1
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Madias JE. Serial electrocardiograms at follow-up for early detection of transplanted heart rejection: A viewpoint. J Electrocardiol 2024; 82:136-140. [PMID: 38141486 DOI: 10.1016/j.jelectrocard.2023.12.008] [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] [Received: 11/14/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 12/25/2023]
Abstract
This viewpoint proposed that serial electrocardiograms (ECG) could be used to monitor for heart transplantation (HT) rejection, based on the expected attenuation of the amplitude of ECG QRS complexes (attQRS) engendered by the rejection-induced decrease in electrical resistance due to the underlying myocardial edema (ME). Previous work in humans has shown attQRS in the setting of a diverse array of edematous states, affecting the myocardium (i.e, ME) and the body volume conductor "enveloping" the heart. Also, animal and human experience has revealed low electrical resistance during mild/moderate HT rejection. Studies with serial correlations of endomyocardial biopsy (EMB), echocardiography, cardiac magnetic resonance imaging, and ECG are recommended, which will merely require recording of an ECG, when EMB and imaging studies are carried out for monitoring of post-HT rejection.
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Affiliation(s)
- John E Madias
- Icahn School of Medicine at Mount Sinai, New York, NY, and the Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States of America.
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2
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Adedinsewo D, Hardway HD, Morales-Lara AC, Wieczorek MA, Johnson PW, Douglass EJ, Dangott BJ, Nakhleh RE, Narula T, Patel PC, Goswami RM, Lyle MA, Heckman AJ, Leoni-Moreno JC, Steidley DE, Arsanjani R, Hardaway B, Abbas M, Behfar A, Attia ZI, Lopez-Jimenez F, Noseworthy PA, Friedman P, Carter RE, Yamani M. Non-invasive detection of cardiac allograft rejection among heart transplant recipients using an electrocardiogram based deep learning model. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:71-80. [PMID: 36974261 PMCID: PMC10039431 DOI: 10.1093/ehjdh/ztad001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/08/2022] [Indexed: 01/15/2023]
Abstract
Aims Current non-invasive screening methods for cardiac allograft rejection have shown limited discrimination and are yet to be broadly integrated into heart transplant care. Given electrocardiogram (ECG) changes have been reported with severe cardiac allograft rejection, this study aimed to develop a deep-learning model, a form of artificial intelligence, to detect allograft rejection using the 12-lead ECG (AI-ECG). Methods and results Heart transplant recipients were identified across three Mayo Clinic sites between 1998 and 2021. Twelve-lead digital ECG data and endomyocardial biopsy results were extracted from medical records. Allograft rejection was defined as moderate or severe acute cellular rejection (ACR) based on International Society for Heart and Lung Transplantation guidelines. The extracted data (7590 unique ECG-biopsy pairs, belonging to 1427 patients) was partitioned into training (80%), validation (10%), and test sets (10%) such that each patient was included in only one partition. Model performance metrics were based on the test set (n = 140 patients; 758 ECG-biopsy pairs). The AI-ECG detected ACR with an area under the receiver operating curve (AUC) of 0.84 [95% confidence interval (CI): 0.78-0.90] and 95% (19/20; 95% CI: 75-100%) sensitivity. A prospective proof-of-concept screening study (n = 56; 97 ECG-biopsy pairs) showed the AI-ECG detected ACR with AUC = 0.78 (95% CI: 0.61-0.96) and 100% (2/2; 95% CI: 16-100%) sensitivity. Conclusion An AI-ECG model is effective for detection of moderate-to-severe ACR in heart transplant recipients. Our findings could improve transplant care by providing a rapid, non-invasive, and potentially remote screening option for cardiac allograft function.
