RADIAL: a novel primary graft failure risk score in heart transplantation.

BACKGROUND: Primary graft failure (PGF) is the leading cause of early mortality after heart transplantation (HT). Our aim is to propose a working definition of PGF and to develop a predictive risk score. METHODS: PGF was defined by four criteria reflecting significant myocardial dysfunction, severe hemodynamic impairment, early onset after HT, and absence of secondary causes of graft dysfunction. We identified independent risk factors for PGF in a derivation series of 621 HTs and constructed a predictive model. After proving its internal consistency we tested the model in a prospective validation series. RESULTS: The incidence and lethality of PGF in our series were 9% and 80%, respectively. We identified 6 multivariate risk factors for PGF (Right atrial pressure ≥ 10 mm Hg, recipient Age ≥ 60 years, Diabetes mellitus, Inotrope dependence, donor Age ≥ 30 years, Length of ischemic time ≥ 240 minutes--i.e., RADIAL). Analysis of isolated right ventricular failure showed similar predictors. The RADIAL score was obtained by adding 1 point for each of these factors present in a given HT. PGF incidence increased significantly as the RADIAL score increased (p < 0.001 for trend). Rates of actual and predicted PGF incidence for RADIAL subgroups showed a good correlation (C-statistic = 0.74). In a prospective validation cohort, RADIAL score kept its predictive ability. CONCLUSIONS: PGF as defined by these criteria showed a high impact on early post-HT mortality in our series. The RADIAL score showed good ability to predict the development of PGF, and could be useful in the prevention and early treatment of this complication.

Cardiac amyloidosis: the importance of a multidisciplinary approach.

Cardiac amyloidosis is associated with the interstitial deposition of abnormal protein in the myocardium, which can lead to a form of restrictive cardiomyopathy with a poor prognosis. This protein can have a number of different origins, which give rise to various subtypes of amyloidosis that have different prognoses and that require different therapeutic approaches. Drugs commonly used in heart failure have little effect in amyloidosis and the use of heart transplantation is controversial because amyloidosis is a multi-organ disease and because there is a possibility of disease recurrence in the graft. The use of new techniques to identify the specific amyloidosis subtype, the emergence of novel ways of preventing or decreasing amyloid production, the ability to monitor responses to therapy and, above all, the introduction of multidisciplinary teams that can implement a combination of therapies, including multiple organ transplantation, have contributed to a substantial improvement in the prognosis of this disease.

Amiloidosis cardiaca: la importancia del manejo multidisciplinario / Cardiac Amyloidosis: the importance of a multidisciplinary approach

La amiloidosis cardiaca causa una miocardiopatía restrictiva de mal pronóstico debida al depósito intersticial de proteína anómala en el miocardio. Esta proteína puede tener diversos orígenes y dar lugar a subtipos de amiloidosis con diferente pronóstico y manejo terapéutico. Los fármacos utilizados habitualmente en la insuficiencia cardiaca son poco eficaces en la amiloidosis, y la indicación de trasplante cardiaco es controvertida porque la enfermedad afecta a múltiples órganos y por la probabilidad de recidiva en el órgano trasplantado. La utilización de nuevas técnicas para la identificación del tipo de amiloidosis, la aparición de procedimientos capaces de impedir o disminuir la producción de amiloide, la posibilidad de monitorizar la respuesta al tratamiento y, sobre todo, la formación de equipos multidisciplinarios capaces de realizar tratamientos combinados, que incluyen el trasplante multiorgánico, han contribuido a mejorar sustancialmente el pronóstico de la enfermedad (AU)

Cardiac amyloidosis is associated with the interstitial deposition of abnormal protein in the myocardium, which can lead to a form of restrictive cardiomyopathy with a poor prognosis. This protein can have a number of different origins, which give rise to various subtypes of amyloidosis that have different prognoses and that require different therapeutic approaches. Drugs commonly used in heart failure have little effect in amyloidosis and the use of heart transplantation is controversial because amyloidosis is a multi-organ disease and because there is a possibility of disease recurrence in the graft. The use of new techniques to identify the specific amyloidosis subtype, the emergence of novel ways of preventing or decreasing amyloid production, the ability to monitor responses to therapy and, above all, the introduction of multidisciplinary teams that can implement a combination of therapies, including multiple organ transplantation, have contributed to a substantial improvement in the prognosis of this disease (AU)