las recomendaciones de la Guia de Diagnostico y Tratamiento de la Hipertension Pulmonar de la Sociedad Espanola de Neumologia y Cirugia Toracica. En dicha guia se presentan las pautas actuales de diagnostico y tratamiento de los distintos grupos de hipertension pulmonar.

Background: This article will review different materials for the treatment of pulps of primary and young permanent teeth. However, innovations in materials and advances in biology suggest that there may soon be a convergence of therapies for teeth of either dentition needing pulp treatment. Objectives: The objective of this study was evaluated the pulp and liver response to biocompatible agents such as lyophilized bone in comparison with classical formocresol. Materials and Methods: Treatment was applied to the upper right and left first molar of each animal, for a total of 120 teeth. Six groups were established according to the agent used and the time elapsed (30, 45 and 60 days). In each group five livers were selected, and a control group subjected to no treatment was also evaluated. At the end of the study the rats were sacrificed and the samples were processed for histological evaluation. Analysis of variance (ANOVA) for repeated measures was used. Results: Dentinal bridge formation and reparative dentin reached higher values in the group treated with lyophilized bone. The formocresol treatment group showed increased inflammation and necrosis. Conclusions: Lyophilized bone afforded improved pulp tissue response. No histological evidence of liver damage was observed in any of the hepatic samples studied.

[EN] Pulmonary hypertension is a hemodynamic disorder defined by abnormally high pulmonary artery pressure that can occur in numerous diseases and clinical situations. The causes of pulmonary hypertension are classified into 5 major groups: arterial, due to left heart disease, due to lung disease and/or hypoxemia, chronic thromboembolic, with unclear and/or multifactorial mechanisms. This is a brief summary of the Guidelines on the Diagnostic and Treatment of Pulmonary Hypertension of the Spanish Society of Pulmonology and Thoracic Surgery. These guidelines describe the current recommendations for the diagnosis and treatment of the different pulmonary hypertension groups., [ES] La hipertensión pulmonar es un trastorno hemodinámico definido por el aumento anómalo de la presión arterial pulmonar, que puede presentarse en numerosas enfermedades y situaciones clínicas. Las causas de hipertensión pulmonar se clasifican en 5 grandes grupos: arterial, debida a cardiopatía izquierda, debida a enfermedad pulmonar y/o hipoxemia, tromboembólica crónica y de mecanismo no establecido y/o multifactorial. El presente documento expone de forma resumida las recomendaciones de la Guía de Diagnóstico y Tratamiento de la Hipertensión Pulmonar de la Sociedad Española de Neumología y Cirugía Torácica. En dicha guía se presentan las pautas actuales de diagnóstico y tratamiento de los distintos grupos de hipertensión pulmonar.

Cardiac allograft vasculopathy (CAV) is a major cause of long-term morbidity and mortality after heart transplantation (HTx), whose relationship with CMV infection is uncertain. This study evaluated the influence of CMV infection in the development of CAV.We enrolled 166 consecutive HTx recipients who underwent their first transplant from January 1995 to July 2002. All patients received 14 days of intravenous ganciclovir and were prospectively monitored for CMV infection during the first year after HTx. CAV was diagnosed by coronary angiography performed at 1, 5, and 10 years after HTx, following the new criteria of the International Society for Heart and Lung Transplantation. We collected all variables potentially related with the development of CAV. Risk factors were studied using a complementary log-log model.After a median follow-up of 11 years (range, 1-17 years), 72 patients (43%) developed CAV (63.8% CAV(1), 15.2% CAV(2), 20.8% CAV(3)). Symptoms secondary to CAV were present in 32% of these patients, and 8% died because of it. In the regression multivariate analysis, independent variables associated with the development of CAV were donor age (hazard ratio [HR], 1.028; 95% confidence interval [CI], 1.002-1.053; p0.028), presence of cellular acute rejection ≥ 2R (HR, 1.764; 95% CI, 1.011-3.078; p0.0414), CMV infection (HR, 2.334; 95% CI, 1.043-5.225; p0.0354), and not having been treated with a calcium channel blocker (HR, 0.472; 95% CI, 0.275-0.811; p0.0055).Standardized angiographic criteria show CMV infection is associated with the development of CAV.

Background The Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) risk score (RRS) calculator was developed using data derived from the REVEAL registry, and predicts survival in patients with pulmonary arterial hypertension (PAH) based on multiple patient characteristics. Herein we applied the RRS to a pivotal PAH trial database, the 12-week PATENT-1 and open-label PATENT-2 extension studies of riociguat . We examined the effect of riociguat vs placebo on RRS in PATENT-1, and investigated the prognostic implications of change in RRS during PATENT-1 on long-term outcomes in PATENT-2. Methods RRS was calculated post hoc for baseline and Week 12 of PATENT-1, and Week 12 of PATENT-2. Patients were grouped into risk strata by RRS. Kaplan–Meier estimates were made for survival and clinical worsening-free survival in PATENT-2 to evaluate the relationship between RRS in PATENT-1 and long-term outcomes in PATENT-2. Results A total of 396 patients completed PATENT-1 and participated in PATENT-2. In PATENT-1, riociguat significantly improved RRS (p = 0.031) and risk stratum (p = 0.018) between baseline and Week 12 compared with placebo. RRS at baseline, and at PATENT-1 Week 12, and change in RRS during PATENT-1 were significantly associated with survival (hazard ratios for a 1-point reduction in RRS: 0.675, 0.705 and 0.804, respectively) and clinical worsening-free survival (hazard ratios of 0.736, 0.716 and 0.753, respectively) over 2 years in PATENT-2. Conclusions RRS at baseline and Week 12, and change in RRS, were significant predictors of both survival and clinical worsening-free survival. These data support the long-term predictive value of the RRS in a controlled study population.