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Affiliation(s)
- Demilade Adedinsewo
- Department of Cardiovascular Medicine, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Heather D Hardway
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Andrea Carolina Morales-Lara
- Department of Cardiovascular Medicine, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Mikolaj A Wieczorek
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Patrick W Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Erika J Douglass
- Department of Cardiovascular Medicine, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Bryan J Dangott
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Raouf E Nakhleh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Tathagat Narula
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Parag C Patel
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Rohan M Goswami
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Melissa A Lyle
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Alexander J Heckman
- Department of Cardiovascular Medicine, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | | | - D Eric Steidley
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Brian Hardaway
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Mohsin Abbas
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Paul Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Mohamad Yamani
- Department of Cardiovascular Medicine, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
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3
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Hashim HT, Ramadhan MA, Ahmad S, Shah J, Varney J, Motawea KR, Kandil OA. The role of the electrocardiogram in the recognition of cardiac transplant rejection: A systematic review and meta‐analysis. Clin Cardiol 2022; 45:258-264. [PMID: 35066923 PMCID: PMC8922543 DOI: 10.1002/clc.23783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background In cardiac transplant recipients, the electrocardiogram (ECG) is a noninvasive measure of early allograft rejection. The ECG can predict an acute cellular rejection, thus shortening the time to recognition of rejection. Earlier diagnosis has the potential to reduce the number and severity of rejection episodes. Methodology A systematic literature review was conducted to identify and select the original research reports on using electrocardiography in diagnosing cardiac transplant rejection in accordance with the PRISMA guidelines. Studies included reported sensitivity and specificity of ECG readings in heart transplant recipients during the first post‐transplant year. Data were analyzed with Review manager version 5.4. p‐value was used in testing the significant difference. Results After the removal of duplicates, 98 articles were eligible for screening. After the full‐text screening, a total of 17 papers were included in the review based on the above criteria. A meta‐analysis of five studies was done. Conclusion In heart transplant recipients, a noninvasive measure of early allograft rejection has the potential to reduce the number and severity of rejection episodes by reducing the time and cost of surveillance of rejection and shortening the time to recognition of rejection.
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Affiliation(s)
| | | | | | - Jaffer Shah
- Drexel University College of Medicine Philadelphia Pennsylvania USA
| | - Joseph Varney
- School of Medicine American University of the Caribbean St Maarten USA
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4
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Li H, Chen Y, Jin Q, Wu Y, Deng C, Gai Y, Sun Z, Li Y, Wang J, Yang Y, Lv Q, Zhang Y, An R, Lan X, Zhang L, Xie M. Noninvasive Radionuclide Molecular Imaging of the CD4-Positive T Lymphocytes in Acute Cardiac Rejection. Mol Pharm 2021; 18:1317-1326. [PMID: 33506680 DOI: 10.1021/acs.molpharmaceut.0c01155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Heart transplantation (HT) is an effective treatment for end-stage heart disease. However, acute rejection (AR) is still the main cause of death within one year after HT. AR is an acute immune response mediated by T lymphocytes, mainly CD4+ T lymphocytes. This study innovatively develops a radiolabeled probe 99mTc-HYNIC-mAbCD4 for noninvasive visualization of CD4+ T lymphocyte infiltration and detection of AR. The 99mTc-HYNIC-mAbCD4 and its isotype control 99mTc-HYNIC-IgG were successfully prepared and characterized. The specificity and affinity of the probe in vitro were assessed by cell-binding experiments. Binding of 99mTc-HYNIC-mAbCD4 to CD4+ T lymphocytes was higher than that of the macrophages and IgG probe groups, and mAbCD4 was effective in the blockade of the binding reaction. The biodistribution data confirmed the SPECT/CT images, with significantly higher levels of 99mTc-HYNIC-mAbCD4 observed in allografts compared to allograft treatment (10 mg/kg/d Cyclosporin A subcutaneously for 5 consecutive days after surgery), isografts, or in rats which received allografts injected with 99mTc-HYNIC-IgG. Histological examination confirmed more CD4+ T lymphocyte infiltration in the allograft hearts than other groups. In summary, 99mTc-HYNIC-mAbCD4 achieved high affinity and specificity of binding to CD4+ T lymphocytes and accumulation in the transplanted heart. Radionuclide molecular imaging with 99mTc-HYNIC-mAbCD4 may be a potential diagnostic method for acute cardiac rejection.
