Gender differences in heart transplantation: Twenty-five year trends in the nationwide Spanish heart transplant registry.

The study of gender differences may lead into improvement in patient care. We have aimed to identify the gender differences in heart transplantation (HT) of adult HT recipients in Spain and their evolution in a study covering the years 1993-2017 in which 6740 HT (20.6% in women) were performed. HT indication rate per million inhabitants was lower in women, remaining basically unchanged during the 25-year study period. HT rate was higher in men, although this decreased over the 25-year study period. Type of heart disease differed in men versus women (p < .001): ischemic heart disease 47.6% versus 22.5%, dilated cardiomyopathy 41.3% versus 34.6%, or other 36% versus 17.8%, respectively. Men were more frequently diabetics (18% vs. 13.1% p < .001), hypertensives (33.1% vs. 24% p < .001), and smokers (21.7% vs. 12.9% p < .001), respectively. Women had more pre-HT malignancies (7.1% vs. 2.8% p < .001), and their clinical status was worse at HT due to renal function and mechanical ventilation. Adjusted survival (p = .198) and most of the mortality-related variables were similar in men and women. Death occurred more frequently in women due to rejection (7.9% vs. 5.1% p < .001) and primary failure (18.2% vs. 12.5% p < .001) and in men due to malignancies (15.1% vs. 6.6% p < .001).

Myocardial deformation and acute cellular rejection after heart transplantation: Impact of inter-vendor variability in diagnostic effectiveness.

PURPOSE: Our objective was to investigate the impact of inter-vendor variability in the ability of myocardial strain analysis to detect acute cellular rejection (ACR) in heart transplant recipients. METHODS: We performed serial echocardiographic examinations in 18 consecutive adult heart transplanted patients, in their first year post-transplantation, within 3 hours of the routine surveillance endomyocardial biopsies (EMB) in a single center. Myocardial strain was analyzed using two software in two different institutions, and inter-vendor variability of strain values and its association with ACR (any grade or grade ≥2R) was investigated. The parameter of comparison was the peak value of the average curve of strain during the entire cardiac cycle. RESULTS: A total of 147 pairs of EMB-echocardiogram were performed, 65 with no ACR, 63 with ACR grade 1R, and 19 with ACR grade ≥2R. Intra-class correlation coefficients for left ventricle longitudinal, radial, and circumferential strain were 0.38, 0.39, and 0.77, respectively, and 0.32 for right ventricular longitudinal strain. Neither software found significant association of left ventricular longitudinal strain with rejection. Grade ≥2R ACR was associated with left ventricular circumferential strain measured with the first software and with left ventricular radial strain with the other; and ACR of any grade was only significantly associated with right ventricle longitudinal strain measured with the first software. CONCLUSIONS: Inter-vendor reproducibility of strain values was low in this study. Some strain parameters were associated to ACR, although these results were inconsistent between two commercially available software. Specific validation of each software is warranted for this clinical indication.

Conversion From Immediate-Release Tacrolimus to Prolonged-Release Tacrolimus in Stable Heart Transplant Patients: A Retrospective Study.

BACKGROUND: Lifelong adherence with post-transplant immunosuppression is challenging, with nonadherence associated with greater acute rejection (AR) risk. METHODS: This retrospective study evaluated conversion from immediate-release tacrolimus (IRT) to prolonged-release tacrolimus (PRT), between January 2008 and December 2012 in stable adult heart transplant recipients. Cumulative incidence rate (IR) of AR and infection pre- and postconversion, safety, tacrolimus dose and trough levels, concomitant immunosuppression, and PRT discontinuation were analyzed (intention-to-treat population). RESULTS: Overall, 467 patients (mean age, 59.3 [SD, 13.3] years) converted to PRT at 5.1 (SD, 4.9) years post transplant and were followed for 3.4 (SD, 1.5) years. During the 6 months post conversion, 5 patients (1.1%; 95% CI, 0.35%-2.48%) had an AR episode and IR was 2.2/100 patient-years (95% CI, 0.91-5.26). Incidence of rejection preconversion varied by time from transplant to conversion. Infection IR was similar post- and preconversion (9.2/100 patient-years [95% CI, 7.4-11.3] vs 10.6/100 patient-years [95% CI, 8.8-12.3], respectively; P = .20). Safety variables remained similar post conversion. The IR of mortality/graft loss was 2.3/100 patient-years (95% CI, 1.7-3.1). CONCLUSIONS: Conversion from IRT to PRT in heart transplant recipients in Spain was associated with no new safety concerns and appropriate immunosuppressive effectiveness.

