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Jones MM, Tangel V, White RS, Rong L. The IMPACT Score: Does Sex Matter? J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00442-7. [PMID: 39069380 DOI: 10.1053/j.jvca.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/10/2024] [Accepted: 07/03/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE The Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score is a quantitative risk index that predicts 1-year mortality risk, derived from United Network for Organ Sharing data in which women are underrepresented. The validity of the IMPACT score in 1-year mortality risk after OHT in women is unknown. The objective of this study was to assess differences in score performance by sex. We hypothesized that the IMPACT score is a poor predictor of 1-year mortality risk after orthotopic heart transplantation (OHT) in women. DESIGN In this external validation study, demographic and clinical characteristics were compared by sex. The IMPACT score was calculated and regression models were constructed for the entire sample and stratified by sex. Model discrimination was assessed with the area under the receiver operating characteristic curve, and calibration was assessed graphically. PARTICIPANTS Patients 18 years and older who were first-time single OHT recipients from the International Society for Heart and Lung Transplantation registry from 2009 to 2018. MEASUREMENTS AND MAIN RESULTS For 1-year mortality, the area under the receiver operating characteristic curve (95% confidence interval) for the full sample was 0.59 (0.57-0.60): 0.58 (0.55-0.61) for women and 0.59 (0.58-0.61) for men. The 1-year mortality was 9.4% in the overall cohort, with no difference in mortality by sex (9.0% v 9.6% women v men, p = 0.22). CONCLUSIONS The IMPACT score exhibited poor discrimination and calibration in the International Society for Heart and Lung Transplantation 2009-2019 cohort, overall and by sex. There was no difference in 1-year mortality between women and men.
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Affiliation(s)
- Mandisa-Maia Jones
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, New York Presbyterian Weill Cornell Medical Center, New York, NY.
| | - Virginia Tangel
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY
| | - Robert S White
- Department of Anesthesiology, Division of Obstetric Anesthesia, New York Presbyterian Weill Cornell Medical Center, New York, NY
| | - Lisa Rong
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, New York Presbyterian Weill Cornell Medical Center, New York, NY
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Karamnov S, Dimentberg R, Cornella L, Shook DC, Nyman C, Shernan SK, Body SC, Muehlschlegel JD. Fostering a New Generation of Cardiothoracic Anesthesiology Clinician-Scientists: A Systematic Approach. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00350-1. [PMID: 38955618 DOI: 10.1053/j.jvca.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/20/2024] [Accepted: 05/16/2024] [Indexed: 07/04/2024]
Affiliation(s)
- Sergey Karamnov
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | | | - Lauren Cornella
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Douglas C Shook
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Charles Nyman
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stanton K Shernan
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Simon C Body
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jochen D Muehlschlegel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Alabdaljabar MS, Elhadi M, Geske JB, Klarich KW, Guerrero M, Eleid MF. Sex-Related Differences in Patients With Hypertrophic Cardiomyopathy Undergoing Alcohol Septal Ablation. J Am Heart Assoc 2024; 13:e032553. [PMID: 38700034 PMCID: PMC11179887 DOI: 10.1161/jaha.123.032553] [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: 12/23/2023] [Accepted: 04/02/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Previous studies have shown that women with hypertrophic obstructive cardiomyopathy (HCM) have worse long-term outcomes irrespective of intervention. However, the outcomes of patients undergoing alcohol septal ablation (ASA) based on sex have not been described. Hence, this study aimed to evaluate pressure changes and long-term mortality in patients with HCM undergoing ASA based on sex. METHODS AND RESULTS This is a single-center retrospective study evaluating hemodynamic changes and long-term mortality in patients with HCM treated with ASA according to sex. A total of 259 patients were included (aged 68.4±11.9 years, 62.2% women). Women had higher age and baseline pressures at the time of ASA, with a greater percent reduction in mean left atrial pressure (men versus women: 2.2% versus 15.9%, respectively; P=0.02). Women had better survival (median survival rate of men versus women: 8.6 versus 12.5 years, respectively; P=0.011). On Cox multivariable regression, predictors of mortality were age (per group change <60 years, 61-70 years, 71-80 years, and >80 years; hazard ratio [HR], 1.45 [95% CI, 1.10-1.91], P=0.008), female sex (HR, 0.59 [95% CI, 0.35-0.99], P=0.048), chronic kidney disease (HR, 1.88 [95% CI, 1.06-3.33], P=0.031), and left ventricular outflow tract gradient reduction ≤86% (HR, 1.91 [95% CI, 1.14-3.19], P=0.014). CONCLUSIONS Women with HCM undergoing ASA are older and have higher left-sided baseline pressures compared with men yet have better survival. Further studies exploring the mechanisms of differential outcomes according to sex in patients with HCM undergoing ASA are needed.