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Affiliation(s)
- Huiling Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yihan Chen
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Qiaofeng Jin
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ya Wu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Cheng Deng
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yongkang Gai
- Hubei Province Key Laboratory of Molecular Imaging, Huazhong University of Science and Technology, Wuhan 430022, China.,Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zhenxing Sun
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yali Yang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yongxue Zhang
- Hubei Province Key Laboratory of Molecular Imaging, Huazhong University of Science and Technology, Wuhan 430022, China.,Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Rui An
- Hubei Province Key Laboratory of Molecular Imaging, Huazhong University of Science and Technology, Wuhan 430022, China.,Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiaoli Lan
- Hubei Province Key Laboratory of Molecular Imaging, Huazhong University of Science and Technology, Wuhan 430022, China.,Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Huazhong University of Science and Technology, Wuhan 430022, China
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5
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DeFilippis EM, Rubin G, Farr MA, Biviano A, Wan EY, Takeda K, Garan H, Topkara VK, Yarmohammadi H. Cardiac Implantable Electronic Devices Following Heart Transplantation. JACC Clin Electrophysiol 2020; 6:1028-1042. [PMID: 32819520 DOI: 10.1016/j.jacep.2020.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/12/2020] [Accepted: 06/27/2020] [Indexed: 11/29/2022]
Abstract
Permanent pacemaker (PPM) implantation is required in a subset of patients (∼10%) for sinus node dysfunction or atrioventricular block both early and late after heart transplantation. The incidence of PPM implantation has decreased to <5% with the advent of bicaval anastamosis transplantation surgery. Pacing dependence upon follow-up has been variably reported. An even smaller percentage of transplantation recipients (1.5% to 3.4%) undergo implantable cardioverter-defibrillator (ICD) placement. Rigorous data are lacking for the use of ICDs in the transplantation population and is largely derived from cohort studies and case series. Sudden cardiac death occurs in approximately 10% of transplantation recipients, but multiple nonarrhythmic factors are believed to be responsible, including acute rejection, late graft failure with electromechanical dissociation, and ischemia due to cardiac allograft vasculopathy. This review provides a comprehensive analysis of the existing data regarding the role for PPMs and ICDs in this population, including leadless PPMs and subcutaneous ICDs, special considerations, and future directions.
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Affiliation(s)
- Ersilia M DeFilippis
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Geoffrey Rubin
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Maryjane A Farr
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
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6
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Doering LV, Chen B, Deng M, Mancini D, Kobashigawa J, Hickey K. Perceived control and health-related quality of life in heart transplant recipients. Eur J Cardiovasc Nurs 2018; 17:513-520. [PMID: 29260888 PMCID: PMC5984108 DOI: 10.1177/1474515117749225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Perceived control has been associated with improved mental health and health-related quality of life (HRQOL) in cardiac populations. However, this concept has not been well-studied in heart transplant groups. AIMS We examine the relationship of perceived control to symptoms of anxiety and depression and HRQOL after transplant. We also examine the extent to which anxiety and depressive symptoms mediate the relationship between perceived control and HRQOL. METHODS Our cross-sectional analysis included 113 adult heart transplant patients from the NEW HEART study. High versus low perceived control groups were determined by median split for chi-square and t-test analyses. Hierarchical multiple linear regression models were used to examine the influence of perceived control on symptoms of depression and anxiety and HRQOL. Mediation analyses included Baron and Kenny's four-step regression approach and Preacher and Hayes' bootstrapping technique to test the indirect effect of perceived control on HRQOL. RESULTS Heart transplant patients who reported lower perceived control were more likely to be female ( p=0.003), and had significantly more depressive symptoms ( p<0.001) and anxiety ( p<0.001), and lower HRQOL ( p<0.001) than those with higher perceived control. Perceived control was a significant predictor in regression models of depressive and anxiety symptoms and HRQOL. In mediation analyses, depressive and anxiety symptoms mediated the effect of perceived control on HRQOL. CONCLUSION Perceived control is associated with improved depressive and anxiety symptoms and HRQOL after transplant. The relationship between perceived control and HRQOL is mediated by depressive and anxiety symptoms. Future interventions should target perceived control to improve overall HRQOL.
