Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Current Cardiology Reports
Erschienen in: Current Cardiology Reports 9/2018

01.09.2018 | Heart Failure (H Eisen, Section Editor)

Complications of Cardiac Transplantation

verfasst von: Luciano Potena, Andreas Zuckermann, Francesco Barberini, Arezu Aliabadi-Zuckermann

Erschienen in: Current Cardiology Reports | Ausgabe 9/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Despite the improvement in medical therapy for heart failure and the advancements in mechanical circulatory support, heart transplantation (HT) still remains the best therapeutic option to improve survival and quality of life in patients with advanced heart failure. Nevertheless, HT recipients are exposed to the risk of several potential complications that may impair their outcomes. In this article, we aim to provide a practical and scholarly framework for clinicians approaching heart transplant medicine, as well as a concise update for the experienced readers on the most relevant post-HT complications.

Recent Findings

While recognizing that most of the treatments herein discussed are based more on experience than on solid scientific evidence, significant step forward has been made in particular in the recognition and management of primary graft dysfunction, antibody-mediated rejection, and renal dysfunction.

Summary

Complications after HT may vary according to the time from surgery and can be related to graft function and pathology or to diseases and dysfunctions occurring in other organs or systems, mainly as side effects of immunosuppressive drugs and progression of pre-existing conditions. Future research needs to focus on improving precision diagnostics of causes of graft dysfunction and on reaching an optimal and customized balance between efficacy and toxicities of immunosuppressive strategies.
Literatur
1.
Lund LH, Khush KK, Cherikh WS, Goldfarb S, Kucheryavaya AY, Levvey BJ, et al. The Registry of the International Society for Heart and Lung Transplantation: thirty-fourth adult heart transplantation report—2017; focus theme: allograft ischemic time. J Heart Lung Transplant. 2017;36:1037–46.
2.
Lindenfeld J, Miller G, Shakar S, Zolty R, Lowes BD, Wolfel EE, et al. Drug therapy in the heart transplant recipient. Part II: immunosuppressive drugs. Circulation. 2004;110:3858–65.
3.
Lund LH, Edwards LB, Kucheryavaya AY, Benden C, Dipchand AI, Goldfarb S, et al. The Registry of the International Society for Heart and Lung Transplantation: thirty-second official adult heart transplantation report—2015; focus theme: early graft failure. J Heart Lung Transplant. 2015;34:1244–54.
4.
• Erasmus M, Neyrink A, Sabatino M, Potena L. Heart allograft preservation: an arduous journey from the donor to the recipient. Curr Opin Cardiol. 2017; Comprehensive review of current and future techniques for heart preservation.
5.
Kumarasinghe G, Gao L, Hicks M, Villanueva J, Doyle A, Rao P, et al. Improved heart function from older donors using pharmacologic conditioning strategies. J Heart Lung Transplant. 2016;35:636–46.
6.
• Kobashigawa J, Zuckermann A, Macdonald P, Leprince P, Esmailian F, Luu M, et al. Report from a consensus conference on primary graft dysfunction after cardiac transplantation. J Heart Lung Transplant. 2014;33:327–40. Seminal paper defining primary graft dysfunction in heart transplantation.
7.
Cosio Carmena MD, Gomez Bueno M, Almenar L, et al. Primary graft failure after heart transplantation: characteristics in a contemporary cohort and performance of the RADIAL risk score. J Heart Lung Transplant. 2013;32:1187–95.CrossRefPubMed
8.
• Sabatino M, Vitale G, Manfredini V, Masetti M, Borgese L, Maria Raffa G, et al. Clinical relevance of the International Society for Heart and Lung Transplantation consensus classification of primary graft dysfunction after heart transplantation: epidemiology, risk factors, and outcomes. J Heart Lung Transplant. 2017;36:1217–25. Clinical validation of the consensus definition of primary graft dysfunction.
9.
Grigioni F, Potena L, Galie N, et al. Prognostic implications of serial assessments of pulmonary hypertension in severe chronic heart failure. J Heart Lung Transplant. 2006;25:1241–6.CrossRefPubMed
