[Show abstract][Hide abstract] ABSTRACT: The prevalence of heart failure (HF) is rising and the only corrective treatment is cardiac transplantation. Advanced HF is associated with congestive hepatopathy and progressive functional and ultrastructural changes of the liver. We hypothesized that hepatic dysfunction is associated with impaired clinical outcome after heart transplantation.
Data of 617 adult patients (75% men, mean age 53 ± 12 years, mean BMI 25 ± 4, mean ejection fraction 19 ± 9%) undergoing orthotopic heart transplantation (OHT) were analyzed retrospectively. Deviation from institutional normal ranges was used to define abnormal liver function. Standard Model for End-stage Liver Disease (MELD) scores were calculated and a modified MELD score with albumin replacing INR (modMELD) was created to eliminate the confounding effects of anti-coagulation.
Before OHT, AST, ALT and total bilirubin were elevated in 20%, 18% and 29% of the population, respectively. Total protein and albumin were decreased in 25% and 52% of the population, respectively. By 2 months post-transplantation, percentages of individuals with pathologic values decreased significantly, except for ALT, total protein and albumin, all of which took longer to normalize. Individuals with a higher pre-transplantation MELD or modMELD score had worse outcome 30 days post-transplant and reduced long-term survival over a 10-year follow-up.
In this large, single-center retrospective study, we demonstrated the dynamics of liver dysfunction after cardiac transplantation and that elevated MELD scores indicating impaired liver function are associated with poor clinical outcome after OHT. Thus, pre-operative liver dysfunction has a significant impact on survival of patients after cardiac transplantation.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 03/2012; 31(6):591-600. · 5.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Epicardial adipose tissue has been linked to cardiovascular metabolism and inflammation and has been shown to predict prevalence and progression of coronary artery disease. Only limited data are available on the role of epicardial fat in patients with heart failure (HF). We analyzed cardiac adiposity and its relation to markers of morbidity and clinical outcome in patients with normal and impaired left ventricular (LV) function. Epicardial fat volume (EFV) and coronary artery calcium were measured in 381 patients (210 women and 171 men, mean age 55 ± 10 years) who underwent low-dose computed tomography. HF was defined by LV ejection fraction (EF) <55%. Three hundred twenty-one patients had an EF >55% (mean 63 ± 6) and 60 patients had an EF <55% (mean 41 ± 12). Subgroup analysis was performed according to degree of LV dysfunction in patients with HF (LVEF 35% to 55% or <35%). Mean EFVs were 114.5 ± 98.5 cm(3) in patients with normal EF and 83.5 ± 67.1 cm(3) in those with decreased EF (p <0.05). Mean EFVs were 96.1 ± 73.9 cm(3) in patients with moderate HF and 52.2 ± 29.7 cm(3) in patients with severe HF (p <0.05). Subgroup analysis revealed a persistently smaller EFV in patients with HF regardless of coronary artery calcium scores, markers of renal function, lipid metabolism, fasting blood glucose, or body mass index. In conclusion, our data demonstrate a stepwise decrease in EFV in patients with impaired cardiac function.
The American journal of cardiology 05/2011; 108(3):397-401. · 3.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Infection following coronary artery bypass grafting (CABG) is a leading cause of morbidity, mortality, and increased length of hospital stay. Many studies have investigated the predictive value of known risk factors for infection in patients following CABG and conclusions have been variable and may reveal regional or institution-specific influence. The purpose of this prospective study was to determine the pre- and peri-operative risk factors for infection in patients undergoing coronary artery bypass surgery in a developing country.
A prospective study was undertaken to collect data on 12 reported risk factors for all patients undergoing CABG during a five-year period at The Aga Khan University Hospital, Pakistan. The relationship of these risk factors to infection following CABG was evaluated.
Out of 767 consecutive patients admitted for CABG, a total of 73 (9.51%) developed 92 infections following surgery. Sternal Surgical Site Infection (SSI) developed in 30 patients (3.91%), of which 29 (96.7%) were superficial and 1 (3.33%) was deep. There were 37 leg wound infections at the site of conduit harvest, and 2 cases of infection at the intra-aortic balloon pump. There were 12 cases of sepsis and 11 urinary tract infections. There were 26 cases (35.6%) of leukocytosis and 17 patients (23.3%) showed elevated erythrocyte sedimentation rate (ESR). Staphylococcus aureus was the most frequently isolated pathogen (39.7%). Bacteremia data was not collected. Of the total cases of infection following CABG, 59 required prolonged hospitalization or readmission. Univariate analysis was performed using a p-value of <0.2 as the inclusion criteria for further analysis using logistic regression. Multivariate analysis with adjusted Relative Risk (RR) showed that diabetes (P=0.002, RR=2.3, 95% CI=1.4-4.0), obesity (P=0.036, RR=2.2, 95% CI=1.0-4.4), use of an intra-aortic balloon pump (P=0.001, RR=3.6, 95% CI=1.7-7.7), female gender (P=0.004, RR=2.5, 95% CI=0.2-0.8) and prolonged mechanical ventilation (P=<0.0001, RR=6.7, 95% CI=2.8-15.5) were independent predictors of infection in the study population.
This study suggests that diabetes, obesity, use of an intra-aortic balloon pump and female gender are independent predictors of infection in patients undergoing CABG. Early and strict diabetic control and pre-operative weight reduction may reduce the incidence of infection following CABG. Contamination of these patients may occur before, during and after the operation and efforts to curb such contamination must be intensive. Further prospective studies need to be undertaken to identify and establish these and other risk factors for infection in the region and elsewhere.
The Journal of cardiovascular surgery 02/2011; 52(1):99-104. · 1.37 Impact Factor