[Abstract] BACKGROUND: New biomarkers are necessary to improve detection of the risk of infection in heart transplantation. We performed a multicenter study to evaluate humoral immunity profiles that could better enable us to identify heart recipients at risk of severe infections. METHODS: We prospectively analyzed 170 adult heart recipients at 8 centers in Spain. Study points were before transplantation and 7 and 30 days after transplantation. Immune parameters included IgG, IgM, IgA and complement factors C3 and C4, and titers of specific antibody to pneumococcal polysaccharide antigens (anti-PPS) and to cytomegalovirus (CMV). To evaluate potential immunologic mechanisms leading to IgG hypogammaglobulinemia, before heart transplantation we assessed serum B-cell activating factor (BAFF) levels using enzyme-linked immunoassay. The clinical follow-up period lasted 6 months. Clinical outcome was need for intravenous anti-microbials for therapy of infection. RESULTS: During follow-up, 53 patients (31.2%) developed at least 1 severe infection. We confirmed that IgG hypogammaglobulinemia at Day 7 (defined as IgG

Background— Chronic thromboembolic pulmonary hypertension, a rare complication of acute pulmonary embolism, is characterized by fibrothrombotic obstructions of large pulmonary arteries combined with small-vessel arteriopathy. It can be cured by pulmonary endarterectomy, and can be clinically improved by medical therapy in inoperable patients. A European registry was set up in 27 centers to evaluate long-term outcome and outcome correlates in 2 distinct populations of operated and not-operated patients who have chronic thromboembolic pulmonary hypertension. Methods and Results— A total of 679 patients newly diagnosed with chronic thromboembolic pulmonary hypertension were prospectively included over a 24-month period. Estimated survival at 1, 2, and 3 years was 93% (95% confidence interval [CI], 90–95), 91% (95% CI, 87–93), and 89% (95% CI, 86–92) in operated patients (n=404), and only 88% (95% CI, 83–91), 79% (95% CI, 74–83), and 70% (95% CI, 64–76) in not-operated patients (n=275). In both operated and not-operated patients, pulmonary arterial hypertension–targeted therapy did not affect survival estimates significantly. Mortality was associated with New York Heart Association functional class IV (hazard ratio [HR], 4.16; 95% CI, 1.49–11.62; P =0.0065 and HR, 4.76; 95% CI, 1.76–12.88; P =0.0021), increased right atrial pressure (HR, 1.34; 95% CI, 0.95–1.90; P =0.0992 and HR, 1.50; 95% CI, 1.20–1.88; P =0.0004), and a history of cancer (HR, 3.02; 95% CI, 1.36–6.69; P =0.0065 and HR, 2.15; 95% CI, 1.18–3.94; P =0.0129) in operated and not-operated patients, respectively. Additional correlates of mortality were bridging therapy with pulmonary arterial hypertension–targeted drugs, postoperative pulmonary hypertension, surgical complications, and additional cardiac procedures in operated patients, and comorbidities such as coronary disease, left heart failure, and chronic obstructive pulmonary disease in not-operated patients. Conclusions— The long-term prognosis of operated patients currently is excellent and better than the outcome of not-operated patients.

A pulmonary hypertension (PH) registry (Spanish Registry of Pulmonary Arterial Hypertension) was undertaken to analyse prevalence, incidence and survival of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) in Spain, and to assess the applicability of recent survival prediction equations. Voluntary reporting of previously diagnosed and incident PAH or CTEPH cases (July 2007-June 2008) was performed. Demographic, functional and haemodynamic variables were evaluated. 866 patients with PAH and 162 with CTEPH were included. PAH associated with toxic oil syndrome and pulmonary veno-occlusive disease were reported for the first time in a PAH registry. Estimated prevalences were as follows: PAH, 16 and CTEPH, 3.2 cases per million adult inhabitants (MAI). Estimated incidences were as follows: PAH, 3.7 and CTEPH, 0.9 cases per MAI per yr. 1-, 3- and 5-yr survival was 87%, 75% and 65%, respectively, with no differences between PAH and CTEPH. Male sex, right atrial pressure and cardiac index were independent predictors of death. Matching between observed survival and that predicted by different equations was closer when the characteristics of the cohorts were similar. Epidemiology and survival of PAH patients in the Spanish registry are similar to recent registries. Characteristics of the population from which survival prediction equations are derived influence their applicability to a different cohort. CTEPH is much less prevalent than PAH, although has a similar survival rate.

The emergence of new technologies is providing opportunities to develop novel solutions that facilitate the integration of visually impaired people in different activities of our daily life. This paper presents a distributed intelligent architecture, called DIAMI, focused on facilitating the integration of blind musicians into orchestras. The DIAMI architecture provides a distributed, ubiquitous system aimed at providing a way for blind musicians to receive instructions from the orchestra conductor in an unobtrusive manner. The structure of the DIAMI architecture and the preliminary results obtained are presented in detail within this paper.

The longer survival of patients with heart transplantation (HT) favors calcineurin inhibitor-related chronic kidney disease (CKD). It behoves to identify risk factors. At 14 Spanish centers, data on 1062 adult patients with HT (age 59.2 ± 12.3 yr, 82.5% men) were collected at routine follow-up examinations. Glomerular filtration rate, GFR, was estimated using the four-variable MDRD equation, and moderate-or-severe renal dysfunction (MSRD) was defined as K/DOQI stage 3 CKD or worse. Time since transplant ranged from one month to 22 yr (mean 6.7 yr). At assessment, 26.6% of patients were diabetic and 63.9% hypertensive; 53.9% were taking cyclosporine and 33.1% tacrolimus; and 61.4% had MSRD. Among patients on cyclosporine or tacrolimus at assessment, multivariate logistic regression identified male sex (OR 0.44), pre- and post-HT creatinine (2.73 and 3.13 per mg/dL), age at transplant (1.06 per yr), time since transplant (1.05 per yr), and tacrolimus (0.65) as independent positive or negative predictors of MSRD. It is concluded that female sex, pre- and one-month post-HT serum creatinine, age at transplant, time since transplant, and immunosuppression with cyclosporine rather than tacrolimus may all be risk factors for development of CKD ≥ stage 3 by patients with HT.

