Long-Term outcomes in adult patients with congenital heart disease considered for transplantation: A single center study.

BACKGROUND: Adult congenital heart disease (ACHD) patients pose unique challenges in identifying the time for transplantation and factors influencing outcomes. OBJECTIVE: To identify hemodynamic, functional, and laboratory parameters that correlate with 1- and 10-year outcomes in ACHD patients considered for transplantation. METHODS: A retrospective chart review of long-term outcomes in adult patients with congenital heart disease (CHD) evaluated for heart or heart + additional organ transplant between 2004 and 2014 at our center was performed. A machine learning decision tree model was used to evaluate multiple clinical parameters correlating with 1- and 10-year survival. RESULTS: We identified 58 patients meeting criteria. D-transposition of the great arteries (D-TGA) with atrial switch operation (20.7%), tetralogy of Fallot/pulmonary atresia (15.5%), and tricuspid atresia (13.8%) were the most common diagnosis for transplant. Single ventricle patients were most likely to be listed for transplantation (39.8% of evaluated patients). Among a comprehensive list of clinical factors, invasive hemodynamic parameters (pulmonary capillary wedge pressure (PCWP), systemic vascular pressure (SVP), and end diastolic pressures (EDP) most correlated with 1- and 10-year outcomes. Transplanted patients with SVP < 14 and non- transplanted patients with PCWP < 15 had 100% survival 1-year post-transplantation. CONCLUSION: For the first time, our study identifies that hemodynamic parameters most strongly correlate with 1- and 10-year outcomes in ACHD patients considered for transplantation, using a data-driven machine learning model.

Effect of expertise on pacing strategies and sprint performance in batsmen.

OBJECTIVES: To assess whether the absence of a known endpoint, at the beginning of repeated-sprint bouts between the wickets, affects how skilled compared to less skilled batsmen pace themselves. DESIGN: Repeated measures. METHODS: Twelve skilled and 12 less skilled batsmen completed three trials. All trials required the same number of sprints (14 shuttles, 28 runs), while only the information before each trial differed. CT: batsmen were aware of the endpoint (28 runs). UT: not informed of the exercise endpoint and were required to run on command for an indefinite period (28 runs). DT: told they were only doing 14 runs when they actually did 28 runs. Sprint times, electrical muscle activity, and ratings of perceived effort were recorded. RESULTS: Skilled batsmen were significantly faster than less skilled across all trials. Hamstring muscles activity decreased significantly over time in the skilled players during the UT, and during the CT and DT for the less skilled players. There were significant reductions in quadriceps muscles activation for the less skilled over time in all trials and in the skilled batsmen in the vastus medialis during the UT only. Perceived effort increased significantly in both groups in all trials. Skilled batsmen were fastest in the UT and less skilled fastest in the CT. CONCLUSIONS: Better batting skill facilitated improved sprint times, especially when the exact endpoint was unknown. These results suggest that less skilled players should be given more central wicket practice with uncertainty to better develop their ability to maintain their sprint performance.