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Fundamento: A cardiotoxicidade induzida por quimioterapia (CiC) é uma complicação importante entre os pacientes que recebem antraciclinas. Biomarcadores e parâmetros de imagem têm sido estudados por sua capacidade de identificar pacientes com risco de desenvolver essa complicação. O strain longitudinal global do ventrículo esquerdo (SLG-VE) tem sido descrito como um parâmetro sensível para detectar disfunção sistólica, mesmo na presença de fração de ejeção do ventrículo esquerdo (FEVE) preservada. Objetivo: avaliar o papel do SLG-VE como preditor de CiC. Métodos: O presente estudo consiste em uma análise post-hoc do estudo CECCY (Carvedilol for Prevention of ChemotherapyRelated Cardiotoxicity [Carvedilol para Prevenção da Cardiotoxicidade Relacionada à Quimioterapia]), que avaliou a prevenção primária de cardiotoxicidade com carvedilol durante quimioterapia com doxorrubicina em uma população com câncer de mama. Definiu-se cardiotoxicidade como uma redução >10% na FEVE. O SLG-VE foi obtido antes da quimioterapia em pacientes sem doença cardiovascular prévia ou anormalidades no ecocardiograma. Resultados: Trinta e um pacientes submetidos a estudo ecocardiográfico completo incluindo avaliação de SLG-VE antes da quimioterapia foram incluídos nesta análise. Um SLG-VE absoluto 17 pg/mL) dois meses após a quimioterapia aumentou a precisão para detectar CiC de início precoce (100% de sensibilidade, 88% de especificidade, AUC=0,94; IC 95% 0,7810,995, p

Background Chemotherapy-induced cardiotoxicity (ChC) is an important complication among patients receiving anthracyclines. Biomarkers and imaging parameters have been studied for their ability to identify patients at risk of developing this complication. Left ventricle global longitudinal strain (LV-GLS) has been described as a sensitive parameter for detecting systolic dysfunction, even in the presence of preserved left ventricle ejection fraction (LVEF). Objective to evaluate the role of the LV-GLS as a predictor of ChC. Methods This study is a post-hoc analysis of CECCY trial (Carvedilol for Prevention of Chemotherapy-Related Cardiotoxicity) that evaluated the primary prevention of cardiotoxicity with carvedilol during doxorubicin chemotherapy in a population with breast cancer. Cardiotoxicity was defined as a reduction ≥10% in LVEF. LV-GLS was obtained before chemotherapy in patients with no prior cardiovascular disease or echocardiogram abnormalities. Results Thirty-one patients who had a complete echocardiography study including measurement of LV-GLS before chemotherapy were included in this analysis. An absolute LV-GLS 17 pg/mL) two months after chemotherapy increased the accuracy for detecting early onset ChC (100% sensitivity, 88% specificity, AUC=0.94; 95%CI 0.781 – 0.995, p

Background: Anthracycline (ANT) is often used for breast cancer treatment but its clinical use is limited by cardiotoxicity (CTX). CECCY trial demonstrated that the β-blocker carvedilol (CVD) could attenuate myocardial injury secondary to ANT. Mieloperoxydase (MPO) is a biomarker of oxidative stress and galectin-3 (Gal-3) is a biomarker of fibrosis and cardiac remodeling. We evaluated the correlation between MPO and Gal-3 behavior with CTX. Materials and Methods: A post hoc analysis was performed in the patients who were included in the CECCY trial. A total of 192 women had her blood samples stored during the study at –80°C until the time of assay in a single batch. Stored blood samples were obtained at baseline, 3 and 6 months after randomization. We excluded samples from 18 patients because of hemolysis. MPO and Gal-3 were measured using Luminex xMAP technology through MILLIPLEX MAP KIT (Merck Laboratories). Results: 26 patients (14.9%) had a decrease of at least 10% in LVEF at 6 months after the initiation of chemotherapy. Among these, there was no significant difference in the MPO and Gal-3 when compared to the group without drop in LVEF (p = 0.85 for both MPO and Gal-3). Blood levels of MPO [baseline: 13.2 (7.9, 24.8), 3 months: 17.7 (11.1, 31.1), 6 months: 19.2 (11.1, 37.8) ng/mL] and Gal-3 [baseline: 6.3 (5.2, 9.6), 3 months: 12.3 (9.8, 16.0), 6 months: 10.3 (8.2, 13.1) ng/mL] increased after ANT chemotherapy, and the longitudinal changes were similar between the placebo and CVD groups (p for interaction: 0.28 and 0.32, respectively). In an exploratory analysis, as there is no normal cutoff value established for Gal-3 and MPO in the literature, the MPO and Gal-3 results were splited in two groups: above and below median. In the placebo group, women with high (above median) baseline MPO blood levels demonstrated a greater increase in TnI blood levels than those with low baseline MPO blood levels (p = 0.041). Compared with placebo, CVD significantly reduced TnI blood levels in women with high MPO blood levels (p < 0.001), but did not reduce the TnI levels in women with low baseline MPO blood levels (p = 0.97; p for interaction = 0.009). There was no significant interaction between CVD treatment and baseline Gal-3 blood levels (p for interaction = 0.99). Conclusions: In this subanalysis of the CECCY trial, MPO and Gal-3 biomarkers did not predict the development of CTX. However, MPO blood levels above median was associated with more severe myocardial injury and identified women who were most likely to benefit from carvedilol for primary prevention (NCT01724450).

