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Özcan KS, Hayıroğlu MI, Çınar T. Admission triglyceride-glucose index is predictor of long-term mortality and appropriate implantable cardiac defibrillator therapy in patients with heart failure. Biomark Med 2023; 17:487-496. [PMID: 37522225 DOI: 10.2217/bmm-2023-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Background: In this study, the main aim was to evaluate the relation of the triglyceride-glucose (TyG) index to long-term mortality and proper shock therapy in patients with an implantable cardiac defibrillator (ICD) implanted for heart failure with reduced ejection fraction. Methods: This retrospective study group consisted of 773 patients treated with ICD for heart failure with reduced ejection fraction. The long-term prognostic effect of the TyG index among tertiles was evaluated regarding mortality and appropriate ICD therapy. Results: In the adjusted model, the mortality rates were 14.0% (hazard ratio: 2.24; 95% CI: 1.42-6.88) in tertile 2 and 23.3% (hazard ratio: 3.88; 95% CI: 1.84-14.38) in tertile 3. Conclusion: The TyG index was found to be an independent predictive marker for both long-term mortality and appropriate ICD therapy.
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Affiliation(s)
- Kazım S Özcan
- Department of Cardiology, Dr Siyami Ersek Thoracic & Cardiovascular Surgery Training & Research Hospital, Istanbul, 34690, Turkey
| | - Mert I Hayıroğlu
- Department of Cardiology, Dr Siyami Ersek Thoracic & Cardiovascular Surgery Training & Research Hospital, Istanbul, 34690, Turkey
| | - Tufan Çınar
- Department of Cardiology, Haydarpasa Sultan II. Abdulhamid Han Training & Research Hospital, Istanbul, 34668, Turkey
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Hayıroğlu Mİ, Çınar T, Çinier G, Pay L, Yumurtaş AÇ, Tezen O, Eren S, Kolak Z, Çetin T, Çiçek V, Tekkeşin Aİ. Evaluating systemic immune-inflammation index in patients with implantable cardioverter defibrillator for heart failure with reduced ejection fraction. Pacing Clin Electrophysiol 2022; 45:188-195. [PMID: 34978742 DOI: 10.1111/pace.14436] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/23/2021] [Accepted: 12/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pro-inflammatory pathways play an important role in the follow-ups of patients with intracardiac defibrillators (ICDs) for heart failure (HF) reduced with ejection fraction (HFrEF). A newly defined index - the systemic immune-inflammation index (SII)-has recently been reported to have prognostic value in patients with cardiovascular disease. This study's aim is to evaluate the SII value regarding its association with long-term mortality and appropriate ICD therapy during a 10-year follow-up. METHODS This retrospective study included 1011 patients with ICD for HFrEF. The SII was calculated as the neutrophil-to-lymphocyte ratio × total platelet count in the peripheral blood. The study population was divided into two groups according to the SII's optimal cut-off value to predict long-term mortality. The long-term prognostic impact of SII on these patients was evaluated regarding mortality and appropriate ICD therapy. RESULTS The patients with a higher SII (≥1119) had significantly higher long-term mortality and appropriate ICD therapy rates. After adjustment for all confounding factors, the long-term mortality rate was 5.1 for a higher SII. (95% CI: 2.9-8.1). The long-term appropriate ICD therapy rate was 2.0 for a higher SII (95% CI: 1.4-3.0). CONCLUSION SII may be an independent predictive marker for both long-term mortality and appropriate ICD therapy in patients with HFrEF.