Association of cardiac resynchronization therapy with the incidence of appropriate implantable cardiac defibrillator therapies in ischaemic and non-ischaemic cardiomyopathy.

AIMS: Cardiac resynchronization therapy (CRT) reduces the incidence of sudden cardiac death and the use of appropriate implantable cardioverter-defibrillator (ICD) therapies (AICDTs); however, this antiarrhythmic effect is only observed in certain groups of patients. To gain insight into the effects of CRT on ventricular arrhythmia (VA) burden, we compared the incidence of AICDT use in four groups of patients: patients with ischaemic cardiomyopathy vs. non-ischaemic dilated cardiomyopathy (NIDC) and patients implanted with an ICD vs. CRT-ICD. METHODS AND RESULTS: We analysed 689 consecutive patients (mean follow-up 37 ± 16 months) included in the Umbrella registry, a multicentre prospective registry including patients implanted with ICD or CRT-ICD devices with remote monitoring capabilities in 48 Spanish Hospitals. The primary outcome was the time to first AICDT. Despite a worse clinical risk profile, NIDC patients receiving a CRT-ICD had a lower cumulative probability of first AICDT use at 2 years compared with patients implanted with an ICD [24.7 vs. 41.6%, hazard ratio (HR): 0.49, P = 0.003]; on the other hand, there were no significant differences in the incidence of first AICDT use at 2 years in ischaemic patients (22.6 vs. 21.9%, P = NS). Multivariate analysis confirmed the association of CRT with lower AICDT rates amongst NIDC patients (Adjusted HR: 0.55, CI 95% 0.35-0.87). CONCLUSIONS: These data suggest that CRT is associated with significantly lower rates of first AICDT use in NIDC patients, but not in ischaemic patients. This study suggests that ICD patients with NIDC and left bundle branch block experiencing VAs may benefit from an upgrade to CRT-ICD despite being in a good functional class.

Registro Español de Trasplante Cardiaco. XXVII Informe Oficial de la Sección de Insuficiencia Cardiaca y Trasplante Cardiaco de la Sociedad Española de Cardiología (1984-2015) / Spanish Heart Transplantation Registry. 27th Official Report of the Spanish Society of Cardiology working group on Heart Failure and Heart Transplantation (1984-2015)

Introducción y objetivos: Se presentan las características y los resultados del trasplante cardiaco en España desde que empezó su actividad en mayo de 1984. Métodos: Se realiza un análisis descriptivo de las características de los receptores, los donantes, los procedimientos quirúrgicos y los resultados de los trasplantes cardiacos realizados en España hasta el 31 de diciembre de 2015. Resultados: Durante 2015 se han realizado 299 procedimientos, con lo que la serie histórica consta de 7.588 trasplantes. Las características generales del procedimiento son similares a las observadas en los últimos años y destacan el alto porcentaje de procedimientos realizados en código urgente y, sobre todo, la extensión del uso de dispositivos de asistencia circulatoria, particularmente la asistencia ventricular de flujo continuo (el 16% del total de trasplantes). La supervivencia ha aumentado significativamente en la última década con respecto a periodos anteriores. Conclusiones: La actividad de trasplante cardiaco en España permanece estable en los últimos años, con alrededor de 250-300 procedimientos al año. A pesar de la mayor complejidad del contexto clínico, se observa una mejora de la supervivencia en los últimos años (AU)

Introduction and objectives: The present article reports the characteristics and results of heart transplants in Spain since this therapeutic modality was first used in May 1984. Methods: We describe the main features of recipients, donors, surgical procedures, and results of all heart transplants performed in Spain until December 31, 2015. Results: A total of 299 cardiac transplants were performed in 2015, with the whole series comprising 7588 procedures. The main transplant features in 2015 were similar to those observed in recent years. A remarkably high percentage of transplants were performed under emergency conditions and there was widespread use of circulatory assist devices, particularly continuous-flow left ventricular assist devices prior to transplant (16% of all transplants). Survival has significantly improved in the last decade compared with previous time periods. Conclusions: During the last few years, between 250 and 300 heart transplants have consistently been performed each year in Spain. Despite a more complex clinical context, survival has increased in recent years (AU)

Spanish Heart Transplantation Registry. 27th Official Report of the Spanish Society of Cardiology Working Group on Heart Failure and Heart Transplantation (1984-2015).