10.
Koulova A, Gass AL, Patibandla S, Gupta CA, Aronow WS, Lanier GM. Management of pulmonary hypertension from left heart disease in candidates for orthotopic heart transplantation. J Thorac Dis. 2017;9:2640–9.CrossRefPubMedPubMedCentral
11.
Ghio S, Crimi G, Pica S, Temporelli PL, Boffini M, Rinaldi M, et al. Persistent abnormalities in pulmonary arterial compliance after heart transplantation in patients with combined post-capillary and pre-capillary pulmonary hypertension. PLoS One. 2017;12:e0188383.
12.
Sabato LA, Salerno DM, Moretz JD, Jennings DL. Inhaled pulmonary vasodilator therapy for management of right ventricular dysfunction after left ventricular assist device placement and cardiac transplantation. Pharmacotherapy. 2017;37:944–55.CrossRefPubMed
13.
Rajek A, Pernerstorfer T, Kastner J, Mares P, Grabenwöger M, Sessler DI, et al. Inhaled nitric oxide reduces pulmonary vascular resistance more than prostaglandin E(1) during heart transplantation. Anesth Analg. 2000;90:523–30.
14.
Bonet LA, Guillen RV, Lazaro IS, et al. Intravenous sildenafil in right ventricular dysfunction with pulmonary hypertension following a heart transplant. Heart Int. 2014;9:22–5.PubMedPubMedCentralCrossRef
15.
D'Ancona G, Santise G, Falletta C, Pirone F, Sciacca S, Turrisi M, et al. Primary graft failure after heart transplantation: the importance of donor pharmacological management. Transplant Proc. 2010;42:710–2.
16.
D’Alessandro C, Aubert S, Golmard JL, Praschker BL, Luyt CE, Pavie A, et al. Extra-corporeal membrane oxygenation temporary support for early graft failure after cardiac transplantation. Eur J Cardiothorac Surg. 2010;37:343–9.
17.
Santise G, Petrou M, Pepper JR, Dreyfus G, Khaghani A, Birks EJ. Levitronix as a short-term salvage treatment for primary graft failure after heart transplantation. J Heart Lung Transplant. 2006;25:495–8.CrossRefPubMed
18.
Mihaljevic T, Jarrett CM, Gonzalez-Stawinski G, Smedira NG, Nowicki ER, Thuita L, et al. Mechanical circulatory support after heart transplantation. Eur J Cardiothorac Surg. 2012;41:200–6. discussion 6
19.
Takeda K, Li B, Garan AR, Topkara VK, Han J, Colombo PC, et al. Improved outcomes from extracorporeal membrane oxygenation versus ventricular assist device temporary support of primary graft dysfunction in heart transplant. J Heart Lung Transplant. 2017 Jun;36(6):650–6.
20.
Stewart S, Winters GL, Fishbein MC, Tazelaar HD, Kobashigawa J, Abrams J, et al. Revision of the 1990 working formulation for the standardization of nomenclature in the diagnosis of heart rejection. J Heart Lung Transplant. 2005;24:1710–20.
21.
• Berry GJ, Burke MM, Andersen C, Bruneval P, Fedrigo M, Fishbein MC, et al. The 2013 International Society for Heart and Lung Transplantation working formulation for the standardization of nomenclature in the pathologic diagnosis of antibody-mediated rejection in heart transplantation. J Heart Lung Transplant. 2013;32:1147–62. Reference paper for diagnostic criteria of ABMR.
22.
Caves PK, Stinson EB, Billingham ME, Shumway NE. Serial transvenous biopsy of the transplanted human heart. Improved management of acute rejection episodes. Lancet. 1974;1:821–6.CrossRefPubMed
23.
Crespo-Leiro MG, Zuckermann A, Bara C, Mohacsi P, Schulz U, Boyle A, et al. Concordance among pathologists in the second cardiac allograft rejection gene expression observational study (CARGO II). Transplantation. 2012;94:1172–7.
24.
Angelini A, Andersen CB, Bartoloni G, Black F, Bishop P, Doran H, et al. A web-based pilot study of inter-pathologist reproducibility using the ISHLT 2004 working formulation for biopsy diagnosis of cardiac allograft rejection: the European experience. J Heart Lung Transplant. 2011;30:1214–20.
25.
Pham MX, Teuteberg JJ, Kfoury AG, Starling RC, Deng MC, Cappola TP, et al. Gene-expression profiling for rejection surveillance after cardiac transplantation. N Engl J Med. 2010;362:1890–900.
26.
Manfredini V, Leone O, Agostini V, Potena L. Antibody-mediated rejection in heart transplantation: new developments and old uncertainties. Curr Opin Organ Transplant. 2017;22:207–14.CrossRefPubMed
27.
