AIMS:Congestion is a major cause of hospitalisation in patients with heart failure (HF), and the persistence of congestive signs at discharge is a robust predictor of early readmission. Currently, there is increasing interest in the comprehensive assessment of subclinical congestion, as it can increase residual risk in individuals who appear to be euvolemic. Our aim was to investigate the prevalence and prognostic impact of subclinical venous congestion assessed by ultrasound. METHODS AND RESULTS:This is a two-centre, prospective observational study. Patients admitted for HF between June 2021 and March 2023 were selected. Clinical [physical examination (PE)] and subclinical venous congestion [Venous Excess Ultrasound score (VExUS)] were assessed. The prognostic impact was assessed through a composite endpoint of death from any cause, HF readmissions, or unscheduled visits requiring intravenous diuretic administration at 6-month follow-up. 120 patients were included (62% male, mean age 75 ± 15 years). Congestion parameters decreased during hospitalisation but tended to worsen at the first outpatient visit. At discharge, 24% showed subclinical venous congestion. This group had a significantly higher incidence of adverse outcomes, comparable to those with overt clinical congestion. Subclinical congestion was an independent predictor of the composite endpoint (HR 2.84; 95% CI: 1.01-8.01, P value = 0.048) after adjustment for age, chronic kidney disease, NYHA class at admission, and NT-proBNP level at discharge. CONCLUSION:Clinical and subclinical congestion decreased during hospitalisation but worsened shortly after discharge. A quarter of patients had residual venous congestion, which was associated with a worse prognosis at 6 months.

Aims:The use of cardiac signal-recording tools to monitor prognostic and diagnostic parameters in heart failure (HF) is an emerging field, constrained by usability and a low signal-to-noise environment. We evaluated a compact, user-friendly prototype for simultaneous acquisition of phonocardiography, photoplethysmography, electrocardiography, and subsequent processing to determine this strategy's usefulness in identifying parameters related to HF decompensation. Methods and results:We conducted a single-centre prospective study of 41 hospitalized patients; 36 included in the analysis. Autonomous recordings of phonocardiography, electrocardiography, and pulse-wave photoplethysmography were obtained. Signal processing employed a new supervised iterative filtering pipeline based on detection of coupled energy peaks, together with an independent analysis of the pulse-wave plethysmogram, enabling extraction of clinically relevant intervals even when one modality was of insufficient quality. In the cohort admitted with decompensated HF, measures at discharge showed shortening of electromechanical coupling time (0.148 ± 0.051 vs. 0.108 ± 0.039 s; P < 0.001), isovolumetric contraction time (0.152 ± 0.098 vs. 0.071 ± 0.023 s; P < 0.001), and ejection period (0.257 ± 0.078 vs. 0.344 ± 0.082 s; P < 0.0001) compared with admission. These findings were corroborated against the cardiology inpatient cohort without clinical congestion and contextualized using a publicly available cohort of 338 healthy individuals. Conclusion:This study presents initial evidence that a compact, easy-to-use device permits autonomous acquisition of diagnostic cardiac signals by non-expert users and that the proposed processing strategy reliably detects clinically relevant intervals in low-signal-to-noise ratio recordings, supporting its potential utility for monitoring patients with HF.

Background/Objectives: Congestion is a hallmark of heart failure (HF) and a major determinant of outcomes. Non-invasive tools enable detection of subclinical congestion, but their correlation and prognostic relevance remain incompletely defined. The present study aimed to assess the prevalence, evolution, interrelationships, and prognostic impact of clinical and subclinical congestion markers in patients hospitalized for HF. Methods: This single-centre, prospective cohort study included adults admitted with HF who underwent serial evaluations at admission, 72 h, pre-discharge, early outpatient follow-up and at 6 months. Clinical congestion was assessed using a standardized physical examination score. Subclinical congestion was evaluated using lung ultrasound (LUS), Venous Excess Ultrasound Score (VExUS), and Remote Dielectric Sensing (ReDS). Patients were classified according to the presence of clinical and/or subclinical congestion at discharge. The primary endpoint was a composite of all-cause mortality, HF readmission, or unscheduled visits requiring intravenous diuretics within six months. Results: Ninety-four patients (mean age 74 ± 11 years, 68% male) were included. While clinical congestion improved significantly during hospitalization, approximately 30% of patients remained clinically congested at discharge. Among clinically euvolemic patients, only 47% showed no evidence of subclinical congestion. Correlations between congestion markers were weak to moderate, suggesting complementary pathophysiological information. At discharge, pulmonary B-lines were the strongest predictor of the composite endpoint (hazard ratio [HR] 3.50, 95% CI 1.41-8.72), followed by clinical congestion (HR 2.67, 95% CI 1.13-6.30). Patients with clinical and subclinical congestion exhibited lower event-free survival. Conclusions: Subclinical congestion is common despite apparent clinical euvolemia and is associated with worse outcomes. Integrating clinical assessment with non-invasive congestion markers may improve post-discharge risk stratification in HF.

