The Tailored Medical Therapy in Patients With Advanced Heart Failure Referred for Cardiac Transplantation

C. Campana, G. Alessandrino, L. Striuli, L. Agnesina, M. C. Dequarti, S. Ghio, L. Scelsi, L. Tavazzi

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction: Optimal pharmacologic management of heart transplant (HT) candidates is required prior to evaluation so as to obtain a reliable prognostic stratification and to address the donor shortage. The aim of this study was to determine whether a tailored medical approach was effectively achieved before HT waiting list enrollment. Materials and Methods: This study concerned 40 consecutive patients referred for HT evaluation who underwent a clinical assessment, including hemodynamic, echocardiographic, and brain natriuretic peptide determinations. Medical therapy was optimized according to the clinical assessment to improve neurohormonal and hemodynamic profiles. We analyzed the distribution of the different drugs between the first and the following evaluation to demonstrate whether a significant improvement of medical therapy could be achieved in advanced chronic heart failure (ACHF). Results: The mean age was 53 years, including 93% males. The etiology of disease was ischemic in 40% and idiopathic in 45%. The mean left ventricular ejection fraction was 23%, mean values of hemodynamic data were cardiac index (CI) 2 ± 0.6 L/min/m2, mean pulmonary arterial pressure (mPAP) 30 ± 10 mm Hg, wedge pressure (PWP) 23 ± 8 mm Hg; mean BNP was 618 pg/mL. Median follow-up was 397 days; 82% of candidates underwent HT waiting-list enrollment. The medical treatment was modified as follows: beta-blockers were introduced or uptitrated in 32%, angiotensin receptor blockers (ARB) were introduced in 7.5%, spironolactone was started in 42%, nitrates were introduced in 20%, and diuretics were uptitrated in 35% of patients. Conclusion: In patients with ACHF referred for HT, a further effort in the assessment of the medical treatment is strongly recommended.

Original languageEnglish
Pages (from-to)1999-2000
Number of pages2
JournalTransplantation Proceedings
Volume40
Issue number6
DOIs
Publication statusPublished - Jul 2008

Fingerprint

Heart Transplantation
Heart Failure
Transplants
Waiting Lists
Hemodynamics
Therapeutics
Spironolactone
Pulmonary Wedge Pressure
Brain Natriuretic Peptide
Angiotensin Receptor Antagonists
Diuretics
Nitrates
Stroke Volume
Arterial Pressure
Tissue Donors
Lung
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

The Tailored Medical Therapy in Patients With Advanced Heart Failure Referred for Cardiac Transplantation. / Campana, C.; Alessandrino, G.; Striuli, L.; Agnesina, L.; Dequarti, M. C.; Ghio, S.; Scelsi, L.; Tavazzi, L.

In: Transplantation Proceedings, Vol. 40, No. 6, 07.2008, p. 1999-2000.

Research output: Contribution to journalArticle

Campana, C. ; Alessandrino, G. ; Striuli, L. ; Agnesina, L. ; Dequarti, M. C. ; Ghio, S. ; Scelsi, L. ; Tavazzi, L. / The Tailored Medical Therapy in Patients With Advanced Heart Failure Referred for Cardiac Transplantation. In: Transplantation Proceedings. 2008 ; Vol. 40, No. 6. pp. 1999-2000.
@article{71b4d20dcf074464b9f3d1b695dcd2d3,
title = "The Tailored Medical Therapy in Patients With Advanced Heart Failure Referred for Cardiac Transplantation",
abstract = "Introduction: Optimal pharmacologic management of heart transplant (HT) candidates is required prior to evaluation so as to obtain a reliable prognostic stratification and to address the donor shortage. The aim of this study was to determine whether a tailored medical approach was effectively achieved before HT waiting list enrollment. Materials and Methods: This study concerned 40 consecutive patients referred for HT evaluation who underwent a clinical assessment, including hemodynamic, echocardiographic, and brain natriuretic peptide determinations. Medical therapy was optimized according to the clinical assessment to improve neurohormonal and hemodynamic profiles. We analyzed the distribution of the different drugs between the first and the following evaluation to demonstrate whether a significant improvement of medical therapy could be achieved in advanced chronic heart failure (ACHF). Results: The mean age was 53 years, including 93{\%} males. The etiology of disease was ischemic in 40{\%} and idiopathic in 45{\%}. The mean left ventricular ejection fraction was 23{\%}, mean values of hemodynamic data were cardiac index (CI) 2 ± 0.6 L/min/m2, mean pulmonary arterial pressure (mPAP) 30 ± 10 mm Hg, wedge pressure (PWP) 23 ± 8 mm Hg; mean BNP was 618 pg/mL. Median follow-up was 397 days; 82{\%} of candidates underwent HT waiting-list enrollment. The medical treatment was modified as follows: beta-blockers were introduced or uptitrated in 32{\%}, angiotensin receptor blockers (ARB) were introduced in 7.5{\%}, spironolactone was started in 42{\%}, nitrates were introduced in 20{\%}, and diuretics were uptitrated in 35{\%} of patients. Conclusion: In patients with ACHF referred for HT, a further effort in the assessment of the medical treatment is strongly recommended.",
author = "C. Campana and G. Alessandrino and L. Striuli and L. Agnesina and Dequarti, {M. C.} and S. Ghio and L. Scelsi and L. Tavazzi",
year = "2008",
month = "7",
doi = "10.1016/j.transproceed.2008.05.044",
language = "English",
volume = "40",
pages = "1999--2000",
journal = "Transplantation Proceedings",
issn = "0041-1345",
publisher = "Elsevier USA",
number = "6",