Objective.Pulmonary arterial hypertension (PAH) prevalence has been reported to be between 0.5% and 17% in systemic lupus erythematosus (SLE). This study assessed PAH prevalence and predictors in an SLE cohort.Methods.The Borg dyspnea scale, DLCO, N-terminal pro–brain natriuretic peptide (NT-proBNP), and Doppler echocardiographic (DE) were performed. An echocardiographic Doppler exercise test was conducted in selected patients. When DE systolic pulmonary arterial pressure was ≥ 45 mmHg or increased during exercise > 20 mmHg, a right heart catheterization was performed. Hemodynamic during exercise was measured if rest mean pulmonary arterial pressure was < 25 mmHg.Results.Of the 203 patients with SLE, 152 were included. The mean age was 44.9 ± 12.3 years, and 94% were women. Three patients had known PAH. The algorithm diagnosed 1 patient with chronic thromboembolic pulmonary hypertension and 5 with exercise-induced pulmonary artery pressure increase (4 with occult left diastolic dysfunction). These patients had significantly more dyspnea, higher NT-proBNP, and lower DLCO.Conclusion.These data confirm the low prevalence of PAH in SLE. In our cohort, occult left ventricular diastolic dysfunction was a frequent diagnosis of unexplained dyspnea. Dyspnea, DLCO, and NT-proBNP could be predictors of pulmonary hypertension in patients with SLE.

Fundamento y objetivo Los pacientes con sindrome del aceite toxico son una poblacion de riesgo de padecer hipertension arterial pulmonar. La elevacion anomala de la presion sistolica pulmonary (PSP) durante el ejercicio podria considerarse un marcador temprano de hipertension pulmonar en poblaciones de riesgo. El objetivo del presente estudio ha sido analizar mediante ecocardiografia la respuesta de la PSP al ejercicio en pacientes con sindrome del aceite toxico. Pacientes y metodo Se estudio a 50 pacientes con sindrome del aceite toxico y a 20 voluntarios sanos con ecocardiograma en reposo y en el maximo ejercicio (cicloergometro semisupino) y se midio la PSP. En los pacientes se determino la capacidad de difusion de monoxido de carbono. Resultados No se observaron diferencias en el valor medio de la PSP en el ejercicio entre los pacientes y los voluntarios sanos. En un 8% de los primeros se observo un valor igual o superior a 80 mmHg, lo que se asocio a hipertension pulmonar leve en reposo, disminucion de la funcion ventricular derecha y trastornos de la difusion pulmonar. Un valor de corte de la PSP en reposo igual o superior a 27 mmHg tuvo una sensibilidad del 100% y una especificidad del 71% para predecir una PSP pico de 80 mmHg o superior. Conclusiones Una minoria de pacientes con sindrome del aceite toxico muestra hipertension pulmonar grave con el ejercicio. Este tipo de respuesta anormal se asocia a otros marcadores de vasculopatia pulmonar. Futuros estudios han de esclarecer la relacion entre estas anomalies y el riesgo de desarrollar ulteriormente hipertension arterial pulmonar.

To identify the clinical factors associated with acute rejection (AR) in the first year after heart transplantation (HT), we analysed 112 patients. All patients received OKT3 and standard triple-drug therapy. We analysed the following variables to determine their relationship with AR: age and gender, panel-reactive antibodies, HLA-DR mismatch, use of Sandimmune vs Neoral, diltiazem administration, and cyclosporine levels in week 2 and months 1, 2, and 3 after HT. Fifty-two patients had no AR and 49 had at least one episode. The variables independently associated with absence of AR were diltiazem administration (odds ratio 0.306, confidence limit 0.102-0.921) and cyclosporine level in the first month after HT (odds ratio 0.996, confidence limit 0.992-0.999). Furthermore, a cyclosporine level greater than 362 ng/ml in the first month predicted the absence of AR. In conclusion, a cyclosporine level greater than 362 ng/ml and diltiazem administration in the first month after HT reduce AR during the first year. Both cyclosporine level and diltiazem show a large and independent protective effect.

Introduction. Primary pulmonary hypertension and its associated forms is a progressive and often fatal disease, the course of which has been favourably modified by prostacyclin therapy in the last decade. Objective. The aim of this study is to analize retrospectively the efficacy of continuous intravenous epoprostenol (synthetic prostacyclin) therapy in pulmonary arterial hypertension, and to compare it with conventional therapy (anticoagulants, digoxin and diuretics). Methods. Between 1990-2000, 31 patients with severe precapillary pulmonary hypertension in functional class III or IV went on continuous intravenous epoprostenol therapy, administered by a portable infusion pump through a Hickman catheter. We compared their survival with a group of 16 patients treated with conventional therapy alone. Results. Time of follow-up was 33.25 months in the prostacyclin group and 20 months in the conventional group. The one- three- and five- year survival rates were 86%, 50% and 38% respectively for patients treated with epoprostenol compared with 40%, 40% and 8% survival rates at idetical periods for patients treated conventionally (p = 0,02). Functional class and the mean distance walked in the 6 minutes test were improved in patients treated with prostacyclin (p < 0,01). Serious complications attributable to the delivery system included 3 deaths, mainly due to infection. Conclusion. Continuous intravenous epoprostenol therapy improves survival and exercise capacity in patients with severe pulmonary arterial hypertension despite potentially serious complications attributable to the delivery system.

