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DeFilippis EM, Sweigart B, Khush KK, Shah P, Agbor-Enoh S, Valantine HA, Vest AR. Sex-specific patterns of donor-derived cell-free DNA in heart transplant rejection: An analysis from the Genomic Research Alliance for Transplantation (GRAfT). J Heart Lung Transplant 2024:S1053-2498(24)01520-1. [PMID: 38460620 DOI: 10.1016/j.healun.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/22/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Noninvasive methods for surveillance of acute rejection are increasingly used in heart transplantation (HT), including donor-derived cell-free DNA (dd-cfDNA). As other cardiac biomarkers differ by sex, we hypothesized that there may be sex-specific differences in the performance of dd-cfDNA for the detection of acute rejection. The purpose of the current study was to examine patterns of dd-cfDNA seen in quiescence and acute rejection in male and female transplant recipients. METHODS Patients enrolled in the Genomic Research Alliance for Transplantation who were ≥18 years at the time of HT were included. Rejection was defined by endomyocardial biopsy with acute cellular rejection (ACR) grade ≥2R and/or antibody-mediated rejection ≥ pAMR 1. dd-cfDNA was quantitated using shotgun sequencing. Median dd-cfDNA levels were compared between sexes during quiescence and rejection. The performance of dd-cfDNA by sex was assessed using area under the receiver operator characteristic (AUROC) curve. Allograft injury was defined as dd-cfDNA ≥0.25%. RESULTS One hundred fifty-one unique patients (49 female, 32%) were included in the analysis with 1,119 available dd-cfDNA measurements. Baseline characteristics including demographics and comorbidities were not significantly different between sexes. During quiescence, there were no significant sex differences in median dd-cfDNA level (0.04% [IQR 0.00, 0.16] in females vs 0.03% [IQR 0.00, 0.12] in males, p = 0.22). There were no significant sex differences in median dd-cfDNA for ACR (0.33% [0.21, 0.36] in females vs 0.32% [0.21, 1.10] in males, p = 0.57). Overall, median dd-cfDNA levels were higher in antibody-mediated rejection (AMR) than ACR but did not significantly differ by sex (0.50% [IQR 0.18, 0.82] in females vs 0.63% [IQR 0.32, 1.95] in males, p = 0.51). Elevated dd-cfDNA detected ACR/AMR with an AUROC of 0.83 in females and 0.89 in males, p-value for comparison = 0.16. CONCLUSIONS There were no significant sex differences in dd-cfDNA levels during quiescence and rejection. Performance characteristics were similar, suggesting similar diagnostic thresholds can be used in men and women for rejection surveillance.
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Affiliation(s)
- Ersilia M DeFilippis
- Division of Cardiology, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, New York
| | - Benjamin Sweigart
- Tufts Clinical and Translational Science Institute, Tufts Medical Center, Boston, Massachusetts
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Palak Shah
- Heart Failure, Mechanical Circulatory Support and Transplant, Inova Schar Heart and Vascular, Falls Church, Virginia
| | - Sean Agbor-Enoh
- Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Hannah A Valantine
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Amanda R Vest
- Division of Cardiology, Tufts Medical Center, Boston, Massachusetts.
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2
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Vest AR, Daly KP. Detecting and managing cardiac allograft vasculopathy within the transition from pediatric to adult heart transplantation care: Lighting the pathway ahead. J Heart Lung Transplant 2024; 43:238-240. [PMID: 37839792 DOI: 10.1016/j.healun.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023] Open
Affiliation(s)
- Amanda R Vest
- Division of Cardiology, CardioVascular Center, Tufts Medical Center, Boston, Massachusetts.
| | - Kevin P Daly
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
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3
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Roehm B, Hedayati SS, Vest AR, Gulati G, Tighiouart H, Weiner DE, Inker LA. Postoperative Acute Kidney Injury Requiring Dialysis and Glomerular Filtration Rate at Follow-up in Patients With Left Ventricular Assist Device. Am J Kidney Dis 2024; 83:119-122. [PMID: 37516300 DOI: 10.1053/j.ajkd.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/11/2023] [Accepted: 04/22/2023] [Indexed: 07/31/2023]
Affiliation(s)
- Bethany Roehm
- Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - S Susan Hedayati
- Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amanda R Vest
- Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - Gaurav Gulati
- Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts; Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
| | - Daniel E Weiner
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Lesley A Inker
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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Stern LK, Grodin JL, Maurer MS, Ruberg FL, Patel AR, Khouri MG, Roth LR, Aras MA, Bhardwaj A, Bhattacharya P, Brailovsky Y, Drachman BM, Ebong IA, Fine NM, Gaggin H, Gopal D, Griffin J, Judge D, Kim P, Mitchell J, Mitter SS, Mohan RC, Ramos H, Reyentovich A, Sheikh FH, Sperry B, Carter S, Urey M, Vaishnav J, Vest AR, Kittleson MM, Patel JK. The Cardiac Amyloidosis Registry Study (CARS): Rationale, Design and Methodology. J Card Fail 2023:S1071-9164(23)00379-2. [PMID: 37907148 DOI: 10.1016/j.cardfail.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND CARS (Cardiac Amyloidosis Registry Study) is a multicenter registry established in 2019 that includes patients with transthyretin (ATTR, wild-type and variant) and light chain (AL) cardiac amyloidosis (CA) evaluated at major amyloidosis centers between 1997 and 2025. CARS aims to describe the natural history of CA with attention to clinical and diagnostic variables at the time of diagnosis, real-world treatment patterns, and associated outcomes of patients in a diverse cohort that is more representative of the at-risk population than that described in CA clinical trials. METHODS AND RESULTS This article describes the design and methodology of CARS, including procedures for data collection and preliminary results. As of February 2023, 20 centers in the United States enrolled 1415 patients, including 1155 (82%) with ATTR and 260 (18%) with AL CA. Among those with ATTR, wild-type is the most common ATTR (71%), and most of the 305 patients with variant ATTR have the p.V142I mutation (68%). A quarter of the total population identifies as Black. More individuals with AL are female (39%) compared to those with ATTR (13%). CONCLUSIONS CARS will answer crucial clinical questions about CA natural history and permit comparison of different therapeutics not possible through current clinical trials. Future international collaboration will further strengthen the validity of observations of this increasingly recognized condition.