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Affiliation(s)
- Mert İlker Hayıroğlu
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Tufan Çınar
- Department of Cardiology, Haydarpasa Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Göksel Çinier
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Levent Pay
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Çağdaş Yumurtaş
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ozan Tezen
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Semih Eren
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Kolak
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Tuğba Çetin
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Vedat Çiçek
- Department of Cardiology, Haydarpasa Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Ahmet İlker Tekkeşin
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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3
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Xie Y, Li Q, Zhang HF, Huang TC, Yang Y, Lin YQ, Mai JT, Wen ZZ, Yuan WL, Wang JF, Chen YX. Effect of C reactive protein on the sodium-calcium exchanger 1 in cardiomyocytes. Exp Ther Med 2021; 22:815. [PMID: 34131438 PMCID: PMC8193207 DOI: 10.3892/etm.2021.10247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/26/2021] [Indexed: 11/18/2022] Open
Abstract
Numerous previous studies have found that C-reactive protein (CRP) is associated with cardiac arrhythmia and cardiac remodeling. However, the underlying mechanisms of this association remain unclear. Sodium-calcium exchanger 1 (NCX1) serves an important role in the regulation of intracellular calcium concentration, which is closely related with cardiac arrhythmia and cardiac remodeling. The present study aimed to evaluate the effects of CRP on NCX1 and intracellular calcium concentration in cardiomyocytes. Primary neonatal mouse ventricular cardiomyocytes were cultured and treated with varying concentrations of CRP (0, 5, 10, 20 and 40 µg/ml). The cardiomyocytes were also treated with NF-κB-specific inhibitor PTDC and a specific inhibitor of the reverse NCX1 KB-R7943 before their intracellular calcium concentrations were measured. mRNA and protein expression levels of NCX1 were detected by reverse transcription-quantitative PCR and western blotting, respectively and intracellular calcium concentration was evaluated by flow cytometry. CRP treatment significantly increased mRNA and protein expression levels of NCX1 in myocytes (P=0.024), as well as intracellular calcium concentration (P=0.01). These results were significantly attenuated by the NF-κB-specific inhibitor PDTC and a specific inhibitor of the reverse NCX1, KB-R7943. CRP significantly upregulated NCX1 expression and increased intracellular calcium concentration in cardiomyocytes via the NF-κB pathway, suggesting that CRP may serve a pro-arrhythmia role via direct influence on the calcium homeostasis of cardiomyocytes.
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Affiliation(s)
- Yong Xie
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Qian Li
- Department of Dermatology, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong 515110, P.R. China
| | - Hai-Feng Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Tu-Cheng Huang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Ying Yang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Yong-Qing Lin
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Jing-Ting Mai
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Zhu-Zhi Wen
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Wo-Liang Yuan
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Jing-Feng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Yang-Xin Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
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Classic and Novel Biomarkers as Potential Predictors of Ventricular Arrhythmias and Sudden Cardiac Death. J Clin Med 2020; 9:jcm9020578. [PMID: 32093244 PMCID: PMC7074455 DOI: 10.3390/jcm9020578] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 02/07/2023] Open
Abstract
Sudden cardiac death (SCD), most often induced by ventricular arrhythmias, is one of the main reasons for cardiovascular-related mortality. While coronary artery disease remains the leading cause of SCD, other pathologies like cardiomyopathies and, especially in the younger population, genetic disorders, are linked to arrhythmia-related mortality. Despite many efforts to enhance the efficiency of risk-stratification strategies, effective tools for risk assessment are still missing. Biomarkers have a major impact on clinical practice in various cardiac pathologies. While classic biomarkers like brain natriuretic peptide (BNP) and troponins are integrated into daily clinical practice, inflammatory biomarkers may also be helpful for risk assessment. Indeed, several trials investigated their application for the prediction of arrhythmic events indicating promising results. Furthermore, in recent years, active research efforts have brought forward an increasingly large number of “novel and alternative” candidate markers of various pathophysiological origins. Investigations of these promising biological compounds have revealed encouraging results when evaluating the prediction of arrhythmic events. To elucidate this issue, we review current literature dealing with this topic. We highlight the potential of “classic” but also “novel” biomarkers as promising tools for arrhythmia prediction, which in the future might be integrated into clinical practice.
