Sequential big endothelin plasma levels in heart transplant recipients during bridging therapy and after successful heart transplantation.

BACKGROUND: The purpose of this study was to investigate the impact of successful heart transplantation in patients with refractory heart failure receiving bridging therapy on sequential plasma levels of big endothelin, norepinephrine, atrial natriuretic peptide and aldosterone. METHODS: Fourteen patients (2 women, 12 men) accepted for heart transplantation were studied. All had severe chronic heart failure refractory to optimized oral therapy with angiotensin-converting enzyme inhibitors and furosemide, were in New York Heart Association functional Class IV, and had a left ventricular ejection fraction of <15%, Right heart catheterization was performed in all patients (cardiac index 1.9 +/- 0.1 liters/min. m(2), pulmonary capillary wedge pressure 30 +/- 2 mmHg, systemic vascular resistance index 2,827 +/- 253 dyn. s/cm(5). m(2)). As bridging therapy, patients received either prostaglandin E(1), prostaglandin E(1) and dobutamine or dobutamine alone as a continuous infusion. Neurohumoral variables were measured prior to bridging therapy and 3.5 months before and 7 and 10 months after successful heart transplantation. RESULTS: Big endothelin, norepinephrine and atrial natriuretic peptide plasma levels decreased from 7.4 +/- 2.9 fmol/ml, 1112 +/- 686 pg/ml and 366 +/- 312 pg/ml to 6.0 +/- 4.5 fmol/ml, 720 +/- 503 pg/ml and 198 +/- 160 pg/ml, respectively, after bridging therapy, and further to 2.1 +/- 0.9 fmol/ml (p < 0.00001 vs baseline), 527 +/- 31 pg/ml (p < 0.02 vs baseline) and 115 +/- 70 pg/ml (p < 0.03 vs baseline), respectively, after cardiac transplantation. Aldosterone plasma levels decreased from 242 +/- 220 pg/ml to 183 +/- 142 pg/ml during bridging therapy and increased after heart transplantation to 252 +/- 189 pg/ml. Plasma creatinine levels increased from 1.2 +/- 0.4 mg/dl at baseline to 1.4 +/- 0.2 mg/dl after transplantation (NS). CONCLUSIONS: The study suggests that excessive overproduction of big endothelin, atrial natriuretic peptide and norepinephrine is predominantly related to pump failure and, after cardiac transplantation, a moderate spillover of big endothelin persists. Its specific origin, however, remains to be elucidated. Furthermore, our data suggest a protective effect of prostaglandin E(1) on kidney function after heart transplantation.

Myocardial involvement in a patient with Burkitt's lymphoma mimicking hypertrophic cardiomyopathy.

Burkitt's lymphoma is a highly aggressive type of non-Hodgkin's lymphoma frequently associated with extranodal or abdominal manifestations. We report the case of a young woman with generalized Burkitt's lymphoma, initially presenting with signs and symptoms of central nervous system involvement. Myocardial infiltration mimicking hypertrophic cardiomyopathy was detected with electrocardiogram, echocardiography, magnetic resonance imaging, and positron emission tomographic scintigraphy with F-18 desoxy-glucose. These abnormalities resolved after high-intensity chemotherapy with a modified B-cell acute lymphoblastic leukemia (B-ALL) protocol.

Peripheral vascular occlusive disease: evaluation with contrast-enhanced moving-bed MR angiography versus digital subtraction angiography in 106 patients.

OBJECTIVE: The purpose of our study was to compare contrast-enhanced moving-bed MR angiography and digital subtraction angiography in the evaluation of peripheral vascular occlusive disease. MATERIALS AND METHODS: This retrospective report includes 106 patients (45 women, 61 men) with known or suspected peripheral vascular occlusive disease who underwent MR angiography and intraarterial digital subtraction angiography of the peripheral arteries. MR angiography was performed on a 1.0-T unit using a moving-bed technique. Every leg was divided into 14 vascular segments, and severity of disease was scored in four categories. Digital subtraction angiography was the standard of reference. RESULTS: In the 106 patients, 2378 vessel segments were evaluated with both imaging modalities. In 2156 segments, MR angiography and digital subtraction angiography were concordant for stenosis classification, in 188 segments the two modalities differed in one category, and in 24 segments they differed in two categories. MR angiography achieved sensitivity and specificity of 96.7% and 95.8%, respectively, for differentiating nonsignificant from hemodynamically significant stenosis (kappa = 0.91). CONCLUSION: This study indicates that MR angiography is an accurate imaging modality in clinical practice. Our data support the concept that MR angiography can modify the diagnosis of suspected peripheral vascular occlusive disease.