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513: Hemodialysis Is Associated with Increased AlloMap Molecular Expression Score in Cardiac Transplant Recipients
S244
Abstracts
vs.1.6⫾0.3, P⬍0.05). EMB was available in 5/7 (71%) patients, but only demonstrated significant rejection in one case. After increased immunosuppression those with presumed late rejection had a significant improvement in LV EF (29⫾4% vs. 42⫾3%, P⬍0.01). There was no significant difference in myocardial oedema between rejection and control groups in either early or late rejection. Conclusions: CMR is a promising modality for the non-invasive detection of cardiac allograft rejection. It may be of particular benefit in late post-transplant rejection where EMB has a lower diagnostic yield.
513 Hemodialysis Is Associated with Increased AlloMap Molecular Expression Score in Cardiac Transplant Recipients B. Ristow, R. Shaw, D. Miniaci, S. Milechman, E. Lo, E. Haeusslein California Pacific Medical Center, San Francisco, CA Purpose: Transcriptional profiling of 11 genes from peripheral blood monocytes (AlloMap) may identify cardiac allograft recipients at increased risk of acute cellular rejection. We hypothesized that hemodialysis is independently associated with increased AlloMap score. Methods and Materials: We retrospectively evaluated 332 AlloMap samples among 133 cardiac allograft recipients at a single institution with simultaneous blinded biopsy results from May 2006 to June 2008. Samples were drawn from 0.3 to 22 years after transplant. We compared recipients with AlloMap scores ⱕ34 and ⱖ35. Results: Biopsy results were ISHLT grade 0/1A in 282, 1B/2 in 44, and 3A in 6 samples. Recipients with AlloMap scores ⱖ35 had younger age, higher daily prednisone dose, higher daily tacrolimus dose, lower white blood cell (WBC) count, lower left ventricular ejection fraction, higher proportion with grade 3A biopsy results (5% vs 1%, p⫽0.03), and higher proportion undergoing hemodialysis (15% vs 1%, p⬍0.001). No significant differences were present in regards to blood urea nitrogen, creatinine, or estimated glomerular filtration rate among recipients not undergoing hemodialysis. After multinomial adjustment, only WBC count (coefficient -0.37, p⫽0.04) and hemodialysis (coefficient 2.7, p⫽⬍0.001) remained significantly correlated with higher AlloMap score. Conclusions: Hemodialysis was independently associated with increased AlloMap score in the study population; milder degrees of renal insufficiency were not associated with increased AlloMap score. The influence of hemodialysis on mononuclear cell genetic profiling may have implications for transcriptional profiling among other patient subgroups.
The Journal of Heart and Lung Transplantation February 2009
514 Echocardiographic Evaluation of Flow across HeartMate II Axial Flow LVADs at Varying Low Speeds R.S. George1, N.K. Sabharwal2, C. Webb2, M. Hedger1, M.H. Yacoub3, G. Dreyfus1, A. Khaghani1, E.J. Birks1 1Royal Brompton and Harefield NHS Trust, Uxbridge, Middlesex, United Kingdom; 2Royal Brompton and Harefield NHS Trust, Uxbridge, Middlesex, United Kingdom; 3Imperial College, Uxbridge, Middlesex, United Kingdom Purpose: Assessment of myocardial recovery in patients with nonpulsatile LVADs involves speed reduction to a degree where there is minimal contribution from the pump into the circulation during assessment. To date we have used 6000rpm to assess recovery in HeartMate II LVAD patients. The aims of this study were to study reverse flow and to assess whether 6000rpm was a safe and sufficient speed to assess recovery. Methods and Materials: 20 patients with HeartMate II LVAD were prospectively studied. After ensuring an INR of ⱖ 2, the device speed was reduced to 6000rpm for 15 mins on 136 occasions, then to either 5000rpm (12 occasions-Group A) or 4000rpm (12 separate occasionsGroup B). The Doppler flow across LVAD was studied at different speeds and the following parameters were recorded: Forward Peak Velocity (FPV– cm/s), Forward VTI (VTIf– cm), Reverse Peak Velocity (RPV– cm/s), Reverse VTI (VTIr– cm), ESD and EDD. Results: During the 136 studies, none of the patients developed any complications especially thromboembolism. In Group A, speed reduction from a mean baseline of 9200rpm (range 8600-9800rpm) resulted in a decrease in VTIf at 6000rpm (19.7⫾9.9 vs 10.8⫾4.1cm, p⬍0.01) and at 5000rpm (19.7⫾9.9 vs 