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Affiliation(s)
- Lynn V Doering
- Los Angeles School of Nursing, University of California, USA
| | - Belinda Chen
- Los Angeles School of Nursing, University of California, USA
| | - Mario Deng
- David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, USA
| | - Donna Mancini
- Department of Medicine, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, USA
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7
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Leong D, Aintablian T, Kittleson M, Olymbios M, Patel J, Chang DH, Kobashigawa J. Prolonged corrected QT interval in the donor heart: Is there a risk? Clin Transplant 2017; 31. [PMID: 28470875 DOI: 10.1111/ctr.12996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Derek Leong
- Cedars-Sinai Heart Institute; Los Angeles CA USA
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8
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Hickey KT, Doering LV, Chen B, Carter EV, Sciacca RR, Pickham D, Castillo C, Hauser NR, Drew BJ. Clinical and gender differences in heart transplant recipients in the NEW HEART study. Eur J Cardiovasc Nurs 2016; 16:222-229. [PMID: 27189203 DOI: 10.1177/1474515116651178] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Little attention has focused on gender differences in cardiac comorbidities and outcomes in patients undergoing orthotropic heart transplant. OBJECTIVE The objective of this study was to investigate gender differences at baseline and during follow-up among heart transplant patients. METHODS An observational cohort within the NEW HEART study was evaluated to determine gender differences in relation to age, coexisting cardiac comorbidities, and outcomes. Differences were assessed by t-test, Fisher's exact test, and logistic regression analysis. RESULTS Male transplant recipients ( n = 238) were significantly older than female recipients ( n = 92), with a greater percentage over 60 years of age (45% vs. 24%, p = 0.0006). Males were more likely to have hypertension (63% vs. 49%, p = 0.034), dyslipidemia (62% vs. 45%, p = 0.006), a history of smoking (52% vs. 35%, p = 0.009), and diabetes (42% vs. 21%, p = 0.0002). Analysis of endomyocardial biopsies obtained during the 1-year follow-up period demonstrated that women averaged more episodes of acute rejection than men (3.9 vs. 3.0, p = 0.009). While most episodes of rejection were mild, women were more likely than men to have episodes of moderate or severe rejection (14% vs. 5%, p = 0.012) and to be hospitalized for acute rejection (15% vs. 6%, p = 0.013). There were no significant differences in mortality. CONCLUSIONS Men were more likely than women to be older and to have diabetes, dyslipidemia, hypertension, and a history of smoking. Women were more likely to experience moderate or severe allograft rejection and to be hospitalized for acute rejection. Future investigation of the reasons for these gender differences is warranted and may improve clinical care of women undergoing cardiac transplantation.
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Affiliation(s)
| | - Lynn V Doering
- 2 University of California Los Angeles School of Nursing, Los Angeles, CA, USA
| | - Belinda Chen
- 2 University of California Los Angeles School of Nursing, Los Angeles, CA, USA
| | - Erik V Carter
- 3 University of California San Francisco School of Nursing, San Francisco, CA, USA
| | | | - David Pickham
- 4 Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - Barbara J Drew
- 3 University of California San Francisco School of Nursing, San Francisco, CA, USA
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9
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Dawes AJ, Reardon S, Chen VL, Kaiser W, Russell MM, Ko CY, Lin AY. Wireless Technology to Track Surgical Patients after Discharge: A Pilot Study. Am Surg 2015. [DOI: 10.1177/000313481508101030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Failure to detect changes in patients’ postoperative health status increases the risk of adverse outcomes, including complications and readmission. We sought to design and implement a realtime surveillance system for postoperative colorectal surgery patients using wireless health technology. Participants were assigned a preprogrammed tablet computer during their inpatient hospitalization, and asked to complete a daily survey regarding their postoperative health status until their first clinic visit. Surveys were transmitted wirelessly to a secure database for review. As a pilot study, we report on our first 20 consecutively enrolled patients, monitored for 265 patient days. Overall compliance was 63 per cent (data available for 166 of the 265 days), but varied by patient from 26 to 100 per cent. We were able to reliably collect basic data on postoperative health status as well as patient-reported outcomes not previously captured by standard assessment techniques. Qualitative data suggest that the experience strengthened patients’ relationship with their surgeon and aided in their recovery. Postoperative remote monitoring is feasible, and provides more detailed and complete information to the clinical team. Wireless health technology represents an opportunity to close the information gap between discharge and first clinic visit, and, eventually, to improve patient-provider communication, increase patient satisfaction, and prevent unnecessary readmissions.