Background: Pulmonary hypertension is a risk factor for early mortality after transplantation, but the risk threshold is debated. Also, little is known about the evolution of pulmonary circulation after transplantation. The aim of this study was to determine the influence of current risk pulmonary pressure parameters on early post-operative mortality and to assess the time-related changes in pulmonary pressure after surgery. Methods: One hundred twelve consecutive transplanted patients were studied retrospectively to determine the influence of trans-pulmonary gradient of >12 mm Hg and pulmonary vascular resistance of >2.5 Wood units, at baseline or after vasodilator test, on early mortality. A multivariate analysis was used to study the hemodynamic parameters associated with early mortality. The pulmonary pressures of all surviving patients were studied for up to 3 years after surgery. Results: Early mortality in the groups with and without pulmonary hypertension were 24.4% and 5.6%, respectively ( p = .009). The only variable that was independently associated with early mortality was the pulmonary vascular resistance index (odds ratio=1.459). Mild pulmonary hypertension disappeared 1 year after heart transplantation. Conclusions: Mild pulmonary hypertension is a risk factor for early postoperative mortality. The hemodynamic parameter most closely associated with early mortality is pulmonary vascular resistance index. The hemodynamic profile of pulmonary circulation after heart transplantation is partially dependent on the level of pulmonary hypertension before transplantation, at least during the first year after surgery.

Background. Standard orthotopic heart transplantation produces important anatomic and functional atrial alterations with subsequent thrombotic risk. Therefore the aim of this study was to analyze the prevalence and evolution of spontaneous echocardiography, atrial thrombi and embolic events. Patients and method. 52 consecutive transplanted patients were analyzed with transesophageal echocardiography and hemodynamic studies performed at 15 days and one year after transplantation. Results. Spontaneous echocardiography contrast was present in 27 patients (52%). Ten atrial thrombi were observed (19.2%), 9 with spontaneous echocardiography contrast. Six atrial thrombi appeared on day 15 and 4 after one year (with spontaneous echocardiography contrast on the previous study). Using multiple logistic regression analysis left atrial size was the only independent predictor factor for spontaneous echocardiography contrast (OR = 1.27; 95% CI, 1.09-1.54) and was an important predictor factor of atrial thrombi formation (OR = 1.19; 95% CI, 1.04-1.42). Likewise, the main predictor of atrial thrombi was the presence of spontaneous echocardiography contrast (OR = 116; 95% CI, 8.4-999). The hemodynamic pattern did not predict either the presence of spontaneous echocardiography contrast or atrial thrombi. The global incidence of embolic events was 4% less than previously described. Conclusions. The incidence of atrial thrombi and spontaneous echocardiographic contrast after standard orthotopic heart transplantation was 19.2% and 52%, respectively. An enlarged atrium and/or spontaneous echocardiography contrast was found to increase the risk of atrial thrombi. Considering the dynamic nature of atrial thrombi formation, periodical transesophageal echocardiography studies are recommended after heart transplantation.

Background— By its inhibitory effect on platelet-derived growth factor signaling, imatinib could be efficacious in treating patients with pulmonary arterial hypertension (PAH). Methods and Results— Imatinib in Pulmonary Arterial Hypertension, a Randomized, Efficacy Study (IMPRES), a randomized, double-blind, placebo-controlled 24-week trial, evaluated imatinib in patients with pulmonary vascular resistance ≥800 dyne·s·cm −5 symptomatic on ≥2 PAH therapies. The primary outcome was change in 6-minute walk distance. Secondary outcomes included changes in hemodynamics, functional class, serum levels of N-terminal brain natriuretic peptide, and time to clinical worsening. After completion of the core study, patients could enter an open-label long-term extension study. Of 202 patients enrolled, 41% patients received 3 PAH therapies, with the remainder on 2 therapies. After 24 weeks, the mean placebo-corrected treatment effect on 6-minute walk distance was 32 m (95% confidence interval, 12–52; P =0.002), an effect maintained in the extension study in patients remaining on imatinib. Pulmonary vascular resistance decreased by 379 dyne·s·cm −5 (95% confidence interval, −502 to − 255; P Conclusions— Imatinib improved exercise capacity and hemodynamics in patients with advanced PAH, but serious adverse events and study drug discontinuations were common. Further studies are needed to investigate the long-term safety and efficacy of imatinib in patients with PAH. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00902174 (core study); NCT01392495 (extension).

Objective: To determine the acute vasodilator effect of sublingual sildenafil in heart transplant candidates with severe pulmonary hypertension due to severe left ventricular dysfunction (LVD). Background: Pulmonary hypertension confers an increased risk of early graft failure. Patients and methods: Seven patients, (mean age of 53±8) with severe LVD (mean EF: 19±1.7%, functional class III–IV) due to coronary artery disease, dilated cardiomyopathy and valvulopathy were evaluated for heart transplant. All patients presented a mean transpulmonary gradient >12 mmHg and pulmonary vascular resistances >2.5 W.U., despite full treatment for advanced heart failure. The following hemodynamic data were obtained at basal state and then 15, 30 and 45 min after administration of 100 mg of sublingual sildenafil: right atrial, mean pulmonary artery pressure (mPAP), mean pulmonary capillary wedge pressures, mean transpulmonary gradient (mTPG), blood pressure, cardiac output, pulmonary vascular resistances (PVR) and systemic vascular resistances. Sublingual sildenafil was given without changing the previous treatment of heart failure. Results: After 30 min of sublingual sildenafil, mPAP decreased from 37 (28–61) to 30 (16–42) mmHg and PVR decreased from 5.2 (1.9–13.8) to 2.5 (1.4–3.9) W.U. after 45 min. Mean TPG decreased from 19 (16–33) to 12 (8–14) mmHg at 45 min. Mean pulmonary capillary wedge pressure, cardiac output, systemic vascular resistances and mean blood pressure were unchanged. Sublingual sildenafil was well tolerated, with only transient facial flushing in 4 patients and mild headache in 2. Conclusions: Based on this initial study, sublingual sildenafil may be a useful alternative drug to perform acute vasodilator test in heart transplant candidates with significant pulmonary hypertension due to severe LVD. Nevertheless, further studies are warranted to confirm our results.