INTRODUCTION AND OBJECTIVES: The present article reports the characteristics and results of heart transplants in Spain since this therapeutic modality was first used in May 1984. METHODS: We describe the main features of recipients, donors, surgical procedures, and results of all heart transplants performed in Spain until December 31, 2015. RESULTS: A total of 299 cardiac transplants were performed in 2015, with the whole series comprising 7588 procedures. The main transplant features in 2015 were similar to those observed in recent years. A remarkably high percentage of transplants were performed under emergency conditions and there was widespread use of circulatory assist devices, particularly continuous-flow left ventricular assist devices prior to transplant (16% of all transplants). Survival has significantly improved in the last decade compared with previous time periods. CONCLUSIONS: During the last few years, between 250 and 300 heart transplants have consistently been performed each year in Spain. Despite a more complex clinical context, survival has increased in recent years.

Registro Español de Trasplante Cardiaco. XXVI Informe Oficial de la Sección de Insuficiencia Cardiaca y Trasplante Cardiaco de la Sociedad Española de Cardiología (1984-2014) / Spanish Heart Transplantation Registry. 26th Official Report of the Spanish Society of Cardiology Working Group on Heart Failure and Heart Transplantation (1984-2014)

Introducción y objetivos. Se presentan las características y resultados del trasplante cardiaco en España desde que empezó su actividad en mayo de 1984. Métodos. Se realiza un análisis descriptivo de las características de los receptores, los donantes, el procedimiento quirúrgico y los resultados de los trasplantes cardiacos realizados en España hasta el 31 de diciembre de 2014. Resultados. Durante 2014 se han realizado 266 procedimientos, con lo que la serie histórica consta de 7.289 trasplantes. El análisis temporal confirma un empeoramiento significativo del perfil clínico de los receptores (mayor porcentaje de pacientes añosos, con insuficiencia renal grave, diabetes insulinodependiente, cirugía cardiaca previa y ventilación mecánica), de los donantes (mayor porcentaje de donantes añosos y con mayor discordancia de peso) y del procedimiento (mayor porcentaje de trasplante urgente, que en 2014 alcanza el 41,4%, y con tiempo de isquemia > 240 min). El uso de dispositivos de asistencia mecánica ha disminuido respecto a 2013, y en 2014 supone el 18,8% del total de pacientes. La supervivencia a 1, 5, 10 y 15 años es del 76, el 65, el 52 y el 38% respectivamente, y permanece estable desde 1995. Conclusiones. La actividad de trasplante cardiaco en España permanece estable en los últimos años, con alrededor de 250 procedimientos al año. A pesar del claro empeoramiento de las características de donantes, receptores y tiempos quirúrgicos, se mantienen unos resultados en mortalidad comparables a los del entorno y se confirma un uso creciente de los dispositivos de asistencia circulatoria antes del trasplante (AU)

Introduction and objectives. We present the characteristics and outcomes of heart transplantation in Spain since it was first performed in 1984. Methods. A descriptive analysis of the characteristics of recipients, donors, the surgical procedure, and the outcomes of heart transplantations performed in Spain until 31 December 2014. Results. In 2014, 266 procedures were performed, making a time series of 7289 transplantations. The temporal analysis confirmed a significant worsening of the clinical profile of recipients (higher percentage of older patients, patients with severe renal failure, insulin-dependent diabetes, previous cardiac surgery, and previous mechanical ventilation), of donors (higher percentage of older donors and greater weight mismatch), and of the procedure (higher percentage of emergency transplantations, reaching 41.4% in 2014, and ischemia time > 240 min). Mechanical assist devices were used less than in 2013; in 2014 they were used in 18.8% of all transplant recipients. Survival at 1, 5, 10, and 15 years was 76%, 65%, 52%, and 38%, respectively, and has remained stable since 1995. Conclusions. Cardiac transplantation activity in Spain has remained stable in recent years, at around 250 procedures per year. Despite a clear deterioration in donor and recipient characteristics and surgical times, the mortality outcomes have remained comparable to those of previous periods in our environment. The growing use of circulatory assist devices before transplantation is also confirmed (AU)

Spanish Heart Transplantation Registry. 26th Official Report of the Spanish Society of Cardiology Working Group on Heart Failure and Heart Transplantation (1984-2014).