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Affiliation(s)
- Lily K Stern
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Justin L Grodin
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, 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, USA
| | - Ayan R Patel
- Division of Cardiology, The CardioVascular Center, Tufts Medical Center, Boston, MA, USA
| | - Michel G Khouri
- Division of Cardiology, Duke University Hospital, Durham, NC, USA
| | - Lori R Roth
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mandar A Aras
- Division of Cardiology, Department of Medicine, Division of Cardiology, University of California, San Francisco, CA, USA
| | - Anju Bhardwaj
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas-Houston, Houston, TX, USA
| | - Priyanka Bhattacharya
- Division of Cardiology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Yevgeniy Brailovsky
- Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Brian M Drachman
- Division of Cardiology, Department of Medicine, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Imo A Ebong
- Division of Cardiology, Department of Medicine, Division of Cardiology, University of California, Davis, CA, USA
| | - Nowell M Fine
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Hanna Gaggin
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Deepa Gopal
- Section of Cardiovascular Medicine, Department of Medicine and Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Jan Griffin
- Division of Cardiology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA; Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel Judge
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Paul Kim
- Division of Cardiology, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Joshua Mitchell
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Cardio-Oncology Center of Excellence, Washington University in St Louis, St Louis, MO, USA
| | - Sumeet S Mitter
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rajeev C Mohan
- Division of Cardiology, Scripps Clinic, San Diego, CA, USA
| | - Hannia Ramos
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Alex Reyentovich
- The Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York, USA
| | - Farooq H Sheikh
- Infiltrative Cardiomyopathy and Advanced Heart Failure Programs, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Brett Sperry
- Saint Luke's Mid America Heart Institute and the University of Kansas City-Missouri, Kansas City, Missouri, USA
| | - Spencer Carter
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Marcus Urey
- Division of Cardiology, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Joban Vaishnav
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Amanda R Vest
- Division of Cardiology, The CardioVascular Center, Tufts Medical Center, Boston, MA, USA
| | - Michelle M Kittleson
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Jignesh K Patel
- Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA.
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5
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Vest AR, Price LL, Chanda A, Sweigart BA, Chery J, Lawrence M, Parsly L, Gulati G, Kiernan MS, Upshaw JN, Kawabori M, Couper GS, Saltzman E. Cardiac Cachexia in Left Ventricular Assist Device Recipients and the Implications of Weight Gain Early After Implantation. J Am Heart Assoc 2023:e029086. [PMID: 37382139 DOI: 10.1161/jaha.122.029086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background Severe cardiac cachexia or malnutrition are commonly considered relative contraindications to left ventricular assist device (LVAD) implantation, but post-LVAD prognosis for patients with cachexia is uncertain. Methods and Results Intermacs (Interagency Registry for Mechanically Assisted Circulatory Support) 2006 to 2017 was queried for the preimplantation variable cachexia/malnutrition. Cox proportional hazards modeling examined the relationship between cachexia and LVAD outcomes. Of 20 332 primary LVAD recipients with available data, 516 (2.54%) were reported to have baseline cachexia and had higher risk baseline characteristics. Cachexia was associated with higher mortality during LVAD support (unadjusted hazard ratio [HR], 1.36 [95% CI, 1.18-1.56]; P<0.0001), persisting after adjustment for baseline characteristics (adjusted HR, 1.23 [95% CI, 1.0-1.42]; P=0.005). Mean weight change at 12 months was +3.9±9.4 kg. Across the cohort, weight gain ≥5% during the first 3 months of LVAD support was associated with lower mortality (unadjusted HR, 0.90 [95% CI, 0.84-0.98]; P=0.012; adjusted HR, 0.89 [95% CI, 0.82-0.97]; P=0.006). Conclusions The proportion of LVAD recipients recognized to have cachexia preimplantation was low at 2.5%. Recognized cachexia was independently associated with higher mortality during LVAD support. Early weight gain ≥5% was independently associated with lower mortality during subsequent LVAD support.
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Affiliation(s)
- Amanda R Vest
- CardioVascular Center Tufts Medical Center Boston MA USA
| | - Lori Lyn Price
- Tufts Clinical and Translational Science Institute Tufts University Boston MA USA
- Institute of Clinical Research and Health Policy Studies Tufts Medical Center Boston MA USA
| | - Anindita Chanda
- Department of Medicine University of Connecticut Hartford CT USA
| | - Benjamin A Sweigart
- Tufts Clinical and Translational Science Institute Tufts University Boston MA USA
- Institute of Clinical Research and Health Policy Studies Tufts Medical Center Boston MA USA
| | - Joronia Chery
- CardioVascular Center Tufts Medical Center Boston MA USA
| | | | - Lauren Parsly
- Frances Stern Nutrition Center Tufts Medical Center Boston MA USA
| | - Gaurav Gulati
- CardioVascular Center Tufts Medical Center Boston MA USA
| | | | | | | | | | - Edward Saltzman
- Friedman School of Nutrition Science and Policy at Tufts University Boston MA USA
- USDA Jean Mayer Human Nutrition Research Center on Aging at Tufts University Boston MA USA
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6
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Upshaw JN, Parker S, Gregory D, Koethe B, Vest AR, Patel AR, Kiernan MS, DeNofrio D, Davidson E, Mohanty S, Arpin P, Strauss N, Sommer C, Brandon L, Butler R, Dwaah H, Nadeau H, Cantor M, Konstam MA. The effect of tablet computer-based telemonitoring added to an established telephone disease management program on heart failure hospitalizations: The Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) III Randomized Controlled Trial. Am Heart J 2023; 260:90-99. [PMID: 36842486 DOI: 10.1016/j.ahj.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Mobile health applications are becoming increasingly common. Prior work has demonstrated reduced heart failure (HF) hospitalizations with HF disease management programs; however, few of these programs have used tablet computer-based technology. METHODS Participants with a diagnosis of HF and at least 1 high risk feature for hospitalization were randomized to either an established telephone-based disease management program or the same disease management program with the addition of remote monitoring of weight, blood pressure, heart rate and symptoms via a tablet computer for 90 days. The primary endpoint was the number of days hospitalized for HF assessed at 90 days. RESULTS From August 2014 to April 2019, 212 participants from 3 hospitals in Massachusetts were randomized 3:1 to telemonitoring-based HF disease management (n = 159) or telephone-based HF disease management (n = 53) with 98% of individuals in both study groups completing the 90 days of follow-up. There was no significant difference in the number of days hospitalized for HF between the telemonitoring disease management group (0.88 ± 3.28 days per patient-90 days) and the telephone-based disease management group (1.00 ± 2.97 days per patient-90 days); incidence rate ratio 0.82 (95% confidence interval, 0.43-1.58; P = .442). CONCLUSIONS The addition of tablet-based telemonitoring to an established HF telephone-based disease management program did not reduce HF hospitalizations; however, study power was limited.
