Carolina Masri

Apoptosis: a potentially reversible, meta-stable state of the heart

Heart failure (HF) is a major problem worldwide, but its pathogenesis remains unclear. Apoptosis or programmed cell death is thought to play a crucial role in its progression. While primarily thought to be a method for cardiomyocyte loss, provocative newer data suggest that the apoptotic cell is not inevitably committed to death. Apoptosis might be one of the meta-stable transition states, like the hibernating myocardium, that may be reversible with appropriate therapy. The cell with activated apoptotic machinery is likely to contribute to reversible systolic dysfunction while awaiting its ultimate fate. We will briefly review some of the data to support such a concept. If proven correct, this may change our future preventive and therapeutic strategies. Methods to reverse apoptosis, thus might help restore systolic function and reverse remodeling or even prevent progression of heart failure.

Echocardiographic Ramp Test for Continuous-Flow Left Ventricular Assist Devices : Do Loading Conditions Matter?

OBJECTIVES This study investigated whether continuous AI and/or elevated mean arterial pressure (MAP) were associated with false positive results for flow obstruction in echocardiographic ramp speed tests in patients with a continuous-flow left ventricular assist device. BACKGROUND Failure to reduce the left ventricular end-diastolic diameter (LVEDD) with increasing device speeds in a ramp test is predictive of pump obstruction. Aortic insufficiency (AI) or increased MAP can diminish the ability to unload the left ventricle. METHODS LVEDD was plotted against device speed, and a linear function slope was calculated. A flat LVEDD slope (≥-0.16) was considered abnormal (suggestive of obstruction). Ramp test results were compared in patients with or without either AI or increased MAP at baseline speed, and receiver-operator characteristic (ROC) curves were constructed for predictors of device obstruction. Device thrombosis was confirmed by direct visualization of clot at explantation or on inspection by the manufacturer. RESULTS Of 78 ramp tests (55 patients), 36 were abnormal (18 true positive, 18 false positive), and 42 were normal (37 true negative, 5 false negative). In patients with AI, LVEDD slope was -0.14 ± 0.17, which was consistent with device obstruction (vs. -0.25 ± 0.11 in patients without AI; p < 0.001), despite no difference in mean lactate dehydrogenase concentration between the 2 groups (1,301 ± 1,651 U/l vs. 1,354 ± 1,365 U/l; p = 0.91). Area under the ROC curve (AUC) for LVEDD slope was 0.76 and improved to 0.88 after removal of patients with AI from the study. LVEDD slope in patients with MAP ≥85 mm Hg was similar to that for device obstruction (-0.18 ± 0.07) and was abnormal in 6 of the 12 ramp tests performed. Combining LVEDD slope with lactate dehydrogenase concentration increased the AUC to 0.96 as an indicator of device obstruction. CONCLUSIONS Abnormal loading conditions due to AI or elevated MAP may result in false positive ramp tests.

Characterization of 25+ year survivors of cardiac transplantation.

t matter r 2013 International Society for Heart and Lung 16/j.healun.2013.01.1053 We conducted a single-center retrospective analysis of 20 consecutive patients at the University of Minnesota who survived at least 25 years after cardiac transplantation. Information regarding transplant recipients and donors was collected retrospectively from paper and electronic records after approval by the Institutional Review Board. For echocardiographic analysis, available echocardiograms were reanalyzed by an independent cardiologist. For right ventricular function, a score of 1 was normal, 2 was mildto-moderate dysfunction, and 3 was moderate-to-severe