INTRODUCTION AND OBJECTIVES: We present the characteristics and outcomes of heart transplantation in Spain since it was first performed in 1984. METHODS: A descriptive analysis of the characteristics of recipients, donors, the surgical procedure, and the outcomes of heart transplantations performed in Spain until 31 December 2014. RESULTS: In 2014, 266 procedures were performed, making a time series of 7289 transplantations. The temporal analysis confirmed a significant worsening of the clinical profile of recipients (higher percentage of older patients, patients with severe renal failure, insulin-dependent diabetes, previous cardiac surgery, and previous mechanical ventilation), of donors (higher percentage of older donors and greater weight mismatch), and of the procedure (higher percentage of emergency transplantations, reaching 41.4% in 2014, and ischemia time>240min). Mechanical assist devices were used less than in 2013; in 2014 they were used in 18.8% of all transplant recipients. Survival at 1, 5, 10, and 15 years was 76%, 65%, 52%, and 38%, respectively, and has remained stable since 1995. CONCLUSIONS: Cardiac transplantation activity in Spain has remained stable in recent years, at around 250 procedures per year. Despite a clear deterioration in donor and recipient characteristics and surgical times, the mortality outcomes have remained comparable to those of previous periods in our environment. The growing use of circulatory assist devices before transplantation is also confirmed.

Donor/recipient sex mismatch and survival after heart transplantation: only an issue in male recipients? An analysis of the Spanish Heart Transplantation Registry.

The results of studies on the association between sex mismatch and survival after heart transplantation are conflicting. Data from the Spanish Heart Transplantation Registry. From 4625 recipients, 3707 (80%) were men. The donor was female in 943 male recipients (25%) and male in 481 female recipients (52%). Recipients of male hearts had a higher body mass index (25.9 ± 4.1 vs. 24.3 ± 3.7; P < 0.01), and male donors were younger than female donors (33.4 ± 12.7 vs. 38.2 ± 12.3; P < 0.01). No further relevant differences related to donor sex were detected. In the univariate analysis, mismatch was associated with mortality in men (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.06-1.32; P = 0.003) but not in women (HR, 0.91; 95% CI 0.74-1.12; P = 0.4). A significant interaction was detected between sex mismatch and recipient gender (P = 0.02). In the multivariate analysis, sex mismatch was associated with long-term mortality (HR, 1.14; 95% CI 1.01-1.29; P = 0.04), and there was a tendency toward significance for the interaction between sex mismatch and recipient gender (P = 0.08). In male recipients, mismatch increased mortality mainly during the first month and in patients with pulmonary gradient >13 mmHg. Sex mismatch seems to be associated with mortality after heart transplantation in men but not in women.

Registro Español de Trasplante Cardiaco. Una visión histórica / The Spanish heart transplantation registry. a historical perspective

El Registro Español de Trasplante Cardiaco cumple 24 años de actividad. En el presente artículo se hace referencia histórica a su evolución hasta el presente, incluyendo su organización, los resultados de su actividad y sus potencialidades (AU)

The Spanish Heart Transplantation Registry has been in existence for 24 years. This article provides a historical perspective on the development of the Registry up to the present day and discusses its organization, achievements and future potential (AU)

Spanish Heart Transplantation Registry. 25th official report of the Spanish Society of Cardiology Working Group on Heart Failure and Heart Transplantation (1984-2013).

INTRODUCTION AND OBJECTIVES: The present article reports the characteristics and outcome of heart transplantation in Spain since it was first performed in May 1984. METHODS: We provide a descriptive analysis of the characteristics of the recipients, the donors, the surgical procedure, and results of the heart transplantations performed in Spain until 31 December 2013. RESULTS: During 2013, a total of 248 transplantation procedures were carried out, bringing the time series to a total of 7023 transplantations. The temporal analysis confirms a significant deterioration in the clinical profile of the recipients (higher percentage of older patients, severe renal failure, insulin-dependent diabetes mellitus, previous heart surgery, mechanical ventilation), of the donors (higher proportion of older donors and greater weight mismatch), and of the procedure (higher percentage of emergency transplantations which, in 2013, reached 49%, and with ischemia times > 240min). There was a marked increase in the use of circulatory assist devices prior to transplantation which, in 2013, were employed in 25.2% of all the patients. The survivals at 1, 5, 10, and 15 years were 76%, 65%, 52%, and 37%, respectively, and have remained stable since 1995. CONCLUSIONS: Heart transplantation activity in Spain remains stable in recent years, with around 250 procedures a year. Despite the clear deterioration in the clinical characteristics of the donors and recipients, and lengthening of the operative times, the results in terms of mortality continue to be comparable to those reported in our neighboring countries, and a growing use of circulatory assist devices prior to transplantation is confirmed.