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Affiliation(s)
- Jenica N Upshaw
- The CardioVascular Center, Tufts Medical Center, Boston, MA.
| | - Susan Parker
- New England Quality Care Alliance, Braintree, MA
| | | | - Benjamin Koethe
- Biostatics, Epidemiology, and Research Design Center, Tufts Medical Center, Boston MA
| | - Amanda R Vest
- The CardioVascular Center, Tufts Medical Center, Boston, MA
| | - Ayan R Patel
- The CardioVascular Center, Tufts Medical Center, Boston, MA
| | | | - David DeNofrio
- The CardioVascular Center, Tufts Medical Center, Boston, MA
| | | | | | - Patrick Arpin
- The CardioVascular Center, Tufts Medical Center, Boston, MA
| | - Nicole Strauss
- The CardioVascular Center, Tufts Medical Center, Boston, MA
| | - Crystal Sommer
- The CardioVascular Center, Tufts Medical Center, Boston, MA
| | | | - Rita Butler
- The CardioVascular Center, Tufts Medical Center, Boston, MA
| | - Henry Dwaah
- Tufts University School of Medicine, Boston, MA
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7
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Holzhauser L, DeFilippis EM, Nikolova A, Byku M, Contreras JP, De Marco T, Hall S, Khush KK, Vest AR. The End of Endomyocardial Biopsy?: A Practical Guide for Noninvasive Heart Transplant Rejection Surveillance. JACC Heart Fail 2023; 11:263-276. [PMID: 36682960 DOI: 10.1016/j.jchf.2022.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 01/13/2023]
Abstract
Noninvasive heart transplant rejection surveillance using gene expression profiling (GEP) to monitor immune activation is widely used among heart transplant programs. With the new development of donor-derived cell-free DNA (dd-cfDNA) assays, more programs are transitioning to a predominantly noninvasive rejection surveillance protocol with a reduced frequency of endomyocardial biopsies. As a result, many practical questions arise that potentially delay implementation of these valuable new tools. The purpose of this review is to provide practical guidance for clinicians transitioning toward a less invasive acute rejection monitoring protocol after heart transplantation, and to answer 10 common questions about the GEP and dd-cfDNA assays. Evidence supporting GEP and dd-cfDNA testing is reviewed, as well as guidance on test interpretation and future directions.
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Affiliation(s)
- Luise Holzhauser
- Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ersilia M DeFilippis
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Andriana Nikolova
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mirnela Byku
- Department of Cardiology, University of North Carolina in Chapel Hill, North Carolina, USA
| | | | - Teresa De Marco
- Division of Cardiology, University of California, San Francisco, California, USA
| | - Shelley Hall
- Baylor University Medical Center, Dallas, Texas, USA
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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8
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Roehm B, Hedayati S, Vest AR, Gulati G, Miao J, Tighiouart H, Weiner DE, Inker LA. Long-Term Changes in Estimated Glomerular Filtration Rate in Left Ventricular Assist Device Recipients: A Longitudinal Joint Model Analysis. J Am Heart Assoc 2023; 12:e025993. [PMID: 36734339 PMCID: PMC9973635 DOI: 10.1161/jaha.122.025993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/28/2022] [Indexed: 02/04/2023]
Abstract
Background Advanced kidney disease is often a relative contraindication to left ventricular assist device (LVAD) implantation because of concerns for poor outcomes including worsening kidney disease. Data are lacking on long-term changes and sex-based differences in estimated glomerular filtration rate (eGFR), with published data limited by potential bias introduced by the competing risks of death and heart transplantation. Methods and Results We conducted a longitudinal analysis of 288 adults receiving durable continuous-flow LVADs from January 2010 to December 2017 at a single center. A joint model was constructed to evaluate change in eGFR over 2 years, the prespecified primary outcome, adjusted for the competing risks of death and heart transplantation. Median baseline eGFR was 60 mL/min per 1.73 m2 (interquartile range 42-78). At 2 years, 74 patients died and 104 received a heart transplant. In unadjusted analysis, LVAD recipients had a modest initial increase in eGFR of ≈2 mL/min per 1.73 m2 within the first 6 months after implantation, followed by a decrease in eGFR below baseline values at 1 and 2 years. Men experienced an eGFR decline of 5 to 10 mL/min per 1.73 m2 over the first year which then stabilized, while women had an ≈5 mL/min per 1.73 m2 increase in eGFR within the first 6 months followed by decline towards baseline eGFR levels (interaction P=0.005). Conclusions Estimated GFR remains relatively stable in most patients following LVAD implantation. Larger studies are needed to investigate sex-based differences in eGFR and to evaluate eGFR trajectory and mortality in LVAD recipients with lower eGFR.
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Affiliation(s)
- Bethany Roehm
- Division of NephrologyUniversity of Texas Southwestern Medical CenterDallasTX
| | - Susan Hedayati
- Division of NephrologyUniversity of Texas Southwestern Medical CenterDallasTX
| | | | | | | | - Hocine Tighiouart
- Tufts Medical CenterInstitute for Clinical Research and Health Policy StudiesBostonMA
- Tufts University, Tufts Clinical and Translational Science InstituteBostonMA
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9
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Jedeon Z, Masotti M, Schultz J, Vest AR, Alexy T, Pritzker M, Maharaj V, Kamdar F, Knopper R, Shaffer A, John R, Cogswell R. Overestimation of Renal Function Using Serum Creatinine in the Advanced Heart Failure Population: A Call for Alternative Measures. J Card Fail 2023; 29:116-118. [PMID: 36336141 DOI: 10.1016/j.cardfail.2022.10.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/23/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Zeina Jedeon
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Maria Masotti
- University of Minnesota School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Jessica Schultz
- University of Minnesota School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Amanda R Vest
- Division of Cardiology, Tufts Medical Center, Boston, Massachusetts
| | - Tamas Alexy
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Marc Pritzker
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Valmiki Maharaj
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Forum Kamdar
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Ryan Knopper
- Department of Surgery, Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Andrew Shaffer
- Department of Surgery, Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Ranjit John
- Department of Surgery, Division of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Rebecca Cogswell
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota.
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10
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Vest AR, Blume ED. Finding the Words and Data to Discuss Donor Characteristics With Heart Transplant Recipients and Families: Reconsidering Risk. JAMA Cardiol 2022; 7:1127-1128. [PMID: 36129704 DOI: 10.1001/jamacardio.2022.3077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Amanda R Vest
- Division of Cardiology, CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Elizabeth D Blume
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
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11
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Vest AR, Udelson J. Does an Ischemic “STICH in Time Save Nine” for Patients Newly Diagnosed With Heart Failure? JACC: Heart Failure 2022; 10:816-818. [DOI: 10.1016/j.jchf.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 11/07/2022]
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12
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Gilstrap LG, Vest AR. How Do I Optimize Heart Failure Medications for Patients with Hypotension or Chronic Kidney Disease? NEJM Evid 2022; 1:EVIDccon2200084. [PMID: 38319838 DOI: 10.1056/evidccon2200084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
HF Medications for Hypotension or CKDThe cornerstone of treatment for HF with reduced ejection fraction is GDMT; however, safely delivering maximal therapy is often hampered by low blood pressure, labile renal function, or both. Reviewing the physiologic basis of GDMT and exploring each drug's mechanism of action and unique properties can enable careful initiation and titration of therapy, even in patients with hypotension or CKD.