Objective To compare the effects of calcitonin, etidronate, and alendronate in preventing bone loss during the first 2 years after heart transplant. Methods A total of 222 heart transplant recipients (mean [SD] age, 52.4 [10] years, 85% male) were evaluated. Patients with normal bone mineral density (reference group, n = 102) received 1000 mg/d calcium plus 800 IU/d vitamin D3. The rest were assigned to 200 IU/d of calcitonin (n = 42), 400 mg/d etidronate orally for 14 days quarterly (n = 33), or 10 mg/d alendronate (n = 45). All patients received calcium and vitamin D. Bone mineral density was assessed by dual-energy x-ray absorptiometry in the lumbar spine, the entire femur, and the femoral neck at baseline and 6, 12, and 24 months after transplant. Results At 2 years after transplant, bone mineral density in the lumbar spine had decreased in the reference group (−3.07%), calcitonin group (−0.93%), and etidronate group (−1.87%) but not in the alendronate group (+4.9%; P < .001). After 2 years, bone mineral density in the entire femur decreased in all groups (−3.2% in the reference group, −3.6% in the calcitonin group, −4.6% in the etidronate group, and −0.5% in the alendronate group) but bone loss was significantly lower in the alendronate group ( P < .001). Bone mineral density in the femoral neck also decreased in all groups. The incidence of vertebral fractures did not differ among groups. Adverse events were similar between groups. Conclusions Alendronate therapy in heart transplant recipients was associated with a significant increase in bone mineral density in the lumbar spine and less bone loss at the hip.

In this article we describe a real and practical mobile solution called Touch Me. This smart mobility project is based on NFC (Near Field Communication) technology. It is implemented for Android phones and has been tested by older and blind people. After a few tests we believe that this kind of software is a new and easier way for accessibility. It is especially useful for identifying and describing objects. The user simply has to touch the object with the smartphone and then listen an audio description of its content. To make this possible it is necessary to attach NFC smart tags to the object and to write the description on it using another mobile application, called Write Me Description. In addition, Touch Me can be used to manage basic functions of a smartphone like making a call or launching an application. In this case we need to combine this software with a personalized pad that must include smart tags. To configure these tags we need another two applications, called Write Me Contact and Write Me App.

A 51-year-old woman presented with a one-year history of progressive dyspnea, WHO functional class III-IV and exercise-related syncope. Transthoracic echocardiography and computed tomography pulmonary angiography were performed, leading to a diagnosis of pulmonary arterial hypertension. She was referred to our pulmonary hypertension unit, where a complete study was performed, including ventilation/perfusion scan, which was consistent with chronic thromboembolic pulmonary hypertension. Risk factors for this condition were excluded and therapeutic options were evaluated. Imaging studies showed distal pulmonary disease so pulmonary endarterectomy was rejected. Further therapeutic options were evaluated and the patient was subsequently enrolled in an open-label uncontrolled trial with riociguat. After one year of treatment, significant improvement in functional class, 6-minute walk test and NT-proBNP were seen, without significant secondary effects. Resumo: Uma mulher de 51 anos de idade apresentou-se com história de um ano de dispneia progressiva com classe funcional III-IV e síncope relacionada com exercício. A ecocardiografia transtorácica e a angiotomografia pulmonar computadorizada foram realizadas, tendo sido diagnosticada hipertensão arterial pulmonar. A doente foi encaminhada para a Unidade de Hipertensão Pulmonar, onde foi repetido o estudo completo, incluindo verificação de ventilação/perfusão, compatível com hipertensão pulmonar tromboembólica crónica. Os fatores de risco para essa situação foram excluídos e foram avaliadas as opções terapêuticas. Estudos de imagem mostraram doença pulmonar distal pelo que a endarterectomia pulmonar foi rejeitada. Foram avaliadas novas opções terapêuticas e a doente foi posteriormente inscrita num estudo aberto, não controlado, com ensaio com riociguat. Após um ano de tratamento, uma melhoria significativa na classe funcional, um teste de caminhada de 6 minutos e NT-proBNP foram alcançados sem efeitos secundários significativos. Keywords: Chronic thromboembolic pulmonary hypertension, Treatment with riociguat, Safety profile of riociguat, Palavras-chave: Hipertensão pulmonar tromboembólica crónica, Tratamento com riociguat, Perfil de segurança do riociguat

A 51-year-old woman presented with a one-year history of progressive dyspnea, WHO functional class III-IV and exercise-related syncope. Transthoracic echocardiography and computed tomography pulmonary angiography were performed, leading to a diagnosis of pulmonary arterial hypertension. She was referred to our pulmonary hypertension unit, where a complete study was performed, including ventilation/perfusion scan, which was consistent with chronic thromboembolic pulmonary hypertension. Risk factors for this condition were excluded and therapeutic options were evaluated. Imaging studies showed distal pulmonary disease so pulmonary endarterectomy was rejected. Further therapeutic options were evaluated and the patient was subsequently enrolled in an open-label uncontrolled trial with riociguat. After one year of treatment, significant improvement in functional class, 6-minute walk test and NT-proBNP were seen, without significant secondary effects. Resumo: Uma mulher de 51 anos de idade apresentou-se com história de um ano de dispneia progressiva com classe funcional III-IV e síncope relacionada com exercício. A ecocardiografia transtorácica e a angiotomografia pulmonar computadorizada foram realizadas, tendo sido diagnosticada hipertensão arterial pulmonar. A doente foi encaminhada para a Unidade de Hipertensão Pulmonar, onde foi repetido o estudo completo, incluindo verificação de ventilação/perfusão, compatível com hipertensão pulmonar tromboembólica crónica. Os fatores de risco para essa situação foram excluídos e foram avaliadas as opções terapêuticas. Estudos de imagem mostraram doença pulmonar distal pelo que a endarterectomia pulmonar foi rejeitada. Foram avaliadas novas opções terapêuticas e a doente foi posteriormente inscrita num estudo aberto, não controlado, com ensaio com riociguat. Após um ano de tratamento, uma melhoria significativa na classe funcional, um teste de caminhada de 6 minutos e NT-proBNP foram alcançados sem efeitos secundários significativos. Keywords: Chronic thromboembolic pulmonary hypertension, Treatment with riociguat, Safety profile of riociguat, Palavras-chave: Hipertensão pulmonar tromboembólica crónica, Tratamento com riociguat, Perfil de segurança do riociguat