• Chih S, Tinckam KJ, Ross HJ. A survey of current practice for antibody-mediated rejection in heart transplantation. Am J Transplant. 2013;13:1069–74. Important survey on clinical practices about treatment of antibody mediated rejection. CrossRefPubMed
28.
Bruneval P, Angelini A, Miller D, Potena L, Loupy A, Zeevi A, et al. The XIIIth Banff conference on allograft pathology: the Banff 2015 heart meeting report: improving antibody-mediated rejection diagnostics: strengths, unmet needs, and future directions. Am J Transplant. 2017;17:42–53.
29.
Colvin M, Cook J, Chang P, Francis G, Hsu DT, Kiernan MS, et al. Antibody-mediated rejection in cardiac transplantation: emerging knowledge in diagnosis and management. Circulation. 2015;131:1608–39.
30.
Kobashigawa J, Crespo-Leiro MG, Ensminger SM, Reichenspurner H, Angelini A, Berry G, et al. Report from a consensus conference on antibody-mediated rejection in heart transplantation. J Heart Lung Transplant. 2011;30:252–69.
31.
St Goar FG, Pinto FJ, Alderman EL, et al. Intracoronary ultrasound in cardiac transplant recipients. In vivo evidence of “angiographically silent” intimal thickening. Circulation. 1992;85:979–87.CrossRefPubMed
32.
Mehra MR, Crespo-Leiro MG, Dipchand A, Ensminger SM, Hiemann NE, Kobashigawa JA, et al. International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy-2010. J Heart Lung Transplant. 2010;29:717–27.
33.
34.
Prada-Delgado O, Estevez-Loureiro R, Paniagua-Martin MJ, Lopez-Sainz A, Crespo-Leiro MG. Prevalence and prognostic value of cardiac allograft vasculopathy 1 year after heart transplantation according to the ISHLT recommended nomenclature. J Heart Lung Transplant. 2012;31:332–3.CrossRefPubMed
35.
Potena L, Masetti M, Sabatino M, Bacchi-Reggiani ML, Pece V, Prestinenzi P, et al. Interplay of coronary angiography and intravascular ultrasound in predicting long-term outcomes after heart transplantation. J Heart Lung Transplant. 2015;34:1146–53.
36.
•• Eisen HJ, Kobashigawa J, Starling RC, Pauly DF, Kfoury A, Ross H, et al. Everolimus versus mycophenolate mofetil in heart transplantation: a randomized, multicenter trial. Am J Transplant. 2013;13:1203–16. Largest randomized trial ever conducted in heart transplantation.
37.
• Clemmensen TS, Holm NR, Eiskjaer H, et al. Layered fibrotic plaques are the predominant component in cardiac allograft vasculopathy: systematic findings and risk stratification by OCT. JACC Cardiovasc Imaging. 2017;10:773–84. Important in vivo anatomic findings in allograft vasculopathy. CrossRefPubMed
38.
Caforio AL, Tona F, Fortina AB, et al. Immune and nonimmune predictors of cardiac allograft vasculopathy onset and severity: multivariate risk factor analysis and role of immunosuppression. Am J Transplant. 2004;4:962–70.CrossRefPubMed
39.
Colvin-Adams M, Agnihotri A. Cardiac allograft vasculopathy: current knowledge and future direction. Clin Transpl. 2011;25:175–84.CrossRef
40.
Huibers MM, Vink A, Kaldeway J, et al. Distinct phenotypes of cardiac allograft vasculopathy after heart transplantation: a histopathological study. Atherosclerosis. 2014;236:353–9.CrossRefPubMed
41.
•• Loupy A, Toquet C, Rouvier P, Beuscart T, Bories MC, Varnous S, et al. Late failing heart allografts: pathology of cardiac allograft vasculopathy and association with antibody-mediated rejection. Am J Transplant. 2016;16:111–20. An outstanding report about findings on allografts from autopsies and explants in patients with severe CAV.
42.
Alam M, Shahzad SA, Akhtar A, Huang HD, Rogers PA, Ramanathan KB, et al. Long-term clinical outcomes after percutaneous coronary intervention for unprotected left main coronary artery in heart transplant patients with cardiac allograft vasculopathy. Int J Cardiol. 2012;156:101–4.
43.
Agarwal S, Parashar A, Kapadia SR, Tuzcu EM, Modi D, Starling RC, et al. Long-term mortality after cardiac allograft vasculopathy: implications of percutaneous intervention. JACC Heart Fail. 2014;2:281–8.
44.
Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007;357:2601–14.CrossRefPubMed
45.
San Juan R, Aguado JM, Lumbreras C, Díaz-Pedroche C, López-Medrano F, Lizasoain M, et al. Incidence, clinical characteristics and risk factors of late infection in solid organ transplant recipients: data from the RESITRA study group. Am J Transplant. 2007;7:964–71.