Background: Chemotherapy-induced cardiotoxicity (ChC) is an important complication among patients receiving anthracyclines. Biomarkers and imaging parameters have been studied for their ability to identify patients at risk of developing this complication. Left ventricle global longitudinal strain (LV-GLS) has been described as a sensitive parameter for detecting systolic dysfunction, even in the presence of preserved left ventricle ejection fraction (LVEF). Objective: to evaluate the role of the LV-GLS as a predictor of ChC. Methods: This study is a post-hoc analysis of CECCY trial (Carvedilol for Prevention of Chemotherapy-Related Cardiotoxicity) that evaluated the primary prevention of cardiotoxicity with carvedilol during doxorubicin chemotherapy in a population with breast cancer. Cardiotoxicity was defined as a reduction >10% in LVEF. LV-GLS was obtained before chemotherapy in patients with no prior cardiovascular disease or echocardiogram abnormalities. Results: Thirty-one patients who had a complete echocardiography study including measurement of LV-GLS before chemotherapy were included in this analysis. An absolute LV-GLS 17 pg/mL) two months after chemotherapy increased the accuracy for detecting early onset ChC (100% sensitivity, 88% specificity, AUC=0.94; 95%CI 0.781 – 0.995, p

Background Anthracycline (ANT) chemotherapy is associated with cardiotoxicity. Prevention with β-blockers remains controversial. Objectives This prospective, randomized, double-blind, placebo-controlled study sought to evaluate the role of carvedilol in preventing ANT cardiotoxicity. Methods The authors randomized 200 patients with HER2-negative breast cancer tumor status and normal left ventricular ejection fraction (LVEF) referred for ANT (240 mg/m2) to receive carvedilol or placebo until chemotherapy completion. The primary endpoint was prevention of a ≥10% reduction in LVEF at 6 months. Secondary outcomes were effects of carvedilol on troponin I, B-type natriuretic peptide, and diastolic dysfunction. Results Primary endpoint occurred in 14 patients (14.5%) in the carvedilol group and 13 patients (13.5%) in the placebo group (p = 1.0). No differences in changes of LVEF or B-type natriuretic peptide were noted between groups. A significant difference existed between groups in troponin I levels over time, with lower levels in the carvedilol group (p = 0.003). Additionally, a lower incidence of diastolic dysfunction was noted in the carvedilol group (p = 0.039). A nonsignificant trend toward a less-pronounced increase in LV end-diastolic diameter during the follow-up was noted in the carvedilol group (44.1 ± 3.64 mm to 45.2 ± 3.2 mm vs. 44.9 ± 3.6 mm to 46.4 ± 4.0 mm; p = 0.057). Conclusions In this largest clinical trial of β-blockers for prevention of cardiotoxicity under contemporary ANT dosage, the authors noted a 13.5% to 14.5% incidence of cardiotoxicity. In this scenario, carvedilol had no impact on the incidence of early onset of LVEF reduction. However, the use of carvedilol resulted in a significant reduction in troponin levels and diastolic dysfunction. (Carvedilol Effect in Preventing Chemotherapy-Induced Cardiotoxicity [CECCY]; NCT01724450)

