XIII Reunión anual de la sección de Insuficiencia Cardiaca de la SEC
OVIEDO, 16-18 JUNIO 2016 HOSPITAL UNIVERSITARIO CENTRAL DE ASTURIAS (HUCA)
http://secardiologia.es/insuficiencia/cientifico/ic-oviedo-2016
Utilidad de las técnicas de imagen de la insuficiencia cardiaca y trasplante ¿Qué técnica debemos utilizar y qué nos aporta en cada situación clínica?
VIERNES, 17 DE JUNIO 10:30-12:15 SALÓN DE ACTOS
Trasplante cardiaco. ¿Es posible la detección no invasiva del rechazo agudo?
José Antonio Vázquez de Prada, Santander
Gastric Cancer: Сlinical Implementation of Artificial Intelligence, Synergeti...
Trasplante cardiaco. ¿Es posible la detección no invasiva del rechazo agudo?
1. TRASPLANTE CARDIACO:¿ES POSIBLE LA
DETECCIÓN NO INVASIVA DEL RECHAZO AGUDO?
José A Vázquez de Prada
HOSPITAL UNIVERSITARIO
VALDECILLA. SANTANDER
2. Chairmen: MA Farr, KK Dhital/Concurrent Session 11
The Heartbreak of Rejection: All Against the Graft
HEART TRANSPLANTATION WITHOUT ROUTINE
ENDOMYOCARDIAL BIOPSIES IS FEASIBLE: RESULTS
OF A CLINICAL-ECHOCARDIOGRAPHIC STRATEGY.
JOSÉ A VÁZQUEZ DE PRADA, MD,PHD, FRANCISCO GONZÁLEZ-VILCHEZ, MD,PHD,
FELIPE RODRIGUEZ-ENTEM MD,PHD, JAVIER RUANO, MD, MARIA ISABEL DEL
CAMPO, RN, AND RAFAEL MARTÍN DURÁN, MD.
WASHINGTON DC, APRIL 27, 2016
PROGRAMA DE TRASPLANTE CARDIACO.
HOSPITAL UNIVERSITARIO MARQUÉS DE VALDECILLA
SANTANDER, SPAIN.
3. • EMB
– Invasive, uncomfortable and expensive
– Small but definite incidence of severe
complications
– Sensitivity? Specificity? Unknown!
– Inter and intra-observer variability? Large!
– Yield? Low!
ENDOMYOCARDIAL BIOPSY
FOR REJECTION SURVEILLANCE
IN HEART TRANSPLANTATION
8. Systolic dysfunction
LVEF <50%
LVEF>10 points
Clinical symptoms
consistent with rejection
Signs of heart failure
Hypotension
Unexplained sinus tachycardia
Arrythmias
+
LV wall thickness (IVS + PW > 4 mm)
Doppler based parameters were
NOT routinely considered
9. SAME PHYSICIAN
performing
• Clinical evaluation
• Echocardiogram
• Clinical decision:
…....biopsy?
Side by side comparison
of echo studies
DICOM
??
10. NO EMB TREATMENT
REJECTION
????
CLINICAL &
ECHO data
NORMAL ABNORMAL
(re-schedule)
Biopsy
NO REJECTION
Valdecilla Hospital clinical-echocardiographic strategy for rejection monitoring
17. 0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4 5 6 7 8 9 10
Hospital Valdecilla
Registro Español
de Tx Cardiaco
Kaplan-Meier survival, HTx 1992-2014
85%
84,5% 73,1%
72,8% 59,6%
58,7%
YEARS
% n=5100
n=488
Log rank test p= 0.85
Patientssurviving
Hazard Ratio = 0,987 (0,86-1,12)
18. Kaplan-Meier estimate of the time to
death from Rejection or Graft failure, or ReTx
MONTHS
%
Patientswithevent
0
20
40
60
80
100
0 1 2 3 4 5 6 7 8 9 10 11 12
Spanish registry
Valdecilla Hospital
Log rank test p= 0.11
Hazard Ratio = 1,41 (0,92-2,16)
0
2
4
6
8
10
0 1 2 3 4 5 6 7 8 9 10 11 12
1-Yr event rate 3,7%
1-Yr event rate 5,3%
19. CONCLUSIONS
• Heart transplantation without routine endomyocardial
biopsies is possible with a clinical-echocardiographic strategy
• The total number of biospsies can be reduced to a minimum
• Our strategy was not associated with an increased risk of
adverse outcomes