46.
Costanzo MR, Dipchand A, Starling R, et al. The International Society of Heart and Lung Transplantation guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2010;29:914–56.CrossRefPubMed
47.
Potena L, Holweg CT, Vana ML, et al. Frequent occult infection with cytomegalovirus in cardiac transplant recipients despite antiviral prophylaxis. J Clin Microbiol. 2007;45:1804–10.CrossRefPubMedPubMedCentral
48.
• Kotton CN, Kumar D, Caliendo AM, Åsberg A, Chou S, Danziger-Isakov L, et al. Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation. 2013;96:333–60. Reference paper on CMV diagnosis and treatment after solid organ transplantation.
49.
Naraqi S. Cytomegalovirus. Textbook of human virology. St. Louis: Mosby-Year Book Inc.; 1991. p. 889–924.
50.
Mocarski ES Jr. Immunomodulation by cytomegaloviruses: manipulative strategies beyond evasion. Trends Microbiol. 2002;10:332–9.CrossRefPubMed
51.
Kudchodkar SB, Yu Y, Maguire TG, Alwine JC. Human cytomegalovirus infection induces rapamycin-insensitive phosphorylation of downstream effectors of mTOR kinase. J Virol. 2004;78:11030–9.CrossRefPubMedPubMedCentral
52.
Potena L, Solidoro P, Patrucco F, Borgese L. Treatment and prevention of cytomegalovirus infection in heart and lung transplantation: an update. Expert Opin Pharmacother. 2016;17:1611–22.CrossRefPubMed
53.
Potena L, Valantine HA. Cytomegalovirus-associated allograft rejection in heart transplant patients. Curr Opin Infect Dis. 2007;20:425–31.CrossRefPubMed
54.
Singh N. Antiviral drugs for cytomegalovirus in transplant recipients: advantages of preemptive therapy. Rev Med Virol. 2006;16:281–7.CrossRefPubMed
55.
Emery VC. Prophylaxis for CMV should not now replace pre-emptive therapy in solid organ transplantation. Rev Med Virol. 2001;11:83–6.CrossRefPubMed
56.
Snydman DR. The case for cytomegalovirus prophylaxis in solid organ transplantation. Rev Med Virol. 2006;16:289–95.CrossRefPubMed
57.
Kowalski RJ, Post DR, Mannon RB, Sebastian A, Wright HI, Sigle G, et al. Assessing relative risks of infection and rejection: a meta-analysis using an immune function assay. Transplantation. 2006;82:663–8.
58.
Kobashigawa JA, Kiyosaki KK, Patel JK, Kittleson MM, Kubak BM, Davis SN, et al. Benefit of immune monitoring in heart transplant patients using ATP production in activated lymphocytes. J Heart Lung Transplant. 2010;29:504–8.
59.
•• Ravaioli M, Neri F, Lazzarotto T, Bertuzzo VR, di Gioia P, Stacchini G, et al. Immunosuppression modifications based on an immune response assay: results of a randomized, controlled trial. Transplantation. 2015;99:1625–32. Important study supporting the concept that immune monitoring may be more effective than drug monitoring to balance immunosuppressive treatment in transplant recipients.
60.
Potena L, Gaudenzi A, Chiereghin A, et al. Quantiferon monitor: a novel immune monitoring assay to stratify risk of infection after heart transplantation. Transpl Int. 2017;30:538.
61.
Gonzalez-Vilchez F, Vazquez de Prada JA. Chronic renal insufficiency in heart transplant recipients: risk factors and management options. Drugs. 2014;74:1481–94.CrossRefPubMed
62.
• Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA, et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: a 10-year update. J Heart Lung Transplant. 2016;35:1–23. Seminal paper on indications for heart transplantation.
63.
Schiferer A, Zuckermann A, Dunkler D, Eskandary F, Bernardi M, Hiesmayr M, et al. Acute kidney injury and outcome after heart transplantation: large differences in performance of scoring systems. Transplantation. 2016;100:2439–46.
64.
Alvarez Arroyo MV, Suzuki Y, Yague S, et al. Role of endogenous vascular endothelial growth factor in tubular cell protection against acute cyclosporine toxicity. Transplantation. 2002;74:1618–24.CrossRefPubMed
65.
Liptak P, Ivanyi B. Primer: histopathology of calcineurin-inhibitor toxicity in renal allografts. Nat Clin Pract Nephrol. 2006;2:398–404.CrossRefPubMed
66.
Patel J, Kobashigawa JA. Minimization of immunosuppression: transplant immunology. Transpl Immunol. 2008;20:48–54.CrossRefPubMed
67.