Registro Español de Trasplante Cardiaco. XXV Informe Oficial de la Sección de Insuficiencia Cardiaca y Trasplante Cardiaco de la Sociedad Española de Cardiología (1984-2013) / Spanish Heart Transplantation Registry. 25th Official Report of the Spanish Society of Cardiology Working Group on Heart Failure and Heart Transplantation (1984-2013)

Introducción y objetivos. El presente artículo presenta las características y resultados del trasplante cardiaco en España desde que empezó su actividad en mayo de 1984. Métodos. Se realiza un análisis descriptivo de las características de los receptores, los donantes, el procedimiento quirúrgico y los resultados de los trasplantes cardiacos realizados en España hasta el 31 de diciembre de 2013. Resultados. Durante 2013 se han realizado 248 procedimientos, con lo que la serie histórica consta de 7.023 trasplantes. El análisis temporal confirma un empeoramiento significativo del perfil clínico de los receptores (mayor porcentaje de pacientes añosos, insuficiencia renal grave, diabetes mellitus insulinodependiente, cirugía cardiaca previa, ventilación mecánica), los donantes (mayor porcentaje de donantes añosos y mayor discordancia de peso) y el procedimiento (mayor porcentaje de trasplante urgente, que en 2013 alcanzó el 49%, y con tiempos de isquemia > 240 min). Hay un incremento notable del uso previo al trasplante de dispositivos de asistencia circulatoria, que en 2013 ha llegado al 25,2% del total de pacientes. Las supervivencias a 1, 5, 10 y 15 años son del 76, el 65, el 52 y el 37% respectivamente, y permanecen estables desde 1995. Conclusiones. La actividad de trasplante cardiaco en España permanece estable en los últimos años, con alrededor de 250 procedimientos al año. A pesar del claro empeoramiento en las características de los donantes, los receptores y los tiempos quirúrgicos, se mantienen unos resultados de mortalidad comparables a los de los países vecinos y se confirma un uso creciente de los dispositivos de asistencia circulatoria antes del trasplante (AU)

Introduction and objectives. The present article reports the characteristics and outcome of heart transplantation in Spain since it was first performed in May 1984. Methods. We provide a descriptive analysis of the characteristics of the recipients, the donors, the surgical procedure, and results of the heart transplantations performed in Spain until 31 December 2013. Results. During 2013, a total of 248 transplantation procedures were carried out, bringing the time series to a total of 7023 transplantations. The temporal analysis confirms a significant deterioration in the clinical profile of the recipients (higher percentage of older patients, severe renal failure, insulin-dependent diabetes mellitus, previous heart surgery, mechanical ventilation), of the donors (higher proportion of older donors and greater weight mismatch), and of the procedure (higher percentage of emergency transplantations which, in 2013, reached 49%, and with ischemia times > 240 min). There was a marked increase in the use of circulatory assist devices prior to transplantation which, in 2013, were employed in 25.2% of all the patients. The survivals at 1, 5, 10, and 15 years were 76%, 65%, 52%, and 37%, respectively, and have remained stable since 1995. Conclusions. Heart transplantation activity in Spain remains stable in recent years, with around 250 procedures a year. Despite the clear deterioration in the clinical characteristics of the donors and recipients, and lengthening of the operative times, the results in terms of mortality continue to be comparable to those reported in our neighboring countries, and a growing use of circulatory assist devices prior to transplantation is confirmed (AU)

Primary graft failure after heart transplantation: characteristics in a contemporary cohort and performance of the RADIAL risk score.