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Affiliation(s)
| | - Mohamed Elhadi
- Department of Internal Medicine Mayo Clinic Rochester MN
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Kyle W Klarich
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Mayra Guerrero
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Mackram F Eleid
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
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Gaudino M, Rong LQ, Baiocchi M, Dimagli A, Doenst T, Fremes SE, Gelijins AC, Kurlansky P, Sandner S, Weinsaft JW, Di Franco A. Research Concepts and Opportunities for Early-Career Investigators in Cardiac Surgery. Ann Thorac Surg 2024; 117:704-713. [PMID: 38048972 PMCID: PMC10960696 DOI: 10.1016/j.athoracsur.2023.10.033] [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: 04/19/2023] [Revised: 08/02/2023] [Accepted: 10/16/2023] [Indexed: 12/06/2023]
Abstract
Basic, translational or clinic, research is a key component of cardiac surgery. Understanding basic cellular and molecular mechanisms is key to improving patient outcomes, and cardiac surgical procedures must be compared with nonsurgical alternatives. However, guidance for early-career investigators interested in cardiac surgery research is limited. This opinion piece aims at providing basic guidance and principles based on the authors' experience.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Michael Baiocchi
- Department of Epidemiology and Population Health, Stanford University, Stanford, California
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University of Jena, Jena, Germany
| | - Stephen E Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Annetine C Gelijins
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paul Kurlansky
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, New York
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
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Räsänen J, Ellam S, Hartikainen J, Juutilainen A, Halonen J. Sex Differences in Red Blood Cell Transfusions and 30-Day Mortality in Cardiac Surgery: A Single Center Observational Study. J Clin Med 2023; 12:7674. [PMID: 38137742 PMCID: PMC10743830 DOI: 10.3390/jcm12247674] [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: 10/15/2023] [Revised: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
In cardiac surgery, women have higher short-term mortality and a higher risk of receiving red blood cell (RBC) transfusions than men. This study's aim was to evaluate possible sex differences in RBC transfusions in cardiac surgery and their association with preoperative hemoglobin levels, body mass index, and 30-day mortality. A single-center retrospective study was conducted with 1583 patients (1181 men and 402 women) undergoing cardiac surgery. A total of 64.4% of the women and 33.0% of the men received an RBC transfusion. In a multivariable analysis, female sex was an independent predictor of RBC transfusion (OR 3.88, 95% CI 2.95-5.11, p < 0.001). Other independent predictors of RBC transfusion were age, preoperative hemoglobin level, and body mass index. The women were more likely to receive RBC transfusions than the men, regardless of the type of cardiac surgery. Decreased transfusion risk was found in all higher-than-normal weight categories in the women, but only in the severe obesity category in the men. Preoperative hemoglobin was similarly associated with RBC transfusion in the men and women. The crude 30-day mortality rate was higher in the women than in the men (2.5% vs. 0.9%, p = 0.018). In both sexes, RBC transfusion was associated with an increased probability of death within 30 days.
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Affiliation(s)
- Jenni Räsänen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (J.H.); (A.J.)
- Heart Center, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Sten Ellam
- Department of Anesthesiology and Operative Services, Kuopio University Hospital, 70029 Kuopio, Finland;
| | - Juha Hartikainen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (J.H.); (A.J.)
- Heart Center, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Auni Juutilainen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (J.H.); (A.J.)
| | - Jari Halonen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, 70211 Kuopio, Finland; (J.H.); (A.J.)
- Heart Center, Kuopio University Hospital, 70029 Kuopio, Finland
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White RS, Bradley S, Tangel VE, Rong LQ. In Response. Anesth Analg 2023; 136:e16-e17. [PMID: 36806239 PMCID: PMC9976788 DOI: 10.1213/ane.0000000000006334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- Robert S White
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Stephanie Bradley
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center, Houston, Texas
| | - Virginia E Tangel
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York,
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York,
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Windrix C, Vandyck K, Stewart K, Tanaka K. Toward a Better Understanding and Narrower Gender and Racial Gaps in the Diagnosis and Treatment of Valvular Heart Disease. Anesth Analg 2023; 136:e15-e16. [PMID: 36806238 DOI: 10.1213/ane.0000000000006333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- Casey Windrix
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kofi Vandyck
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kenneth Stewart
- Department of Surgery and Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kenichi Tanaka
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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