To determine the effects of short-term, maximum-tolerated-dose and long-term, optimum-dose iloprost treatment of severe pulmonary hypertension associated with systemic sclerosis (SSc) and the primary antiphospholipid syndrome (APS).Three patients with SSc and 2 with APS who had failed to respond to oral vasodilator therapy for pulmonary hypertension were enrolled in a 32-week, open, prospective trial. Short-term infusion of maximum-tolerated doses and continuous infusion of optimum doses of iloprost were carried out following baseline cardiac catheterization. Catheterization was repeated at 2 and 32 weeks. All 5 patients completed the study and continued therapy for an average of 82 weeks (range 58-103).Acute infusion of maximum tolerated doses significantly ameliorated the cardiac index (0.92 liters/minute/m2; P0.01), pulmonary artery O2 saturation (10.6%; P0.05), and pulmonary resistance (-6.7 units; P0.05). After 2 weeks of continuous infusion of optimum doses, there was improvement in pulmonary resistance (or = 16%) and pulmonary artery O2 saturation (30%) in the 2 patients with primary APS. After 2 and 32 weeks, the 3 SSc patients showed variable hemodynamic responses. New York Heart Association functional class and exercise tolerance improved in all patients. There was 1 episode of bacteremia, and 1 patient died after 72 weeks of study.Continuous iloprost infusion may improve exercise tolerance and quality of life in patients with severe pulmonary hypertension associated with SSc and primary APS.

Background— Chronic thromboembolic pulmonary hypertension (CTEPH) is often a sequel of venous thromboembolism with fatal natural history; however, many cases can be cured by pulmonary endarterectomy. The clinical characteristics and current management of patients enrolled in an international CTEPH registry was investigated. Methods and Results— The international registry included 679 newly diagnosed (≤6 months) consecutive patients with CTEPH, from February 2007 until January 2009. Diagnosis was confirmed by right heart catheterization, ventilation-perfusion lung scintigraphy, computerized tomography, and/or pulmonary angiography. At diagnosis, a median of 14.1 months had passed since first symptoms; 427 patients (62.9%) were considered operable, 247 (36.4%) nonoperable, and 5 (0.7%) had no operability data; 386 patients (56.8%, ranging from 12.0%– 60.9% across countries) underwent surgery. Operable patients did not differ from nonoperable patients relative to symptoms, New York Heart Association class, and hemodynamics. A history of acute pulmonary embolism was reported for 74.8% of patients (77.5% operable, 70.0% nonoperable). Associated conditions included thrombophilic disorder in 31.9% (37.1% operable, 23.5% nonoperable) and splenectomy in 3.4% of patients (1.9% operable, 5.7% nonoperable). At the time of CTEPH diagnosis, 37.7% of patients initiated at least 1 pulmonary arterial hypertension–targeted therapy (28.3% operable, 53.8% nonoperable). Pulmonary endarterectomy was performed with a 4.7% documented mortality rate. Conclusions— Despite similarities in clinical presentation, operable and nonoperable CTEPH patients may have distinct associated medical conditions. Operability rates vary considerably across countries, and a substantial number of patients (operable and nonoperable) receive off-label pulmonary arterial hypertension–targeted treatments.

Context-aware technologies allow Ambient Assisted Living systems and applications to automatically obtain information from users and their environment in a distributed and ubiquitous way. One of the most important technologies used to provide context-awareness to a system is Wireless Sensor Networks. This paper describes last improvements made on ALZ-MAS, an Ambient Intelligence based multi-agent system aimed at enhancing the assistance and healthcare for Alzheimer patients. In this sense, a new ZigBee platform is used to improve ALZ-MAS. This platform provides the system with new telemonitoring and locating engines that facilitate the integration of context-awareness into it.

Museum guides present a great opportunity where the Ambient Intelligence (AmI) paradigm can be successfully applied. Together with pervasive computing, context and location awareness are the AmI features that allow users to receive customized information in a transparent way. In this sense, Real-Time Locating Systems (RTLS) can improve context-awareness in AmI-based systems. This paper presents ARTIZT, an innovative AmI-based museum guide system where a novel RTLS based on the ZigBee protocol provides highly precise users’ position information. Thus, it can be customized the content offered to the users without their explicit interaction, as well as the granularity level provided by the system.

Most of elderly people suffer physical degeneration that makes them particularly vulnerable to falls. Falls cause injuries, time of hospitalization, re-habilitation which is particularly difficult for the elderly and disabled. This paper presents a new system with advanced capacities for learning and adaptation specifically designed to detect falls through mobile devices. The systems proposes a new adaptive algorithm able to learn, classify and identify falls from data obtained by mobile devices and user profile. The system is based on machine learning and data classification using decision trees. The main contribution of the proposed system is the use of posturographic data and medical patterns as a knowledge base, which notably improves the classification process.

This article introduces the use of a practical application of smart mobility called MASEL (Mobile Assistant for the Elder). This system is more than a typical medical reminder, and it is specially oriented to help to the elder. It is the combination of mobile applications with e-health systems and other web applications and services to connect patients, doctors, pharmacist and families. And this is the main objective of MASEL project. It is based on several technologies to improve the quality of life and facilitate certain tasks to dependent people and to bring a detailed monitoring of medication needed by the patient. MASEL controls the medicines the user has taken and warns him at the right time to be taking medications and monitoring the operation. This is an innovative system especially easy to use. In addition, it is able to manage and keep track of medication that a patient needs regardless of location. Patients will not even need to configure the application with the medicines they need in their treatments. Medical personnel perform this task remotely.