}

TY - JOUR

T1 - The Tailored Medical Therapy in Patients With Advanced Heart Failure Referred for Cardiac Transplantation

AU - Campana, C.

AU - Alessandrino, G.

AU - Striuli, L.

AU - Agnesina, L.

AU - Dequarti, M. C.

AU - Ghio, S.

AU - Scelsi, L.

AU - Tavazzi, L.

PY - 2008/7

Y1 - 2008/7

N2 - Introduction: Optimal pharmacologic management of heart transplant (HT) candidates is required prior to evaluation so as to obtain a reliable prognostic stratification and to address the donor shortage. The aim of this study was to determine whether a tailored medical approach was effectively achieved before HT waiting list enrollment. Materials and Methods: This study concerned 40 consecutive patients referred for HT evaluation who underwent a clinical assessment, including hemodynamic, echocardiographic, and brain natriuretic peptide determinations. Medical therapy was optimized according to the clinical assessment to improve neurohormonal and hemodynamic profiles. We analyzed the distribution of the different drugs between the first and the following evaluation to demonstrate whether a significant improvement of medical therapy could be achieved in advanced chronic heart failure (ACHF). Results: The mean age was 53 years, including 93% males. The etiology of disease was ischemic in 40% and idiopathic in 45%. The mean left ventricular ejection fraction was 23%, mean values of hemodynamic data were cardiac index (CI) 2 ± 0.6 L/min/m2, mean pulmonary arterial pressure (mPAP) 30 ± 10 mm Hg, wedge pressure (PWP) 23 ± 8 mm Hg; mean BNP was 618 pg/mL. Median follow-up was 397 days; 82% of candidates underwent HT waiting-list enrollment. The medical treatment was modified as follows: beta-blockers were introduced or uptitrated in 32%, angiotensin receptor blockers (ARB) were introduced in 7.5%, spironolactone was started in 42%, nitrates were introduced in 20%, and diuretics were uptitrated in 35% of patients. Conclusion: In patients with ACHF referred for HT, a further effort in the assessment of the medical treatment is strongly recommended.

AB - Introduction: Optimal pharmacologic management of heart transplant (HT) candidates is required prior to evaluation so as to obtain a reliable prognostic stratification and to address the donor shortage. The aim of this study was to determine whether a tailored medical approach was effectively achieved before HT waiting list enrollment. Materials and Methods: This study concerned 40 consecutive patients referred for HT evaluation who underwent a clinical assessment, including hemodynamic, echocardiographic, and brain natriuretic peptide determinations. Medical therapy was optimized according to the clinical assessment to improve neurohormonal and hemodynamic profiles. We analyzed the distribution of the different drugs between the first and the following evaluation to demonstrate whether a significant improvement of medical therapy could be achieved in advanced chronic heart failure (ACHF). Results: The mean age was 53 years, including 93% males. The etiology of disease was ischemic in 40% and idiopathic in 45%. The mean left ventricular ejection fraction was 23%, mean values of hemodynamic data were cardiac index (CI) 2 ± 0.6 L/min/m2, mean pulmonary arterial pressure (mPAP) 30 ± 10 mm Hg, wedge pressure (PWP) 23 ± 8 mm Hg; mean BNP was 618 pg/mL. Median follow-up was 397 days; 82% of candidates underwent HT waiting-list enrollment. The medical treatment was modified as follows: beta-blockers were introduced or uptitrated in 32%, angiotensin receptor blockers (ARB) were introduced in 7.5%, spironolactone was started in 42%, nitrates were introduced in 20%, and diuretics were uptitrated in 35% of patients. Conclusion: In patients with ACHF referred for HT, a further effort in the assessment of the medical treatment is strongly recommended.

UR - http://www.scopus.com/inward/record.url?scp=48049120448&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=48049120448&partnerID=8YFLogxK

U2 - 10.1016/j.transproceed.2008.05.044

DO - 10.1016/j.transproceed.2008.05.044

M3 - Article

C2 - 18675112

AN - SCOPUS:48049120448

VL - 40

SP - 1999

EP - 2000

JO - Transplantation Proceedings

JF - Transplantation Proceedings

SN - 0041-1345

IS - 6

ER -