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Affiliation(s)
- Lauren G Gilstrap
- Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Amanda R Vest
- Division of Cardiology, Tufts Medical Center, Boston
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13
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Gulati G, Grandin EW, DeNofrio D, Upshaw JN, Vest AR, Kiernan MS. Association between postoperative hemodynamic metrics of pulmonary hypertension and right ventricular dysfunction and clinical outcomes after left ventricular assist device implantation. J Heart Lung Transplant 2022; 41:1459-1469. [DOI: 10.1016/j.healun.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 06/08/2022] [Accepted: 07/05/2022] [Indexed: 10/16/2022] Open
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14
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e895-e1032. [PMID: 35363499 DOI: 10.1161/cir.0000000000001063] [Citation(s) in RCA: 549] [Impact Index Per Article: 274.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
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15
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Vest AR, Wong WW, Chery J, Coston A, Telfer L, Lawrence M, Celkupa D, Kiernan MS, Couper G, Kawabori M, Saltzman E. Skeletal Muscle Mass Recovery Early After Left Ventricular Assist Device Implantation in Patients With Advanced Systolic Heart Failure. Circ Heart Fail 2022; 15:e009012. [PMID: 35378982 PMCID: PMC9117416 DOI: 10.1161/circheartfailure.121.009012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with advanced systolic heart failure are at risk of unintentional weight loss and muscle wasting. It has been observed that left ventricular assist device (LVAD) recipients gain weight after device implantation, although it is unknown whether this represents skeletal muscle mass gains. We aimed to determine whether skeletal muscle mass increases early during LVAD support. METHODS We prospectively recruited 30 adults with systolic heart failure ±21 days from LVAD implantation. Participants underwent whole-body dual X-ray absorptiometry to measure fat free mass, appendicular lean mass (ALM, lean mass in the arms and legs) and fat mass. Dual X-ray absorptiometry imaging was repeated at 3 and 6 months after LVAD implantation, with participation ending after the 6-month visit or heart transplantation, whichever occurred first. Changes in body composition were evaluated using mixed effects linear regression models. RESULTS The cohort was 87% male, with mean age 56±12 (SD) years, and mean body mass index 26.4±5.4 kg/m2. Per sarcopenia ALM criteria, 52% of participants had muscle wasting at baseline. At baseline, mean fat free mass and ALM were 56.4±11.7 and 21.0±5.3 kg, respectively. Both measures increased significantly (P<0.001) over 6 months of LVAD support: mean fat free mass change at 3 and 6 months: 2.3 kg (95% CI, 1.0-3.5) and 4.2 kg (95% CI, 2.2-6.1); mean ALM change at 3 and 6 months: 1.5 kg (95% CI, 0.7-2.3) and 2.3 kg (95% CI, 0.9-3.6). CONCLUSIONS Among LVAD recipients with advanced systolic heart failure and high baseline prevalence of muscle wasting, there were significant gains in skeletal muscle mass, as represented by dual X-ray absorptiometry fat free mass and ALM, over the first 6 months of LVAD support.
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Affiliation(s)
- Amanda R Vest
- CardioVascular Center, Tufts Medical Center, Boston, MA (A.R.V., L.T., M.L., D.C., M.S.K., G.C., M.K.)
| | - William W Wong
- Department of Pediatrics, US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX (W.W.W.)
| | - Joronia Chery
- Tufts University School of Medicine, Boston, MA (J.C., A.C.)
| | - Alex Coston
- Tufts University School of Medicine, Boston, MA (J.C., A.C.)
| | - Laura Telfer
- CardioVascular Center, Tufts Medical Center, Boston, MA (A.R.V., L.T., M.L., D.C., M.S.K., G.C., M.K.)
| | - Matthew Lawrence
- CardioVascular Center, Tufts Medical Center, Boston, MA (A.R.V., L.T., M.L., D.C., M.S.K., G.C., M.K.)
| | - Didjana Celkupa
- CardioVascular Center, Tufts Medical Center, Boston, MA (A.R.V., L.T., M.L., D.C., M.S.K., G.C., M.K.)
| | - Michael S Kiernan
- CardioVascular Center, Tufts Medical Center, Boston, MA (A.R.V., L.T., M.L., D.C., M.S.K., G.C., M.K.)
| | - Gregory Couper
- CardioVascular Center, Tufts Medical Center, Boston, MA (A.R.V., L.T., M.L., D.C., M.S.K., G.C., M.K.)
| | - Masashi Kawabori
- CardioVascular Center, Tufts Medical Center, Boston, MA (A.R.V., L.T., M.L., D.C., M.S.K., G.C., M.K.)
| | - Edward Saltzman
- Friedman School of Nutrition Science and Policy at Tufts University, Boston, MA (E.S.)
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16
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary. J Am Coll Cardiol 2022; 79:1757-1780. [DOI: 10.1016/j.jacc.2021.12.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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17
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW, Beckman JA, O'Gara PT, Al-Khatib SM, Armbruster AL, Birtcher KK, Cigarroa JE, de las Fuentes L, Deswal A, Dixon DL, Fleisher LA, Gentile F, Goldberger ZD, Gorenek B, Haynes N, Hernandez AF, Hlatky MA, Joglar JA, Jones WS, Marine JE, Mark DB, Mukherjee D, Palaniappan LP, Piano MR, Rab T, Spatz ES, Tamis-Holland JE, Wijeysundera DN, Woo YJ. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Card Fail 2022; 28:e1-e167. [DOI: 10.1016/j.cardfail.2022.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2022; 79:e263-e421. [PMID: 35379503 DOI: 10.1016/j.jacc.2021.12.012] [Citation(s) in RCA: 636] [Impact Index Per Article: 318.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. STRUCTURE Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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19
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Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e876-e894. [PMID: 35363500 DOI: 10.1161/cir.0000000000001062] [Citation(s) in RCA: 103] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" replaces the "2013 ACCF/AHA Guideline for the Management of Heart Failure" and the "2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure." The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. METHODS A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure: Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients' interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.
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Affiliation(s)
| | | | | | | | | | | | - Anita Deswal
- ACC/AHA Joint Committee on Clinical Practice Guidelines Liaison
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20
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Cho L, Vest AR, O'Donoghue ML, Ogunniyi MO, Sarma AA, Denby KJ, Lau ES, Poole JE, Lindley KJ, Mehran R. Increasing Participation of Women in Cardiovascular Trials: JACC Council Perspectives. J Am Coll Cardiol 2021; 78:737-751. [PMID: 34384555 DOI: 10.1016/j.jacc.2021.06.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/20/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Abstract
Although some progress has been made in the last 3 decades to increase the number of women in clinical cardiology trials, review of recent cardiovascular literature demonstrates that women and underrepresented minority women are still underrepresented in most clinical cardiology trials. This is especially notable in trials of patients with coronary artery disease, heart failure with reduced ejection fraction, and arrhythmia studies, especially those involving devices and procedures. Despite the call from National Institutes of Health, Food and Drug Administration, Institute of Medicine, and various professional societies, the gap remains. This paper seeks to identify the barriers for low enrollment and retention from patient, clinician, research team, study design, and system perspectives, and offers recommendations to improve recruitment and retention in the current era.