10.6⫾3cm, p⬍0.05). Similarly, in Group B speed reduction resulted in a drop in VTIf at 6000rpm (22⫾7.1 vs 11.2⫾2.5cm, p⬍0.001) and at 4000rpm (22⫾7.1 vs 9.5⫾3.9cm, p⬍0.001), compared to baseline. No changes in VTIf, ESD, EDD were found between 6000rpm and 5000rpm (10.8⫾4.1 vs 10.6⫾3cm, 42.0⫾11.2 vs 41.3⫾10.5mm, 54.5⫾9.8 vs 55.7⫾7.8mm, respectively) or 6000rpm and 4000rpm (11.2⫾2.5 vs 9.5⫾3.9cm, 39⫾8.7 vs 41.4⫾8.6mm, 53.2⫾6.5 vs 54.5⫾7mm). Although there was an increase in reverse flow as the speed was reduced, there was no significant change in RPV or VTIr. Conclusions: Reducing the speed of HeartMate II is safe for assessment. A significant reduction in VTIf was noted when the speed was reduced to 6000rpm. At speeds of 6000rpm and below no significant changes in RPV, VTIf, VTIr, ESD and EDD were seen suggesting that testing at speeds below 6000rpm is not required. 515 Predictors of Stroke on Heartmate II Left Ventricular Assist Device B. Kar1, S. Basra2, P. Loyalka1, I. Gregoric1, R. Delgado1, A. Civitello1, R. Bogaev1, W. Cohn1, A. Attallah3, R. Wagle3, O.H. Frazier1 1Texas Heart Institute, Houston, TX; 2University of Texas Health Science Center, Houston, TX; 3Baylor College of Medicine, Houston Purpose: The Heartmate II is an effective treatment alternative for patients with end stage heart failure refractory to medical therapy. However, a relatively large proportion of patients on Heartmate II develop stroke. We aimed to determine the predictors of stroke in this patient population. Methods and Materials: All patients (n⫽71) implanted with Heartmate II at our institute were included in the study. Patients developing a stroke were classified as cases (n ⫽ 18) with the remaining as controls (n⫽53). We specifically assessed the following predictors of stroke: Non-Pulsatile flow, Anticoagulation, Mean Arterial Pressure (MAP) and Infections.
Abstracts
vs.1.6⫾0.3, P⬍0.05). EMB was available in 5/7 (71%) patients, but only demonstrated significant rejection in one case. After increased immunosuppression those with presumed late rejection had a significant improvement in LV EF (29⫾4% vs. 42⫾3%, P⬍0.01). There was no significant difference in myocardial oedema between rejection and control groups in either early or late rejection. Conclusions: CMR is a promising modality for the non-invasive detection of cardiac allograft rejection. It may be of particular benefit in late post-transplant rejection where EMB has a lower diagnostic yield.
513 Hemodialysis Is Associated with Increased AlloMap Molecular Expression Score in Cardiac Transplant Recipients B. Ristow, R. Shaw, D. Miniaci, S. Milechman, E. Lo, E. Haeusslein California Pacific Medical Center, San Francisco, CA Purpose: Transcriptional profiling of 11 genes from peripheral blood monocytes (AlloMap) may identify cardiac allograft recipients at increased risk of acute cellular rejection. We hypothesized that hemodialysis is independently associated with increased AlloMap score. Methods and Materials: We retrospectively evaluated 332 AlloMap samples among 133 cardiac allograft recipients at a single institution with simultaneous blinded biopsy results from May 2006 to June 2008. Samples were drawn from 0.3 to 22 years after transplant. We compared recipients with AlloMap scores ⱕ34 and ⱖ35. Results: Biopsy results were ISHLT grade 0/1A in 282, 1B/2 in 44, and 3A in 6 samples. Recipients with AlloMap scores ⱖ35 had younger age, higher daily prednisone dose, higher daily tacrolimus dose, lower white blood cell (WBC) count, lower left ventricular ejection fraction, higher proportion with grade 3A biopsy results (5% vs 1%, p⫽0.03), and higher proportion undergoing hemodialysis (15% vs 1%, p⬍0.001). No significant differences were present in regards to blood urea nitrogen, creatinine, or estimated glomerular filtration rate among recipients not undergoing hemodialysis. After multinomial adjustment, only WBC count (coefficient -0.37, p⫽0.04) and hemodialysis (coefficient 2.7, p⫽⬍0.001) remained significantly correlated with higher AlloMap score. Conclusions: Hemodialysis was independently associated with increased AlloMap score in the study population; milder degrees of renal insufficiency were not associated with increased AlloMap score. The influence of hemodialysis on mononuclear cell genetic profiling may have implications for transcriptional profiling among other patient subgroups.
