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Objective: Transplant patients have an increased risk in case of exposure to vaccine-preventable diseases. Immunization against diphtheria-tetanus-acellular pertussis, influenza and pneumococcal disease is strongly recommended. In this study the documented vaccination rate and factors influencing (non)vaccination in heart and/or lung transplant patients were examined. Methods: During a four-month period, 255 heart (HTx) and/ or lung transplant (LTx) patients were surveyed in a single university Hospital. Vaccination data were collected through questionnaires, medical files, Vaccinnet (the Flemish vaccination Registry) and general practitioners (GP's). Reasons for (non)vaccination and socio-demographic data were noted. Findings: The documented vaccination coverage was 29% for diphtheria-tetanus, 11.4% for pertussis, 52.5% for influenza and 34.9% for pneumococcus. Older age, information and less time to transplantation were predictive factors for higher vaccination rate. Conclusions: Despite the national recommendations, vaccination coverage remains low among heart and/or lung transplant patients. The most important barrier in determining the vaccination status is incomplete documentation. Routine registration, follow-up and education can positively influence vaccination coverage rates.

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Background: C-reactive protein (CRP) is an inflammatory marker associated with worse outcome (including heart failure and death) in acute coronary syndromes. Peak CRP levels correlate with infarct size in ST-segment elevation myocardial infarction (STEMI), but less is known about the correlation in non-ST-segment elevation myocardial infarction (NSTEMI). Since the increasing incidence of NSTEMI, we aimed to investigate whether CRP production is related to infarct size specifically in NSTEMI patients, and whether it can be used as a marker for subsequent heart failure. Methods: We retrospectively screened 568 patients with an acute coronary syndrome (ACS) and excluded patients with active malignancy, Takotsubo cardiomyopathy, pulmonary embolism, recent surgery or inflammatory disease (systemic or infectious) to avoid influence on the CRP levels caused by the ACS. After exclusion, the final cohort consisted of 130 STEMI and 140 NSTEMI patients. Baseline clinical, biochemical, angiography and electrocardiography characteristics were obtained on admission (creatinine, CRP on admission, peak CRP, Troponin T on admission, peak Troponin T) as well as biochemical (CRP at follow-up), electrocardiography and outcome data at a mean follow-up time of 21 months. Results: There was a significant linear correlation between peak Troponin T, as a marker of cardiac injury, and peak CRP in patients with STEMI. Although the same correlation was observed in patients with NSTEMI, the correlation coefficient was weaker in NSTEMI. ROC curve analysis suggested an ideal cut-off value of peak CRP (24 mg/L) to predict heart failure in both STEMI (p= 0,001) and NSTEMI (p=0,001) Conclusion: Peak CRP is highly correlated with infarct size, both in STEMI and NSTEMI. Also after correcting for infarct size, a peak CRP > 24mg/L is an independent predictor of heart failure, defined as left ventricular dysfuction (ejection fraction <45%) or hospitalization for heart failure, in patients with NSTEMI