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Item Approach To Optimal Assessment Of Right Ventricular Remodelling In Heart Transplant Recipients: Insights From Myocardial Work Index, T1 Mapping, And Endomyocardial Biopsy(2023) Colak, Ayse; Duzgun, Selin Ardali; Hazirolan, Tuncay; Sezgin, Atilla; Donal, Erwan; Butcher, Steele C.; Ozdemir, Handan; Pirat, Bahar; Eroglu, Serpil; Muderrisoglu, Haldun; Sade, Leyla Elif; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0003-3737-8595; 35666833; X-8540-2019; AAQ-7583-2021Aims Right ventricular (RV) dysfunction is an important cause of graft failure after heart transplantation (HTx). We sought to investigate relative merits of echocardiographic tools and cardiac magnetic resonance (CMR) with T1 mapping for the assessment of functional adaptation and remodelling of the RV in HTx recipients. Methods and results Sixty-one complete data set of echocardiography, CMR, right heart catheterization, and biopsy were obtained. Myocardial work index (MWI) was quantified by integrating longitudinal strain (LS) with invasively measured pulmonary artery pressure. CMR derived RV volumes, T1 time, and extracellular volume (ECV) were quantified. Endomyocardial biopsy findings were used as the reference standard for myocardial microstructural changes. In HTx recipients who never had a previous allograft rejection, longitudinal function parameters were lower than healthy organ donors, while ejection fraction (EF) (52.0 +/- 8.7%) and MWI (403.2 +/- 77.2 mmHg%) were preserved. Rejection was characterized by significantly reduced LS, MWI, longer T1 time, and increased ECV that improved after recovery, whereas RV volumes and EF did not change MWI was the strongest determinant of rejection related myocardial damage (area under curve: 0.812, P < 0.0001, 95% CI: 0.69-0.94) with good specificity (77%), albeit modest sensitivity. In contrast, T1 time and ECV were sensitive (84%, both) but not specific to detect subclinical RV damage. Conclusion Subclinical adaptive RV remodelling is characterized by preserved RV EF despite longitudinal function abnormalities, except for MWI. While ultrastructural damage is reflected by MWI, ECV, and T1 time, only MWI has the capability to discriminate functional adaptation from transition to subclinical structural damage.Item Neurologic Complications in Heart Transplant Recipients Readmitted to the Intensive Care Unit(2021) Sahinturk, Helin; Yurtsever, Beyza Meltem; Ersoy, Ozgur; Kibaroglu, Seda; Zeyneoglu, Pinar; 34926017Introduction Neurologic complications after transplantation surgery are major causes of morbidity, and the incidence of neurologic complications among heart transplant recipients varies from 7% to 81%. In our study, we aimed to determine the incidence, etiologies, and risk factors of neurologic complications among patients readmitted to the intensive care unit (ICU) after heart transplantation. Method In this retrospective cohort study, the medical records of all patients who underwent cardiac transplantation from February 2003 to July 2019 were reviewed, and those admitted to the ICU due to neurologic complications during the early and late postoperative period were evaluated. The patients were divided into two groups based on the development of neurologic complications to compare demographic and other characteristics. Results A total of 130 heart transplant recipients were analyzed. We excluded 33 patients from the study because they either had neurologic complications or died postoperatively without discharge from the intensive care unit. The mean age of the cohort was 35.4 +/- 18.5 years, and 74 (76.3%) were male. Out of those 97 heart transplant recipients, 22 (22.7%) developed neurologic complications. Five patients (22.7% ) were admitted to the ICU in the first month, six patients (27.3%) were admitted to the ICU between one and six months, and 11 patients (50%) were admitted to the ICU six months after transplantation due to neurologic complications. The most common diagnosis was posterior reversible encephalopathy syndrome (PRES) (n = 6, 27.3%). The other diagnoses were calcineurin inhibitor toxicity (n = 5, 22.7%), intracranial hemorrhage (n = 3, 13.6%), seizures (n = 2, 9.2%), stroke (n = 2, 9.2%), femoral neuropathy (n = 1, 4.5%), myopathy (n = 1, 4.5%), phrenic nerve damage (n = 1, 4.5%), and cerebral abscess (n = 1, 4.5%). The rate of neurologic complications was higher in males when compared with females (p = 0.03). Both groups were similar in terms of the etiologies of cardiac failure, coexisting disease, and anticoagulant and immunosuppressive usage. The requirement for mechanical ventilation, renal replacement therapy, and the incidence of acute kidney injury were similar in both groups (p > 0.05). The incidence of sepsis was significantly higher in patients with neurologic complications (n = 8, 36.4%, versus n = 5, 6.7%; p < 0.001). The mean length of hospital stay was significantly higher in patients with neurologic complications (21.4 +/- 15.8 versus 11.1 +/- 13.3 days, p = 0.01). The risk of developing neurologic complications is 3.036 times higher in males, and this is statistically significant (odds ratio (OR), 3.036; 95% confidence interval (CI), 1.078-8.444; p = 0.036). Conclusion Our results suggest that neurologic complications develop in 22.7% of heart transplant recipients admitted to the ICU, and half of them are seen after six months postoperatively. PRES was the most frequent (27.3%) neurologic complication. The risk of neurologic complications is three times higher for males. The mean length of hospital stay and incidence of sepsis were significantly higher in heart transplant recipients who developed neurologic complications.Item Periodontal status and dental behaviour of heart transplant recipients and healthy controls(2019) Sezgin, Yasemin; Sezgin, Atila; 31661343; AAC-5931-2020Objective: The aim of this study was to compare the periodontal status and dental behaviour of heart transplant recipients with systemically healthy controls. Material and Methods: Forty heart transplant recipients and 40 systemically healthy patients were included. A questionnaire was used to record demographic, systemic health and dental behaviour data, and the following clinical parameters were recorded: plaque index, bleeding on probing, probing depth, gingival recession, and clinical attachment level. Results: Mean probing depth (p = .045), mean gingival recession (p = .016), mean clinical attachment level (p = .021) and mean plaque index scores (p = .001) were higher in heart transplant recipients than the systemically healthy group. However, bleeding on probing was similar in both groups (p > .05). Tooth brushing frequency and number of participants who used dental floss/interdental brush was lower in the heart transplant group. Conclusion: Considering the poor oral hygiene and high clinical periodontal parameters of heart transplant recipients, periodontal evaluation should be done regularly before and after transplantation. The patient's daily oral hygiene regimens should be evaluated carefully in this evaluation session and modified based on their gingival health, manual skill and motivational levels. The importance of oral health and its effects on systemic health should also be explained to the transplant recipients in detail.