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Affiliation(s)
- Leslie Cho
- Cleveland Clinic Heart, Vascular, Thoracic Institute, Cleveland, Ohio, USA.
| | | | | | | | - Amy A Sarma
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kara J Denby
- Cleveland Clinic Heart, Vascular, Thoracic Institute, Cleveland, Ohio, USA
| | - Emily S Lau
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeanne E Poole
- University of Washington Medical Center, Seattle, Washington, USA
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21
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Chow JKL, Ruthazer R, Boucher HW, Vest AR, DeNofrio DM, Snydman DR. Factors associated with neutropenia post heart transplantation. Transpl Infect Dis 2021; 23:e13634. [PMID: 33982834 DOI: 10.1111/tid.13634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neutropenia is a serious complication following heart transplantation (OHT); however, risk factors for its development and its association with outcomes is not well described. We sought to study the prevalence of neutropenia, risk factors associated with its development, and its impact on infection, rejection, and survival. METHODS A retrospective single-center analysis of adult OHT recipients from July 2004 to December 2017 was performed. Demographic, laboratory, medication, infection, rejection, and survival data were collected for 1 year post-OHT. Baseline laboratory measurements were collected within the 24 hours before OHT. Neutropenia was defined as absolute neutrophil count ≤1000 cells/mm3. Cox proportional hazards models explored associations with time to first neutropenia. Associations between neutropenia, analyzed as a time-dependent covariate, with secondary outcomes of time to infection, rejection, or death were also examined. RESULTS Of 278 OHT recipients, 84 (30%) developed neutropenia at a median of 142 days (range 81-228) after transplant. Factors independently associated with increased risk of neutropenia included lower baseline WBC (HR 1.12; 95% CI 1.11-1.24), pre-OHT ventricular assist device (1.63; 1.00-2.66), high-risk CMV serostatus [donor positive, recipient negative] (1.86; 1.19-2.88), and having a previous CMV infection (4.07; 3.92-13.7). CONCLUSIONS Neutropenia is a fairly common occurrence after adult OHT. CMV infection was associated with subsequent neutropenia, however, no statistically significant differences in outcomes were found between neutropenic and non-neutropenic patients in this small study. It remains to be determined in future studies if medication changes in response to neutropenia would impact patient outcomes.
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Affiliation(s)
- Jennifer K L Chow
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
| | - Robin Ruthazer
- Tufts Clinical and Translational Science Institute, Biostatistics, Epidemiology, and Research Design Center, Tufts Medical Center, Boston, MA, USA
| | - Helen W Boucher
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
| | - Amanda R Vest
- Division of Cardiology, Tufts University School of Medicine, Tufts Medical Center, Boston, MA, USA
| | - David M DeNofrio
- Division of Cardiology, Tufts University School of Medicine, Tufts Medical Center, Boston, MA, USA
| | - David R Snydman
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
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22
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Affiliation(s)
- Amanda R Vest
- Division of Cardiology, CardioVascular Center, Tufts Medical Center, Boston, MA
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23
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Vest AR, Cherikh WS, Noreen SM, Stehlik J, Khush KK. New Onset Diabetes Mellitus After Adult Heart Transplantation and the Risk of Renal Dysfunction or Mortality. Transplantation 2021; 106:178-187. [PMID: 33496556 DOI: 10.1097/tp.0000000000003647] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) may occur either pre-heart transplant (HT) or as new onset DM post-HT. We sought to define the contemporary incidence of post-HT DM, evaluate risk factors for post-HT DM, and assess the impact of post-HT DM on major outcomes. METHODS The cohort included International Society for Heart and Lung Transplantation (ISHLT) Thoracic Organ Transplant Registry adult primary HT-alone recipients, transplanted January 1995-June 2017, who survived to 1 year post-HT. DM status was characterized as (1) No DM pre- or post-HT; (2) Pre-HT DM; or (3) Post-HT DM (onset within 5 years of HT). Cox proportional hazards models were constructed to identify risk factors for post-HT DM onset, as well as risk factors for post-HT severe renal dysfunction and death/retransplantation. RESULTS Of 26 263 eligible subjects, 57% had no DM pre- or post-HT, 22% had pre-HT DM; 21% had new onset post-HT DM. Risk factors for the development of post-HT DM included use of tacrolimus or steroids at 1-year post-HT, as well as with higher recipient age, female sex, ischemic cardiomyopathy, higher body mass index (BMI), pre-HT dialysis, and pre-HT steroid use. Post-HT DM within 5 years was associated with increased subsequent severe renal dysfunction (hazard ratio, HR, 1.89; 95% CI 1.77, 2.01) and death/retransplantation (HR 1.38; 95% CI 1.32, 1.45), compared to patients without post-HT DM. CONCLUSIONS Post-HT DM is common, occurring in 21% of recipients within 5 years of HT. Post-HT DM is associated with increased risk of severe renal dysfunction and death or retransplantation.
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Affiliation(s)
- Amanda R Vest
- The CardioVascular Center, Tufts Medical Center, Boston, MA United Network for Organ Sharing (UNOS), Richmond, VA Division of Cardiovascular Medicine, University of Utah, Salt Lake City, UT Division of Cardiovascular Medicine, Stanford University, Stanford, CA
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24
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Gulati G, Ruthazer R, Denofrio D, Vest AR, Kent D, Kiernan MS. Understanding Longitudinal Changes in Pulmonary Vascular Resistance After Left Ventricular Assist Device Implantation. J Card Fail 2021; 27:552-559. [PMID: 33450411 DOI: 10.1016/j.cardfail.2021.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 12/29/2020] [Accepted: 01/03/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Elevated pulmonary vascular resistance (PVR) is common in patients with advanced heart failure. PVR generally improves after left ventricular assist device (LVAD) implantation, but the rate of decrease has not been quantified and the patient characteristics most strongly associated with this improvement are unknown. METHODS AND RESULTS We analyzed 1581 patients from the Interagency Registry for Mechanically Assisted Circulatory Support registry who received a primary continuous-flow LVAD, had a baseline PVR of ≥3 Wood units (WU), and had PVR measured at least once postoperatively. Multivariable linear mixed effects modeling was used to evaluate independent associations between postoperative PVR and patient characteristics. PVR decreased by 1.53 WU (95% confidence interval [CI] 1.27-1.79 WU) per month in the first 3 months postoperatively, and by 0.066 WU (95% CI 0.060-0.070 WU) per month thereafter. Severe mitral regurgitation at any time during follow-up was associated with a 1.29 WU (95% CI 1.05-1.52 WU) higher PVR relative to absence of mitral regurgitation at that time. In a cross-sectional analysis, 15%-25% of patients had persistently elevated PVR of ≥3 WU at any given time within 36 months after LVAD implantation. CONCLUSION The PVR tends to decrease rapidly early after implantation, and only more gradually thereafter. Residual mitral regurgitation may be an important contributor to elevated postoperative PVR. Future research is needed to understand the implications of elevated PVR after LVAD implantation and the optimal strategies for prevention and treatment.
