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Dra. Sonia Mirabet Pérez: Enfermedad vascular del injerto

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Trasplante cardiaco: viejos problemas con nuevos enfoques. Enfermedad vascular del injerto

Trasplante cardiaco: viejos problemas con nuevos enfoques. Enfermedad vascular del injerto

Published in: Health & Medicine

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  • This table shows the percentage of patients experiencing various morbidities as reported within 5 years and within 10 years following transplantation. The percentages are based on patients with known responses. To reduce bias, only patients with responses reported on every follow-up through the 5-year annual (or 10-year annual) follow-up were included. Because the outcomes are reported to be unknown at different rates the number with known responses for each outcome are also provided.
  • Survival following CAV and survival from the median time to CAV development were computed using the Kaplan-Meier method. The development of CAV is reported on annual follow-ups; a date of diagnosis is not provided. For this figure the midpoint between the date of previous follow-up (when event had not occurred) and the date of follow-up when the event was reported was used as the date of occurrence.
  • Estudio de Mancini Time to primary end point (death, angioplasty, myocardial infarction, or >25% increase in catheterization score) in the control and rapamycin groups
  • El endotelio es el principal determiantne de la fucnión de la pared arteriañl, En situaciones normales inhibe la fomración de trombos, inhibe la adhesion de leucocitos, regula la funcion vasomotora e inhibe la proliferación de las celuls musculares lisas. El daño endotelial altera dichas funciones p, y predispone a la inflamacion,a la trobosis , a la asoconstriccion y al crecimiento de fibras musculares lisas. Tras el TC se pone en marcha la respuesta inmunológica humoral y predominantemente celular en respuesta a los antigenos HLA del donatnes y a los Ag de la superficie endotelial. Y pone en marcha toda una cascada de eventos
  • Freedom from CAV and freedom from severe renal dysfunction rates by era were computed using the Kaplan-Meier method. The development of CAV and/or severe renal dysfunction is reported on annual follow-ups; a date of diagnosis is not provided. For this figure the midpoint between the date of previous follow-up (when event had not occurred) and the date of follow-up when the event was reported was used as the date of occurrence. Patients were included in the analysis until an unknown response for the outcome of interest was reported. Therefore, the rates seen here may differ from those reported in the cumulative prevalence slide which is based on only those patients with known responses for each of the outcomes at all follow-up time points.
  • Transcript

