2
|
Wardhere A, Bampatsias D, Cohn E, Fine D, Freitas CD, Gallegos C, Helmke S, Ionescu N, Ivrose J, Rodriguez C, Sabogal N, Fils S, Henry T, Teruya S, Ullah I, Kurian D, Raiszadeh F, Miller EJ, Ruberg FL, Maurer MS. Unlocking Diversity in Cardiovascular Clinical Research: Lessons from the Screening for Cardiac Amyloidosis With Nuclear Imaging in a Minority Populations Study. J Card Fail 2024:S1071-9164(24)00161-1. [PMID: 38740174 DOI: 10.1016/j.cardfail.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 04/22/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The Screening for Cardiac Amyloidosis with Nuclear Imaging in Minority Populations study seeks to determine the prevalence of transthyretin cardiac amyloidosis (ATTR-CA) among older Black or Caribbean Hispanic individuals with heart failure and an increased wall thickness. We noticed varied recruitment percentages across the recruiting sites and sought to determine the factors associated with greater percentage enrollment of eligible participants. METHODS The percentage of enrolled to eligible participants was calculated across study sites. Baseline demographic and clinical characteristics, health literacy, trust in providers, perceived discrimination, area deprivation index (ADI) and English proficiency were compared by site using Kruskal-Wallis's test or one-way ANOVA for continuous variables and the Chi-Square test or Fisher's exact test for categorical variables. Wilcoxon rank sum and Chi-Square tests, with multiple comparisons correction using the false discovery rate (FDR) method, were used as post-hoc analysis when results were statistically significant. RESULTS Among the four recruiting sites, Boston Medical Center, Columbia University Irving Medical Center, Harlem Hospital and Yale University, which employed different recruitment approaches, the percentage of participants enrolled among eligible participants differed, with the highest rate at Harlem Hospital (n=149 of 310, 48%), followed by Yale University (n=27 of 67, 40%), Boston University (n=247 of 655, 38%), and Columbia University (n=137of 442, 32%), p <0.01. Direct recruitment by the primary cardiovascular care team providing clinical care was associated with higher percent enrolled across sites as were higher education levels and English proficiency. Enrollment differences across sites were not associated with the number of chronic diseases, physician trust, perceived discrimination, or health literacy. CONCLUSIONS Recruitment of eligible under-represented minorities (URMs) in SCAN-MP was associated with approaches employed in recruitment, including direct initial contact by the primary cardiovascular care team providing the potential participant's clinical care. Such data may help improve approaches to more successful recruitment of URMs in clinical research.
Collapse
Affiliation(s)
- Abdirahaman Wardhere
- Department of Cardiology, Cardiac Amyloidosis Program, Columbia University Irving Medical, New York City, NY
| | - Dimitrios Bampatsias
- Department of Cardiology, Cardiac Amyloidosis Program, Columbia University Irving Medical, New York City, NY
| | - Elizabeth Cohn
- Feinstein Institute for Medical Research/Northwell Health, Manhasset, NY
| | - Denise Fine
- Section of Cardiovascular Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA
| | - Cinthia de Freitas
- Yale School of Medicine, Section of Cardiovascular Medicine, New Haven, CT
| | - Cesia Gallegos
- Yale School of Medicine, Section of Cardiovascular Medicine, New Haven, CT
| | - Stephen Helmke
- Department of Cardiology, Cardiac Amyloidosis Program, Columbia University Irving Medical, New York City, NY
| | | | | | - Carlos Rodriguez
- Department of Cardiology, Cardiac Amyloidosis Program, Columbia University Irving Medical, New York City, NY
| | - Natalia Sabogal
- Section of Cardiovascular Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA
| | - Sergylensky Fils
- Section of Cardiovascular Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA
| | | | - Sergio Teruya
- Department of Cardiology, Cardiac Amyloidosis Program, Columbia University Irving Medical, New York City, NY
| | - Ikram Ullah
- Section of Cardiovascular Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA
| | | | | | - Edward J Miller
- Yale School of Medicine, Section of Cardiovascular Medicine, New Haven, CT
| | - Frederick L Ruberg
- Section of Cardiovascular Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA
| | - Mathew S Maurer
- Department of Cardiology, Cardiac Amyloidosis Program, Columbia University Irving Medical, New York City, NY.