Background/Objectives: Congestion is a hallmark of heart failure (HF) and a major determinant of outcomes. Non-invasive tools enable detection of subclinical congestion, but their correlation and prognostic relevance remain incompletely defined. We aimed to assess the prevalence, evolution, interrelationship, and prognostic impact of clinical and subclinical congestion markers in patients hospitalized for HF. Methods: This single-centre, prospective cohort study included adults admitted with HF who underwent serial evaluations at admission, 72 hours, pre-discharge, early outpatient follow-up and at 6-month. Clinical congestion was assessed using a standardized physical examination score. Subclinical congestion was evaluated using lung ultrasound (LUS), Venous Excess Ultrasound Score (VExUS), and Remote Dielectric Sensing (ReDS). Patients were classified according to the presence of clinical and/or subclinical congestion at discharge. The primary endpoint was a composite of all-cause mortality, HF readmission, or unscheduled visits requiring intravenous diuretics within six months of follow-up. Results: Ninety-four patients (mean age 74±11 years, 68% male) were included. While clinical congestion improved significantly during hospitalization, approximately 30% of patients remained clinically congested at discharge. Among clinically euvolemic patients, only 47% showed no evidence of subclinical congestion. Correlations between congestion markers were weak to moderate, suggesting complementary pathophysiological information. At discharge, pulmonary B-lines were the strongest predictor of the composite endpoint (hazard ratio [HR] 3.50, 95% CI 1.41–8.72), followed by clinical congestion (HR 2.67, 95% CI 1.13–6.30). Patients with both clinical and subclinical congestion had the lowest event-free survival, approximately 50% at six months of follow-up (log-rank p = 0.03). Conclusions: Subclinical congestion is common despite apparent clinical euvolemia and is associated with worse outcomes. Integrating clinical assessment with non-invasive congestion markers may improve post-discharge risk stratification and patient management in HF.

INTRODUCTION AND OBJECTIVES:This report presents updated data on heart transplants in Spain, including procedures carried out in 2024. It reviews trends over the past decade (2015-2024) in donor and recipient characteristics, surgical techniques, immunosuppression strategies, and survival rates. METHODS:Data were drawn from the Spanish heart transplant registry, which is updated annually. The analysis includes 347 transplants performed in 2024, as well as procedures from 2015 to 2023 (n=2721). RESULTS:In 2024, the number of heart transplants increased by 6.8% compared with 2023. There were no significant changes in recipient age or sex, but the proportion of urgent transplants rose to 47.0%. Use of circulatory support devices increased, particularly extracorporeal membrane oxygenation. The average donor age showed a slight increase in 2024, although the long-term trend remained downward. Donation after circulatory death accounted for 29.1% of transplants in 2024. One-year survival rates improved, reaching 85.2% for transplants performed between 2021 and 2023. CONCLUSIONS:The number of heart transplants continued to grow, nearing historic highs, largely due to the expansion of donation after circulatory death. Improved 1-year survival reflects the maturity of transplant programs, advances in surgical and medical management, and better pretransplant conditions in recipients.

Cardiogenic shock remains one of the main challenges in modern cardiovascular medicine. In Spain, urgent cardiac transplantation is the most widely used heart replacement therapy fin eligible patients who do not achieve cardiac recovery. However, this approach has significant implications related to the principle of equity, influenced by the characteristics of the recipient, the donor, and organ access. When selecting a recipient, multiorgan failure must first be addressed before considering transplantation. At the same time, it is essential to expand the donor pool through various strategies to meet the growing demand, even if it involves using suboptimal organs. Given the scarcity of donors and favorable outcomes, long-term left ventricular assist devices should be considered as an alternative to transplantation. Finally, designing organ distribution criteria remains a constantly evolving challenge, as there is no universal system that can address all the issues involved. Allocating organs to the most critically ill patients can provide substantial individual benefits, as long as it does not significantly compromise the common good.