The longer survival of patients with heart transplantation (HT) favors calcineurin inhibitor-related chronic kidney disease (CKD). It behoves to identify risk factors. At 14 Spanish centers, data on 1062 adult patients with HT (age 59.2 ± 12.3 yr, 82.5% men) were collected at routine follow-up examinations. Glomerular filtration rate, GFR, was estimated using the four-variable MDRD equation, and moderate-or-severe renal dysfunction (MSRD) was defined as K/DOQI stage 3 CKD or worse. Time since transplant ranged from one month to 22 yr (mean 6.7 yr). At assessment, 26.6% of patients were diabetic and 63.9% hypertensive; 53.9% were taking cyclosporine and 33.1% tacrolimus; and 61.4% had MSRD. Among patients on cyclosporine or tacrolimus at assessment, multivariate logistic regression identified male sex (OR 0.44), pre- and post-HT creatinine (2.73 and 3.13 per mg/dL), age at transplant (1.06 per yr), time since transplant (1.05 per yr), and tacrolimus (0.65) as independent positive or negative predictors of MSRD. It is concluded that female sex, pre- and one-month post-HT serum creatinine, age at transplant, time since transplant, and immunosuppression with cyclosporine rather than tacrolimus may all be risk factors for development of CKD ≥ stage 3 by patients with HT.

Individualization of induction therapy for heart transplantation (HT) is needed, given that only patients at significant risk for fatal rejection seem to present a favorable risk-benefit ratio. The question whether monoclonal interleukin 2 antagonists or antilymphocyte antibodies should be recommended remains unanswered. As most studies suggest that they have similar efficacy in preventing acute rejection, other variables related to safety or management costs should be taken into account. The cytokine release syndrome, associated with the use of OKT3, complicates management of HT patient. The experience in our center with 2 consecutive cohorts, treated with basiliximab (BAS) and OKT3, respectively, suggests that the use of BAS is associated, in addition to similar immunosuppressive efficacy and better safety profile than OKT3, with simpler patient management during the initial hospital stay, which could be associated with a reduction in posttransplant costs. Because few centers continue to use OKT3 as induction therapy in HT, more studies comparing cost-effectiveness of BAS vs polyclonal antilymphocyte antibodies (ATG) are needed.

This document was produced by the Spanish Society of Cardiology Section on Geriatric Cardiology "End-stage heart disease in the elderly" working group. Its aim was to provide an expert overview that would increase understanding of the last days of life of elderly patients with heart disease and improve treatment and clinical decision-making. As elderly heart disease patients form a heterogeneous group, thorough clinical evaluation is essential, in particular to identify factors that could influence prognosis (e.g., heart disease, comorbid conditions, functional status and frailty). The evaluation should be carried out before any clinical decisions are made, especially those that could restrict therapy, such as do-not-resuscitate orders or instructions to deactivate an implantable cardioverter-defibrillator. Elderly patients with terminal heart disease have the right to expect a certain level of care and consideration: they should not suffer unnecessarily, their freely expressed wishes should be respected, they should be fully informed about their medical condition, they should be able to express an opinion about possible interventions, and they should be entitled to receive psychospiritual care. After an incurable disease has been diagnosed, the aim of palliative care should be to control symptoms. It should not be used only when the patient is close to death. Although palliative care is relatively undeveloped in heart disease, its use must be borne in mind in elderly patients with advanced heart failure. The main aims are to make the patient as comfortable as possible in all senses and to optimize quality of life in the patient's final days, while avoiding the use of aggressive treatments that consume health-care resources without providing any benefits.

Guidelines and Expert Consensus Documents summarise and evaluate all currently available evidence on a particular issue with the aim to assist physicians in selecting the best management strategies for a typical patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk/benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes for textbooks. The legal implications of medical guidelines have been discussed previously. A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organisations. Because of the impact on clinical practice, quality criteria for development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC website (http://www.escardio.org/knowledge/guidelines). In brief, experts in the field are selected and undertake a comprehensive review of the published evidence for management and/or prevention of a given condition. Unpublished clinical trial results are not taken into account. A critical evaluation of diagnostic and therapeutic procedures is performed including assessment of the risk/benefit ratio. Estimates of expected health outcomes for larger societies are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to predefined scales, as outlined in tables 1⇓ and 2⇓. The experts of the writing panels have provided disclosure statements of all relationships they may have which might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at the European Heart House, headquarters of the ESC. Any changes in conflict of interest that arise during the writing period must …

The emergence of new technologies provides the opportunity to develop novel solutions that facilitate the integration of the visual disabled people in different activities of our daily life. This paper presents a distributed intelligent architecture, called DIAMI, focused on facilitating the integration of blind musicians in orchestras. The DIAMI architecture provides a distributed, ubiquitous system aimed at providing a way for blind musicians to receive the instructions of the orchestra conductor in an unobstructive manner. The structure of the DIAMI architecture and the preliminary results obtained are presented in detail within this paper.

Organizations have to work with large volumes of information at different formats. In this context they are necessary tools and formats like XML, to integrate these data and solve the heterogeneity problem. In this paper we proposed a new software tool called XDS. XDS is a new system to integrate data from relational databases, native XML databases and XML documents. On the other hand, the environment of libraries has also their bibliographical catalogues at different sources and formats. Therefore, we show the use and validity of the XDS system in this environment obtaining the results in a bibliographical format like MODS. Hereby the resources of different bibliographical catalogues can be consulted obtaining the results in the same common format as MODS.

