Clinical heart transplantationChanges in Myocardial Vasoreactivity After Drastic Reduction of Plasma Fibrinogen and Cholesterol: a Clinical Study in Long-term Heart Transplant Survivors Using Positron Emission Tomography
Section snippets
Objective and Study Design
The primary objective of this study was the comparison of myocardial blood flow before and shortly after apheresis treatment. Secondary objectives were the analysis of the hemorheologic consequences and the possible role of mediators such as nitric oxide or vascular endothelial growth factor (VEGF) in this setting. The study protocol is outlined in Figure 1. First, a baseline PET examination was performed under rest conditions and after adenosine infusion. At that time, patients had elevated
Comparison of Laboratory Variables
Plasma concentrations of LDL-cholesterol (LDL-C), lipoprotein (a), fibrinogen and CRP before and after apheresis are outlined in Table 2. The baseline concentration of LDL-cholesterol was elevated considerably (191 ± 44 mg/dl), as were the concentrations of lipoprotein (a) (63 ± 29 mg/dl), CRP (0.95 ± 1.31 mg/dl) and fibrinogen (4.65 ± 0.95 g/liter). HELP-apheresis significantly reduced the concentrations to almost normal levels. On the following day before the second PET study the
Discussion
Long-term transplant survival involves a number of adaptation processes in the hemodynamic environment to accommodate the allograft for daily physiologic needs, despite advanced graft arteriosclerosis. The present study has demonstrated that a 50% reduction of most of the relevant atherogenic blood compounds after a single HELP-apheresis treatment has significant hemodynamic implications for cardiac allograft macro- and microcirculation. Remarkably, these findings suggest that the
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2011, CytokineCitation Excerpt :Clinical studies have proven the cardiovascular benefits of this treatment in patients with FH and ischemic stroke [20–22]. Studies have also shown the improvement of myocardial perfusion in heart transplant patients and in the treatment of illnesses caused by a change in microcirculation such as sudden deafness and optic ischemic neuropathy [23–26]. The H.E.L.P. system is also able to remove lipopolysaccharides (LPS; endotoxin), tumor necrosis factor-α (TNF-α), IL-6 and C-reactive protein (CRP) from plasma [27–36].
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Supported by B. Braun AG, Melsungen, Germany.