Introdução - Os custos para o tratamento da doença arterial coronariana (DAC) são altos em todo o mundo. Foi realizada uma análise post hoc de custo-efetividade de três estratégias terapêuticas para DAC multiarterial. Métodos - De maio de 1995 a maio de 2000, um total de 611 pacientes foram aleatoriamente designados para CRM (n = 203), ICP (n = 205) ou TM (n = 203). Este estudo de análise de custos baseou-se na perspectiva do Sistema Público de Saúde. Os custos iniciais de procedimentos e acompanhamento de medicamentos, exames cardiológicos e hospitalizações por complicações foram calculados após a randomização. Anos de vida e anos de vida ajustados pela qualidade (QALY) foram usados como medidas de eficácia. As razões de custo-efetividade incremental (RCEI) foram obtidas usando métodos de bootstrap não paramétricos com 5.000 replicações. Resultados - Os custos iniciais do procedimento foram menores para o TM. No entanto, os custos acumulados de 5 anos foram menores para a CRM. Em comparação com a linha de base, as 3 opções de tratamento produziram melhorias significativas no QALY. Após 5 anos, a ICP e a CRM tiveram melhores resultados de QALY em comparação com o TM. Os resultados da RCEI favoreceram a CRM e a ICP quando comparadas ao TM, já a ICP em relação à CRM foi mais custo-efetiva em 61% para limiares até 3 PIB per capita por QALY. Por outro lado, a análise de sensibilidade mostrou o TM como a terapia preferida em comparação com a CRM e ICP, na análise considerando custos mais elevados. Conclusão - No seguimento de 5 anos, a ICP e CRM mostraram ser os tratamentos com QALYs cumulativos mais altos entre pacientes com DAC multiarterial quando comparados com TM. Além disso, apesar dos custos iniciais serem mais elevados, a comparação de custo-efetividade após 5 anos de acompanhamento entre os 3 tratamentos mostrou que ambas as intervenções (CRM e ICP) são estratégias custo-efetivas em comparação com a TM Background. The costs for treating coronary artery disease (CAD) are high worldwide. We performed a post hoc analysis of cost-effectiveness of 3 therapeutic strategies for multivessel CAD. Methods. From May 1995 to May 2000, a total of 611 patients were randomly assigned to CABG (n=203), PCI (n=205), or MT (n=203). This cost analysis study was based on the perspective of the Public Health Care System. Initial procedural and follow-up costs for medications, cardiology examinations, and hospitalizations for complications were calculated after randomization. Life-years and quality-adjusted life years (QALY) were used as effectiveness measures. Incremental cost-effectiveness ratios (ICER) were obtained by using nonparametric bootstrapping methods with 5000 resamples. Results. Initial procedural costs were lower for MT. However, the subsequent 5-year cumulative costs were lower for CABG. Compared with baseline, the 3 treatment options produced significant improvements in QALY. After 5 years, PCI and CABG had better QALY results compared with MT. The ICER results favored CRM and PCI when compared to the TM, since the PCI in relation to the CRM was more costeffective in 61% for the thresholds up to 3 GDP per capita per QALY. On the other hand, sensitivity analysis showed MT as the preferred therapy compared with CABG and PCI, in the analysis considering higher costs. Conclusion. At 5-year follow-up, the 3 treatment options yielded improvements in quality of life, with comparable and acceptable costs. However, despite higher initial costs, the comparison of costeffectiveness after 5 years of follow-up among the 3 treatments showed both interventions (CABG and PCI) to be cost-effective strategies compared with MT