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Nauffal V, Zhang Y, Tanawuttiwat T, Blasco-Colmenares E, Rickard J, Marine JE, Butcher B, Norgard S, Dickfeld TM, Ellenbogen KA, Guallar E, Tomaselli GF, Cheng A. Clinical decision tool for CRT-P vs. CRT-D implantation: Findings from PROSE-ICD. PLoS One 2017; 12:e0175205. [PMID: 28388657 PMCID: PMC5384669 DOI: 10.1371/journal.pone.0175205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 03/22/2017] [Indexed: 12/01/2022] Open
Abstract
Background Cardiac resynchronization therapy (CRT) devices reduce mortality through pacing-induced cardiac resynchronization and implantable cardioverter defibrillator (ICD) therapy for ventricular arrhythmias (VAs). Whether certain factors can predict if patients will benefit more from implantation of CRT pacemakers (CRT-P) or CRT defibrillators (CRT-D) remains unclear. Methods and results We followed 305 primary prevention CRT-D recipients for the two primary outcomes of HF hospitalization and ICD therapy for VAs. Serum biomarkers, electrocardiographic and clinical variables were collected prior to implant. Multivariable analysis using Cox-proportional hazards model was used to fit the final models. Among 282 patients with follow-up outcome data, 75 (26.6%) were hospitalized for HF and 31 (11%) received appropriate ICD therapy. Independent predictors of HF hospitalization were atrial fibrillation (HR = 1.8 (1.1,2.9)), NYHA class III/IV (HR = 2.2 (1.3,3.6)), ejection fraction <20% (HR = 1.7 (1.1,2.7)), HS-IL6 >4.03pg/ml (HR = 1.7 (1.1,2.9)) and hemoglobin (<12g/dl) (HR = 2.2 (1.3,3.6)). Independent predictors of appropriate therapy included BUN >20mg/dL (HR = 3.0 (1.3,7.1)), HS-CRP >9.42mg/L (HR = 2.3 (1.1,4.7)), no beta blocker therapy (HR = 3.2 (1.4,7.1)) and hematocrit ≥38% (HR = 2.7 (1.03,7.0)). Patients with 0–1 risk factors for appropriate therapy (IR 1 per 100 person-years) and ≥3 risk factors for HF hospitalization (IR 23 per 100-person-years) were more likely to die prior to receiving an appropriate ICD therapy. Conclusions Clinical and biomarker data can risk stratify CRT patients for HF progression and VAs. These findings may help characterize subgroups of patients that may benefit more from the use of CRT-P vs. CRT-D systems. Trial registration ClinicalTrials.gov NCT00733590
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Affiliation(s)
- Victor Nauffal
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America
| | - Yiyi Zhang
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Tanyanan Tanawuttiwat
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America
| | - Elena Blasco-Colmenares
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - John Rickard
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America
| | - Joseph E. Marine
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America
| | - Barbara Butcher
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America
| | - Sanaz Norgard
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America
| | - Timm-Michael Dickfeld
- Department of Medicine, University of Maryland, Baltimore, Maryland, United States of America
| | - Kenneth A. Ellenbogen
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Eliseo Guallar
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Gordon F. Tomaselli
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America
| | - Alan Cheng
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Institutes, Baltimore, Maryland, United States of America
- * E-mail:
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6
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Uçar FM, Açar B. Neutrophil to lymphocyte ratio predicts appropriate therapy in idiopathic dilated cardiomyopathy patients with primary prevention implantable cardioverter defibrillator. Saudi Med J 2017; 38:143-148. [PMID: 28133686 PMCID: PMC5329625 DOI: 10.15537/smj.2017.2.15929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To investigate whether an inflammatory marker of neutrophil to lymphocyte ratio (NLR) predicts appropriate implantable cardioverter defibrillator (ICD) therapy (shock or anti tachycardia pacing) in idiopathic dilated cardiomyopathy (IDC) patients. METHODS We retrospectively examined IDC patients (mean age: 58.3 ± 11.8 years, 81.5% male) with ICD who admitted to outpatient clinic for pacemaker control at 2 tertiary care hospitals in Ankara and Edirne, Turkey from January 2013-2015. All ICDs were implanted for primary prevention. Hematological and biochemical parameters were measured prior procedure. Results: Over a median follow-up period of 43 months (Range 7-125), 68 (33.1%) patients experienced appropriate ICD therapy. The NLR was increased in patients that received appropriate therapy (4.39 ± 2.94 versus 2.96 ± 1.97, p less than 0.001).To identify independent risk factors for appropriate therapy, a multivariate linear regression model was conducted and age (β=0.163, p=0.013), fasting glucose (β=0.158, p=0.017), C-reactive protein (CRP) (β=0.289, p less than 0.001) and NLR (β=0.212, p less than 0.008) were found to be independent risk factors for appropriate ICD therapy. Conclusions: Before ICD implantation by using NLR and CRP, arrhythmic episodes may be predictable and better antiarrhythmic medical therapy optimization may protect these IDC patients from unwanted events.
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Affiliation(s)
- Fatih M Uçar
- Department of Cardiology, Trakya University Hospital, Edirne, Turkey. E-mail.
