International journal of cardiology
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Review Comparative Study
Left ventricular vs. biventricular mechanical support: Decision making and strategies for avoidance of right heart failure after left ventricular assist device implantation.
Left ventricular assist devices (LVADs) are safer and provide better survival and better quality of life than biventricular assist devices (BVADs) but end-stage heart failure often involves both ventricles, even if its initial cause was left-sided heart disease. Right ventricular failure (RVF) is also a severe complication in about 25% of patients receiving an LVAD, with high perioperative morbidity (renal, hepatic or multi-organ failure) and mortality. Patients who receive an RV assist device (RVAD) only days after LVAD insertion fare much worse than those who receive an RVAD simultaneously with LVAD implantation. ⋯ This article summarizes the knowledge of risk factors for irreversible RVF after LVAD implantation and strategies to optimize RV function (preoperatively, intra-operatively and post-operatively) aimed to reduce the number of BVAD implantations. Special attention is focused on assessment of RV size, geometry and function in relation to loading conditions with the goal of predicting preoperatively the RV changes which might be induced by RV afterload reduction with the LVAD. The review also provides a theoretical and practical basis for clinicians intending to be engaged in this field.
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To describe the natural history of common heart disease incidence on a population study. ⋯ This is the first investigation to report heart disease incidence and its natural history in a quasi-extinction cohort data from Italy in a pre-cardiac surgery era.
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Observational Study
Pre-operative growth differentiation factor 15 as a novel biomarker of acute kidney injury after cardiac bypass surgery.
Pre-operative GDF-15 plasma levels significantly improve the prognostic value of the EuroSCORE for mortality after cardiac surgery. However, despite the strong correlation between GDF-15 and renal function, no data are available regarding the potential interest of pre-operative GDF-15 levels to improve the prediction of acute kidney injury (AKI) after cardiac artery bypass graft (CABG) surgery. ⋯ Pre-operative GDF-15 plasma levels are associated with post-operative AKI in CABG patients. If confirmed in larger cohorts, pre-operative GDF-15 may be of value to improve pre-operative risk stratification among candidates for surgery.
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Adipokines released by adipose tissue have been recognised as important players in the development of cardiovascular disease. Leptin is a well-studied adipokine with an important role in body metabolism and energy expenditure and leptin-deficiency or deficient leptin signalling results in excessive obesity and type 2 diabetes. ⋯ Notably, clinical studies have failed to convincingly link leptin with increased cardiovascular disease risk. We herein summarise the role of leptin in cardiovascular disease as another example of the 'adipokine paradox' and discuss the complexity in using serum adipokine levels as biomarkers in cardiovascular disease.