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Affiliation(s)
- Aaron J. Dawes
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
- VA/Robert Wood Johnson Clinical Scholars Program, UCLA, Los Angeles, California
| | - Sarah Reardon
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Victor L. Chen
- Department of Electrical Engineering, UCLA, Los Angeles, California; and
- UCLA Wireless Health Institute, Los Angeles, California
| | - William Kaiser
- Department of Electrical Engineering, UCLA, Los Angeles, California; and
- UCLA Wireless Health Institute, Los Angeles, California
| | - Marcia M. Russell
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Clifford Y. Ko
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Anne Y. Lin
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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10
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Abstract
A biomarker is a characteristic that can be used as an indicator of a biological state. A biomarker can be a clinical observation, laboratory test or an imaging parameter. In this review, we discuss the use of biomarkers in differentiating cardiac from noncardiac disease; predicting the prognosis of patients with heart failure, pulmonary hypertension and dilated cardiomyopathy; diagnosing subclinical cardiac involvement in muscular dystrophy and postchemotherapy cancer patients; detecting acute rejection following heart transplantation; diagnosing Kawasaki disease; aiding the management of postoperative cardiac patients; and managing both common (tetralogy of Fallot) and complex (single-ventricle physiology) congenital heart diseases.
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Affiliation(s)
- Hythem Nawaytou
- Department of Pediatrics, University of California, San Francisco, CA, USA
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11
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Puehler T, Ensminger S, Schulz U, Fuchs U, Tigges-Limmer K, Börgermann J, Morshuis M, Hakim K, Oldenburg O, Niedermeyer J, Renner A, Gummert J. [Heart and combined heart-lung transplantation. Indications, chances and risks]. Herz 2014; 39:66-73. [PMID: 24452762 DOI: 10.1007/s00059-013-4042-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Orthotopic heart transplantation (HTX) is nowadays the worldwide accepted gold standard for the treatment of terminal heart failure. The main indications for HTX are non-ischemic dilatative (54%) and ischemic (37%) heart failure. In the acute phase after HTX the survival rate is approximately 90%. Good short and long-term results with survival rates ranging from 81% after 1 year to more than 50% after 11 years demonstrate that there is currently no real treatment alternative to HTX for treatment of end-stage heart failure. In the case of irreversible pulmonary hypertension in combination with end-stage heart failure or complex congenital heart syndromes, a combined heart and lung transplantation (HLTX) is necessary. Compared with HTX the short-term survival of HLTX is reduced, mostly for technical reasons. Improved long-term results after HTX and HLTX are a result of highly specialized transplantation units and effective immunosuppression. However, a major problem is the shortage of organ donors in Germany and the resulting long waiting times for patients with frequently occurring blood groups of up to 10 months for transplantation. The consequence of the latter is the ever increasing number of implanted cardiac assist devices in patients not only as a bridge to transplant but also as destination therapy.
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Affiliation(s)
- T Puehler
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinikum der Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland,
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12
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Pickham D, Hickey K, Doering L, Chen B, Castillo C, Drew BJ. Electrocardiographic abnormalities in the first year after heart transplantation. J Electrocardiol 2013; 47:135-9. [PMID: 24119878 DOI: 10.1016/j.jelectrocard.2013.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Indexed: 10/26/2022]
Abstract
STUDY AIM Describe ECG abnormalities in the first year following transplant surgery. METHODS Analysis of 12-lead ECGs from heart transplant subjects enrolled in an ongoing multicenter clinical trial. RESULTS 585 ECGs from 98 subjects showed few with abnormal cardiac rhythm (99% of ECGs were sinus rhythm/tachycardia). A majority of subjects (69%) had either right intraventricular conduction delay (56%) or right bundle branch block (13%). A second prevalent ECG abnormality was atrial enlargement (64% of subjects) that was more commonly left atrial (55%) than right (30%). CONCLUSIONS Right intraventricular conduction delay or right bundle branch block is prevalent in heart transplant recipients in the first year following transplant surgery. Whether this abnormality is related to acute allograph rejection or endomyocardial biopsy procedures is the subject of the ongoing clinical trial. Atrial enlargement ECG criteria (especially, left atrial) are also common and are likely due to transplant surgery with subsequent atrial remodeling.
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Affiliation(s)
- David Pickham
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Lynn Doering
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Belinda Chen
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Barbara J Drew
- University of California, San Francisco, San Francisco, CA, USA.
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