    • 1. ENFERMEDAD VASCULAR DEL INJERTO: VIEJOS PROBLEMAS , NUEVOS ENFOQUES Sonia Mirabet Pérez Unidad de Miocardiopatías y Trasplante Cardíaco Hospital de la Sant Creu i Sant Pau
    • 2. Enfermedad vascular del injerto Viejos problemas, nuevos enfoques Declaración de potenciales conflictos de intereses Relativas a esta presentación existen las siguientes relaciones que podrían ser percibidas como potenciales conflictos de intereses: Proyecto de investigación financiado parcialmente por Novartis
    • 3. ADULT HEART TRANSPLANT RECIPIENTS: Relative Incidence of Leading Causes of Death (Deaths: January 1992 - June 2008) J Heart Lung Transplant 2009;28: 989-1049
    • 4. PREVALENCIA DE EVI A 5 Y 10 AÑOS POSTRASPLANTE J Heart Lung Transplant 2009;28: 989-1049
    • 5. SUPERVIVENCIA TRAS EL DIAGNOSTICO DE EVI VS SUPERVIVENCIA SIN EVI DOCUMENTADA J Heart Lung Transplant 2009;28: 989-1049
    • 6. RETRASPLANTE ISHLT ; J Heart Lung Transplant 2009 Escasez de donantes Recidiva EVI Morbimortalidad J Heart Lung Transplant 2009;28: 1007-22
    • 7. Mancini, D. et al. Circulation 2003;108:48-53 J, Segovia et al J Heart Lung Transpl 2004;23:S51-2
      • ENFERMEDAD DIFUSA
      • ¿IMPACTO SOBRE LA SUPERVIVENCIA?
      BMS reestenosis 51 % DES reestenosis 11 % Aqel et al. J Heart Lung Transplant 2008;27:610-5 Zakliczynski et al. Transplant proceedings 2007;2859-2861 Rev Esp Cardiol Supl.2007; 7 :55 B-57B J Thorac Cardiovasc Surg 2009;137:1488-92
    • 8. DIAGNÓSTICO PRECOZ PREVENCIÓN
    • 9. Grado Mínima Leve Moderada Severa
      • MIT (mm)
      • < 0,3
      • < 0,3
      • 0,3-0,5
      • 0,5
      IVUS AL AV MIT
    • 10. Rev Esp Cardiol Supl.2007; 7 :55 B-57B
    • 11. AW Leber et al. J Am Coll Cardiol 2005;46:147 – 54.
      • No útil en caso de stents < 3mm
      • Ritmo rápido
      • (sobretodo FA rápida e IC)
      • Ateroesclerosis calcificada
      VENTAJAS LIMITACIONES NEFROTOXICIDAD
      • No invasivo
      • Menor irradiaci ó n
      • No limitado a un vaso “ sospechoso ”
      • Estudio de segmentos “ no abordables ”
      • Rápida
      • Coste econ ó mico
    • 12. JACC 2005;45:1826-31
    • 13. Raichlin et al. JACC 2009;53:1279-86 -placa inflamatoria >30% core necrotico + calcio -placa no inflamatoria <30% core necrotico + calcio De la Torre et al. J Heart Lung Transplant 2009;28:156-62
      • Caracterización de las placas
      • Información pronóstica
      • Monitorización nuevos IS
      HISTOLOGIA VIRTUAL
    • 14. J Nucl Cardiol2008;15:818-29
    • 15. DONANTE ISQUEMIA HTA, DM , DLP, TABACO CMV FACTORES INMUNOLÓGICOS
    • 16. Proliferación de cls ms lisas Depósito de colágeno Acúmulo de macrófagos Respuesta inmunológica frente a AgHLA y Ag endoteliales Activación linfocitos T Liberación de interferon e IL Expresión de moléculas de adhesión vascular en endotelio Producción de citocinas y factores de crecimiento R Mitchell, P Libby. Circ Res. 2007;100: 967-978
    • 17. Raichlin et al. JACC 2009;53:1279-86 Raichlin et al J Heart Lung Transplant 2009 ; 28-320-7 H. Valantine et al. J Heart Lung Transplant 2004 ; suppl
    • 18. Potena et al. J Heart Lung Transplant 2009;28:416-7
      • - Daño endotelial por CMV
      • Aumento de la expresión de moléculas de superficie implicadas en la
      • adhesión de leucocitos
      H Valantine. Transplantation 2006;82:1 CMV Y ENFERMEDAD VASCULAR DEL INJERTO
    • 19. Zuckermann et al. Heart Lung Transplant 2008;27:141-9
    • 20. EVEROLIMUS SIROLIMUS Chapman et al. Transplantation Proceedings 2007;39:2937-2950 J Heart Lung Transplant 2008;27:141-9
    • 21. RAD B253 study group. J Heart Lung transplant 2007: 26:584-92 Eisen et al N Engl J Med 2003, EVEROLIMUS
    • 22. SIROLIMUS Keogh et al. Circulation 2004; 110: 2694-2700
    • 23.
      • % de los pacientes discontinuan ISP por efectos adversos
      • Seguridad de los regímenes sin anticalcineurínico
      • Menor incidencia de rechazo agudo
      • Menor incidencia de CMV
      INHIBIDORES DE LA SEÑAL DE PROLIFERACION - De novo disminuyen la proliferación intimal respecto a Aza
    • 24. J Heart Lung Transplant 2009;28: 1007-22
    • 25. ? ‘ H.Valantine et al. JACC 2008;52:587-593