BACKGROUND: Primary graft failure (PGF) is the leading cause of early heart transplantation (HT) mortality. Our aim was to analyze PGF currently and explore the ability of a dedicated score for PGF risk stratification. METHODS: After applying a dedicated PGF definition, we analyzed its incidence, mortality, and associated factors in a multicenter cohort of 857 HTs performed in 2006 to 2009. We used the following criteria: recipient right (R) atrial pressure ≥ 10 mm Hg; age (A) ≥ 60 years; diabetes (D) mellitus, and inotrope (I) dependence; donor age (A) ≥ 30 years, and length (L) of ischemia ≥ 240 minutes to calculate the RADIAL score for PGF risk prediction. RESULTS: PGF incidence was 22%. The right ventricle was almost always affected, alone (45%) or as part of biventricular failure (47%). Mechanical circulatory support was used in 55%. Mortality attributable to PGF was 53% and extended through the third month after HT, but thereafter, PGF had little influence in long-term outcome. The RADIAL score was higher in PGF patients (2.78 ± 1.1 vs. 2.42 ± 1.1, p = 0.001) and stratified 3 groups with incremental PGF incidence: low risk (12.1%), intermediate risk (19.4%), and high risk (27.5%, p = 0.001). CONCLUSIONS: PGF had a strong impact, with an incidence of 22% and a mortality exceeding 50% that extends through the third post-HT month. The RADIAL score classified patients into 3 groups with incremental risk for PGF and may be useful for its prevention and early therapy.

Rejection after conversion to a proliferation signal inhibitor in chronic heart transplantation.

We sought to determine the incidence, risk factors, and consequences of acute rejection (AR) after conversion from a calcineurin inhibitor (CNI) to a proliferation signal inhibitor (PSI) in maintenance heart transplantation. Relevant clinical data were retrospectively obtained for 284 long-term heart transplant recipients from nine centers in whom CNIs were replaced with a PSI (sirolimus or everolimus) between October 2001 and March 2009. The rejection rate at one yr was 8.3%, stabilizing to 2% per year thereafter. The incidence rate after conversion (4.9 per 100 patient-years) was significantly higher than that observed on CNI therapy in the pre-conversion period (2.2 per 100 patient-years). By multivariate analysis, rejection risk was associated with a history of late AR prior to PSI conversion, early conversion (<5 yr) after transplantation and age <50 yr at the time of conversion. Use of mycophenolate mofetil was a protective factor. Post-conversion rejection did not significantly influence the evolution of left ventricular ejection fraction, renal function, or mortality during further follow-up. Conversion to a CNI-free immunosuppression based on a PSI results in an increased risk of AR. Awareness of the clinical determinants of post-conversion rejection could help to refine the current PSI conversion strategies.

Long-term survival in elderly patients with stable coronary disease.

BACKGROUND: This study aimed to assess long-term prognosis of stable coronary artery disease (sCAD) in patients aged ≥ 75 years and to identify clinical predictors of cardiovascular and overall mortality. MATERIALS AND METHODS: From February 2000 to January 2007, 391 outpatients aged ≥ 75 years (median 78 years, interquartile range [IQR] 76-81 years, 66% male) with sCAD were recruited in this prospective cohort study. Associations of baseline variables with long-term cardiovascular and all-cause death were investigated. RESULTS: After up to 11 years of follow-up (median 4 years, IQR 2-6 years), 89 patients died (23%, 5·45%/year), 35 from cardiovascular causes (9%, 2·14%/year). Multivariate analysis identified family history of coronary disease (HR 4·28, 95% CI 1·22-15·02, P = 0·02), baseline atrial fibrillation (HR 3·18, 95% CI 1·37-7·39, P = 0·007), age (HR 1·61 per 5 year increase, 95% CI 1·04-2·50, P = 0·03), resting heart rate (HR 1·26 per 5 bpm increase, 95% CI 1·09-1·47, P = 0·003) and previous revascularization (HR 0·17, 95% CI 0·04-0·77, P = 0·02) as independent predictors of cardiovascular death, and previous acute coronary syndrome (HR 4·93, 95% CI 1·49-16·30, P = 0·009), baseline atrial fibrillation (HR 1·96, 95% CI 1·12-3·43, P = 0·02), tobacco use (HR 1·69, 95% CI 1·00-2·84, P = 0·049 for ex-smoking and HR 6·78, 95% CI 0·89-51·47, P = 0·06 for active smoking), age (HR 1·58 per 5 year increase, 95% CI 1·18-2·11, P = 0·002), resting heart rate (HR 1·10 per 5 bpm increase, 95% CI 1·00-1·22, P = 0·05) and diastolic blood pressure (HR 0·97, 95% CI 0·94-0·99, P = 0·01) as independent predictors of overall mortality. CONCLUSIONS: In this study, 4-years overall mortality was 23% among elderly patients with sCAD. Simple clinical variables can identify patients at higher risk of mortality.

Epidemiology and clinical impact of infection in patients awaiting heart transplantation.