Gonzalez-Vilchez F, Vazquez de Prada JA, Paniagua MJ, Gomez-Bueno M, Arizon JM, Almenar L, et al. Use of mTOR inhibitors in chronic heart transplant recipients with renal failure: calcineurin-inhibitors conversion or minimization? Int J Cardiol. 2014;171:15–23.
68.
• Cornu C, Dufays C, Gaillard S, Gueyffier F, Redonnet M, Sebbag L, et al. Impact of the reduction of calcineurin inhibitors on renal function in heart transplant patients: a systematic review and meta-analysis. Br J Clin Pharmacol. 2014;78:24–32. Meta-analysis on the use of mTOR inhibitors as renal sparing strategy.
69.
•• Andreassen AK, Andersson B, Gustafsson F, Eiskjaer H, Rådegran G, Gude E, et al. Everolimus initiation with early calcineurin inhibitor withdrawal in de novo heart transplant recipients: three-year results from the randomized SCHEDULE study. Am J Transplant. 2016;16:1238–47. First randomized study showing safety of early CNI avoidance strategy in heart transplantation.
70.
• Potena L, Pellegrini C, Grigioni F, et al. Optimizing the safety profile of everolimus by delayed initiation in de novo heart transplant recipients: results of the prospective randomized study EVERHEART. Transplantation. 2018 Mar;102(3):493–501. Important randomized study guiding the timing of everolimus utilization in heart transplant recipients.
71.
Zuckermann A, Wang SS, Epailly E, Barten MJ, Sigurdardottir V, Segovia J, et al. Everolimus immunosuppression in de novo heart transplant recipients: what does the evidence tell us now? Transplant Rev (Orlando). 2013;27:76–84.
72.
Gonzalez-Vilchez F, Arizon JM, Segovia J, et al. Chronic renal dysfunction in maintenance heart transplant patients: the ICEBERG study. Transplant Proc. 2014;46:14–20.CrossRefPubMed
73.
Gullestad L, Mortensen SA, Eiskjaer H, et al. Two-year outcomes in thoracic transplant recipients after conversion to everolimus with reduced calcineurin inhibitor within a multicenter, open-label, randomized trial. Transplantation. 2010;90:1581–9.CrossRefPubMed
74.
Piselli P, Serraino D, Segoloni GP, Sandrini S, Piredda GB, Scolari MP, et al. Risk of de novo cancers after transplantation: results from a cohort of 7217 kidney transplant recipients, Italy 1997–2009. Eur J Cancer. 2013;49:336–44.
75.
Gutierrez-Dalmau A, Campistol JM. Immunosuppressive therapy and malignancy in organ transplant recipients: a systematic review. Drugs. 2007;67:1167–98.CrossRefPubMed
76.
Crespo-Leiro MG, Villa-Arranz A, Manito-Lorite N, Paniagua-Martin MJ, Rábago G, Almenar-Bonet L, et al. Lung cancer after heart transplantation: results from a large multicenter registry. Am J Transplant. 2011;11:1035–40.
77.
Hojo M, Morimoto T, Maluccio M, Asano T, Morimoto K, Lagman M, et al. Cyclosporine induces cancer progression by a cell-autonomous mechanism. Nature. 1999;397:530–4.
78.
Tremblay F, Fernandes M, Habbab F, de BEMD, Loertscher R, Meterissian S. Malignancy after renal transplantation: incidence and role of type of immunosuppression. Ann Surg Oncol. 2002;9:785–8.CrossRefPubMed
79.
Taylor L, Hughes RA, McPherson K. The risk of cancer from azathioprine as a treatment for multiple sclerosis. Eur J Neurol. 2004;11:141.CrossRefPubMed
80.
81.
Campistol JM, Eris J, Oberbauer R, Friend P, Hutchison B, Morales JM, et al. Sirolimus therapy after early cyclosporine withdrawal reduces the risk for cancer in adult renal transplantation. J Am Soc Nephrol. 2006;17:581–9.
82.
Epailly E, Albanell J, Andreassen A, Bara C, Campistol JM, Delgado JF, et al. Proliferation signal inhibitors and post-transplant malignancies in heart transplantation: practical clinical management questions. Clin Transpl. 2011 Sep–Oct;25(5):E475–86.
83.
Yanik EL, Siddiqui K, Engels EA. Sirolimus effects on cancer incidence after kidney transplantation: a meta-analysis. Cancer Med. 2015;4:1448–59.CrossRefPubMedPubMedCentral
Metadaten
Titel
Complications of Cardiac Transplantation
verfasst von
Luciano Potena
Andreas Zuckermann
Francesco Barberini
Arezu Aliabadi-Zuckermann
Publikationsdatum
01.09.2018
Verlag
Springer US
Erschienen in
Current Cardiology Reports / Ausgabe 9/2018
Print ISSN: 1523-3782
Elektronische ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-018-1018-3