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Affiliation(s)
- Gaurav Gulati
- Cardiovascular Center, Tufts Medical Center; Predictive Analytics and Comparative Effectiveness Center.
| | - Robin Ruthazer
- Clinical and Translational Sciences Institute, Tufts Medical Center, Boston, Massachusetts
| | | | | | - David Kent
- Predictive Analytics and Comparative Effectiveness Center
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25
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Blumer V, Greene SJ, Ortiz M, Kittipibul V, Hernandez GA, Fudim M, Lemor A, Mentz RJ, Vest AR. In-hospital outcomes after bariatric surgery in patients with heart failure. Am Heart J 2020; 230:59-62. [PMID: 32991845 DOI: 10.1016/j.ahj.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
Based on the largest publicly available all-payer inpatient database in the United States, this study sought to evaluate real-world outcomes after bariatric surgery among patients with heart failure.
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26
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Telfer L, Chery J, Lawrence M, Haynes A, Vest AR. Evaluation of Skeletal Muscle Ultrasound For The Assessment of Body Composition In Healthy Controls And Patients With Heart Failure. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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27
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Vest AR, Upshaw JN, Dean K, Donovan E, Diakos N, Hong C, Conway L, Kiernan MS, DeNofrio D, Konstam MA. The Decrease in Hospitalizations For Heart Failure During the Covid-19 Pandemic: A Community and Academic Hospital Comparison Study. J Card Fail 2020. [PMCID: PMC7527197 DOI: 10.1016/j.cardfail.2020.09.207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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28
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Vest AR, Cho L. No Woman Left Behind: Recognizing and Responding to Cardiogenic Shock in Younger Women. Circ Heart Fail 2020; 13:e007782. [PMID: 32988219 DOI: 10.1161/circheartfailure.120.007782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amanda R Vest
- Division of Cardiology, CardioVascular Center, Tufts Medical Center, Boston, MA (A.R.V.)
| | - Leslie Cho
- Women's Cardiovascular Center, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (L.C.)
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29
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Olchanski N, Vest AR, Cohen JT, DeNofrio D. Two-year outcomes and cost for heart failure patients following discharge from the hospital after an acute heart failure admission. Int J Cardiol 2020; 307:109-113. [DOI: 10.1016/j.ijcard.2019.10.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/13/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
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30
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Lee Y, Lai HTM, de Oliveira Otto MC, Lemaitre RN, McKnight B, King IB, Song X, Huggins GS, Vest AR, Siscovick DS, Mozaffarian D. Serial Biomarkers of De Novo Lipogenesis Fatty Acids and Incident Heart Failure in Older Adults: The Cardiovascular Health Study. J Am Heart Assoc 2020; 9:e014119. [PMID: 32020839 PMCID: PMC7070205 DOI: 10.1161/jaha.119.014119] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/06/2019] [Indexed: 12/14/2022]
Abstract
Background De novo lipogenesis (DNL) is an endogenous pathway that converts excess dietary starch, sugar, protein, and alcohol into specific fatty acids (FAs). Although elevated DNL is linked to several metabolic abnormalities, little is known about how long-term habitual levels and changes in levels of FAs in the DNL pathway relate to incident heart failure (HF). Methods and Results We investigated whether habitual levels and changes in serial measures of FAs in the DNL pathway were associated with incident HF among 4249 participants free of HF at baseline. Plasma phospholipid FAs were measured at baseline, 6 years, and 13 years using gas chromatography, and risk factors for HF were measured using standardized methods. Incident HF was centrally adjudicated using medical records. We prospectively evaluated associations with HF risk of (1) habitual FA levels, using cumulative updating to assess long-term exposure, and (2) changes in FA levels over time. During 22.1 years of follow-up, 1304 HF cases occurred. After multivariable adjustment, habitual levels and changes in levels of palmitic acid (16:0) were positively associated with incident HF (interquintile hazard ratio [95% CI]=1.17 [1.00-1.36] and 1.26 [1.03-1.55], respectively). Changes in levels of 7-hexadecenoic acid (16:1n-9) and vaccenic acid (18:1n-7) were each positively associated with risk of HF (1.36 [1.13-1.62], and 1.43 [1.18-1.72], respectively). Habitual levels and changes in levels of myristic acid (14:0), palmitoleic acid (16:1n-7), stearic acid (18:0), and oleic acid (18:1n-9) were not associated with incident HF. Conclusions Both habitual levels and changes in levels of 16:0 were positively associated with incident HF in older adults. Changes in 16:1n-9 and 18:1n-7 were also positively associated with incident HF. These findings support a potential role of DNL or these DNL-related FAs in the development of HF.
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Affiliation(s)
- Yujin Lee
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMA
| | - Heidi T. M. Lai
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMA
| | - Marcia C. de Oliveira Otto
- Division of EpidemiologyHuman Genetics and Environmental SciencesThe University of Texas Health Science Center at Houston (UTHealth) School of Public HealthHoustonTX
| | - Rozenn N. Lemaitre
- Cardivascular Health Research UnitDepartment of MedicineUniversity of WashingtonSeattleWA
| | | | - Irena B. King
- Department of Internal MedicineUniversity of New MexicoAlbuquerqueNM
| | | | - Gordon S. Huggins
- Molecular Cardiology Research Institute Center for Translational GenomicsTufts Medical CenterBostonMA
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Kiernan MS, Najjar SS, Vest AR, Birks EJ, Uriel N, Ewald GA, Leadley K, Patel CB. Outcomes of Severely Obese Patients Supported by a Centrifugal-Flow Left Ventricular Assist Device. J Card Fail 2020; 26:120-127. [DOI: 10.1016/j.cardfail.2019.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/16/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022]
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Kuttab R, Chery J, Carr K, Vest AR. Elevated Neutrophil-Lymphocyte Ratio is Associated with a Poorer Cardiopulmonary Exercise Test Performance in Patients with Heart Failure. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vest AR, Chan M, Deswal A, Givertz MM, Lekavich C, Lennie T, Litwin SE, Parsly L, Rodgers JE, Rich MW, Schulze PC, Slader A, Desai A. Nutrition, Obesity, and Cachexia in Patients With Heart Failure: A Consensus Statement from the Heart Failure Society of America Scientific Statements Committee. J Card Fail 2019; 25:380-400. [DOI: 10.1016/j.cardfail.2019.03.007] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 03/04/2019] [Accepted: 03/08/2019] [Indexed: 12/31/2022]
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Affiliation(s)
- James B Young
- From the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, the Kaufman Center for Heart Failure, and the Endocrinology and Metabolism and Heart and Vascular Institutes of the Cleveland Clinic, OH (J.B.Y.); and the Division of Cardiology, The CardioVascular Center, Tufts Medical Center, Boston, MA (A.V.).
| | - Amanda R Vest
- From the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, the Kaufman Center for Heart Failure, and the Endocrinology and Metabolism and Heart and Vascular Institutes of the Cleveland Clinic, OH (J.B.Y.); and the Division of Cardiology, The CardioVascular Center, Tufts Medical Center, Boston, MA (A.V.)
