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Author: search.filters.author.Aydinalp, AlpSubject: search.filters.subject.Heart transplant

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    Follow-Up of Heart Transplant Recipients with Serial Echocardiographic Coronary Flow Reserve and Dobutamine Stress Echocardiography to Detect Cardiac Allograft Vasculopathy
    (2014) Sade, Leyla Elif; Eroglu, Serpil; Yuce, Deniz; Bircan, Asli; Pirat, Bahar; Sezgin, Atilla; Aydinalp, Alp; Muderrisoglu, Haldun; https://orcid.org/0000-0003-3737-8595; https://orcid.org/0000-0003-3055-7953; https://orcid.org/0000-0003-4576-8630; https://orcid.org/0000-0002-3761-8782; https://orcid.org/0000-0002-9635-6313; 24613313; AAQ-7583-2021; ABG-1582-2021; AAI-8897-2021; AAD-5841-2021; AAG-8233-2020
    Background: Implementation of reliable noninvasive testing for screening cardiac allograft vasculopathy (CAV) is of critical importance. The most widely used modality, dobutamine stress echocardiography (DSE), has moderate sensitivity and specificity. The aim of this study was to assess the potential role of serial coronary flow reserve (CFR) assessment together with DSE for predicting CAV. Methods: A total of 90 studies were performed prospectively over 5 years in 23 consecutive heart transplant recipients who survived > 1 year after transplantation. Assessment of CFR with transthoracic Doppler echocardiography, DSE, coronary angiography, and endomyocardial biopsy was performed annually. Results of CFR assessment and DSE were compared with angiographic findings of CAV. Results: Acute cellular rejections were excluded by endomyocardial biopsies. CAV was detected in 17 of 90 angiograms. Mean CFR was similarly lower in both mild (CAV grade 1) and more severe (CAV grades 2 and 3) vasculopathy, but wall motion score index became higher in parallel with increasing grades of vasculopathy. Any CAV by angiography was detected either simultaneously with or later than CFR impairment, yielding 100% sensitivity for CFR. The combination of CFR and DSE increased the specificity of the latter from 64.3% to 87.2% without compromising sensitivity (77.8%). Conclusions: CFR is very sensitive for detecting CAV and increases the diagnostic accuracy of DSE, raising the potential for patient management tailored to risk modification and to avoid unnecessary angiographic procedures.
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    Predictive Value of Hematologic Parameters for Detecting Asymptomatic Graft Rejection After Heart Transplant: Preliminary Results
    (2015) Karacaglar, Emir; Bal, Ugur; Ciftci, Orcun; Turgay, Ozge; Yilmaz, Mustafa; Sade, Elif; Aydinalp, Alp; Sezgin, Atilla; Atar, Ilyas; Muderrisoglu, Haldun; 0000-0002-2557-9579; 0000-0002-9446-2518; 0000-0001-8926-9142; 0000-0002-2538-1642; 0000-0002-3761-8782; 0000-0002-9635-6313; 0000-0002-6731-4958; 0000-0003-3737-8595; 26640937; S-6973-2016; AAK-4322-2021; W-5233-2018; ABI-6723-2020; GPX-1387-2022; AAD-5841-2021; AAG-8233-2020; AAQ-7583-2021
    Objectives: Hematologic parameters, such as mean platelet volume, red-cell distribution width, and neutrophil-to-lymphocyte ratio, have prognostic value in multiple cardiac conditions such as stable angina pectoris, acute coronary syndromes, and heart failure. However, no previous studies have evaluated the association between hematologic parameters and asymptomatic graft rejection after heart transplant. We evaluated the role of hematologic parameters for detecting asymptomatic graft rejection after heart transplant. Materials and Methods: We retrospectively evaluated medical records of 47 adult patients who underwent orthotopic heart transplant between February 25, 2005, and July 6, 2014, in our hospital, noting their hematologic parameters before each biopsy. Two groups were created according to biopsy results: rejection and no-rejection. Results: We excluded 4 patients who died during the first month posttransplant owing to early complications. We evaluated 422 endomyocardial biopsy results of 43 adult patients (mean age, 43.4 +/- 11.4 y; 14 women). Mean follow-up was 33 months. A total of 109 biopsies performed because of clinical suspicion of rejection were excluded. Redcell distribution width levels were similar between groups (17.2% +/- 2.6% in the rejection group and 17.1% +/- 2.5% in the no-rejection group; P=.856). Neutrophil-to-lymphocyte ratio was similar between groups (7.8 +/- 9.9 in the rejection group and 8.2 +/- 9.7 in the no-rejection group; P=.791). Mean platelet volume levels were significantly lower in the rejection group (8.3 +/- 1.3 fL) than in the no-rejection group (8.8 +/- 1.8 fL) (P=.037) (Table 1). Conclusions: According to our results, only lower mean platelet volume levels were significantly associated with asymptomatic graft rejection in patients with a transplanted heart. More detailed analyses are needed to exclude the effects of immunosuppressant drugs, and further studies are needed to clarify the exact role of hematologic parameters for detecting asymptomatic rejection after heart transplant.