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7
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Cheng A, Zhang Y, Blasco-Colmenares E, Dalal D, Butcher B, Norgard S, Eldadah Z, Ellenbogen KA, Dickfeld T, Spragg DD, Marine JE, Guallar E, Tomaselli GF. Protein biomarkers identify patients unlikely to benefit from primary prevention implantable cardioverter defibrillators: findings from the Prospective Observational Study of Implantable Cardioverter Defibrillators (PROSE-ICD). Circ Arrhythm Electrophysiol 2014; 7:1084-91. [PMID: 25273351 DOI: 10.1161/circep.113.001705] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Primary prevention implantable cardioverter defibrillators (ICDs) reduce all-cause mortality, but the benefits are heterogeneous. Current risk stratification based on left ventricular ejection fraction has limited discrimination power. We hypothesize that biomarkers for inflammation, neurohumoral activation, and cardiac injury can predict appropriate shocks and all-cause mortality in patients with primary prevention ICDs. METHODS AND RESULTS The Prospective Observational Study of Implantable Cardioverter Defibrillators (PROSe-ICD) enrolled 1189 patients with systolic heart failure who underwent ICD implantation for primary prevention of sudden cardiac death. The primary end point was an ICD shock for adjudicated ventricular tachyarrhythmia. The secondary end point was all-cause mortality. After a median follow-up of 4.0 years, 137 subjects experienced an appropriate ICD shock and 343 participants died (incidence rates of 3.2 and 5.8 per 100 person-years, respectively). In multivariable-adjusted models, higher interleukin-6 levels increased the risk of appropriate ICD shocks. In contrast, C-reactive protein, interleukin-6, tumor necrosis factor-α receptor II, pro-brain natriuretic peptide (pro-BNP), and cardiac troponin T showed significant linear trends for increased risk of all-cause mortality across quartiles. A score combining these 5 biomarkers identified patients who were much more likely to die than to receive an appropriate shock from the ICD. CONCLUSIONS An increase in serum biomarkers of inflammation, neurohumoral activation, and myocardial injury increased the risk for death but poorly predicted the likelihood of an ICD shock. These findings highlight the potential importance of serum-based biomarkers in identifying patients who are unlikely to benefit from primary prevention ICDs. CLINICAL TRIAL REGISTRATION URL clinicaltrials.gov; Unique Identifier: NCT00733590.
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Affiliation(s)
- Alan Cheng
- From the Department of Medicine (A.C., E.B.-C., D.D., B.B., S.N., D.D.S., J.E.M., G.F.T.) and the Welch Center for Prevention, Epidemiology and Clinical Research (Y.Z., E.G.), Johns Hopkins Medical Institutions, Baltimore, MD; Washington Hospital Center, DC (Z.E.); Medical College of Virginia, Richmond (K.A.E.); and University of Maryland, Baltimore (T.D.)
| | - Yiyi Zhang
- From the Department of Medicine (A.C., E.B.-C., D.D., B.B., S.N., D.D.S., J.E.M., G.F.T.) and the Welch Center for Prevention, Epidemiology and Clinical Research (Y.Z., E.G.), Johns Hopkins Medical Institutions, Baltimore, MD; Washington Hospital Center, DC (Z.E.); Medical College of Virginia, Richmond (K.A.E.); and University of Maryland, Baltimore (T.D.)
| | - Elena Blasco-Colmenares
- From the Department of Medicine (A.C., E.B.-C., D.D., B.B., S.N., D.D.S., J.E.M., G.F.T.) and the Welch Center for Prevention, Epidemiology and Clinical Research (Y.Z., E.G.), Johns Hopkins Medical Institutions, Baltimore, MD; Washington Hospital Center, DC (Z.E.); Medical College of Virginia, Richmond (K.A.E.); and University of Maryland, Baltimore (T.D.)
| | - Darshan Dalal
- From the Department of Medicine (A.C., E.B.-C., D.D., B.B., S.N., D.D.S., J.E.M., G.F.T.) and the Welch Center for Prevention, Epidemiology and Clinical Research (Y.Z., E.G.), Johns Hopkins Medical Institutions, Baltimore, MD; Washington Hospital Center, DC (Z.E.); Medical College of Virginia, Richmond (K.A.E.); and University of Maryland, Baltimore (T.D.)