OBJECTIVES: The aim of this study was to determine the epidemiology and clinical impact of infections in patients awaiting heart transplantation. METHODS: We evaluated all patients considered for a heart transplant in our center over a period of 18 months over a period of 18 months from 2007 to 2009. The patients were followed up for 8 months or until death, transplant, or loss to follow-up. RESULTS: Ninety patients were included in the study. During follow-up, 25 infections were recorded in 22 heart transplant candidates (24.4%). Respiratory infections were the most frequent infection (12 bronchitis; 48.0%), followed by skin and soft tissue infections (four infections; 16.0%), intra-abdominal infections (four infectious diarrhea; 16.0%), bacteremia (three infections; 12.0%), and urinary tract infections (two infections; 2.0%). Age, comorbidity, sex, and diabetes were not found to be risk factors for infection. Twenty-four patients (26.7%) were transplanted during follow-up. Infection before transplantation was not associated with an increased risk of mortality or a higher rate of infection in the immediate post-transplant period. CONCLUSIONS: Infections are common in heart transplant candidates, affecting almost 25% of them. Respiratory tract infections are the most frequent type of infection. However, they are not associated with increased mortality in the immediate post-transplant period.

Spanish Heart Transplantation Registry. 24th official report of the Spanish Society of Cardiology Working Group on Heart Failure and Heart Transplantation (1984-2012).

INTRODUCTION AND OBJECTIVES: The present article reports the characteristics and results of heart transplantation in Spain since this therapeutic modality was first used in May 1984. METHODS: We summarize the main features of recipients, donors, and surgical procedures, as well as the results of all heart transplantations performed in Spain until December 31, 2012. RESULTS: A total of 247 heart transplantations were performed in 2012. The whole series consisted of 6775 procedures. Recent years have seen a progressive worsening in the clinical characteristics of recipients (34% aged over 60 years, 22% with severe kidney failure, 17% with insulin-dependent diabetes, 29% with previous heart surgery, 16% under mechanical ventilation) and donors (38% aged over 45 years, 26% with recipient: donor weight mismatch>20%), and in surgical conditions (29% of procedures at >4 h ischemia and 36% as emergency transplantations). The probability of survival at 1, 5, 10, and 15 years of follow-up was 78%, 67%, 53%, and 38%, respectively. These results have remained stable since 1995. CONCLUSIONS: In recent years, the number of heart transplantations/year in Spain has remained stable at around 250. Despite the worsening of recipient and donor clinical characteristics and of time-to-surgery, the results in terms of mortality have remained stable and compare favorably with those of other countries.

Registro Español de Trasplante Cardiaco. XXIII Informe Oficial de la Sección de Insuficiencia Cardiaca y Trasplante Cardiaco de la Sociedad Española de Cardiología (1984-2011) / Spanish Registry on Heart Transplantation. 23rd Official Report of the Spanish Society of Cardiology Working Group on Heart Failure and Heart Transplantation (1984-2011)

Introducción y objetivos. El propósito de este artículo es presentar los resultados del trasplante cardiaco desde que se inició esta modalidad terapéutica en España en mayo de 1984. Métodos. Se ha realizado un análisis descriptivo de todos los trasplantes cardiacos realizados hasta el 31 de diciembre de 2011. Resultados. El número total de trasplantes cardiacos es de 6.528. El perfil clínico medio del paciente que se trasplantó en España en 2011 fue el de un varón de 53 años, diagnosticado de cardiopatía isquémica no revascularizable con depresión grave de la función ventricular y situación funcional avanzada, al que se implantó un corazón de 38 años procedente de un donante fallecido por hemorragia cerebral y con un tiempo en lista de espera de 122 días. El tiempo medio de supervivencia se ha incrementado con los años. Así, mientras en la serie total la probabilidad de supervivencia tras 1, 5, 10 y 15 años es del 77, el 66, el 53 y el 39%, respectivamente, en los últimos 5 años la probabilidad de supervivencia tras 1 y 5 años es del 80 y el 73%, respectivamente. La causa más frecuente de fallecimiento es el fallo agudo del injerto (16%), seguido de infección (15,6%), combinado de enfermedad vascular del injerto y muerte súbita (14%), tumores (12,3%) y rechazo agudo (7,7%). Conclusiones. La supervivencia obtenida en España con el trasplante cardiaco, sobre todo en los últimos años, lo sitúa como el tratamiento de elección para cardiopatías irreversibles en situación funcional avanzada y sin otras opciones médicas o quirúrgicas establecidas (AU)