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35
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Sundararajan S, Kiernan MS, Couper GS, Upshaw JN, DeNofrio D, Vest AR. The Neutrophil-Lymphocyte Ratio and Survival During Left Ventricular Assist Device Support. J Card Fail 2019; 25:188-194. [PMID: 30658084 DOI: 10.1016/j.cardfail.2019.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 01/03/2019] [Accepted: 01/13/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Systolic heart failure (HF) is a low-grade systemic inflammatory state. Neutrophil-lymphocyte ratio (NLR) is a nonspecific inflammatory marker with prognostic value in HF. We aimed to determine the relationship between NLR and mortality during left ventricular assist device (LVAD) support. METHODS AND RESULTS We retrospectively reviewed LVAD recipients implanted in the years 2010-2018. NLR was recorded before LVAD implantation and at intervals during LVAD support; pre-LVAD and 90-day LVAD NLRs were compared. Cox proportional hazard models were constructed to study the impact of NLR, both before LVAD implantation and at 90 days with LVAD, on mortality during subsequent LVAD support. Among 301 subjects, the median pre-LVAD NLR was 4.7 (interquartile range 3.0-8.0). Higher pre-LVAD NLR was independently associated with increased mortality during a median 324 days of LVAD support (adjusted hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.01-1.06; P = .012, adjusted for pre-LVAD age, HF etiology, white blood count, hemoglobin, blood urea nitrogen, and sodium). After LVAD implantation, the NLR rose initially and then plateaued lower by day 90. Despite the mean decrease, higher 90-day LVAD NLR remained independently associated with increased mortality (adjusted HR 1.06, 95% CI 1.01-1.13; P = .033, stratified by early infection events). CONCLUSIONS Higher pre-LVAD NLR is independently associated with mortality during LVAD support. NLR improves during LVAD support, but even accounting for early infections, a higher NLR at day 90 remains associated with subsequent mortality.
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Affiliation(s)
- Sakthi Sundararajan
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Michael S Kiernan
- Division of Cardiology, Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Gregory S Couper
- Division of Cardiothoracic Surgery, Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Jenica N Upshaw
- Division of Cardiology, Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts
| | - David DeNofrio
- Division of Cardiology, Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Amanda R Vest
- Division of Cardiology, Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts.
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Magnusson P, Levin C, Mattsson G, Vest AR. A case of fulminant perimyocarditis leading to extensive ECMO treatment and spinal injury resulting in paraplegia. Clin Case Rep 2018; 6:2471-2474. [PMID: 30564351 PMCID: PMC6293179 DOI: 10.1002/ccr3.1835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/26/2018] [Accepted: 09/06/2018] [Indexed: 11/16/2022] Open
Abstract
Perimyocarditis has varying disease manifestations and prognosis. It may rapidly deteriorate into a life-threatening state requiring advanced intensive care including veno-arterial extra-corporeal membrane oxygenation, which may be lifesaving. Close follow-up is warranted to detect both short-term and long-term complications.
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Affiliation(s)
- Peter Magnusson
- Department of Medicine, Cardiology Research UnitKarolinska InstitutetStockholmSweden
- Centre for Research and DevelopmentUppsala University/Region GävleborgGävleSweden
| | - Charlotte Levin
- Medicinkliniken, Centralsjukhuset i KarlstadLandstinget i VärmlandKarlstadSweden
| | - Gustav Mattsson
- Centre for Research and DevelopmentUppsala University/Region GävleborgGävleSweden
| | - Amanda R. Vest
- Division of CardiologyTufts Medical CenterBostonMassachusetts
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37
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Olchanski N, Vest AR, Cohen JT, Neumann PJ, DeNofrio D. Cost comparison across heart failure patients with reduced and preserved ejection fractions: Analyses of inpatient decompensated heart failure admissions. Int J Cardiol 2018; 261:103-108. [PMID: 29657034 DOI: 10.1016/j.ijcard.2018.03.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/29/2018] [Accepted: 03/06/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Heart failure (HF) is the leading cause of inpatient admissions in the US for adults aged over 65 years and accounts for more than $17 billion in Medicare expenditures annually. There are limited published data on factors influencing expenditure and the relationship between cost and hospital length of stay. We sought to describe institutional costs of HF hospitalization, as well as demographic and clinical predictors of higher hospitalization costs in an academic hospital setting. METHODS AND RESULTS Demographic and clinical information was collected retrospectively for 564 unique consecutive patients with a decompensated HF admission during 2010-2013. Forty-six percent had a baseline LVEF >40%, categorized as HF with preserved ejection fraction (HFpEF). Forty-three percent were female and the mean age was 71 years. Patients with reduced ejection fraction (HFrEF) were predominantly male, younger and had a lower burden of baseline comorbidities than HFpEF patients. Length of stay was longer for HFrEF (median 4 days) than HFpEF (median 3 days, p = 0.01). Mean total hospitalization cost was $9521. Mean costs trended higher for HFrEF patients than for HFpEF patients ($10,286 versus $8858, p = 0.07). Room and board contributed more than half of all costs. CONCLUSIONS In this single-center study, we observed a trend towards higher HF hospitalization costs for patients with HFrEF, compared to HFpEF, even though patients with HFpEF are older and had more comorbid conditions. Costs were largely driven by length of stay, with higher heart rate at admission, lower systolic blood pressure, and higher creatinine associated with higher inpatient costs.
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Affiliation(s)
- Natalia Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, MA, United States.
| | - Amanda R Vest
- Division of Cardiology, Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, MA, United States
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, MA, United States
| | - David DeNofrio
- Division of Cardiology, Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
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Vest AR, DeNofrio A, Coston A, Sundararajan SK, Lawrence M, Yuen NG, Parsly L, Kiernan MS, DeNofrio D, Couper G, Saltzman E. Impact of Early Weight Changes after Left Ventricular Assist Device Implantation on Subsequent Survival. J Card Fail 2018. [DOI: 10.1016/j.cardfail.2018.07.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Brinkley DM, DeNofrio D, Ruthazer R, Vest AR, Kapur NK, Couper GS, Kiernan MS. Outcomes After Continuous-Flow Left Ventricular Assist Device Implantation as Destination Therapy at Transplant Versus Nontransplant Centers. Circ Heart Fail 2018. [DOI: 10.1161/circheartfailure.117.004384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- D. Marshall Brinkley
- From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (D.M.B.); Cardiovascular Center (D.D., A.R.V., N.K.K., M.S.K.) and Division of Cardiac Surgery (G.S.C.), Tufts Medical Center, Boston, MA; and Clinical and Translational Science Institute, Tufts University, Boston, MA (R.R.)
| | - David DeNofrio
- From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (D.M.B.); Cardiovascular Center (D.D., A.R.V., N.K.K., M.S.K.) and Division of Cardiac Surgery (G.S.C.), Tufts Medical Center, Boston, MA; and Clinical and Translational Science Institute, Tufts University, Boston, MA (R.R.)
| | - Robin Ruthazer
- From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (D.M.B.); Cardiovascular Center (D.D., A.R.V., N.K.K., M.S.K.) and Division of Cardiac Surgery (G.S.C.), Tufts Medical Center, Boston, MA; and Clinical and Translational Science Institute, Tufts University, Boston, MA (R.R.)
