Mechanical circulatory support restores eligibility for heart transplant in patients with significant pulmonary hypertension.

BACKGROUND: An increasing number of patients with end­stage heart failure implies a wider use of left ventricular assist devices (LVADs). Irreversible pulmonary hypertension (PH) is a predictor of unfavorable prognosis and a contraindication to orthotopic heart transplant (OHT). AIMS: The aim of this study was to evaluate the effect of continuous­flow LVAD (CF­LVAD) support on pulmonary pressure and pulmonary vascular resistance (PVR) as well as the impact of pre­LVAD hemodynamic parameters on survival during LVAD support. METHODS: Data collected from 106 patients who underwent CF­LVAD implantation in the years 2009 to 2018 (men, 95.3%; mean [SD] age, 51.8 [12] years; mean [SD] INTERMACS profile, 2.9 [1.6]; mean [SD] LVAD support time, 661 [520] days; follow­up until May 2019) were retrospectively analyzed. RESULTS: Right heart catheterization was performed before LVAD implantation in 94 patients (88.7%), after implantation-in 31 (29.2%), and before and after implantation-in 28 (26.4%). We observed mean pulmonary artery pressure (mPAP) >25 mm Hg in 65 patients (61.3%) and PVR >2.5 Wood units in 33 patients (31.1%) before LVAD implantation. A significant improvement after CF­LVAD implantation was noted in mPAP, pulmonary capillary wedge pressure, transpulmonary gradient, PVR, cardiac output (P <0.001 for all parameters), and cardiac index (P = 0.003). All patients with initially irreversible PH became eligible for OHT during LVAD support. Survival during LVAD support did not depend on initial mPAP and PVR. CONCLUSIONS: In patients with end­stage heart failure, CF­LVAD support leads to a significant reduction of pre­ and postcapillary PH. Survival on CF­LVAD support is independent of elevated mPAP and PVR before implantation, which suggests that LVADs decrease the risk associated with PH.

[Corticosteroids effect on angiogenesis in heart muscle]. / Wplyw kortykosteroidów na angiogeneze w miesniu sercowym.

The process of angiogenesis in a heart muscle is a way of providing the ischaemic myocardium with oxygen and nutritive ingredients. This natural process called therapeutic angiogenesis has been tried in the treatment of patients with coronary artery disease mainly. It has been seen as a chance of an effective beneficial therapy particularly in these patients for whom pharmacological treatment is not sufficient and who are disqualified for operative methods such as the percutaneous coronary angioplasty, or coronary bypass transplantation. The goal of therapeutic angiogenesis is to stimulate the growth of new capillaries in a heart and, as a result, to improve the perfusion and function of a heart muscle. The positive impact of the angiogenesis in a heart muscle is impeded in patients using corticosteroids in treatment for other illnesses. Corticosteroids inhibit the angiogenesis process on a cellular and tissue level. They decrease gene expression for VEGF, iNOS, inhibit the activity of transcriptive factors for AP-1 and NF(k)B. Corticosteroids cause the degradation of a pericellular matrix, inhibit the migration of macrophages and inhibit the synthesis of NO and interleukin. These activities of corticosteroids decrease the number of new vessels in a ischaemic myocardium and, consequently, worsen vascularization and progressive hypoxia.