Second (alectinib, brigatinib) and third (lorlatinib) generation ALK-inhibitors (ALK-i) are the cornerstone in the treatment of patients with ALK translocated non-small cell lung cancer (NSCLC). Although ALK-i have shown unprecedented survival results, cardiovascular (CV) risk factor worsening and cardiotoxicity may hinder these benefits. The aim of this study is to describe the CV toxicities reported in patients treated with second or third ALK-i in our institution. We retrospectively collected data from electronic clinical records of 45 patients treated with a new generation ALK-i, irrespective of its use in front or subsequent line. However, as some patients received more than one ALK-i, the total treatment records was 69. We used the SCORE-2 and the SCORE-OP systems to assess the CV risk before the start of the treatment. Baseline characteristics of the population are described in Table-1. Overall, the whole cohort baseline CV risk was low (26 patients, 57,8%), although 17 patients (37,8%) and 2 patients (4,4%) were of high or very high risk. The median follow up from the start of the first ALK-i for each patient was 21 months (range: 1-93). At the data cut-off, 26 patients (57,8%) were alive and remained on treatment with, 7 patients (15,6%) receiving a new generation ALK-i for over 5 years. During the follow up period, we identified 30 (43,5%) cases of worsening CV risk factors or CV adverse events related to ALK-i therapy. The most frequently reported toxicities were dyslipidemia (19 patients, 27,5%) and hypertension (13 patients, 18,8%). Other cardiovascular complications included new onset arrythmias (4 patients), thromboembolic events (2 patients) or new onset diabetes (1 patient). Notably only two patients developed a major cardiovascular adverse event (MACE): one case of heart failure in a patient receiving brigatinib and one sudden cardiovascular death within weeks of initiating alectinib. Overall, 9 patients (13%) required referral to the Cardio-Oncology clinic. The CV toxicity profile varied among individual ALK-i: Lorlatinib exhibited the highest rate of CV toxicity, with dyslipidemia affecting nearly all treated patients (18/20, 90%). However, no MACE occurred during follow-up (median drug-time exposure months: 13). Brigatinib was associated with a higher incidence of hypertension, leading to temporary treatment discontinuation in three patients (median drug-time exposure months: 14). Alectinib appeared to have the most favorable CV safety profile, with only 3 patients (11,1%) experiencing any form of cardiotoxicity (drug-time exposure months: 10,5). While ALK-i demonstrate an overall manageable CV safety profile, they are associated with a notable risk of dyslipidemia and hypertension. Given the expected long-term survival of patients receiving ALK-targeted therapies, CV monitoring and risk management should be an integral part of patient care.Table 1

Immune checkpoint inhibitors (ICIs) have transformed cancer treatment, significantly enhancing patient survival. However, while ICIs are not commonly associated with cardiotoxicity, elevations in cardiac troponin are frequently observed, with unclear clinical implications. This study aims to describe the dynamic of cardiac troponin levels in patients with various types of cancer who are candidates to ICI during the first year following treatment initiation. The analysis includes the first 288 cancer patients from the SIRCVT, a multicenter prospective registry, who were treated with ICIs and showed no clinical evidence of cardiotoxicity during the first 12 months of follow-up . All patients underwent comprehensive cardiovascular assessments, including EKG, cardiac biomarkers, and cardiac imaging tests, at baseline and over 12 months after ICI initiation. Troponin results were normalized as a multiple of the upper reference limit (URL) of each site laboratory. Statistical analysis included ANOVA test, and a linear mixed model adjusted for time of visit, age, sex and tumour type. The median age was 66 ±12 years (68% male, 83% had at least one cardiovascular risk factor and 32% had previous cardiac disease). The most common malignancies were non-small cell lung cancer (57%), breast cancer (7%) and melanoma (7%). ICIs included antiPD-1 (64%), antiPD-L1 (26%) and antiPD-1 combined with antiCTLA4 (9%), with metastatic disease as the predominant setting (73%). Baseline average cardiac troponin measures were within normal limit (0.32±1.19 fold-change over URL); however, 10 patients showed abnormal baseline levels. A transient rise was observed at the first month visit (0.62±4.55 above URL) which returned to baseline levels by the third month (ANOVA test: p=0.32, Figure 1). This trend was confirmed in the linear mixed model (variance at 1st month = 0.31 ± 0.18; p = 0.08) among patients with initially normal troponin levels. Abnormal troponin levels were frequent during the first year, even in the absence of clinical cardiotoxicity (Figure 2). NT-proBNP levels showed no significant variation over time. Mild elevations of cardiac troponin are common in patients treated with ICI and no clinical evidence of cardiotoxicity during the first 12 months of follow-up. Nevertheless, the long-term clinical relevance of these changes remains uncertain. Clinical and translational correlations are necessary to understand its real significance.ANOVA test result for troponin Troponin dynamics during 1st year of ICI