| |
Collapse
|
4
|
Cochran J, Yura Y, Thel MC, Doviak H, Polizio AH, Arai Y, Arai Y, Horitani K, Park E, Chavkin NW, Kour A, Sano S, Mahajan N, Evans M, Huba M, Naya NM, Sun H, Ban Y, Hirschi KK, Toldo S, Abbate A, Druley TE, Ruberg FL, Maurer MS, Ezekowitz JA, Dyck JR, Walsh K. Clonal Hematopoiesis in Clinical and Experimental Heart Failure With Preserved Ejection Fraction. Circulation 2023; 148:1165-1178. [PMID: 37681311 PMCID: PMC10575571 DOI: 10.1161/circulationaha.123.064170] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Clonal hematopoiesis (CH), which results from an array of nonmalignant driver gene mutations, can lead to altered immune cell function and chronic disease, and has been associated with worse outcomes in patients with heart failure (HF) with reduced ejection fraction. However, the role of CH in the prognosis of HF with preserved ejection fraction (HFpEF) has been understudied. This study aimed to characterize CH in patients with HFpEF and elucidate its causal role in a murine model. METHODS Using a panel of 20 candidate CH driver genes and a variant allele fraction cutoff of 0.5%, ultradeep error-corrected sequencing identified CH in a cohort of 81 patients with HFpEF (mean age, 71±6 years; ejection fraction, 63±5%) and 36 controls without a diagnosis of HFpEF (mean age, 74±7 years; ejection fraction, 61.5±8%). CH was also evaluated in a replication cohort of 59 individuals with HFpEF. RESULTS Compared with controls, there was an enrichment of TET2-mediated CH in the HFpEF patient cohort (12% versus 0%, respectively; P=0.02). In the HFpEF cohort, patients with CH exhibited exacerbated diastolic dysfunction in terms of E/e' (14.9 versus 11.7, respectively; P=0.0096) and E/A (1.69 versus 0.89, respectively; P=0.0206) compared with those without CH. The association of CH with exacerbated diastolic dysfunction was corroborated in a validation cohort of individuals with HFpEF. In accordance, patients with HFpEF, an age ≥70 years, and CH exhibited worse prognosis in terms of 5-year cardiovascular-related hospitalization rate (hazard ratio, 5.06; P=0.042) compared with patients with HFpEF and an age ≥70 years without CH. To investigate the causal role of CH in HFpEF, nonconditioned mice underwent adoptive transfer with Tet2-wild-type or Tet2-deficient bone marrow and were subsequently subjected to a high-fat diet/L-NAME (Nω-nitro-l-arginine methyl ester) combination treatment to induce features of HFpEF. This model of Tet2-CH exacerbated cardiac hypertrophy by heart weight/tibia length and cardiomyocyte size, diastolic dysfunction by E/e' and left ventricular end-diastolic pressure, and cardiac fibrosis compared with the Tet2-wild-type condition. CONCLUSIONS CH is associated with worse heart function and prognosis in patients with HFpEF, and a murine experimental model of Tet2-mediated CH displays greater features of HFpEF.
Collapse
Affiliation(s)
- Jesse Cochran
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
- Medical Scientist Training Program, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Yoshimitsu Yura
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
- Current address: Department of Cardiovascular Medicine, Nagoya University School of Medicine, Nagoya 466-8550, Japan
| | - Mark C. Thel
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Heather Doviak
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Ariel H. Polizio
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Yuka Arai
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Yohei Arai
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Keita Horitani
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
- Current address: Department of Internal Medicine II, Kansai Medical University, Osaka 573-1010, Japan
| | - Eunbee Park
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Nicholas W. Chavkin
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Anupreet Kour
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Soichi Sano
- Laboratory of Cardiovascular Mosaicism, National Cerebral and Cardiovascular Center, Osaka 564-8565, Japan
| | | | - Megan Evans
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Mahalia Huba
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | | | - Hanna Sun
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Youngho Ban
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Karen K. Hirschi
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
- Department of Cell Biology, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
| | - Stefano Toldo
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Antonio Abbate
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | | | - Frederick L. Ruberg
- Section of Cardiovascular Medicine, Department of Medicine and Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, Boston, MA 02118, USA
| | - Mathew S. Maurer
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Justin A. Ezekowitz
- Alberta Heart Failure Etiology and Analysis Research Team (HEART) project
- Department of Medicine, Division of Cardiology, University of Alberta, Edmonton, Alberta, T6G 2R3, Canada
| | - Jason R.B. Dyck
- Alberta Heart Failure Etiology and Analysis Research Team (HEART) project
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, T6G 2S2, Canada
| | - Kenneth Walsh
- Robert M. Berne Cardiovascular Research Center, Division of Cardiovascular Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| |
Collapse
|
5
|
Smiley DA, Maurer MS, Einstein AJ. Reply to the letter: In the thick of it: highlighting the importance of SPECT imaging. J Nucl Cardiol 2023; 30:1735-1736. [PMID: 37386274 DOI: 10.1007/s12350-023-03328-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Dia A Smiley
- Seymour, Paul, and Gloria Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Mathew S Maurer
- Seymour, Paul, and Gloria Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA.
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA
- Department of Radiology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA
| |
Collapse
|