Introduction The coronavirus 2019 disease (COVID-19) affected almost 40 million people worldwide and caused more than one million deaths. Some conditions are associated with worse prognosis such as heart failure and left ventricular assist device (LVAD) recipients. Case Report A 31-year-old male patient without comorbidities was admitted due to cardiogenic shock and pneumonia. He required IABP and ECMO. The patient recovered from organ dysfunctions and ECMO was weaned off. He persisted dependent on dobutamine and IABP. Echocardiogram showed severe left ventricular dysfunction and moderate right ventricular dysfunction (RVD), but right heart catheterization revealed no pulmonary hypertension. SARS-CoV-2 RT-PCR was negative and myocardiopathy investigation was inconclusive after endomyocardial biopsy. LVAD implantation was planned as a bridge to transplant. A Heart Mate 3 was successfully implanted. The patient presented fever in the operating room and persisted febrile for 3 days. COVID-19 was suspected and SARS-CoV-2 RT-PCR was positive. He was extubated on 3rd postoperative day (POD) and echocardiogram showed only mild RVD. On 5th POD, he became hypoxemic requiring high flow nasal cannula, and chest X-ray revealed multiple pulmonary bilateral opacities. Antibiotics and corticosteroids were prescribed. Echocardiogram showed severe RVD and hemodynamic instability led to milrinone and dobutamine requirement in maximal doses. On 10th POD endotracheal intubation was required. The patient experienced severe acute respiratory distress syndrome (ARDS) and multiple complications: shock, bacterial pneumonia, hemothorax, pneumothorax due to barotrauma and bloodstream infection. He had no thromboembolic events. After 48 days he was free from mechanical ventilation and from inotropes. Echocardiogram showed moderate RVD and pulmonary artery systolic pressure 35mmHg. After 51 days he was discharged from the intensive care unit and is now in rehabilitation program. Summary Severe cases of COVID-19 are associated with a cytokine storm and a prothrombotic state. LVAD recipients are at particular risk of unfavorable outcomes. Besides the higher risk of thromboembolic events, LVAD recipients are more vulnerable to RVD in the setting of ARDS. This could be particularly critical during the perioperative management of RV failure as presented in this case.

In the six months CECCY trial analyses, use of carvedilol resulted in a significant reduction in troponin levels and diastolic dysfunction (DD), without difference in LVEF. We tested a hypothesis that carvedilol would have a protection effect on long term follow-up. We assigned 200 patients with

Background The costs for treating coronary artery disease (CAD) are high worldwide. We performed a prespecified analyses of cost-effectiveness of three therapeutic strategies for multivessel CAD. Methods From May 1995 to May 2000, a total of 611 patients were randomly assigned to coronary artery bypass graft (CABG), n = 203; percutaneous coronary intervention (PCI), n = 205; or medical treatment (MT), n = 203. This cost analysis study was based on the perspective of the Public Health Care System. Initial procedural and follow-up costs for medications, cardiology examinations, and hospitalizations for complications were calculated after randomization. Life-years and quality-adjusted life years (QALYs) were used as effectiveness measures. Incremental cost-effectiveness ratios (ICER) were obtained by using nonparametric bootstrapping methods with 5000 resamples. Results Initial procedural costs were lower for MT. However, the subsequent 5-year cumulative costs were lower for CABG. Compared with baseline, the three treatment options produced significant improvements in QALYs. After 5 years, PCI and CABG had better QALYs results compared with MT. The ICER results favored CABG and PCI, and favored PCI over CABG in 61% of the drawings. On the other hand, sensitivity analysis showed MT as the preferred therapy compared with CABG and PCI, in the analysis considering higher costs. Conclusions At 5-year follow-up, the three treatment options yielded improvements in quality of life, with comparable and acceptable costs. However, despite higher initial costs, the comparison of cost-effectiveness after 5 years of follow-up among the three treatments showed both interventions (CABG and PCI) to be cost-effective strategies compared with MT. Trial registration ISRCTN, ISRCTN66068876, Registered 06/10/1994, http://www.controlled-trials.com/ISRCTN66068876

Anthracycline (ANT) chemotherapy is associated with cardiotoxicity. Prevention with β-blockers remains controversial.This prospective, randomized, double-blind, placebo-controlled study sought to evaluate the role of carvedilol in preventing ANT cardiotoxicity.The authors randomized 200 patients with HER2-negative breast cancer tumor status and normal left ventricular ejection fraction (LVEF) referred for ANT (240 mg/mPrimary endpoint occurred in 14 patients (14.5%) in the carvedilol group and 13 patients (13.5%) in the placebo group (p = 1.0). No differences in changes of LVEF or B-type natriuretic peptide were noted between groups. A significant difference existed between groups in troponin I levels over time, with lower levels in the carvedilol group (p = 0.003). Additionally, a lower incidence of diastolic dysfunction was noted in the carvedilol group (p = 0.039). A nonsignificant trend toward a less-pronounced increase in LV end-diastolic diameter during the follow-up was noted in the carvedilol group (44.1 ± 3.64 mm to 45.2 ± 3.2 mm vs. 44.9 ± 3.6 mm to 46.4 ± 4.0 mm; p = 0.057).In this largest clinical trial of β-blockers for prevention of cardiotoxicity under contemporary ANT dosage, the authors noted a 13.5% to 14.5% incidence of cardiotoxicity. In this scenario, carvedilol had no impact on the incidence of early onset of LVEF reduction. However, the use of carvedilol resulted in a significant reduction in troponin levels and diastolic dysfunction. (Carvedilol Effect in Preventing Chemotherapy-Induced Cardiotoxicity [CECCY]; NCT01724450).

