Volume 4, Number 14; July 22, 2005
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Volume 4, Number 14; July 22, 2005 |
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57-year-old obese male with SOB, left extremity edema, and chest pain.
Recommended reading:
Selection of patients for heart transplantation in the current era of heart failure therapy.
Selecting patients for heart transplantation: which patients are too well for transplant?. [Review]
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Patient: 57 year old obese male presenting with shortness of breath, chest pain, and left extremity edema. Physical exam revealed hypertension (166/96) and 3/6 systolic murmur. EKG indicated left ventricular hypertrophy. Echocardiography revealed a 50-50% ejection fraction, LVH, and mitral regurgitation.
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Session Handout:
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Clinical Question: 1) When should a patient be referred to surgery for heart failure?
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Readings:
<10> Link Directly to Fulltext Article at Publisher Unique Identifier [PMID]: 12748317 Authors: Jessup M. Brozena S. Institution: Heart Failure-Cardiac Transplantation Program, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA. jessupm@uphs.upenn.edu Title: Heart failure.[see comment]. [Review] [89 refs]
Source: New England Journal of Medicine. 348(20):2007-18, 2003 May 15. Publication Type: Journal Article. Review. Review, Tutorial.
<8> Link Directly to Fulltext Article at Science Direct Unique Identifier [PMID]: 14998618 Authors: Butler J. Khadim G. Paul KM. Davis SF. Kronenberg MW. Chomsky DB. Pierson RN 3rd. Wilson JR. Institution: Department of Medicine, and Center for Health Services Research, Vanderbilt University Medical Center and Medicine Service, Nashville Veterans Affairs Medical Center, Tennessee 27232-6300, USA. javed.butler@vanderbilt.edu Title: Selection of patients for heart transplantation in the current era of heart failure therapy.[see comment].
Source: Journal of the American College of Cardiology. 43(5):787-93, 2004 Mar 3. Abstract: OBJECTIVES: We sought to assess the relationship between survival, peak exercise oxygen consumption (VO(2)), and heart failure survival score (HFSS) in the current era of heart failure (HF) therapy. BACKGROUND: Based on predicted survival, HF patients with peak VO(2) <14 ml/min/kg or medium- to high-risk HFSS are currently considered eligible for heart transplantation. However, these criteria were developed before the widespread use of beta-blockers, spironolactone, and defibrillators-interventions known to improve the survival of HF patients. METHODS: Peak VO(2) and HFSS were assessed in 320 patients followed from 1994 to 1997 (past era) and in 187 patients followed from 1999 to 2001 (current era). Outcomes were compared between these two groups of patients and those who underwent heart transplantation from 1993 to 2000. RESULTS: Survival in the past era was 78% at one year and 67% at two years, as compared with 88% and 79%, respectively, in the current era (both p < 0.01). One-year event-free survival (without urgent transplantation or left ventricular assist device) was improved in the current era, regardless of initial peak VO(2): 64% vs. 48% for peak VO(2) <10 ml/min/kg (p = 0.09), 81% vs. 70% for 10 to 14 ml/min/kg (p = 0.05), and 93% vs. 82% for >14 ml/min/kg (p = 0.04). Of the patients with peak VO(2) of 10 to 14 ml/min/kg, 55% had low-risk HFSS and exhibited 88% one-year event-free survival. One-year survival after transplantation was 88%, which is similar to the 85% rate reported by the United Network for Organ Sharing for 1999 to 2000. CONCLUSIONS: Survival for HF patients in the current era has improved significantly, necessitating re-evaluation of the listing criteria for heart transplantation. Publication Type: Journal Article.
<11> Link Directly to Fulltext article in Ovid Unique Identifier [PMID]: 11981245 Authors: Deng MC. Smits JM. Packer M. Institution: Heart Failure Center, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, Milstein Hospital Building Room 5-407, 177 Fort Washington Avenue, New York, NY 10032, USA. md785@columbia.edu Title: Selecting patients for heart transplantation: which patients are too well for transplant?. [Review] [30 refs]
Source: Current Opinion in Cardiology. 17(2):137-44, 2002 Mar. Abstract: In the context of contemporary medical and surgical therapy, the revolutionary procedure of cardiac transplantation should be redefined in its relative role. Based on the assumption that its goal is to prolong life while improving its quality, and in the absence of randomized clinical trial data testing its benefit, data from early breakthrough studies, more recent observational cohort studies, and studies testing other therapies in advanced heart failure must be analyzed to characterize clinical profiles of patients who should be considered too well for cardiac transplantation at specific stages of their disease processes. These profiles likely include advanced heart failure with (1) low risk according to the Heart Failure Survival Score, (2) peak oxygen consumption greater than 14 to 18 mL/kg/min without other indications, (3) left ventricular ejection fraction less than 20% alone, (4) history of New York Heart Association class III to IV symptoms alone, (5) history of ventricular arrhythmias alone, (6) no previous attempt at comprehensive neurohormonal blockade, and (7) no structured cardiac transplantation evaluation in a designated cardiac transplantation center. The evaluation may identify the potential transplant candidate, who could be placed on a national potential transplant candidate list, combining the psychologic benefit of acceptance by the program with an ongoing openness to the diversity of advanced heart failure treatment modalities. [References: 30] Publication Type: Journal Article. Review. Review, Tutorial.
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Resident Report / Department of Medicine & Grady Branch Library Emory University School of Medicine 2005 Edition Participating Faculty: Carlos Del Rio MD / Joyce Doyle MD / Lorenzo Difrancesco MD / Erich Folch MD / Alicia Hidron MD
Contact:
Karl Woodworth
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