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment by enhancing the immune response against tumor cells. However, their mechanism of action can lead to immune-related adverse events (irAEs), including myocarditis, a rare but life-threatening complication. The role of CD69+ regulatory T cells (Treg) in maintaining immune tolerance has been highlighted in cardiovascular diseases. This study investigates the immune profile of cancer patients undergoing immunotherapy, aiming to identify biomarkers associated with cardiovascular toxicity. To analyze immune cell dynamics in cancer patients receiving ICIs and evaluate the potential of CD69 expression as a biomarker for cardiovascular risk. This sub-study is part of the SIR-CVT study. Peripheral blood samples were collected from 215 cancer patients before ICI-treatment initiation and at different time points (2-4 weeks, 10-12 weeks, 6 months, and 1 year). Flow cytometry was performed to characterize lymphocyte subsets, with a focus on Treg (CD4+FOXP3+CD69+) and proinflammatory Th17 cells (CD4+IL-17+). Patients were stratified into high- and low-cardiovascular risk groups based on CD69 expression (1, 2). Differences were compared by ANOVA. Bioinformatic analysis of SIR-CVT patients stratified by CD69 expression according to the data GeoMean and smooth conditional means are shown (using Loess method). The median age was 66 ±12 years (68% male, 83% had at least one cardiovascular risk factor and 32% had previous cardiac disease). The most common malignancies were none-small cell lung cancer (57%), breast cancer (7%) and melanoma (7%). ICIs included antiPD-1 (67%), antiPD-L1 (24%) and antiCTLA-4 (9%). While total CD4+ T cells did not show significant changes (Figure 1A), patients exhibited a significant decline in activated Treg (CD4+FOXP3+CD69+) within the first 2-4 weeks of treatment (Fig. 1B), suggesting a systemic loss of immune tolerance. Patients with lower baseline CD69 expression experienced a pronounced decline, suggesting increased susceptibility to cardiovascular toxicity (Figure 1C). As a consequence, cytotoxic CD8+ T cells showed an increase after 3 weeks, which became significant at weeks 11 and 26 after ICIs (Fig. 2A). Additionally, a steady increase in proinflammatory Th17 cells was observed over time, becoming significant at one year (Fig. 2B). Bioinformatic analysis confirmed distinct immune profiles between high- and low-risk patients (Fig. 2C). This study reveals dynamic immune shifts during immunotherapy, characterized by a decline in protective Treg and an increase in Th17 cells, which may be responsible of immune-related cardiovascular toxicity. Stratification of patients by CD69 expression could help as a predictive tool for identifying those at higher risk of developing irAEs. These findings pave the way for personalized strategies to stratify cardiovascular toxicity risk in patients undergoing immunotherapy