Background: Published studies have generated mixed, controversial results regarding the Cost-effectiveness of heart failure disease management programs (HF-DMPs). This study assessed the cost-effectiveness of an HF-DMP in ambulatory patients compared with usual care (UC).Methods: In the prospective randomized REMADHE trial, we evaluated incremental costs per quality adjusted life-year (QALY) and life-year (LY) gained as effectiveness ratios (ICERs) over a study period of 2.47 +/- 1.75 years.Results: The REMADHE HF-DMP was more effective and less costly than UC in terms of both QALYs and LYs (95% and 55% chance of dominance, respectively). Average saving was US$7345 (2.5%-97.5% bootstrapped confidence interval similar to 16,573 to +921). The chance of DMP being cost-effective at a willingness to pay US$10,000 per QALY or LY was 99% and 96%, respectively. Cost-effectiveness of HF-DMP was highest in subgroups with left ventricular ejection fraction 50 years, male sex, New York Heart Association (NYHA) functional class >= III, and ischemic etiology. The chance of DMP being cost-effective at a willingness to pay US$10,000 per QALY was >= 90% in all subgroups apart from NYHA functional class I-II, where it was 70%. Even when the intervention costs increased by 500% or when excluding outliers in costs, DMP had a high chance of being cost-effective (87%-99%).Conclusions: The HF-DMP of the REMADHE trial, which encompasses long-term repeated education alongside telephone monitoring, has a high probability of being cost-effective in ambulatory patients with HF.

// Vagner Oliveira-Carvalho Rigaud 1, 2 , Ludmila R.P. Ferreira 2, 3 , Silvia M. Ayub-Ferreira 1 , Monica S. Avila 1 , Sara M.G. Brandao 1 , Fatima D. Cruz 1 , Marilia H.H. Santos 1 , Cecilia B.B.V. Cruz 1 , Marco S.L. Alves 1 , Victor S. Issa 1 , Guilherme V. Guimaraes 1 , Edecio Cunha-Neto 2 , Edimar A. Bocchi 1 1 Heart Failure Unit, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC-FMUSP), Sao Paulo, Brazil 2 Laboratory of Immunology, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC-FMUSP), Sao Paulo, Brazil 3 University of Santo Amaro (UNISA), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC-FMUSP), Sao Paulo, Brazil Correspondence to: Vagner Oliveira-Carvalho Rigaud, email: vagnercarvalho@usp.br Keywords: microRNAs, doxorubicin, breast neoplasms, cardiotoxicity, biomarkers Received: September 26, 2016 Accepted: December 07, 2016 Published: December 29, 2016 ABSTRACT Cardiotoxicity is associated with the chronic use of doxorubicin leading to cardiomyopathy and heart failure. Identification of cardiotoxicity-specific miRNA biomarkers could provide clinicians with a valuable prognostic tool. The aim of the study was to evaluate circulating levels of miRNAs in breast cancer patients receiving doxorubicin treatment and to correlate with cardiac function. This is an ancillary study from “Carvedilol Effect on Chemotherapy-induced Cardiotoxicity” (CECCY trial), which included 56 female patients (49.9±3.3 years of age) from the placebo arm. Enrolled patients were treated with doxorubicin followed by taxanes. cTnI, LVEF, and miRNAs were measured periodically. Circulating levels of miR-1, -133b, -146a, and -423-5p increased during the treatment whereas miR-208a and -208b were undetectable. cTnI increased from 6.6±0.3 to 46.7±5.5 pg/mL (p