Introduction and objectives. The purpose of this article is to present the results obtained from heart transplantation since this therapeutic modality first began to be used in Spain in May 1984. Methods. A descriptive analysis was performed of all heart transplantations performed until 31 December 2011. Results. The total number of transplantations is 6528. The average clinical profile of the Spanish heart transplantation patient in 2011 was that of a 53-year-old male who had been diagnosed with nonrevascularizable ischemic heart disease accompanied by severely depressed ventricular function and poor functional status. The implanted heart was typically from a 38-year-old donor who had died from brain hemorrhage. The average waiting list time was 122 days. Mean survival time has progressively increased over the years. For the overall series, the probability of survival at 1, 5, 10, and 15 years was 77%, 66%, 53%, and 39%, respectively, whereas over the past 5 years the probability of survival at 1 and 5 years was 80% and 73%, respectively. The most frequent cause of death was acute graft failure (16%), followed by infection (15.6%), the combination of graft vascular disease and sudden death (14%), tumors (12.3%) and acute rejection (7.7%). Conclusions. The survival rates obtained in Spain from heart transplantation, especially in recent years, place heart transplantation as the treatment of choice in irreversible heart failure patients without other established medical or surgical options (AU)

Spanish registry on heart transplantation. 23rd official report of the Spanish Society of Cardiology Working Group on Heart Failure and Heart Transplantation (1984-2011).

INTRODUCTION AND OBJECTIVES: The purpose of this article is to present the results obtained from heart transplantation since this therapeutic modality first began to be used in Spain in May 1984. METHODS: A descriptive analysis was performed of all heart transplantations performed until 31 December 2011. RESULTS: The total number of transplantations is 6528. The average clinical profile of the Spanish heart transplantation patient in 2011 was that of a 53-year-old male who had been diagnosed with nonrevascularizable ischemic heart disease accompanied by severely depressed ventricular function and poor functional status. The implanted heart was typically from a 38-year-old donor who had died from brain hemorrhage. The average waiting list time was 122 days. Mean survival time has progressively increased over the years. For the overall series, the probability of survival at 1, 5, 10, and 15 years was 77%, 66%, 53%, and 39%, respectively, whereas over the past 5 years the probability of survival at 1 and 5 years was 80% and 73%, respectively. The most frequent cause of death was acute graft failure (16%), followed by infection (15.6%), the combination of graft vascular disease and sudden death (14%), tumors (12.3%) and acute rejection (7.7%). CONCLUSIONS: The survival rates obtained in Spain from heart transplantation, especially in recent years, place heart transplantation as the treatment of choice in irreversible heart failure patients without other established medical or surgical options.

Prognostic impact of baseline low blood pressure in hypertensive patients with stable coronary artery disease of daily clinical practice.

The authors' aim was to investigate the prognostic value of first-visit systolic and diastolic blood pressure (SBP/DBP) in hypertensive patients with stable coronary artery disease (sCAD) in conditions of contemporary daily clinical practice. From February 1, 2000, to January 31, 2004, 690 consecutive hypertensive patients with sCAD (mean age 68 ± 10 years, 65% male) were prospectively followed in the outpatient cardiology clinic for major events (acute coronary syndrome, revascularization, stroke, heart failure, or death) and associations with baseline SBP/DBP were investigated. At first visit, median SBP/SDP were 130/75 mm Hg (interquartile range, 25-75; 120-140/70-80 mm Hg). After 25 months of follow-up (median), 19 patients died (2.8%); 10 from cardiovascular causes (1.5%), 87 patients experienced a coronary event (13%), and 130 patients (19%) a major event. After adjusting for baseline variables, DBP <75 mm Hg or SBP <130 mm Hg resulted in independent predictors of major events (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.07-2.16, P=.02; HR, 1.68; 95% CI, 1.18-2.40, P=.004, respectively), coronary events (HR, 1.78; 95% CI, 1.15-2.75, P=.009; HR, 1.84; 95% CI, 1.20-2.83, P=.005, respectively), and cardiovascular mortality (HR, 7.02; 95% CI, 1.26-39.04, P=.03; HR, 9.26; 95% CI, 1.33-64.32, P=.02, respectively). In this study, a low first-visit SBP or DBP was associated with an adverse prognosis in hypertensive patients with sCAD of contemporary daily clinical practice.