On Demand Business concept, from IBM, shows how to coordinate the transformation of the enterprise organization and its technological infrastructure to bridge the gap between business and technology. This problem appears in most of information systems. This concept is based on Service Oriented Architecture (SOA) to improve the connection between business services and software services. If companies can reach this On Demand Business context they could improve the software development process by applying standards like Model Driven Architecture (MDA), to separate business logic from software and technological platforms, and Business Process Management (BPM) to define business processes. In this article we propose a new approach that combines On Demand Business with MDA, BPM and SOA to improve software development process starting on business knowledge. The most important contribution of this approach to Knowledge Society is the method used to connect business knowledge with technological resources using a well defined architecture.

Background Inhaled nitric oxide (iNO) is a potent pulmonary vasodilator, but therapeutic experience in patients with severe pulmonary hypertension is scarce. Methods Eleven patients with severe pulmonary hypertension, 6 due to pulmonary arterial hypertension and 4 due to chronic thromboembolic disease, were selected for iNO therapy. A phosphodiesterase type 5 inhibitor (PDE5i) was added in cases of clinical worsening. In this study we evaluate the clinical effectiveness and safety of long-term treatment with iNO either alone or combined with a PDE5i. Results After 1 month of iNO administration, improvements were observed in World Health Organization functional class, Borg scale ( p = 0.003), brain natriuretic peptide levels ( p = 0.002) and 6-minute walk test ( p = 0.003). After 6 months of treatment, 7 patients had clinical deterioration that was reversed upon adding a PDE5i. One of these patients died in Month 8 and another underwent pulmonary transplantation in Month 9. The clinical condition of the remaining 9 patients was unchanged after 1 year. A second right catheterization showed improvement in mean pulmonary arterial pressure (66 ± 15 mm Hg to 56 ± 18 mm Hg; p = 0.01), pulmonary vascular resistance (1,234 ± 380 dyn/s/cm 5 to 911 ± 410 dyn/s/cm 5 ; p = 0.008) and cardiac index (2.0 ± 0.4 liters/min/m 2 to 2.5 ± 0.4 liters/min/m 2 ; p = 0.04). There was no significant increase in methemoglobin, no worsening of pulmonary function and no sudden withdrawal syndrome. Conclusions We suggest that iNO therapy alone or in combination with a PDE5i could be a therapeutic alternative for severe pulmonary hypertension.

This paper presents a Hybrid Multi-Agent Architecture based on an Ambient Intelligence model, for the control and supervision of dependent environments. HoCa architecture incorporates a management system of alerts based on SMS and MMS technologies, and an automated identification, localization, and movement control system based on Java Card and RFID technologies. HoCa is independent from the programming language and operating system in that it is executable. The core of the architecture is formed by both deliberative agents and reactive agents that interact to offer efficient services. The architecture has been tested in a real environment and the results obtained are presented in this paper.

Background. Antilymphocytic antibodies have been long used for the prevention of acute rejection early after heart transplantation (HTx), but their adverse effects have limited their widespread use. Our aim was to evaluate the safety, tolerability, and efficacy of the novel anti-CD25 antibody basiliximab (BAS) compared with muromonab (OKT3). Patients and methods. In this multicenter study, 99 patients were randomly assigned to receive either BAS or OKT3 in the early post-HTx period. The primary endpoint was safety and tolerability. Specific safety variables were predefined for a better comparison of adverse effects. Secondary endpoints concerning anti-rejection efficacy were also evaluated. Results. No adverse events related to study medication were found in the BAS group, whereas 23 were observed among patients receiving OKT3 (P

Toxic oil syndrome is a risk factor for pulmonary arterial hypertension (PAH) and new cases of this entity are emerging after more than 20 years since the initial toxic oil epidemic. Abnormal elevation of pulmonary systolic pressure with exercise may be considered an early marker of PAH in populations at risk. We aimed to analyze the pulmonary systolic pressure with exercise echocardiography in toxic oil syndrome patients.50 toxic oil syndrome patients (cases), and 20 healthy control subjects were submitted to rest and peak exercise echocardiography (semi supine cycloergometer) measuring pulmonary systolic pressure. In toxic oil syndrome patients, pulmonary carbon monoxide diffusion capacity was also analyzed.Peak exercise pulmonary systolic pressure was statistically similar in cases and controls. Nevertheless, 8% of cases reached a pulmonary systolic pressureor = 80 mmHg and this fact was associated with mild pulmonary arterial hypertension, reduced right ventricular function and abnormal pulmonary diffusion capacity in the rest study. A rest pulmonary systolic pressure cut-off valueor = 27 mmHg had a 100% sensitivity and 71% specificity to predict a peak exercise systolic pulmonary pressureor = 80 mmHg.A minority of toxic oil syndrome patients develop severe pulmonary arterial hypertension during exercise. This abnormal response is associated with other markers of pulmonary vasculopathy. Further studies are needed to elucidate the relation between these findings and the likelihood to develop pulmonary arterial hypertension in the future.

Pulmonary hypertension (PHT) associated with chronic heart failure (CHF) is a risk factor of right ventricular failure after heart transplantation (HT). Our aim was to study pulmonary vascular changes in patients with CHF and to assess any correlation with haemodynamic data. Methods: We studied 17 HT recipients with preoperative CHF who died shortly after HT. Preoperative haemodynamic information was obtained immediately before HT. Vascular lesions in muscular arteries were assessed by linear morphometry. Haemodynamic data were correlated with the morphologic changes. Results: Mean transpulmonary gradient (TPG) was 8.9±4.5 mm Hg and pulmonary vascular resistance (PVR) was 2.25±1.34 Wu. According to the threshold for at-risk PHT (TPG>12 mm Hg or PVR>2.5 Wu), six patients had at-risk PHT. Medial thickness was 23.82±7.23% in patients with at-risk PHT and 17.16±3.24% in patients without at-risk PHT (p=0.018). Conclusions: Medial hypertrophy of muscular pulmonary arteries is more common and severe than expected in patients with CHF, even in patients without at-risk PHT. This structural change could explain why PHT, even in range of values not excluding HT, is a risk factor for right ventricular failure after HT and influences post-HT haemodynamic behaviour.