Introduction and objectives: Our aim was to describe the characteristics and outcomes of heart transplants in Spain. Methods: We analyzed trends in recipient and donor characteristics, recipient-donor interaction, surgical procedures, immunosuppression, and outcomes of patients included in the Spanish heart transplant registry from 2014 to 2023. Changes in survival were analyzed using the Kaplan-Meier method. Results: In 2023, 325 cardiac transplants were performed (4.5% more than in the previous year), with a total of 2987 procedures from 2014 to 2023. There was a trend toward performing more transplants in women (29.2%), with etiologies other than cardiomyopathy (32.6%), and with better pretransplant status (less hepatic [12.5%], renal [glomerular filtration rate, 81.5 mL/min/1.73 m2], and respiratory [8.7%] involvement). In 2023, the number of urgent transplants increased (44% of the total), especially those performed after circulatory support with extracorporeal membrane oxygenation (36% of total assistance), and transplants performed with donation after circulatory death (17.9%). Survival improved in the triennium from 2020 to 2022 compared with 2014 to 2016 (83.0% at 1 year from 2020-2022 vs 79.0% from 2014-2016). Conclusions: The number of transplants performed in Spain showed an upward trend, with recipients with better clinical status and an increasing use of donation after circulatory death. Survival improved in the last triennium. (C) 2024 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Introduction and objectives: Repetitive ambulatory doses of levosimendan are an option as a bridge to heart transplantation (HT), but evidence regarding the safety and efficacy of this treatment is scarce. The objective of the LEVO-T Registry is to describe the profile of patients on the HT list receiving levosimendan, prescription patterns, and clinical outcomes compared with patients not on levosimendan. Methods: We retrospectively reviewed all patients listed for elective HT from 2015 to 2020 from 14 centers in Spain. Results: A total of 1015 consecutive patients were included, of whom 238 patients (23.4%) received levosimendan. Patients treated with levosimendan had more heart failure (HF) admissions in the previous year and a worse clinical profile. The most frequent prescription pattern were fixed doses triggered by the patients' clinical needs. Nonfatal ventricular arrhythmias occurred in 2 patients (0.8%). No differences in HF hospitalizations were found between patients who started levosimendan in the first 30 days after listing and those who did not (33.6% vs 34.5%; P = .848). Among those who did not, 102 patients (32.9%) crossed over to levosimendan after an HF admission. These patients had a rate of 0.57 HF admissions per month before starting levosimendan and 0.21 afterwards. Propensity score matching analysis showed no differences in survival at 1 year after listing between patients receiving levosimendan and those who did not (HR, 1.03; 95%CI, 0.36-2.97; P = .958) or in survival after HT (HR, 0.97; 95%CI, 0.60-1.56; P = .958). Conclusions: Repetitive levosimendan in an ambulatory setting as a bridge to heart transplantation is commonly used, is safe, and may reduce HF hospitalizations. (c) 2023 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

Introduction: Chagas disease, caused by the infection of Trypanosoma cruzi, is the third cause of heart transplant in endemic areas of Latin America, and is increasingly prevalent in western countries. Acute Chagas reactivation after the transplant is a well-known phenomenon that happens up to 75% of patients, generally diagnosed with serial PCR. This report highlights its emergence in Spain as well as the need to reach a proper diagnosis.

El shock cardiogénico continúa siendo uno de los principales retos de la medicina cardiovascular de nuestro tiempo. El trasplante cardiaco urgente es el tratamiento de reemplazo cardiaco más empleado en España para los pacientes candidatos sin recuperación cardiaca. Esta estrategia tiene importantes connotaciones relacionadas con el principio de equidad y ligadas a las características del receptor y el donante y la accesibilidad de los órganos. Por un lado, en la selección del receptor es clave superar la fase de fracaso multiorgánico antes de plantear el trasplante. Por otro, es necesario ampliar el total de donantes a través de diferentes estrategias que permitan dar respuesta al mayor número de candidatos, incluso empleando órganos subóptimos. El uso de dispositivos de asistencia ventricular de larga duración como alternativa al trasplante ha de considerarse ante la escasez de donantes y los buenos resultados. Por último, el diseño de los criterios de distribución de órganos continúa siendo un reto en constante evolución dado que no existe un sistema universal capaz de dar respuesta a todos los problemas que se plantean. La adjudicación de órganos a los pacientes más críticos puede proporcionar un gran beneficio individual siempre que no afecte significativamente al bien común.