Inconsistencies in cardiac rejection grading systems corroborate the concept that the evaluation of inflammatory intensity and myocyte damage seems to be subjective. We studied in 36 patients the potential role of the immunohistochemical (IHC) counting of inflammatory cells in endomyocardial biopsy (EMB) as an objective tool, testing the hypothesis of correlation between the International Society for Heart and Lung Transplantation 2004 rejection and IHC counting of inflammatory cells. We observed a progressive increment in CD68+ cells/mm 2 ( P = .000) and CD3+ cells/mm 2 ( P = .000) with higher rejection grade. A strong correlation between the grade of cellular rejection and both CD68+ cells/mm 2 and CD3+ cells/mm 2 was obtained ( P = .000). One patient with CD3+ and CD68+ cells/mm 2 above the upper limit of the 95% confidence interval for cells/mm 2 found in rejection grade 1R evolved to rejection grade 2R without treatment. In patients with 2R that did not respond to treatment the values of CD68+ or CD3+ cells were higher than the overall median values for rejection grade 2R. For diagnosis of rejection needing treatment, the CD68+ and CD3+ cells/mm 2 areas under the receiver operating characteristic curves were 0.956 and 0.934, respectively. IHC counting of mononuclear inflammatory infiltrate in EMB seems to have additive potential role in evaluation of EMB for the diagnosis and prognosis of rejection episodes.

OBJECTIVE. The study aims to proceed a literature review of defining characteristics (DCs) of decreased cardiac output (DCO). METHODS. Medline database was used to perform this study. The descriptors used were “low cardiac output” and “nursing diagnosis.” RESULTS. Seventy-nine DCs were identified. Among them, 28 have already been approved by NANDA-I. Some data from microcirculation assessment such as high levels of serum lactate and decreased oxygen venous saturation were identified as indicators of this nursing diagnosis. CONCLUSIONS. Some of the approved DCs were identified through literature review but others seem to be new as they have not been cited in the NANDA-I classification. PRACTICAL IMPLICATIONS. Further content and clinical validations are needed to confirm if data from microcirculation might be considered as DCs of DCO. OBJETIVO. Realizar uma revisao da literatura das caracteristicas definidoras (CD) do Debito Cardiaco Diminuido (DCD). METODOS. A base de dados do Medline foi utilizada neste estudo. Os descritores utilizados foram “baixo debito cardiaco” e “diagnostico de enfermagem”. RESULTADOS. Foram identificadas 79 CD. Dentre estas, 28 ja estavam contidas na classificacao de diagnosticos da NANDA-I. Alguns dados referentes a avaliacao da microcirculacao como os niveis de lactato aumentados e diminuicao da saturacao venosa de oxigenio foram identificados como indicadores deste diagnostico. CONCLUSOES. Algumas CD aprovadas pela NANDA-I foram identificadas na revisao da literatura, entretanto, outras parecem ser novas, uma vez que nao encontram-se citadas nesta classificacao. IMPLCIACOES PARA PRATICA. Novos estudos de validacao de conteudo e clinica devem ser realizados para confirmar se os dados sobre a microcirculacao podem ser considerados como CD do DCD.

Aims and objectives. To compare the clinical profile of patients included in a clinical trial of autologous bone marrow cells as an adjunctive therapy to coronary artery bypass grafting with that of patients undergoing routine coronary artery bypass grafting. Background. The therapeutic potential of autologous bone marrow cells has been explored in the treatment of severe coronary artery disease. There are few data regarding the clinical and socio-economic profile of patients included in clinical trials using bone marrow cell. Design. Case–control study. Method. Sixty-seven patients (61 SD 9) years, 82% men) with multivessel coronary artery disease were divided into two groups: patients in the bone marrow cell group (n = 34) underwent incomplete coronary artery bypass grafting + intramyocardial injection of autologous bone marrow cells (lymphomonocytic fraction −2·0 (SD 0·2 × 108) cells/patient) in the ischaemic, non-revascularised myocardium, whereas patients in the coronary artery bypass grafting group (n = 33) underwent routine bypass surgery. Demographics, socio-economic status, clinical and echocardiographic data were collected. Statistical analysis included the Fisher’s exact test (categorical variables) and the Student’s t-test (continuous variables). Results. There were no significant differences between groups regarding age, gender, BMI, heart rate, blood pressure and echo data. There was a greater prevalence of obesity (65 vs. 33%; OR = 3·7 [1·3–10·1]), of previous myocardial infarction (68 vs. 39%; OR = 3·2 [1·2–8·8]) and prior revascularisation procedures (59 vs. 24%; OR = 4·5 [1·6–12·7]) in the autologous bone marrow cells group and of smokers in the coronary artery bypass grafting group (51 vs. 23%; OR = 3·5 [1·2–10·4]). Conclusions. Patients included in this clinical trial of autologous bone marrow cells for severe coronary artery disease presented a greater prevalence of myocardial revascularisation procedures, indicating a more severe clinical presentation of the disease. Fewer smokers in this group could be attributable to life style changes after previous cardiovascular events and/or interventions. Relevance to clinical practice. The knowledge of the clinical profile of patients included in cell therapy trials may help researchers in the identification of patients that may be enroled in future clinical trials of this new therapeutic strategy.

