South American Heart Transplantation Registry of patients receiving everolimus in their immunosuppressive regimens.

The increasing number of heart transplant recipients receiving immunosuppression with mammalian target of rapamycin inhibitors prompted the implementation of a South American Transplant Physicians Group to register these patients in a database. Everolimus (EVL) is a signal proliferation inhibition that reduces graft vascular disease when used de novo. Recently, its administration has expanded to subjects with resistant rejection or with side effects due to other immunosuppressive drugs (calcineurin inhibitors and/or steroids), allowing for better regulation of the immunosuppressive regimen. Herein we have shown the data collected from patients receiving EVL in ten South American Heart Transplant Centers. We have concluded that the administration of EVL is a useful adjunctive therapy that allows the reduction or suspension of other immunosuppressive drugs that caused unwanted side effects, without a loss of immunosuppressive efficacy, with manageable side effects, and constituting a valuable therapeutic option.

Recommendations for use of everolimus after heart transplantation: results from a Latin-American Consensus Meeting.

Despite improvements during the last decades, heart transplantation remains associated with several medical complications, which limit clinical outcomes: acute rejection with hemodynamic compromise, cytomegalovirus (CMV) infections, allograft vasculopathy, chronic renal failure, and neoplasias. Everolimus, a proliferation signal inhibitor, represents a new option for adjunctive immunosuppressive therapy. Everolimus displays better efficacy in de novo heart transplant patients than azathioprine for prophylaxis of biopsy-proven acute rejection episodes of at least ISHLT grade 3A (P < .001), of allograft vasculopathy (P < .01), and of CMV infections (P < .01). These findings suggest that everolimus potentially play an important role as part of immunosuppressive therapy in heart transplant recipients. Heart transplant investigators from Latin America produced recommendations for everolimus use in daily practice based on available data and their own experience.

[A clinical screening can predict coronary artery disease in women]. / Un cribado clínico puede pronosticar la enfermedad arterial coronaria en la mujer.

INTRODUCTION AND OBJECTIVE: Cardiovascular disease is the leading cause of death in women. Approximately one of every two women will die of some cardiovascular event, such as myocardial infarction. Thereby, the significance of discarding or confirming coronary artery disease in women presenting with chest pain. The objective of this trial was to demonstrate that on the bases of the Douglas and Ginsburg's clinic screening, it is possible to predict the existence of coronary artery disease in the angiography. MATERIAL AND METHODS: For this research only women with angina pectoris were included. These were 189 patients (cineangiographies) whose clinical determinants and angiographic findings were related. RESULTS: Taking in to account the estimated likelihood, there was a low-risk group A with 29 patients, a moderate-risk group B with 55 patients and a high-risk group C with 105 patients. There was no significant coronary artery disease in the first group, there was a significant coronary artery disease in 13 patients in the second group and 72 patients in the third group. Group A had 0%, 72%, 0% and 47%, group B 15.2%, 59.6%, 23.6% and 46.3%, and group C had 84.7%, 68.3%, 68.5% and 84.5%, of sensibility, specificity, positive and negative predictive value, respectively. CONCLUSION: The usage of the Douglas and Ginsburg's clinic Screening is very effective at the time of deciding whether to perform a coronary angiograpy or not, and it has very good correlation between the probability degree and the presence of coronary artery disease in the coronary angiography.