Weitere Artikel der Ausgabe 9/2018

Current Cardiology Reports 9/2018 Zur Ausgabe

Hypertension (DS Geller and DL Cohen, Section Editors)

The Emerging Role of Mobile-Health Applications in the Management of Hypertension

Congenital Heart Disease (RA Krasuski, Section Editor)

Preoperative Evaluation of Adult Congenital Heart Disease Patients for Non-cardiac Surgery

Congenital Heart Disease (RA Krasuski, Section Editor)

Resynchronization Therapy for Patients with Congenital Heart Disease: Are We Ready for Prime Time?

Lipid Abnormalities and Cardiovascular Prevention (G De Backer, Section Editor)

Lipid Screening, Action, and Follow-up in Children and Adolescents

Invasive Electrophysiology and Pacing (EK Heist, Section Editor)

An Overview of Clinical Outcomes in Transvenous and Subcutaneous ICD Patients

Peripheral Vascular Disease (CJ Cooper and R Gupta, Section Editors)

Percutaneous Endovascular Aortic Aneurysm Repair for Abdominal Aortic Aneurysm

Neu im Fachgebiet Kardiologie

Die „Zehn Gebote“ des Endokarditis-Managements

30.04.2024 Endokarditis Leitlinie kompakt

Worauf kommt es beim Management von Personen mit infektiöser Endokarditis an? Eine Kardiologin und ein Kardiologe fassen die zehn wichtigsten Punkte der neuen ESC-Leitlinie zusammen.

Strenge Blutdruckeinstellung lohnt auch im Alter noch

30.04.2024 Arterielle Hypertonie Nachrichten

Ältere Frauen, die von chronischen Erkrankungen weitgehend verschont sind, haben offenbar die besten Chancen, ihren 90. Geburtstag zu erleben, wenn ihr systolischer Blutdruck < 130 mmHg liegt. Das scheint selbst für 80-Jährige noch zu gelten.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Dihydropyridin-Kalziumantagonisten können auf die Nieren gehen

30.04.2024 Hypertonie Nachrichten

Im Vergleich zu anderen Blutdrucksenkern sind Kalziumantagonisten vom Diyhdropyridin-Typ mit einem erhöhten Risiko für eine Mikroalbuminurie und in Abwesenheit eines RAS-Blockers auch für ein terminales Nierenversagen verbunden.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise