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Shakoor A, Abou Kamar S, Malgie J, Kardys I, Schaap J, de Boer RA, van Mieghem NM, van der Boon RMA, Brugts JJ. The different risk of new-onset, chronic, worsening, and advanced heart failure: A systematic review and meta-regression analysis. Eur J Heart Fail 2024; 26:216-229. [PMID: 37823229 DOI: 10.1002/ejhf.3048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023] Open
Abstract
AIMS Heart failure (HF) is a chronic and progressive syndrome associated with a poor prognosis. While it may seem intuitive that the risk of adverse outcomes varies across the different stages of HF, an overview of these risks is lacking. This study aims to determine the risk of all-cause mortality and HF hospitalizations associated with new-onset HF, chronic HF (CHF), worsening HF (WHF), and advanced HF. METHODS AND RESULTS We performed a systematic review of observational studies from 2012 to 2022 using five different databases. The primary outcomes were 30-day and 1-year all-cause mortality, as well as 1-year HF hospitalization. Studies were pooled using random effects meta-analysis, and mixed-effects meta-regression was used to compare the different HF groups. Among the 15 759 studies screened, 66 were included representing 862 046 HF patients. Pooled 30-day mortality rates did not reveal a significant distinction between hospital-admitted patients, with rates of 10.13% for new-onset HF and 8.11% for WHF (p = 0.10). However, the 1-year mortality risk differed and increased stepwise from CHF to advanced HF, with a rate of 8.47% (95% confidence interval [CI] 7.24-9.89) for CHF, 21.15% (95% CI 17.78-24.95) for new-onset HF, 26.84% (95% CI 23.74-30.19) for WHF, and 29.74% (95% CI 24.15-36.10) for advanced HF. Readmission rates for HF at 1 year followed a similar trend. CONCLUSIONS Our meta-analysis of observational studies confirms the different risk for adverse outcomes across the distinct HF stages. Moreover, it emphasizes the negative prognostic value of WHF as the first progressive stage from CHF towards advanced HF.
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Affiliation(s)
- Abdul Shakoor
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Sabrina Abou Kamar
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Jishnu Malgie
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Jeroen Schaap
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Nicolas M van Mieghem
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Robert M A van der Boon
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus Medical Center, Cardiovascular Institute, Rotterdam, The Netherlands
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Ma JI, Zern EK, Parekh JK, Owunna N, Jiang N, Wang D, Rambarat PK, Pomerantsev E, Picard MH, Ho JE. Obesity Modifies Clinical Outcomes of Right Ventricular Dysfunction. Circ Heart Fail 2023; 16:e010524. [PMID: 37886836 PMCID: PMC10841712 DOI: 10.1161/circheartfailure.123.010524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 08/18/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Right ventricular (RV) dysfunction is associated with increased mortality across a spectrum of cardiovascular diseases. The role of obesity in RV dysfunction and adverse outcomes is unclear. METHODS We examined patients undergoing right heart catheterization between 2005 and 2016 in a hospital-based cohort. Linear regression was used to examine the association of obesity with hemodynamic indices of RV dysfunction (pulmonary artery pulsatility index, right atrial pressure:pulmonary capillary wedge pressure ratio, RV stroke work index). Cox models were used to examine the association of RV function measures with clinical outcomes. RESULTS Among 8285 patients (mean age, 63 years; 40% women), higher body mass index was associated with worse indices of RV dysfunction, including lower pulmonary artery pulsatility index (β, -0.23; SE, 0.01; P<0.001), higher right atrium:pulmonary capillary wedge pressure ratio (β, 0.25; SE, 0.01; P<0.001), and lower RV stroke work index (β, -0.05; SE, 0.01; P<0.001). Over median of 7.3 years of follow-up, we observed 3006 mortality and 2004 heart failure hospitalization events. RV dysfunction was associated with a greater risk of mortality (eg, pulmonary artery pulsatility index:hazard ratio, 1.11 per 1-SD increase [95% CI, 1.04-1.18]), with similar associations with risk of heart failure hospitalization. Body mass index modified the effect of RV dysfunction on all-cause mortality (Pinteraction≤0.005 for PAPi and RA:PCWP ratio), such that the effect of RV dysfunction was more pronounced at higher body mass index. CONCLUSIONS Patients with obesity had worse hemodynamic measured indices of RV function across a broad hospital-based sample. While RV dysfunction was associated with worse clinical outcomes including mortality and heart failure hospitalization, this association was especially pronounced among individuals with higher body mass index.
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Affiliation(s)
- Janet I. Ma
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Emily K. Zern
- Providence Heart Institute, Center for Cardiovascular Analytics, Research, and Data Science (CARDS), Providence St. Joseph Health, Portland, Oregon
| | - Juhi K. Parekh
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ndidi Owunna
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nona Jiang
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Dongyu Wang
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Paula K. Rambarat
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Eugene Pomerantsev
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael H. Picard
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer E. Ho
- Cardiovascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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3
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Shahnazaryan S, Pepoyan S, Sisakian H. Heart Failure with Reduced Ejection Fraction: The Role of Cardiovascular and Lung Ultrasound beyond Ejection Fraction. Diagnostics (Basel) 2023; 13:2553. [PMID: 37568916 PMCID: PMC10416843 DOI: 10.3390/diagnostics13152553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
Heart failure with reduced ejection fraction (HFrEF) is considered a major health care problem with frequent decompensations, high hospitalization and mortality rates. In severe heart failure (HF), the symptoms are refractory to medical treatment and require advanced therapeutic strategies. Early recognition of HF sub- and decompensation is the cornerstone of the timely treatment intensification and, therefore, improvement in the prognosis. Echocardiography is the gold standard for the assessment of systolic and diastolic functions. It allows one to obtain accurate and non-invasive measurements of the ventricular function in HF. In severely compromised HF patients, advanced cardiovascular ultrasound modalities may provide a better assessment of intracardiac hemodynamic changes and subclinical congestion. Particularly, cardiovascular and lung ultrasound allow us to make a more accurate diagnosis of subclinical congestion in HFrEF. The aim of this review was to summarize the advantages and limitations of the currently available ultrasound modalities in the ambulatory monitoring of patients with HFrEF.
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Affiliation(s)
| | | | - Hamayak Sisakian
- Clinic of General and Invasive Cardiology, “Heratsi” Hospital Complex #1, Yerevan State Medical University, 2 Koryun Street, Yerevan 375025, Armenia; (S.S.); (S.P.)
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4
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Ma JI, Zern E, Jiang N, Wang D, Rambarat P, Pomerantsev E, Picard MH, Ho JE. Obesity Modifies Clinical Outcomes of Right Ventricular Dysfunction. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.18.23284734. [PMID: 36711542 PMCID: PMC9882441 DOI: 10.1101/2023.01.18.23284734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Introduction Right ventricular (RV) dysfunction is associated with increased mortality across a spectrum of cardiovascular diseases. The role of obesity in RV dysfunction and adverse outcomes is unclear. Methods We examined patients undergoing right heart catheterization between 2005-2016 in a hospital-based cohort. Linear regression was used to examine the association of obesity with hemodynamic indices of RV dysfunction [pulmonary artery pulsatility index (PAPi), right atrial pressure: pulmonary capillary wedge pressure ratio (RAP:PCWP), RV stroke work index (RVSWI)]. Cox models were used to examine the association of RV function measures with clinical outcomes. Results Among 8285 patients (mean age 63 years, 40% women), higher BMI was associated with worse indices of RV dysfunction, including lower PAPi (β -0.26, SE 0.01, p <0.001), higher RA:PCWP ratio (β 0.25, SE 0.01, p-value <0.001), and lower RVSWI (β -0.05, SE 0.01, p-value <0.001). Over 7.3 years of follow-up, we observed 3006 mortality and 2004 heart failure (HF) hospitalization events. RV dysfunction was associated with greater risk of mortality (eg PAPi: HR 1.11 per 1-SD increase, 95% CI 1.04-1.18), with similar associations with risk of HF hospitalization. BMI modified the effect of RV dysfunction on outcomes (P-interaction <=0.005 for both), such that the effect of RV dysfunction was more pronounced at higher BMI. Conclusions Patients with obesity had worse hemodynamic measured indices of RV function across a broad hospital-based sample. While RV dysfunction was associated with worse clinical outcomes including mortality and HF hospitalization, this association was especially pronounced among individuals with higher BMI.
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Koschker AC, Warrings B, Morbach C, Seyfried F, Rickert N, Jung P, Geier A, Dischinger U, Krauthausen M, Herrmann MJ, Stier C, Frantz S, Malzahn U, Störk S, Fassnacht M. Cardio-psycho-metabolic outcomes of bariatric surgery: design and baseline of the WAS trial. Endocr Connect 2022; 11:e210338. [PMID: 35015697 PMCID: PMC8859939 DOI: 10.1530/ec-21-0338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/11/2022] [Indexed: 12/02/2022]
Abstract
Obesity is a rapidly emerging health problem and an established risk factor for cardiovascular diseases. Bariatric surgery profoundly reduces body weight and mitigates sequelae of obesity. The open, randomized controlled Würzburg Adipositas Studie (WAS) trial compares the effects of Roux-en-Y gastric bypass (RYGB) vs psychotherapy-supported lifestyle modification in morbidly obese patients. The co-primary endpoint addresses 1-year changes in cardiovascular function (peak VO2 during cardiopulmonary exercise testing) and the quality of life (QoL) (Short-Form-36 physical functioning scale). Prior to randomization, all included patients underwent a multimodal anti-obesity treatment for 6-12 months. Thereafter, the patients were randomized and followed through month 12 to collect the primary endpoints. Afterwards, patients in the lifestyle group could opt for surgery, and final visit was scheduled for all patients 24 months after randomization. Sample size calculation suggested to enroll 90 patients in order to arrive at minimally 22 patients per group evaluable for the primary endpoint. Secondary objectives were to quantify changes in body weight, left ventricular hypertrophy, systolic and diastolic function (by echocardiography and cardiac MRI), functional brain MRI, psychometric scales, and endothelial and metabolic function. WAS enrolled 93 patients (72 women, median age 38 years, BMI 47.5 kg/m2) exhibiting a relevantly compromised exercise capacity (median peakVO2 18.3 mL/min/kg) and the QoL (median physical functioning scale 50). WAS is the first randomized controlled trial focusing on the effects of RYGB on cardiovascular function beyond hypertension. In addition, it will provide a wealth of high-quality data on the cerebral, psychiatric, hepatic, and metabolic function in obese patients after RYGB.
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Affiliation(s)
- Ann-Cathrin Koschker
- Division of Endocrinology and Diabetology, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, University & University Hospital Würzburg, Würzburg, Germany
| | - Bodo Warrings
- Comprehensive Heart Failure Center, University & University Hospital Würzburg, Würzburg, Germany
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, University of Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Comprehensive Heart Failure Center, University & University Hospital Würzburg, Würzburg, Germany
- Division of Cardiology, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Florian Seyfried
- Department of General, Visceral, Transplant, Vascular, and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
| | - Nicole Rickert
- Department of Radiology, University Hospital, University of Würzburg, Würzburg, Germany
| | - Pius Jung
- Division of Pneumology, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Andreas Geier
- Division of Hepatology, Department of Internal Medicine II, University Hospital, University of Würzburg, Würzburg, Germany
| | - Ulrich Dischinger
- Division of Endocrinology and Diabetology, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Maike Krauthausen
- Department of General Practice, University Hospital, University of Würzburg, Würzburg, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, University of Würzburg, Würzburg, Germany
| | - Christine Stier
- Division of Endocrinology and Diabetology, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
- Department of General, Visceral, Transplant, Vascular, and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Comprehensive Heart Failure Center, University & University Hospital Würzburg, Würzburg, Germany
- Division of Cardiology, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Uwe Malzahn
- Center for Clinical Trials, University Hospital, University of Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University & University Hospital Würzburg, Würzburg, Germany
- Division of Cardiology, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
| | - Martin Fassnacht
- Division of Endocrinology and Diabetology, Department of Internal Medicine I, University Hospital, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, University & University Hospital Würzburg, Würzburg, Germany
- Correspondence should be addressed to M Fassnacht:
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Wang S, Wang Y, Luo M, Lin K, Xie X, Lin N, Yang Q, Zou T, Chen X, Xie X, Guo Y. MMMELD-XI Score Is Associated With Short-Term Adverse Events in Patients With Heart Failure With Preserved Ejection Fraction. Front Cardiovasc Med 2021; 8:650191. [PMID: 34113661 PMCID: PMC8186531 DOI: 10.3389/fcvm.2021.650191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: Accumulating evidence suggests that MELD-XI score holds the ability to predict the prognosis of congestive heart failure. However, most of the evidence is based on the end-stage heart failure population; thus, we aim to explore the association between the MELD-XI score and the prognosis in heart failure with preserved ejection fraction (HFpEF). Methods: A total of 30,096 patients hospitalized for HFpEF in Fujian Provincial Hospital between January 1, 2014 and July 17, 2020 with available measures of creatinine and liver function were enrolled. The primary endpoint was 60-day in-hospital all-cause mortality. Secondary endpoints were 60-day in-hospital cardiovascular mortality and 30-day rehospitalization for heart failure. Results: A total of 222 patients died within 60 days after admission, among which 75 deaths were considered cardiogenic. And 73 patients were readmitted for heart failure within 30 days after discharge. Generally, patients with an elevated MELD-XI score tended to have more comorbidities, higher NYHA class, and higher inflammatory biomarkers levels. Meanwhile, the MELD-XI score was positively correlated with NT-pro BNP, left atrial diameter, E/e' and negatively correlated with LVEF. After adjusting for conventional risk factors, the MELD-XI score was independently associated with 60-day in-hospital all-cause mortality [hazard ratio(HR) = 1.052, 95% confidential interval (CI) 1.022–1.083, P = 0.001], 60-day in-hospital cardiovascular mortality (HR = 1.064, 95% CI 1.013–1.118, P = 0.014), and 30-day readmission for heart failure (HR = 1.061, 95% CI 1.015–1.108, P = 0.009). Furthermore, the MELD-XI score added an incremental discriminatory capacity to risk stratification models developed based on this cohort. Conclusion: The MELD-XI score was associated with short-term adverse events and provided additional discriminatory capacity to risk stratification models in patients hospitalized for HFpEF.
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Affiliation(s)
- Sunying Wang
- Department of Cardiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Yuwei Wang
- Department of Cardiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Manqing Luo
- Department of Cardiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Kaiyang Lin
- Department of Cardiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Xiaoxu Xie
- Department of Cardiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Na Lin
- Department of Cardiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Qingyong Yang
- Department of Cardiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Tian Zou
- Department of Cardiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Xinan Chen
- Department of Cardiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Xianwei Xie
- Department of Cardiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Yansong Guo
- Department of Cardiology, Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
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Agostoni P, Sciomer S, Palermo P, Contini M, Pezzuto B, Farina S, Magini A, De Martino F, Magrì D, Paolillo S, Cattadori G, Vignati C, Mapelli M, Apostolo A, Salvioni E. Minute ventilation/carbon dioxide production in chronic heart failure. Eur Respir Rev 2021; 30:30/159/200141. [PMID: 33536259 PMCID: PMC9489123 DOI: 10.1183/16000617.0141-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/21/2020] [Indexed: 11/05/2022] Open
Abstract
In chronic heart failure, minute ventilation (V'E) for a given carbon dioxide production (V'CO2 ) might be abnormally high during exercise due to increased dead space ventilation, lung stiffness, chemo- and metaboreflex sensitivity, early metabolic acidosis and abnormal pulmonary haemodynamics. The V'E versus V'CO2 relationship, analysed either as ratio or as slope, enables us to evaluate the causes and entity of the V'E/perfusion mismatch. Moreover, the V'E axis intercept, i.e. when V'CO2 is extrapolated to 0, embeds information on exercise-induced dead space changes, while the analysis of end-tidal and arterial CO2 pressures provides knowledge about reflex activities. The V'E versus V'CO2 relationship has a relevant prognostic power either alone or, better, when included within prognostic scores. The V'E versus V'CO2 slope is reported as an absolute number with a recognised cut-off prognostic value of 35, except for specific diseases such as hypertrophic cardiomyopathy and idiopathic cardiomyopathy, where a lower cut-off has been suggested. However, nowadays, it is more appropriate to report V'E versus V'CO2 slope as percentage of the predicted value, due to age and gender interferences. Relevant attention is needed in V'E versus V'CO2 analysis in the presence of heart failure comorbidities. Finally, V'E versus V'CO2 abnormalities are relevant targets for treatment in heart failure.
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Affiliation(s)
- Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy .,Dept of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Susanna Sciomer
- Dept of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | | | | | | | | | | | | | - Damiano Magrì
- Dept of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Stefania Paolillo
- Dept of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Gaia Cattadori
- Unità Operativa Cardiologia Riabilitativa, Multimedica IRCCS, Milan, Italy
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Dept of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Dept of Clinical Science and Community Health, University of Milan, Milan, Italy
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Okano T, Motoki H, Minamisawa M, Kimura K, Kanai M, Yoshie K, Higuchi S, Saigusa T, Ebisawa S, Okada A, Shoda M, Kuwahara K. Cardio-renal and cardio-hepatic interactions predict cardiovascular events in elderly patients with heart failure. PLoS One 2020; 15:e0241003. [PMID: 33095810 PMCID: PMC7584193 DOI: 10.1371/journal.pone.0241003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/07/2020] [Indexed: 12/28/2022] Open
Abstract
Background The composite Model for End-Stage Liver Disease Excluding International Normalized Ratio Score (MELD-XI) is a novel tool to evaluate cardio-renal and cardio-hepatic interactions in patients with advanced heart failure (HF). However, its prognostic ability remains unclear in elderly HF patients. Methods and results From July 2014 to July 2018, patients hospitalized for HF were prospectively recruited at 16 centers. Clinical features, laboratory findings, and echocardiography results were assessed prior to discharge. Cardiovascular (CV) death and HF re-hospitalization were recorded. Of the 676 patients enrolled, 264 (39.1%) experienced CV events throughout a 1-year median follow-up period. Patients with high MELD-XI were predominantly male and had a higher prevalence of NYHA III/IV, history of HF admission, hyperuricemia, ventricular tachycardia, anemia, and ischemic heart disease. In Kaplan-Meyer analysis, patients with higher MELD-XI (≥11) scores showed a worse prognosis than did those with lower (<11) scores (log-rank p≤0.001). Multivariate Cox proportional hazards testing revealed MELD-XI as an independent predictor of CV events (HR: 1.033, 95% CI: 1.006–1.061, p = 0.015) after adjusting for age, gender, body mass index, NYHA III/IV, prior HF hospitalization, systolic blood pressure, ischemic etiology, ventricular tachycardia, anemia, BNP, and left ventricular ejection fraction. Conclusions Cardio-renal and cardio-hepatic interactions predicted CV events in aged HF patients.
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Affiliation(s)
- Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
- * E-mail:
| | - Masatoshi Minamisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kazuhiro Kimura
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Masafumi Kanai
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Satoko Higuchi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Impact of right ventricular stroke work index on predicting hospital readmission and functional status of patients with advanced heart failure. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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10
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Ozenc E, Yildiz O, Baydar O, Yazicioglu N, Koc NA. Impact of right ventricular stroke work index on predicting hospital readmission and functional status of patients with advanced heart failure. Rev Port Cardiol 2020; 39:565-572. [PMID: 33008692 DOI: 10.1016/j.repc.2020.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/25/2019] [Accepted: 06/11/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND AIMS The prognosis of chronic heart failure with reduced ejection fraction (HFrEF) has been studied extensively, but factors predicting cardiac decompensation are poorly defined. Right ventricular stroke work index (RVSWI), an invasive measure of right ventricular (RV) systolic function, is a well-known prognostic marker of RV failure after left ventricular assist device insertion and after lung transplantation. Thus, the aim of this study was to assess whether there is a relationship between RVSWI, HFrEF hospital readmission due to cardiac decompensation, and prognosis. METHODS We prospectively enrolled 132 consecutive patients with HFrEF. Right heart catheterization was performed and RVSWI values were calculated in all patients. The relationship between RVSWI values and readmission and prognosis was analyzed. RESULTS During a median follow-up of 20±7 months, 33 patients were readmitted due to cardiac decompensation in the survivor group, and 18 patients died due to cardiac causes. There was no difference between patients who died and survived in terms of RVSWI values. Among patients with decompensation, mean RVSWI was significantly lower than in patients with stable HFrEF (6.0±2.2 g/m2/beat vs. 8.8±3.5 g/m2/beat, p<0.001). On correlation analysis, RVSWI was negatively correlated with NYHA functional class. RVSWI was also identified as an independent risk factor for cardiac decompensation in Cox regression survival analysis. CONCLUSIONS We showed that RVSWI predicts cardiac decompensation and correlates with functional class in advanced stage HFrEF. Our data suggest the value of combining information on right heart hemodynamics with assessment of RV function when defining the risk of patients with advanced HFrEF.
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Affiliation(s)
- Ebru Ozenc
- Department of Cardiology, Istanbul Bilim University, Florence Nightingale Hospital, Istanbul, Turkey
| | - Omer Yildiz
- Department of Cardiology, Istanbul Bilim University, Florence Nightingale Hospital, Istanbul, Turkey
| | - Onur Baydar
- Department of Cardiology, Koc University Hospital, Istanbul, Turkey.
| | - Nuran Yazicioglu
- Department of Cardiology, Istanbul Bilim University, Florence Nightingale Hospital, Istanbul, Turkey
| | - Nurcan Arat Koc
- Department of Cardiology, Istanbul Bilim University, Florence Nightingale Hospital, Istanbul, Turkey
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11
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A right ventricular state of mind in the progression of heart failure with reduced ejection fraction: implications for left ventricular assist device therapy. Heart Fail Rev 2020; 26:1467-1475. [DOI: 10.1007/s10741-020-09935-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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12
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Loforte A, Fiorentino M, Gliozzi G, Mariani C, Folesani G, Suarez SM, Russo A, Masetti M, Potena L, Pacini D. Heart Transplant and Hepato-Renal Dysfunction: The Model of End-Stage Liver Disease Excluding International Normalized Ratio as a Predictor of Postoperative Outcomes. Transplant Proc 2019; 51:2962-2966. [PMID: 31607616 DOI: 10.1016/j.transproceed.2019.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/28/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Preoperative liver and renal dysfunction remain surgical risk factors for both postoperative morbidity and mortality. The Model of End-Stage Liver Disease Excluding INR (international normalized ratio), or MELD-XI, score calculation may help as a predictor in patients with advanced heart failure. We analyzed the impact of progressive elevated MELD-XI values among recipients of heart transplant at our institution. METHODS The data of a total of 425 consecutive adult patients who underwent heart transplantation, between January 2000 and August 2018, have been reviewed and divided into 3 cohorts according to preoperative MELD-XI calculations (MELD-XI < 11; MELD-XI 11-18; and MELD-XI > 18). Early and late outcomes have been analyzed. RESULTS Patients with a MELD-XI score > 18 had a more critical clinical condition preoperatively and had a higher risk of early mortality (hazard ratio [HR] 1.45 [1.11-1.67], P < .001). They showed high risk for postoperative dialysis (HR 2.8 [1.5-5.3], P < .001), rethoracothomy for bleeding (HR 2.1 [1.2-4.1], P = .001), prolonged time of mechanical ventilation, time of intensive care unit stay (HR 2.2 [1.3-3.8], P = .005), and graft failure requiring mechanical circulatory support (HR 1.9 [1.1-3.3], P = .003). After risk adjustment per MELD-XI cohort, ischemic dilated cardiomyopathy, redo operation, and cold ischemic time > 240 minutes resulted in being the strongest predictors of early mortality (P < .001). The 5-year and 10-year survival for MELD-XI > 18 cohort was 63% and 47% vs 72% and 59% in the control group (MELD-XI < 18) (log-rank, P < .001). CONCLUSIONS Patients with an elevated preoperative MELD-XI profile presented more comorbidities and significantly lower survival. This suggests the MELD-XI score may provide further insight into appropriate recipient and eventual donor selection. Renal insufficiency and congestive hepatopathy should be properly optimized before heart transplantation.
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Affiliation(s)
- Antonio Loforte
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy.
| | - Mariafrancesca Fiorentino
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Gregorio Gliozzi
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Carlo Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Gianluca Folesani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Sofia Martin Suarez
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Antonio Russo
- Department of Cardiology and Transplantation, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Marco Masetti
- Department of Cardiology and Transplantation, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Luciano Potena
- Department of Cardiology and Transplantation, S. Orsola Hospital, Bologna University, Bologna, Italy
| | - Davide Pacini
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna University, Bologna, Italy
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13
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Szabó B, Marosi EK, Vargová K, Nyolczas N. Cardiac Index by Transthoracic Echocardiography (CITE) study. PLoS One 2018; 13:e0207269. [PMID: 30540751 PMCID: PMC6291087 DOI: 10.1371/journal.pone.0207269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/29/2018] [Indexed: 11/17/2022] Open
Abstract
AIMS Left ventricular ejection fraction (LVEF) is the most frequently used parameter in the assessment of heart failure (HF). Cardiac index (CI) is considered a potential alternative to LVEF despite limited evidence. We aimed to assess and compare the predictive accuracy of LVEF and echocardiographically-assessed CI in HF patients. METHODS AND RESULTS A single-centre, retrospective cohort study was conducted in patients hospitalized for acute HF from 2010-2016. Cox proportional hazard models including either LVEF or CI were created to predict all cause death, cardiovascular (CV) death, or first HF-readmission. Of 334 patients included in the analysis, 58.7% exhibited HF with reduced LVEF (HFrEF). Left ventricular ejection fraction did not show correlation with any endpoint, while CI was predictive of HF-readmission in the entire cohort. Both the LVEF-based and CI-based models demonstrated moderate discriminative accuracy when predicting all-cause death, CV death, or HF-readmission. Left ventricular ejection fraction proved to be an independent predictor of CV mortality in HFrEF-patients, while CI was predictive of HF-readmission in the non-HFrEF group. CONCLUSIONS Left ventricular ejection fraction seemed to be associated more closely with disease severity in HFrEF, and CI in the non-HFrEF group, in this real-life cohort of elderly HF patients. The LVEF-based and CI-based predictive models have clinically similar predictive accuracy for mortality and HF-readmission, thus CI may be a potential alternative to LVEF in the assessment of left ventricular function. Cardiac index may be an important new tool in the assessment of HF patients with midrange or preserved LVEF.
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Affiliation(s)
- Barna Szabó
- Heart-Lung-Physiology Clinic, Örebro University Hospital, Örebro, Sweden
| | | | - Katarina Vargová
- Heart-Lung-Physiology Clinic, Örebro University Hospital, Örebro, Sweden
| | - Noémi Nyolczas
- Cardiology, Military Hospital State Health Centre, Budapest, Hungary
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14
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Lebray P, Varnous S, Pascale A, Leger P, Luyt CE, Ratziu V, Munteanu M, Ould Amar S, Thabut D, Chastre J, Pavie A, Poynard T, Leprince P. Predictive value of liver damage for severe early complications and survival after heart transplantation: A retrospective analysis. Clin Res Hepatol Gastroenterol 2018; 42:416-426. [PMID: 29655525 DOI: 10.1016/j.clinre.2018.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 02/28/2018] [Accepted: 03/01/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hepatic dysfunction is often associated with advanced heart failure. Its impact on complications following heart transplantation is not well known. We studied the influence of preoperative hepatic dysfunction on the results of heart transplantation with a specific priority access for critical patients. METHODS Consecutive heart transplantation patients were retrospectively analyzed at listing to detect predictive factors for early complications and survival following heart transplantation. RESULTS Among heart transplant candidates (n=384), median age was 52 years, dilated and ischemic cardiopathies were present in 44% and 32%, respectively. Clinical ascites was present in 15.6% and median MELD score was 13. A temporary circulatory support and a national priority access were necessary in 14.8% and 35% respectively. Whereas 12% of the global cohort died on the waiting list, 321 patients were transplanted, 34.2% suffered from severe early complications, 26.3% needed extracorporeal membrane oxygenation in postoperative period, 27.7% died before 3 months with a 5-year survival rate of 56%. At listing, clinical ascites, and creatinine were independently associated with specific early complications i.e. primary graft dysfunction and septic shock respectively. Bilirubin level was also an independent marker of other early complications. Finally, need for postoperative circulatory support and postoperative 90-day mortality were strongly and exclusively associated with clinical ascites and creatinine at listing. In a subgroup analysis, we predicted more accurately the postoperative survival at 3 months by combining MELD score and ascites. CONCLUSION At listing, hepatic and renal dysfunctions are independent risk factors that could predict severe early complications and mortality following heart transplantation in the most severe patients.
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Affiliation(s)
- Pascal Lebray
- Hépato-gastroentérologie, Hôpital de la Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France.
| | | | - Alina Pascale
- Hépato-gastroentérologie, Hôpital de la Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Philippe Leger
- Hépato-gastroentérologie, Hôpital de la Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France; Cardiothoracic Surgical Unit, Paris, France; Anaesthesia and Intensive Care Unit Department, Pitié-Salpêtrière Hospital, Paris, France; Biopredictive Research, Paris, France
| | - Charles Edouard Luyt
- Anaesthesia and Intensive Care Unit Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Vlad Ratziu
- Hépato-gastroentérologie, Hôpital de la Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | | | | | - Dominique Thabut
- Hépato-gastroentérologie, Hôpital de la Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - Jean Chastre
- Anaesthesia and Intensive Care Unit Department, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Thierry Poynard
- Hépato-gastroentérologie, Hôpital de la Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France
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15
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Tecson KM, Lima B, Lee AY, Raza FS, Ching G, Lee CH, Felius J, Baxter RD, Still S, Collier JDG, Hall SA, Joseph SM. Determinants and Outcomes of Vasoplegia Following Left Ventricular Assist Device Implantation. J Am Heart Assoc 2018; 7:JAHA.117.008377. [PMID: 29773577 PMCID: PMC6015358 DOI: 10.1161/jaha.117.008377] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Vasoplegia is associated with adverse outcomes following cardiac surgery; however, its impact following left ventricular assist device implantation is largely unexplored. METHODS AND RESULTS In 252 consecutive patients receiving a left ventricular assist device, vasoplegia was defined as the occurrence of normal cardiac function and index but with the need for intravenous vasopressors within 48 hours following surgery for >24 hours to maintain a mean arterial pressure >70 mm Hg. We further categorized vasoplegia as none; mild, requiring 1 vasopressor (vasopressin, norepinephrine, or high-dose epinephrine [>5 μg/min]); or moderate to severe, requiring ≥2 vasopressors. Predictors of vasoplegia severity were determined using a cumulative logit (ordinal logistic regression) model, and 1-year mortality was evaluated using competing-risks survival analysis. In total, 67 (26.6%) patients developed mild vasoplegia and 57 (22.6%) developed moderate to severe vasoplegia. The multivariable model for vasoplegia severity utilized preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile, central venous pressure, systolic blood pressure, and intraoperative cardiopulmonary bypass time, which yielded an area under the curve of 0.76. Although no significant differences were noted in stroke or pump thrombosis rates (P=0.87 and P=0.66, respectively), respiratory failure and major bleeding increased with vasoplegia severity (P<0.01). Those with moderate to severe vasoplegia had a significantly higher risk of mortality than those without vasoplegia (adjusted hazard ratio: 2.12; 95% confidence interval, 1.08-4.18; P=0.03). CONCLUSIONS Vasoplegia is predictive of unfavorable outcomes, including mortality. Risk factors for future research include preoperative INTERMACS profile, central venous pressure, systolic blood pressure, and intraoperative cardiopulmonary bypass time.
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Affiliation(s)
- Kristen M Tecson
- Baylor Heart and Vascular Institute, Baylor Scott & White Research Institute, Dallas, TX.,Department of Internal Medicine, Texas A&M University College of Medicine Health Science Center, Dallas, TX
| | - Brian Lima
- Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Manhasset, NY
| | - Andy Y Lee
- Department of Cardiology, Baylor University Medical Center, Dallas, TX
| | - Fayez S Raza
- Department of Cardiology, Baylor University Medical Center, Dallas, TX
| | - Grace Ching
- Department of Internal Medicine, Texas A&M University College of Medicine Health Science Center, Dallas, TX
| | - Cheng-Han Lee
- Department of Internal Medicine, Texas A&M University College of Medicine Health Science Center, Dallas, TX
| | - Joost Felius
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX
| | - Ronald D Baxter
- Department of Surgery, Baylor University Medical Center, Dallas, TX
| | - Sasha Still
- Department of Surgery, Baylor University Medical Center, Dallas, TX
| | | | - Shelley A Hall
- Department of Cardiology, Baylor University Medical Center, Dallas, TX.,Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX.,Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX
| | - Susan M Joseph
- Department of Cardiology, Baylor University Medical Center, Dallas, TX .,Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, Dallas, TX.,Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX
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16
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Kanjanahattakij N, Sirinvaravong N, Aguilar F, Agrawal A, Krishnamoorthy P, Gupta S. High Right Ventricular Stroke Work Index Is Associated with Worse Kidney Function in Patients with Heart Failure with Preserved Ejection Fraction. Cardiorenal Med 2018; 8:123-129. [PMID: 29617005 DOI: 10.1159/000486629] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 01/02/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In patients with heart failure with preserved ejection fraction (HFpEF), worse kidney function is associated with worse overall cardiac mechanics. Right ventricular stroke work index (RVSWI) is a parameter of right ventricular function. The aim of our study was to determine the relationship between RVSWI and glomerular filtration rate (GFR) in patients with HFpEF. METHOD This was a single-center cross-sectional study. HFpEF is defined as patients with documented heart failure with ejection fraction > 50% and pulmonary wedge pressure > 15 mm Hg from right heart catheterization. RVSWI (normal value 8-12 g/m/beat/m2) was calculated using the formula: RVSWI = 0.0136 × stroke volume index × (mean pulmonary artery pressure - mean right atrial pressure). Univariate and multivariate linear regression analysis was performed to study the correlation between RVSWI and GFR. RESULT Ninety-one patients were included in the study. The patients were predominantly female (n = 64, 70%) and African American (n = 61, 67%). Mean age was 66 ± 12 years. Mean GFR was 59 ± 35 mL/min/1.73 m2. Mean RVSWI was 11 ± 6 g/m/beat/m2. Linear regression analysis showed that there was a significant independent inverse relationship between RVSWI and GFR (unstandardized coefficient = -1.3, p = 0.029). In the subgroup with combined post and precapillary pulmonary hypertension (Cpc-PH) the association remained significant (unstandardized coefficient = -1.74, 95% CI -3.37 to -0.11, p = 0.04). CONCLUSION High right ventricular workload indicated by high RVSWI is associated with worse renal function in patients with Cpc-PH. Further prospective studies are needed to better understand this association.
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Affiliation(s)
| | - Natee Sirinvaravong
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Francisco Aguilar
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Akanksha Agrawal
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Parasuram Krishnamoorthy
- Cardiology Division, Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Shuchita Gupta
- Cardiology Division, Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
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17
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Bossers GP, Hagdorn QA, Ploegstra MJ, Borgdorff MA, Silljé HH, Berger RM, Bartelds B. Volume load-induced right ventricular dysfunction in animal models: insights in a translational gap in congenital heart disease. Eur J Heart Fail 2017; 20:808-812. [DOI: 10.1002/ejhf.931] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 06/01/2017] [Accepted: 06/05/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Guido P.L. Bossers
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology; University of Groningen, University Medical Center Groningen; The Netherlands
| | - Quint A.J. Hagdorn
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology; University of Groningen, University Medical Center Groningen; The Netherlands
| | - Mark Jan Ploegstra
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology; University of Groningen, University Medical Center Groningen; The Netherlands
| | - Marinus A.J. Borgdorff
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology; University of Groningen, University Medical Center Groningen; The Netherlands
| | - Herman H.W. Silljé
- Department of Cardiology, University of Groningen; University Medical Center Groningen; The Netherlands
| | - Rolf M.F. Berger
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology; University of Groningen, University Medical Center Groningen; The Netherlands
| | - Beatrijs Bartelds
- Center for Congenital Heart Diseases, Department of Pediatric Cardiology; University of Groningen, University Medical Center Groningen; The Netherlands
- Department of Pediatrics, Division of Pediatric Cardiology; Sophia Children's Hospital; Rotterdam The Netherlands
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18
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Hsich EM, Blackstone EH, Thuita L, McNamara DM, Rogers JG, Ishwaran H, Schold JD. Sex Differences in Mortality Based on United Network for Organ Sharing Status While Awaiting Heart Transplantation. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003635. [PMID: 28611123 DOI: 10.1161/circheartfailure.116.003635] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 05/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are sex differences in mortality while awaiting heart transplantation, and the reason remains unclear. METHODS AND RESULTS We included all adults in the Scientific Registry of Transplant Recipients placed on the heart transplant active waitlist from 2004 to 2015. The primary end point was all-cause mortality. Multivariable Cox proportional hazards models were performed to evaluate survival by United Network for Organ Sharing (UNOS) status at the time of listing. Random survival forest was used to identify sex interactions for the competing risk of death and transplantation. There were 33 069 patients (25% women) awaiting heart transplantation. This cohort included 7681 UNOS status 1A (26% women), 13 027 UNOS status 1B (25% women), and 12 361 UNOS status 2 (26% women). During a median follow-up of 4.3 months, 1351 women and 4052 men died. After adjusting for >20 risk factors, female sex was associated with a significant risk of death among UNOS status 1A (adjusted hazard ratio, 1.14; 95% confidence interval, 1.01-1.29) and UNOS status 1B (adjusted hazard ratio, 1.17; 95% confidence interval, 1.05-1.30). In contrast, female sex was significantly protective for time to death among UNOS status 2 (adjusted hazard ratio, 0.85; 95% confidence interval, 0.76-0.95). Sex differences in probability of transplantation were present for every UNOS status, and >20 sex interactions were identified for mortality and transplantation. CONCLUSIONS When stratified by initial UNOS status, women had a higher mortality than men as UNOS status 1 and a lower mortality as UNOS status 2. With >20 sex interactions for mortality and transplantation, further evaluation is warranted to form a more equitable allocation system.
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Affiliation(s)
- Eileen M Hsich
- From the Heart and Vascular Institute, Cleveland Clinic, OH (E.M.H., E.H.B.); Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, OH (E.M.H., E.H.B.); Department of Quantitative Health Sciences, Cleveland Clinic, OH (E.H.B., L.T., J.D.S.); University of Pittsburgh Medical Center, PA (D.M.M.); Division of Cardiology, Duke University, Durham, NC (J.G.R.); and Division of Biostatistics, Department of Public Health Sciences, University of Miami, FL (H.I.).
| | - Eugene H Blackstone
- From the Heart and Vascular Institute, Cleveland Clinic, OH (E.M.H., E.H.B.); Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, OH (E.M.H., E.H.B.); Department of Quantitative Health Sciences, Cleveland Clinic, OH (E.H.B., L.T., J.D.S.); University of Pittsburgh Medical Center, PA (D.M.M.); Division of Cardiology, Duke University, Durham, NC (J.G.R.); and Division of Biostatistics, Department of Public Health Sciences, University of Miami, FL (H.I.)
| | - Lucy Thuita
- From the Heart and Vascular Institute, Cleveland Clinic, OH (E.M.H., E.H.B.); Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, OH (E.M.H., E.H.B.); Department of Quantitative Health Sciences, Cleveland Clinic, OH (E.H.B., L.T., J.D.S.); University of Pittsburgh Medical Center, PA (D.M.M.); Division of Cardiology, Duke University, Durham, NC (J.G.R.); and Division of Biostatistics, Department of Public Health Sciences, University of Miami, FL (H.I.)
| | - Dennis M McNamara
- From the Heart and Vascular Institute, Cleveland Clinic, OH (E.M.H., E.H.B.); Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, OH (E.M.H., E.H.B.); Department of Quantitative Health Sciences, Cleveland Clinic, OH (E.H.B., L.T., J.D.S.); University of Pittsburgh Medical Center, PA (D.M.M.); Division of Cardiology, Duke University, Durham, NC (J.G.R.); and Division of Biostatistics, Department of Public Health Sciences, University of Miami, FL (H.I.)
| | - Joseph G Rogers
- From the Heart and Vascular Institute, Cleveland Clinic, OH (E.M.H., E.H.B.); Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, OH (E.M.H., E.H.B.); Department of Quantitative Health Sciences, Cleveland Clinic, OH (E.H.B., L.T., J.D.S.); University of Pittsburgh Medical Center, PA (D.M.M.); Division of Cardiology, Duke University, Durham, NC (J.G.R.); and Division of Biostatistics, Department of Public Health Sciences, University of Miami, FL (H.I.)
| | - Hemant Ishwaran
- From the Heart and Vascular Institute, Cleveland Clinic, OH (E.M.H., E.H.B.); Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, OH (E.M.H., E.H.B.); Department of Quantitative Health Sciences, Cleveland Clinic, OH (E.H.B., L.T., J.D.S.); University of Pittsburgh Medical Center, PA (D.M.M.); Division of Cardiology, Duke University, Durham, NC (J.G.R.); and Division of Biostatistics, Department of Public Health Sciences, University of Miami, FL (H.I.)
| | - Jesse D Schold
- From the Heart and Vascular Institute, Cleveland Clinic, OH (E.M.H., E.H.B.); Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, OH (E.M.H., E.H.B.); Department of Quantitative Health Sciences, Cleveland Clinic, OH (E.H.B., L.T., J.D.S.); University of Pittsburgh Medical Center, PA (D.M.M.); Division of Cardiology, Duke University, Durham, NC (J.G.R.); and Division of Biostatistics, Department of Public Health Sciences, University of Miami, FL (H.I.)
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19
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Robinson MR, Al-Kindi SG, Oliveira GH. Heart and heart-liver transplantation in patients with hemochromatosis. Int J Cardiol 2017; 244:226-228. [PMID: 28655414 DOI: 10.1016/j.ijcard.2017.06.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/26/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hemochromatosis predisposes to dilated or restrictive cardiomyopathy which can progress to end-stage heart failure, requiring the use of advanced heart therapies including heart (HT) and heart liver (HLT) transplantation. Little is known about the characteristics and outcomes of these patients. METHODS AND RESULTS We queried the United Network for Organ Sharing (UNOS) registry for all patients listed for HT or HLT for a diagnosis of 'hemochromatosis' between 1987 and 2014. Waitlist and post-transplantation outcomes were compared between patients with hemochromatosis (HT vs HLT) and other etiologies. Of the 81,356 adults listed for heart transplantation, 23 patients with hemochromatosis were identified (16 listed for HLT; and 7 listed for HT). Compared with other etiologies, HC patients were younger (39 vs 51years, p<0.0001), and more likely to need inotropes (56.5% vs 25.6%, p=0.003) and mechanical ventilation (13% vs 3.4%, p=0.041). Cumulative hazards of waitlist mortality or delisting were higher in hemochromatosis patients than for other etiologies of heart failure (p<0.001). There were 4 HT and 4 HLT during the study period. Post-transplantation, patients with HC had a 1- and 2-year cumulative survival of 88% and 75%, respectively. CONCLUSIONS Both HT and HLT are viable options for patients with hemochromatosis. Patients with hemochromatosis are younger with increased wait-list mortality compared with other etiologies.
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Affiliation(s)
- Monique R Robinson
- Advanced Heart Failure and Transplantation Center, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
| | - Sadeer G Al-Kindi
- Advanced Heart Failure and Transplantation Center, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Guilherme H Oliveira
- Advanced Heart Failure and Transplantation Center, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
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20
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Cappelli F, Baldasseroni S, Bergesio F, Spini V, Fabbri A, Angelotti P, Grifoni E, Attanà P, Tarantini F, Marchionni N, Moggi Pignone A, Perfetto F. Liver dysfunction as predictor of prognosis in patients with amyloidosis: utility of the Model for End-stage Liver disease (MELD) scoring system. Intern Emerg Med 2017; 12:23-30. [PMID: 27480755 DOI: 10.1007/s11739-016-1500-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/01/2016] [Indexed: 11/30/2022]
Abstract
Amyloidosis prognosis is often related to the onset of heart failure and a worsening that is concomitant with kidney-liver dysfunction; thus the Model for End-stage Liver disease (MELD) may be an ideal instrument to summarize renal-liver function. Our aim has been to test the MELD score as a prognostic tool in amyloidosis. We evaluated 128 patients, 46 with TTR-related amyloidosis and 82 with AL amyloidosis. All patients had a complete clinical and echocardiography evaluation; overall biohumoral assessment included troponin I, NT-proBNP, creatinine, total bilirubin and INR ratio. The study population was dichotomized at the 12 cut-off level of MELD scores; those with MELD score >12 had a lower survival compared to controls in the study cohort (40.7 vs 66.3 %; p = 0.006). Either as a continuous and dichotomized variable, MELD shows its independent prognostic value at multivariable analysis (HR = 1.199, 95 % CI 1.082-1.329; HR = 2.707, 95 % CI 1.075-6.817, respectively). MELD shows a lower prognostic sensitivity/specificity ratio than troponin I and NT-proBNP in the whole study population and AL subgroup, while in TTR patients MELD has a higher sensitivity/specificity ratio compared to troponin and NT-proBNP (ROC analysis-AUC: 0.853 vs 0.726 vs 0.659). MELD is able to predict prognosis in amyloidosis. A MELD score >12 selects a subgroup of patients with a higher risk of death. The predictive accuracy seems to be more evident in TTR patients in whom currently no effective scoring systems have been validated.
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Affiliation(s)
- Francesco Cappelli
- Intensive Cardiac Unit, Department of Heart and Vessels, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Largo Brambilla 3, 50134, Florence, Italy.
- Regional Amyloid Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Samuele Baldasseroni
- Intensive Cardiac Unit, Department of Heart and Vessels, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Largo Brambilla 3, 50134, Florence, Italy
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Franco Bergesio
- Regional Amyloid Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Valentina Spini
- Intensive Cardiac Unit, Department of Heart and Vessels, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Largo Brambilla 3, 50134, Florence, Italy
| | - Alessia Fabbri
- Department of Heart and Vessels, University of Florence, Florence, Italy
| | - Paola Angelotti
- Department of Heart and Vessels, University of Florence, Florence, Italy
| | - Elisa Grifoni
- Department of Internal Medicine, University of Florence, Florence, Italy
| | - Paola Attanà
- Department of Internal Medicine, University of Florence, Florence, Italy
| | - Francesca Tarantini
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Niccolò Marchionni
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Federico Perfetto
- Regional Amyloid Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Department of Internal Medicine, University of Florence, Florence, Italy
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Mantegazza V, Badagliacca R, Nodari S, Parati G, Lombardi C, Di Somma S, Carluccio E, Dini FL, Correale M, Magrì D, Agostoni P. Management of heart failure in the new era. J Cardiovasc Med (Hagerstown) 2016; 17:569-80. [DOI: 10.2459/jcm.0000000000000152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Szyguła-Jurkiewicz B, Nadziakiewicz P, Zakliczynski M, Szczurek W, Chraponski J, Zembala M, Gasior M. Predictive Value of Hepatic and Renal Dysfunction Based on the Models for End-Stage Liver Disease in Patients With Heart Failure Evaluated for Heart Transplant. Transplant Proc 2016; 48:1756-60. [DOI: 10.1016/j.transproceed.2016.01.079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/21/2016] [Indexed: 12/28/2022]
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Frea S, Pidello S, Bovolo V, Iacovino C, Franco E, Pinneri F, Galluzzo A, Volpe A, Visconti M, Peirone A, Morello M, Bergerone S, Gaita F. Prognostic incremental role of right ventricular function in acute decompensation of advanced chronic heart failure. Eur J Heart Fail 2016; 18:564-72. [DOI: 10.1002/ejhf.504] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 12/17/2015] [Accepted: 12/25/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Simone Frea
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Stefano Pidello
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Virginia Bovolo
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Cristina Iacovino
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Erica Franco
- Division of Cardiology; Ospedale Civico of Chivasso; Torino Italy
| | | | - Alessandro Galluzzo
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Alessandra Volpe
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Massimiliano Visconti
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Andrea Peirone
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Mara Morello
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Serena Bergerone
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
| | - Fiorenzo Gaita
- Division of Cardiology; Città della Salute e della Scienza University Hospital of Torino; Italy
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Johnson AK, McCandless SP, Alharethi R, Caine WT, Budge D, Wright GA, Rauf A, Miller A, Stoker S, Smith H, Afshar K, Reid BB, Rasmusson BY, Kfoury AG. Reasons for, and outcomes of patients who were referred for a ventricular assist device but were declined: the recent era forgotten ones. Clin Transplant 2016; 30:195-201. [DOI: 10.1111/ctr.12670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Alexis K. Johnson
- Intermountain Medical Center; Mechanical Circulatory Support; Utah Artificial Heart Program; Murray UT USA
| | | | - Rami Alharethi
- Cardiology; Intermountain Medical Center; Salt Lake City UT USA
| | - William T. Caine
- Intermountain Medical Center; Mechanical Circulatory Support; Utah Artificial Heart Program; Murray UT USA
| | - Deborah Budge
- Cardiology; Intermountain Medical Center; Salt Lake City UT USA
| | - G. Andrew Wright
- Intermountain Medical Center; Mechanical Circulatory Support; Utah Artificial Heart Program; Murray UT USA
| | - Asad Rauf
- Intermountain Medical Center; Mechanical Circulatory Support; Utah Artificial Heart Program; Murray UT USA
| | - Andrew Miller
- Intermountain Medical Center; Mechanical Circulatory Support; Utah Artificial Heart Program; Murray UT USA
| | - Sandi Stoker
- Intermountain Medical Center; Mechanical Circulatory Support; Utah Artificial Heart Program; Murray UT USA
| | - Hildegard Smith
- Intermountain Heart Institute; Heart Failure & Transplant; Salt Lake City UT USA
| | - Kia Afshar
- Intermountain Medical Center; Mechanical Circulatory Support; Utah Artificial Heart Program; Murray UT USA
| | - Bruce B. Reid
- Intermountain Medical Center; Mechanical Circulatory Support; Utah Artificial Heart Program; Murray UT USA
| | - Brad Y. Rasmusson
- Intermountain Medical Center; Mechanical Circulatory Support; Utah Artificial Heart Program; Murray UT USA
| | - Abdallah G. Kfoury
- Intermountain Heart Institute; Heart Failure & Transplant; Salt Lake City UT USA
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Reich H, Awad M, Ruzza A, De Robertis M, Ramzy D, Nissen N, Colquhoun S, Esmailian F, Trento A, Kobashigawa J, Czer L. Combined Heart and Liver Transplantation: The Cedars-Sinai Experience. Transplant Proc 2015; 47:2722-6. [DOI: 10.1016/j.transproceed.2015.07.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/08/2015] [Indexed: 10/22/2022]
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Yost GL, Coyle L, Bhat G, Tatooles AJ. Model for end-stage liver disease predicts right ventricular failure in patients with left ventricular assist devices. J Artif Organs 2015; 19:21-8. [DOI: 10.1007/s10047-015-0853-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 07/06/2015] [Indexed: 12/28/2022]
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Farr M, Mitchell J, Lippel M, Kato TS, Jin Z, Ippolito P, Dove L, Jorde UP, Takayama H, Emond J, Naka Y, Mancini D, Lefkowitch JH, Schulze PC. Combination of liver biopsy with MELD-XI scores for post-transplant outcome prediction in patients with advanced heart failure and suspected liver dysfunction. J Heart Lung Transplant 2015; 34:873-82. [PMID: 25851466 PMCID: PMC4941637 DOI: 10.1016/j.healun.2014.12.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 12/05/2014] [Accepted: 12/17/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Functional and structural liver abnormalities may be found in patients with advanced heart failure (HF). The Model of End-Stage Liver Disease Excluding INR (MELD-XI) score allows functional risk stratification of HF patients on and off anti-coagulation awaiting heart transplantation (HTx), but these scores may improve or worsen depending on bridging therapies and during time on the waiting list. Liver biopsy is sometimes performed to assess for severity of fibrosis. Uncertainty remains whether biopsy in addition to MELD-XI improves prediction of adverse outcomes in patients evaluated for HTx. METHODS Sixty-eight patients suspected of advanced liver disease underwent liver biopsy as part of their HTx evaluation. A liver risk score (fibrosis-on-biopsy + 1) × MELD-XI was generated for each patient. RESULTS Fifty-two patients were listed, of whom 14 had mechanical circulatory support (MCS). Thirty-six patients underwent transplantation and 27 patients survived ≥1 year post-HTx (74%, as compared with 88% average 1-year survival in HTx patients without suspected liver disease; p < 0.01). Survivors had a lower liver risk score at evaluation for HTx (31.0 ± 20.4 vs 65.2 ± 28.6, p < 0.01). A cut-point of 45 for liver risk score was identified by receiver-operating-characteristic (ROC) analysis. In the analysis using Cox proportional hazards models, a liver risk score ≥45 at evaluation for HTx was associated with greater risk of death at 1 year post-HTx compared with a score of <45 in both univariable (HR 3.94, 95% CI 1.77-8.79, p < 0.001) and multivariable (HR 4.35, 95% CI 1.77-8.79, p < 0.001) analyses. Patients who died <1 year post-HTx had an increased frequency of acute graft dysfunction (44.4% vs 3.7%, p = 0.009), longer ventilation times (55.6% vs 11.1%, p = 0.013) and severe bleeding events (44.4% vs 11.1%, p = 0.049). The liver risk score at evaluation for HTx also predicted 1-year mortality after HTx listing (p < 0.001). CONCLUSIONS Patients with HF and advanced liver dysfunction are high-risk HTx candidates. Liver biopsy in addition to MELD-XI improves risk stratification of patients with advanced HF and suspected irreversible liver dysfunction.
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Affiliation(s)
| | | | | | | | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health
| | | | - Lorna Dove
- Department of Surgery, Columbia University Medical Center, New York, New York
| | | | - Hiroo Takayama
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - Jean Emond
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - Yoshifumi Naka
- Department of Surgery, Columbia University Medical Center, New York, New York
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Terminal heart failure: who should be transplanted and who should have mechanical circulatory support? Curr Opin Organ Transplant 2015; 19:486-93. [PMID: 25186823 DOI: 10.1097/mot.0000000000000120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Permanent long-term mechanical circulatory support (MCS) is currently reserved for patients who are transplant ineligible. In light of improved outcomes with current continuous flow devices, increased interest has focused on the potential extension of MCS therapy to ambulatory advanced heart failure patients and as an alternative to cardiac transplantation. RECENT FINDINGS Average 1-year and 2-year survival with heart transplantation is about 85 and 80%, and with MCS therapy, it is 85 and 70% (with censoring at transplant). Specific subsets of destination therapy patients enjoy survival out to 2 years, which is comparable with transplant survival. Risk factor analyses identify similar risk profiles for each therapy. Life satisfaction after each is highly dependent on the frequency and severity of adverse events, which are quite different for these interventions. Patients with long expected waiting times will likely be the initial group for triage off the transplant wait list to MCS therapy. SUMMARY MCS has progressively improved and may become a reasonable alternative to transplantation for highly selected patients with long expected waiting time. More routine extension of MCS therapy to the transplant population awaits further reduction of major adverse events, miniaturized devices, and less invasive implant techniques.
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Nathan AS, Loukas B, Moko L, Wu F, Rhodes J, Rathod RH, Systrom DM, Ubeda Tikkanen A, Shafer K, Lewis GD, Landzberg MJ, Opotowsky AR. Exercise oscillatory ventilation in patients with Fontan physiology. Circ Heart Fail 2014; 8:304-11. [PMID: 25550441 DOI: 10.1161/circheartfailure.114.001749] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Exercise oscillatory ventilation (EOV) refers to regular oscillations in minute ventilation (VE) during exercise. Its presence correlates with heart failure severity and worse prognosis in adults with acquired heart failure. We evaluated the prevalence and predictive value of EOV in patients with single ventricle Fontan physiology. METHODS AND RESULTS We performed a cross-sectional analysis and prospective survival analysis of patients who had undergone a Fontan procedure and subsequent cardiopulmonary exercise test. Data were reviewed for baseline characteristics and incident mortality, heart transplant, or nonelective cardiovascular hospitalization. EOV was defined as regular oscillations for >60% of exercise duration with amplitude >15% of average VE. Survival analysis was performed using Cox regression. Among 253 subjects, EOV was present in 37.5%. Patients with EOV were younger (18.8±9.0 versus 21.7±10.1 years; P=0.02). EOV was associated with higher New York Heart Association functional class (P=0.02) and VE/VCO2 slope (36.8±6.9 versus 33.7±5.7; P=0.0002), but not with peak VO2 (59.7±14.3 versus 61.0±16.0% predicted; P=0.52) or noninvasive measures of cardiac function. The presence of EOV was associated with slightly lower mean cardiac index but other invasive hemodynamic variables were similar. During a median follow-up of 5.5 years, 22 patients underwent transplant or died (n=19 primary deaths, 3 transplants with 2 subsequent deaths). EOV was associated with increased risk of death or transplant (hazard ratio, 3.9; 95% confidence interval, 1.5-10.0; P=0.002) and also predicted the combined outcome of death, transplant, or nonelective cardiovascular hospitalization after adjusting for New York Heart Association functional class, peak VO2, and other covariates (multivariable hazard ratio, 2.0; 95% confidence interval, 1.2-3.6; P=0.01). CONCLUSIONS EOV is common in the Fontan population and strongly predicts lower transplant-free survival.
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Affiliation(s)
- Ashwin S Nathan
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.)
| | - Brittani Loukas
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.)
| | - Lilamarie Moko
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.)
| | - Fred Wu
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.)
| | - Jonathan Rhodes
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.)
| | - Rahul H Rathod
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.)
| | - David M Systrom
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.)
| | - Ana Ubeda Tikkanen
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.)
| | - Keri Shafer
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.)
| | - Gregory D Lewis
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.)
| | - Michael J Landzberg
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.)
| | - Alexander R Opotowsky
- From the Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.S.N., F.W., D.M.S., K.S., M.J.L., A.R.O.); Departments of Cardiology (B.L., L.M., F.W., J.R., R.H.R., A.U.T., K.S., M.J.L., A.R.O.) and Cardiovascular Surgery (A.U.T.), Boston Children's Hospital, MA; and Department of Medicine, Massachusetts General Hospital, Boston (G.D.L.).
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Prescimone T, Masotti S, D’Amico A, Caruso R, Cabiati M, Caselli C, Viglione F, Verde A, Del Ry S, Giannessi D. Cardiac molecular markers of programmed cell death are activated in end-stage heart failure patients supported by left ventricular assist device. Cardiovasc Pathol 2014; 23:272-82. [DOI: 10.1016/j.carpath.2014.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 03/24/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022] Open
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Agostoni P, Sciomer S, Farina S. Reactive Pulmonary Hypertension in Heart Failure is Another Disease Identified by Cardiopulmonary Exercise Test. J Card Fail 2014; 20:658-61. [DOI: 10.1016/j.cardfail.2014.06.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
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Prescimone T, D'Amico A, Caselli C, Cabiati M, Viglione F, Caruso R, Verde A, Del Ry S, Trivella MG, Giannessi D. Caspase-1 transcripts in failing human heart after mechanical unloading. Cardiovasc Pathol 2014; 24:11-8. [PMID: 25200478 DOI: 10.1016/j.carpath.2014.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/06/2014] [Accepted: 08/06/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Caspase (Casp)-1 has been indicated as a molecular target capable of preventing the progression of cardiovascular diseases, including heart failure (HF), due to its central role in promoting inflammation and cardiomyocyte loss. The aim of this study was to assess whether Left Ventricular Assist Device (LVAD) implantation modifies the inflammatory and apoptotic profile in the heart through the modulation of Casp-1 expression level. METHODS Cardiac tissue was collected from end-stage HF patients before LVAD implant (pre-LVAD group, n=22) and at LVAD removal (post-LVAD, n=6), and from stable HF patients on medical therapy without prior circulatory support (HTx, n=7) at heart transplantation, as control. The cardiac expression of Casp-1, of its inhibitors caspase recruitment domain (CARD) only protein (COP) and CARD family, member 18 (ICEBERG), was evaluated by real-time PCR in the three groups of patients. RESULTS Casp-1 was increased in the pre-LVAD group compared to HTx (p=0.006), while on the contrary the ICEBERG level was significantly decreased in pre-LVAD with respect to HTx patients (p<0.001); no difference in COP expression level was found. CONCLUSIONS This study describes a specific pattern of the Casp-1 system associated with inflammation and apoptosis markers in patients who require LVAD insertion. The inflammation could be the key process regulating, in a negative loop, Casp-1 signaling and its down-stream effects, apoptosis included.
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Affiliation(s)
- Tommaso Prescimone
- CNR Institute of Clinical Physiology, Laboratory of Cardiovascular Biochemistry, Pisa, Italy
| | | | - Chiara Caselli
- CNR Institute of Clinical Physiology, Laboratory of Cardiovascular Biochemistry, Pisa, Italy
| | - Manuela Cabiati
- CNR Institute of Clinical Physiology, Laboratory of Cardiovascular Biochemistry, Pisa, Italy
| | - Federica Viglione
- CNR Institute of Clinical Physiology, Laboratory of Cardiovascular Biochemistry, Pisa, Italy
| | - Raffaele Caruso
- CNR Institute of Clinical Physiology, Cardiovascular Department, Niguarda Cà Granda Hospital, Milan, Italy
| | - Alessandro Verde
- CardioThoracic and Vascular Department, "A. De Gasperis" Niguarda Ca' Granda Hospital, Milan, Italy
| | - Silvia Del Ry
- CNR Institute of Clinical Physiology, Laboratory of Cardiovascular Biochemistry, Pisa, Italy
| | - Maria Giovanna Trivella
- CNR Institute of Clinical Physiology, Laboratory of Cardiovascular Biochemistry, Pisa, Italy
| | - Daniela Giannessi
- CNR Institute of Clinical Physiology, Laboratory of Cardiovascular Biochemistry, Pisa, Italy.
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Lundgren J, Algotsson L, Kornhall B, Rådegran G. Preoperative pulmonary hypertension and its impact on survival after heart transplantation. SCAND CARDIOVASC J 2014; 48:47-58. [PMID: 24460475 DOI: 10.3109/14017431.2013.877153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Pulmonary hypertension (PH) due to left heart disease may impair outcome after heart transplantation (HT). To evaluate to what extent previous, and present, haemodynamic criteria discriminate the impact of pre-operative-PH on survival, we characterized the PH in our HT-patients according to ESC's guidelines, ISHLT's summary statement and ISHLT's relative contraindications and criteria for early risk of death after HT. DESIGN Records from the 215 HT-patients in Lund during 1988-2010 were reviewed. Subsequent analysis included adults (n = 94) evaluated with right-heart-catheterization at our lab, at rest before HT. End of follow-up was 30th of June 2012. RESULTS Survival (mean, n) did not differ (p = ns) for the 94 HT-patients; without (13.0 years, n = 28) or with (13.9 years, n = 66) PH, passive (13.8 years, n = 50) or reactive (12.2 years, n = 13) post-capillary-PH, "modified" passive (13.1 years, n = 40), mixed (16.6 years, n = 23), "modified" reactive (12.6 years, n = 7) or non-reactive (12.2 years, n = 8) post-capillary-PH; or for ISHLT's relative contraindications (12.0 years, n = 22) or increased risk of right-heart-failure and early death (16.5 years, n = 23) after HT. CONCLUSIONS As previous and present haemodynamic criteria did not sufficiently discriminate the impact of pre-operative-PH for survival after HT at our centre, larger multi-centre studies are encouraged to redefine criteria that may influence outcome.
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Affiliation(s)
- Jakob Lundgren
- The Haemodynamic Lab, The Clinic for Heart Failure and Valvular Disease, Skåne University Hospital , Lund , Sweden
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Mehra MR. Fat, Cachexia, and the Right Ventricle in Heart Failure. J Am Coll Cardiol 2013; 62:1671-1673. [DOI: 10.1016/j.jacc.2013.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 07/02/2013] [Indexed: 01/01/2023]
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Bartos JA, Francis GS. The High-Risk Patient With Heart Failure With Reduced Ejection Fraction: Treatment Options and Challenges. Clin Pharmacol Ther 2013; 94:509-18. [DOI: 10.1038/clpt.2013.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/08/2013] [Indexed: 12/17/2022]
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