Supplemental Digital Content is available in the text, Objectives: This study evaluated the utility and quality-of-life year measurements for patients with coronary artery disease who underwent any of 3 therapeutic strategies with a 5-year follow-up. Methods: Quality-of-life data were obtained from the Medicine, Angioplasty, or Surgery Study II trial. To obtain utilities, the 36-Item Short-Form questionnaire was converted to a 6-Dimensional Health State Classification System. Results: Of the 611 initial patients, 579 completed the questionnaire. In all, 188 patients received the surgical treatment—194 the percutaneous, and the remaining 197 the medical. The median utility scores for the 5 years analyzed were 0.809 (95% confidence interval [CI] 0.794–0.842) for patients assigned to percutaneous coronary intervention, 0.755 (95% CI 0.723–0.774) for medical treatment, and 0.780 (95% CI 0.761–0.809) for coronary artery bypass graft surgery. The difference between percutaneous coronary intervention and medical treatment was statistically significant (P

The study aims to proceed a literature review of defining characteristics (DCs) of decreased cardiac output (DCO). Medline database was used to perform this study. The descriptors used were "low cardiac output" and "nursing diagnosis."Seventy-nine DCs were identified. Among them, 28 have already been approved by NANDA-I. Some data from microcirculation assessment such as high levels of serum lactate and decreased oxygen venous saturation were identified as indicators of this nursing diagnosis.Some of the approved DCs were identified through literature review but others seem to be new as they have not been cited in the NANDA-I classification.Further content and clinical validations are needed to confirm if data from microcirculation might be considered as DCs of DCO.

Purpose The ISHLT rejection grading system presents limited reproducibility. The assessment of myocyte injury that is the key point to distinguish high to low-grade rejection and quantification of the inflammatory infiltrate are done in a subjective manner. The primary goal was to determine the number of cells (CD3, CD68) by area in mm 2 according to each ISHLT 2004 rejection grade. The secondary purpose was to determine the correlation between cell counting and ISHLT 2004 grading and the correlation between cell counting and follow-up. Methods and Materials We analyzed myocardial fragments of 36 EMB of different patients after heart transplantation. We selected the EMB according 2004 ISHLT criteria: 10 graded as 0R, 10 as 1R, 9 as 2R, and 7 as 3R. Immunohistochemical counting of mononuclear infiltrates for detection of CD 68 (macrophages) and CD 3 (T cells) per mm2 were performed. The evaluation was carried out blindly. It was excluded: reactivation of T. cruzi infection, EMB for monitoring of rejection treatment, EMB up to one month after heart transplantation, retransplantation, graft dysfunction, suspected or diagnosis of humoral rejection, and any recent previous suspected infection episode or actual infection. Results The mean CD3 cells per mm 2 in OR, 1R, 2R, and 3R ISHLT grade rejection were 5.3±5.7, 40.6±41.9, 96.6±40.8, 227.4± 130.8 respectively (p=0.000). The mean CD 68 cells per mm 2 were 9.3±4.3, 32.1±25.7, 89.2±36.3, and 94.3±35.8 respectively (p=0.000). There was a positive correlation between grade rejection and CD 68 and CD 3 cells per mm 2 . In the follow-up low CD3 and low CD 68 cells count had a negative predictive value for rejection. In addition, 1R EMB with higher CD3 progressed to 2R. Conclusions Immunohistochemical counting of mononuclear infiltrates in EMB showed strong correlation with ISHLT grade rejection. Also, our results indicate that immunohistochemical counting is a potential objective method to improve diagnosis of rejection.