BACKGROUND: The front-line treatment in AL amyloidosis includes autologous stem cell transplantation (ASCT) for selected patients. Cardiac involvement determines patient's eligibility and may delay ASCT or compromise patient outcomes. METHODS: Retrospective analysis of all consecutive patients with AL amyloidosis receiving an ASCT in our hospital between 2008 and 2023, to assess its safety and efficacy to consolidate disease response in these patients. RESULTS: Thirty-one patients with AL amyloidosis received an ASCT in our center: median age 56 years (IQR 53-63), 18 male (58.1%), light chain lambda in 24 (77.4%) and gamma in 7 (22.6%), 21 (67.7%) also had multiple myeloma (≥10% plasma cells in the bone marrow), and 23 (74.2%) had been referred to us from other hospitals. Patients were classified as Mayo 2012 stages I, II, III and IV in 4 (13.8%), 4 (13.8%), 13 (44.8%) and 8 (27.6%) cases, respectively (2 missing). Most affected organs by AL amyloid were the heart in 25 (80.6%), kidneys in 22 (71.0%), bone marrow in 15 (48.4%) and gastrointestinal in 13 (41.9%). The commonest chemotherapy employed was bortezomib-cyclophosphamide-dexamethasone (17, 54.8%), and 14 patients (45.2%) received a daratumumab-based therapy. Following one (22, 71.0%), two (5, 16.1%), three (3, 9.7%) or four (1, 3.2%) lines of treatment, at the time of ASCT, all patients were in hematological response, including complete response in 22 (71.0%), very good partial response in 5 (16.1%) and partial response in 4 (12.9%). Also, most patients with cardiac involvement (22 out of 25, 88%) reached ASCT in cardiac response, showing an overall marked reduction in NT-proBNP from 3785 pg/mL (IQR 2342.5-7505.5) at diagnosis to 804pg/mL (IQR 185.5-1385) at ASCT (p<0.001). Achieving such response required a longer time from diagnosis to ASCT in patients with cardiac involvement than in those without it (52.3 months, IQR 35.8-77.0, versus 17.9 months, IQR 13-23.2, respectively; p=0.03). Patients were mobilized for transplant with G-CSF, either steady-state (28, 90.3%) or with chemotherapy (3, 9.7%), and seven required mobilization salvage with plerixafor (22.6%), five out of 14 treated with daratumumab (35.7%) and two out of 17 without it (11.7%). Conditioning regimen was melphalan-200 in all patients but one (96.8%). who received melphalan-140. A median of 4.23x106 CD34+ cells/kg (IQR, 3.02-5.10) were infused. Patients were managed by a multidisciplinary team including cardiologists in patients with cardiac involvement, and other specialists. Commonest posttransplant complications were mucositis (93.5%), infections (64.5%), mainly febrile neutropenia without microbiological documentation, and congestive heart failure (32.3%). Two out of seven patients (28.6%) who received G-CSF to accelerate neutrophil engraftment developed engraftment syndrome and recovered from it. Since G-CSF was withdrawn no other patients have developed this complication. Neutrophil and platelet engraftment were reached at a median of 13 days (IQR 12-15) and 12.5 days (IQR 12-14), respectively. Median duration of hospital admission was 21 days (IQR 18-25). Cardiac response remained stable after ASCT (NT-proBNP at 1 year 511.5 pg/mL (IQR, 193.5-1398.5). With a median follow-up of 3.6 years, only six patients had a disease progression, at a median of 8.7 years (CI95%, 4.0- not reached), and only one patient has died, from a secondary myeloid neoplasm, 9.6 years after ASCT. CONCLUSIONS: ASCT consolidates the hematologic and organic response of patients with AL amyloidosis. In particular, patients with cardiac involvement can be safely brought to ASCT when cardiac response is favorable. A multidisciplinary management is needed. The experience of our center, which receives patients from all over Spain, shows safety and very prolonged sustained responses after ASCT with high rates of overall and progression-free survival. ACKNOWLEDGMENTS: We would like to acknowledge Dr Isabel Krsnik, who led and inspired the work of our AL Amyloidosis Unit until her recent retirement, and many colleagues from other hospitals in Spain who kindly refer their patients to our Unit.

Introducción y objetivos: El objetivo es describir las características y los resultados del trasplante cardiaco en España.Métodos: Se realizó un análisis de la evolución de las características de receptor, donante, interacción receptor-donante, inmunosupresión y resultados de los pacientes incluidos en el Registro español de trasplante cardiaco en el periodo 2014-2023. La evolución de la supervivencia se analizó mediante el método de Kaplan-Meier.Resultados: En 2023 se realizaron 325 trasplantes cardiacos (el 4,5% más que el año anterior), con un total de 2.987 procedimientos en el periodo 2014-2023. Se comprobó una tendencia a trasplantar a más mujeres (29,2%), con etiologías diferentes de las dilatadas habituales (32,6%) y con mejor estado antes del trasplante (menos afecciones hepática [12,5%], renal [filtrado glomerular, 81,5 ml/min/1,73 m2] y respiratoria [8,7%]). En 2023 se incrementó el número de trasplantes urgentes (el 44% del total), sobre todo los realizados tras asistencia circulatoria con oxigenador extracorpóreo de membrana (el 36% del total de asistencias) y los trasplantes con donación en asistolia (17,9%). La supervivencia mejoró en el trienio 2020-2022 respecto a 2014-2016 (el 83,0% al primer año en 2020-2022 frente al 79,0% en 2014-2016).Conclusiones: El número de trasplantes en España muestra una tendencia al alza, en receptores en mejor estado clínico y con aumento de la donación en asistolia. La supervivencia mejoró en el último trienio.