| | - Barbara Butcher
- From the Department of Medicine (A.C., E.B.-C., D.D., B.B., S.N., D.D.S., J.E.M., G.F.T.) and the Welch Center for Prevention, Epidemiology and Clinical Research (Y.Z., E.G.), Johns Hopkins Medical Institutions, Baltimore, MD; Washington Hospital Center, DC (Z.E.); Medical College of Virginia, Richmond (K.A.E.); and University of Maryland, Baltimore (T.D.)
| | - Sanaz Norgard
- From the Department of Medicine (A.C., E.B.-C., D.D., B.B., S.N., D.D.S., J.E.M., G.F.T.) and the Welch Center for Prevention, Epidemiology and Clinical Research (Y.Z., E.G.), Johns Hopkins Medical Institutions, Baltimore, MD; Washington Hospital Center, DC (Z.E.); Medical College of Virginia, Richmond (K.A.E.); and University of Maryland, Baltimore (T.D.)
| | - Zayd Eldadah
- From the Department of Medicine (A.C., E.B.-C., D.D., B.B., S.N., D.D.S., J.E.M., G.F.T.) and the Welch Center for Prevention, Epidemiology and Clinical Research (Y.Z., E.G.), Johns Hopkins Medical Institutions, Baltimore, MD; Washington Hospital Center, DC (Z.E.); Medical College of Virginia, Richmond (K.A.E.); and University of Maryland, Baltimore (T.D.)
| | - Kenneth A Ellenbogen
- From the Department of Medicine (A.C., E.B.-C., D.D., B.B., S.N., D.D.S., J.E.M., G.F.T.) and the Welch Center for Prevention, Epidemiology and Clinical Research (Y.Z., E.G.), Johns Hopkins Medical Institutions, Baltimore, MD; Washington Hospital Center, DC (Z.E.); Medical College of Virginia, Richmond (K.A.E.); and University of Maryland, Baltimore (T.D.)
| | - Timm Dickfeld
- From the Department of Medicine (A.C., E.B.-C., D.D., B.B., S.N., D.D.S., J.E.M., G.F.T.) and the Welch Center for Prevention, Epidemiology and Clinical Research (Y.Z., E.G.), Johns Hopkins Medical Institutions, Baltimore, MD; Washington Hospital Center, DC (Z.E.); Medical College of Virginia, Richmond (K.A.E.); and University of Maryland, Baltimore (T.D.)
| | - David D Spragg
- From the Department of Medicine (A.C., E.B.-C., D.D., B.B., S.N., D.D.S., J.E.M., G.F.T.) and the Welch Center for Prevention, Epidemiology and Clinical Research (Y.Z., E.G.), Johns Hopkins Medical Institutions, Baltimore, MD; Washington Hospital Center, DC (Z.E.); Medical College of Virginia, Richmond (K.A.E.); and University of Maryland, Baltimore (T.D.)
| | - Joseph E Marine
- From the Department of Medicine (A.C., E.B.-C., D.D., B.B., S.N., D.D.S., J.E.M., G.F.T.) and the Welch Center for Prevention, Epidemiology and Clinical Research (Y.Z., E.G.), Johns Hopkins Medical Institutions, Baltimore, MD; Washington Hospital Center, DC (Z.E.); Medical College of Virginia, Richmond (K.A.E.); and University of Maryland, Baltimore (T.D.)
| | - Eliseo Guallar
- From the Department of Medicine (A.C., E.B.-C., D.D., B.B., S.N., D.D.S., J.E.M., G.F.T.) and the Welch Center for Prevention, Epidemiology and Clinical Research (Y.Z., E.G.), Johns Hopkins Medical Institutions, Baltimore, MD; Washington Hospital Center, DC (Z.E.); Medical College of Virginia, Richmond (K.A.E.); and University of Maryland, Baltimore (T.D.)
| | - Gordon F Tomaselli
- From the Department of Medicine (A.C., E.B.-C., D.D., B.B., S.N., D.D.S., J.E.M., G.F.T.) and the Welch Center for Prevention, Epidemiology and Clinical Research (Y.Z., E.G.), Johns Hopkins Medical Institutions, Baltimore, MD; Washington Hospital Center, DC (Z.E.); Medical College of Virginia, Richmond (K.A.E.); and University of Maryland, Baltimore (T.D.).
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