Abstract:
BACKGROUND:Due to the lack of nephrotoxic activity, proliferation signal inhibitors (PSI) such as everolimus are recommended for immunosuppression after heart transplantation, but the assessment of renal function in patients receiving PSI has led to conflicting results. We examined renal integrity and function using neutrophil gelatinase-associated lipocalin (NGAL) and conventional markers [plasma creatinine, cystatin C, urine albumin, α1-microglobulin (α1M)] in heart transplant patients, who underwent conversion to everolimus due to allograft vasculopathy, graft rejection episodes, or renal function deterioration, and in patients maintained on calcineurin inhibitors (CNI). METHODS:This cross-sectional study included 121 consecutive heart transplant recipients: 44 patients received CNI-free immunosuppressive therapy with everolimus and 77 patients received CNI. Renal parameters were determined in plasma and urine samples using standard enzymatic or immunochemical methods. RESULTS:Heart transplant recipients receiving everolimus therapy had significantly lower NGAL concentrations in plasma [median (95% CI): 128 (97-176)ng/mL vs. 252 (224-283)ng/mL, p<0.001] and urine [median (95% CI): 6.4 (4.5-7.6)ng/g vs. 15.7 (10.2-25.9)ng/g creatinine, p<0.001]. In contrast, no significant differences were observed between everolimus- and CNI-treated groups with regard to creatinine and cystatin C, as well as urine albumin and α1M levels. Significant correlations were noted between plasma NGAL and creatinine (r=0.42, p<0.001), cystatin C (r=0.44, p<0.001), N-terminal brain natriuretic propeptide (r=0.31, p<0.01) and indicators of chronic inflammation [lipoprotein-associated phospholipase A2 (Lp-PLA2), r=0.31, p<0.01] and soluble CD40 ligand (sCD40L, r=0.22, p<0.05), and between urinary NGAL and α1M (r=0.21, p<0.05). Multiple regression analysis indicated that cystatin C and Lp-PLA2 were the best predictors of plasma NGAL. CONCLUSION:The present study documents reduced plasma and urinary NGAL levels in the absence of differences in conventional renal parameters in patients on CNI-free immunosuppressive therapy with everolimus. These results support favorable effects of everolimus on renal integrity in heart transplant recipients.
journal_name
J Cardioljournal_title
Journal of cardiologyauthors
Stypmann J,Fobker M,Rosing K,Engelen M,Gunia S,Dell'Aquila AM,Nofer JRdoi
10.1016/j.jjcc.2014.12.010subject
Has Abstractpub_date
2015-10-01 00:00:00pages
347-52issue
4eissn
0914-5087issn
1876-4738pii
S0914-5087(14)00363-3journal_volume
66pub_type
杂志文章abstract::A long-term follow-up study was performed for 110 patients with idiopathic dilated cardiomyopathy (DCM) for 34 +/- 12 months (range 3-122 months). Thirteen patients died of heart failure, 15 of sudden death and one of non-cardiac death. The 3- and 5-year survival rates were 78 and 62%, respectively. The important fact...
journal_title:Journal of cardiology
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更新日期:1990-01-01 00:00:00
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pub_type: 杂志文章,meta分析
doi:10.1016/j.jjcc.2019.03.018
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doi:10.1016/j.jjcc.2017.10.023
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更新日期:1989-12-01 00:00:00
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journal_title:Journal of cardiology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jjcc.2013.07.006
更新日期:2014-02-01 00:00:00
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journal_title:Journal of cardiology
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.jjcc.2015.09.015
更新日期:2016-09-01 00:00:00
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journal_title:Journal of cardiology
pub_type: 临床试验,杂志文章
doi:
更新日期:2000-05-01 00:00:00
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journal_title:Journal of cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1993-01-01 00:00:00
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journal_title:Journal of cardiology
pub_type: 杂志文章
doi:10.1016/j.jjcc.2012.06.006
更新日期:2012-12-01 00:00:00
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journal_title:Journal of cardiology
pub_type: 杂志文章
doi:
更新日期:1988-12-01 00:00:00
abstract:BACKGROUND:There are limited data on the impact of smoking status on outcomes after isolated coronary artery bypass graft (CABG) surgery. METHODS:Data obtained prospectively between June 2001 and December 2009 by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database Program w...
journal_title:Journal of cardiology
pub_type: 杂志文章
doi:10.1016/j.jjcc.2013.01.002
更新日期:2013-05-01 00:00:00
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journal_title:Journal of cardiology
pub_type: 杂志文章
doi:
更新日期:1988-06-01 00:00:00
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journal_title:Journal of cardiology
pub_type: 杂志文章
doi:
更新日期:2001-10-01 00:00:00
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doi:
更新日期:1997-06-01 00:00:00
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journal_title:Journal of cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jjcc.2012.02.011
更新日期:2012-08-01 00:00:00
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journal_title:Journal of cardiology
pub_type: 杂志文章
doi:
更新日期:2002-06-01 00:00:00
abstract:BACKGROUND:The SAPIEN 3 (S3; Edwards Lifescience, Irvine, CA, USA) is a new-generation percutaneous aortic valve with better profile, more precise handling and positioning, designed to reduce the risk of post-procedural paravalvular aortic leak (PVL). The aim of this study was to compare the S3 valve and SAPIEN XT valv...
journal_title:Journal of cardiology
pub_type: 杂志文章
doi:10.1016/j.jjcc.2016.04.012
更新日期:2017-03-01 00:00:00
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journal_title:Journal of cardiology
pub_type: 杂志文章
doi:10.1016/j.jjcc.2016.05.017
更新日期:2017-04-01 00:00:00
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journal_title:Journal of cardiology
pub_type: 杂志文章
doi:10.1016/j.jjcc.2009.01.004
更新日期:2009-06-01 00:00:00
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journal_title:Journal of cardiology
pub_type: 杂志文章
doi:10.1016/j.jjcc.2009.12.014
更新日期:2010-05-01 00:00:00
abstract:BACKGROUND:Coregistration system of instantaneous wave-free ratio (iFR) pullback and angiography has been developed to enhance benefits of physiology oriented percutaneous coronary intervention (PCI), but its reproducibility has not yet been fully assessed. METHODS AND RESULTS:In 51 coronary arteries from 39 patients ...
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pub_type: 杂志文章
doi:10.1016/j.jjcc.2019.09.016
更新日期:2020-05-01 00:00:00
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journal_title:Journal of cardiology
pub_type: 杂志文章
doi:
更新日期:1997-09-01 00:00:00
abstract::To investigate which time constant of isovolumic left ventricular pressure (LVP) decay is the most sensitive measure in acute myocardial ischemia, the time constant of isovolumic relaxation (IR) was calculated by two different models, the semilogarithmic model assuming a zero of LVP decline (TL) and an exponential mod...
journal_title:Journal of cardiology
pub_type: 临床试验,杂志文章
doi:
更新日期:1994-09-01 00:00:00
abstract::Noninvasive assessment of the distal left anterior descending coronary artery and intramyocardial blood flow were attempted in 50 consecutive patients (28 males and 22 females, mean age [+/-SD] 58 +/- 12 years) using a 7.5 MHz transducer (Doppler frequency: 5 MHz) and a SSA-380A ultrasound digital system with special ...
journal_title:Journal of cardiology
pub_type: 杂志文章
doi:
更新日期:1997-07-01 00:00:00