The Journal of Heart and Lung Transplantation February 2009
514 Echocardiographic Evaluation of Flow across HeartMate II Axial Flow LVADs at Varying Low Speeds R.S. George1, N.K. Sabharwal2, C. Webb2, M. Hedger1, M.H. Yacoub3, G. Dreyfus1, A. Khaghani1, E.J. Birks1 1Royal Brompton and Harefield NHS Trust, Uxbridge, Middlesex, United Kingdom; 2Royal Brompton and Harefield NHS Trust, Uxbridge, Middlesex, United Kingdom; 3Imperial College, Uxbridge, Middlesex, United Kingdom Purpose: Assessment of myocardial recovery in patients with nonpulsatile LVADs involves speed reduction to a degree where there is minimal contribution from the pump into the circulation during assessment. To date we have used 6000rpm to assess recovery in HeartMate II LVAD patients. The aims of this study were to study reverse flow and to assess whether 6000rpm was a safe and sufficient speed to assess recovery. Methods and Materials: 20 patients with HeartMate II LVAD were prospectively studied. After ensuring an INR of ⱖ 2, the device speed was reduced to 6000rpm for 15 mins on 136 occasions, then to either 5000rpm (12 occasions-Group A) or 4000rpm (12 separate occasionsGroup B). The Doppler flow across LVAD was studied at different speeds and the following parameters were recorded: Forward Peak Velocity (FPV– cm/s), Forward VTI (VTIf– cm), Reverse Peak Velocity (RPV– cm/s), Reverse VTI (VTIr– cm), ESD and EDD. Results: During the 136 studies, none of the patients developed any complications especially thromboembolism. In Group A, speed reduction from a mean baseline of 9200rpm (range 8600-9800rpm) resulted in a decrease in VTIf at 6000rpm (19.7⫾9.9 vs 10.8⫾4.1cm, p⬍0.01) and at 5000rpm (19.7⫾9.9 vs 10.6⫾3cm, p⬍0.05). Similarly, in Group B speed reduction resulted in a drop in VTIf at 6000rpm (22⫾7.1 vs 11.2⫾2.5cm, p⬍0.001) and at 4000rpm (22⫾7.1 vs 9.5⫾3.9cm, p⬍0.001), compared to baseline. No changes in VTIf, ESD, EDD were found between 6000rpm and 5000rpm (10.8⫾4.1 vs 10.6⫾3cm, 42.0⫾11.2 vs 41.3⫾10.5mm, 54.5⫾9.8 vs 55.7⫾7.8mm, respectively) or 6000rpm and 4000rpm (11.2⫾2.5 vs 9.5⫾3.9cm, 39⫾8.7 vs 41.4⫾8.6mm, 53.2⫾6.5 vs 54.5⫾7mm). Although there was an increase in reverse flow as the speed was reduced, there was no significant change in RPV or VTIr. Conclusions: Reducing the speed of HeartMate II is safe for assessment. A significant reduction in VTIf was noted when the speed was reduced to 6000rpm. At speeds of 6000rpm and below no significant changes in RPV, VTIf, VTIr, ESD and EDD were seen suggesting that testing at speeds below 6000rpm is not required. 515 Predictors of Stroke on Heartmate II Left Ventricular Assist Device B. Kar1, S. Basra2, P. Loyalka1, I. Gregoric1, R. Delgado1, A. Civitello1, R. Bogaev1, W. Cohn1, A. Attallah3, R. Wagle3, O.H. Frazier1 1Texas Heart Institute, Houston, TX; 2University of Texas Health Science Center, Houston, TX; 3Baylor College of Medicine, Houston Purpose: The Heartmate II is an effective treatment alternative for patients with end stage heart failure refractory to medical therapy. However, a relatively large proportion of patients on Heartmate II develop stroke. We aimed to determine the predictors of stroke in this patient population. Methods and Materials: All patients (n⫽71) implanted with Heartmate II at our institute were included in the study. Patients developing a stroke were classified as cases (n ⫽ 18) with the remaining as controls (n⫽53). We specifically assessed the following predictors of stroke: Non-Pulsatile flow, Anticoagulation, Mean Arterial Pressure (MAP) and Infections.