| | - Amanda R. Vest
- From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (D.M.B.); Cardiovascular Center (D.D., A.R.V., N.K.K., M.S.K.) and Division of Cardiac Surgery (G.S.C.), Tufts Medical Center, Boston, MA; and Clinical and Translational Science Institute, Tufts University, Boston, MA (R.R.)
| | - Navin K. Kapur
- From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (D.M.B.); Cardiovascular Center (D.D., A.R.V., N.K.K., M.S.K.) and Division of Cardiac Surgery (G.S.C.), Tufts Medical Center, Boston, MA; and Clinical and Translational Science Institute, Tufts University, Boston, MA (R.R.)
| | - Gregory S. Couper
- From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (D.M.B.); Cardiovascular Center (D.D., A.R.V., N.K.K., M.S.K.) and Division of Cardiac Surgery (G.S.C.), Tufts Medical Center, Boston, MA; and Clinical and Translational Science Institute, Tufts University, Boston, MA (R.R.)
| | - Michael S. Kiernan
- From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (D.M.B.); Cardiovascular Center (D.D., A.R.V., N.K.K., M.S.K.) and Division of Cardiac Surgery (G.S.C.), Tufts Medical Center, Boston, MA; and Clinical and Translational Science Institute, Tufts University, Boston, MA (R.R.)
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40
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Roehm B, Vest AR, Weiner DE. Left Ventricular Assist Devices, Kidney Disease, and Dialysis. Am J Kidney Dis 2018; 71:257-266. [DOI: 10.1053/j.ajkd.2017.09.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/20/2017] [Indexed: 12/19/2022]
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41
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Margoles L, DeNofrio D, Patel AR, Golan Y, Vest AR, Arkun K, Boucher HW, Kiernan MS, Upshaw JN. Disseminated mucormycosis masquerading as rejection early after orthotopic heart transplantation. Transpl Infect Dis 2018; 20. [DOI: 10.1111/tid.12820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/05/2017] [Accepted: 08/25/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Lindsay Margoles
- Division of Infectious Disease; Department of Medicine; Tufts Medical Center; Boston MA USA
| | - David DeNofrio
- Division of Cardiology; Department of Medicine; Tufts Medical Center; Boston MA USA
| | - Ayan R. Patel
- Division of Cardiology; Department of Medicine; Tufts Medical Center; Boston MA USA
| | - Yoav Golan
- Division of Infectious Disease; Department of Medicine; Tufts Medical Center; Boston MA USA
| | - Amanda R. Vest
- Division of Cardiology; Department of Medicine; Tufts Medical Center; Boston MA USA
| | - Knarik Arkun
- Department of Pathology; Tufts Medical Center; Boston MA USA
| | - Helen W. Boucher
- Division of Infectious Disease; Department of Medicine; Tufts Medical Center; Boston MA USA
| | - Michael S. Kiernan
- Division of Cardiology; Department of Medicine; Tufts Medical Center; Boston MA USA
| | - Jenica N. Upshaw
- Division of Cardiology; Department of Medicine; Tufts Medical Center; Boston MA USA
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42
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DeNofrio D, Olchanski N, Vest AR, Cohen JT, Neumann PJ, Patel HK, Maya JF. The Impact of Clinical Factors Observed during the Index Heart Failure Hospitalization on Costs Over 2 Years. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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43
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Vest AR, Kennel PJ, Maldonado D, Young JB, Mountis MM, Naka Y, Colombo PC, Mancini DM, Starling RC, Schulze PC. Recovery of Serum Cholesterol Predicts Survival After Left Ventricular Assist Device Implantation. Circ Heart Fail 2017; 9:CIRCHEARTFAILURE.115.002881. [PMID: 27623768 DOI: 10.1161/circheartfailure.115.002881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 08/10/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Advanced systolic heart failure is associated with myocardial and systemic metabolic abnormalities, including low levels of total cholesterol and low-density lipoprotein. Low cholesterol and low-density lipoprotein have been associated with greater mortality in heart failure. Implantation of a left ventricular assist device (LVAD) reverses some of the metabolic derangements of advanced heart failure. METHODS AND RESULTS A cohort was retrospectively assembled from 2 high-volume implantation centers, totaling 295 continuous-flow LVAD recipients with ≥2 cholesterol values available. The cohort was predominantly bridge-to-transplantation (67%), with median age of 59 years and 49% ischemic heart failure cause. Total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride levels all significantly increased after LVAD implantation (median values from implantation to 3 months post implantation 125-150 mg/dL, 67-85 mg/dL, 32-42 mg/dL, and 97-126 mg/dL, respectively). On Cox proportional hazards modeling, patients achieving recovery of total cholesterol levels, defined as a median or greater change from pre implantation to 3 months post-LVAD implantation, had significantly better unadjusted survival (hazard ratio, 0.445; 95% confidence interval, 0.212-0.932) and adjusted survival (hazard ratio, 0.241; 95% confidence interval, 0.092-0.628) than those without cholesterol recovery after LVAD implantation. The continuous variable of total cholesterol at 3 months post implantation and the cholesterol increase from pre implantation to 3 months were also both significantly associated with survival during LVAD support. CONCLUSIONS Initiation of continuous-flow LVAD support was associated with significant recovery of all 4 lipid variables. Patients with a greater increase in total cholesterol by 3 months post implantation had superior survival during LVAD support.
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Affiliation(s)
- Amanda R Vest
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.).
| | - Peter J Kennel
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Dawn Maldonado
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - James B Young
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Maria M Mountis
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Yoshifumi Naka
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Paolo C Colombo
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Donna M Mancini
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - Randall C Starling
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
| | - P Christian Schulze
- From the Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Department of Medicine (P.J.K., D.M., P.C.C., P.C.S.) and Division of Cardiothoracic Surgery, Department of Surgery (Y.N.), Columbia University Medical Center, New York; Kaufman Center for Heart Failure, Cardiovascular Medicine Department, Heart and Vascular Institute, Cleveland Clinic, OH (J.B.Y., M.M.M., R.C.S.); Division of Cardiology, Department of Medicine, Mount Sinai Icahn School of Medicine, New York (D.M.M.); and Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Germany (P.C.S.)
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Affiliation(s)
- Amanda R Vest
- From the Division of Cardiology, Tufts Medical Center, Boston, MA.
| | - Ayan R Patel
- From the Division of Cardiology, Tufts Medical Center, Boston, MA
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Hawwa N, Vest AR, Kumar R, Lahoud R, Young JB, Wu Y, Gorodeski EZ, Cho L. Comparison Between the Kansas City Cardiomyopathy Questionnaire and New York Heart Association in Assessing Functional Capacity and Clinical Outcomes. J Card Fail 2017; 23:280-285. [DOI: 10.1016/j.cardfail.2016.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/06/2016] [Accepted: 12/07/2016] [Indexed: 11/16/2022]
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Vest AR, Meltzer SN, Sun JL, McNulty S, Anstrom K, Huggins GS, Kiernan MS, DeNofrio D, Konstam MA. THE IMPACT OF GLUCAGON LIKE PEPTIDE-1 AGONIST THERAPY ON HEART RATE IN ADVANCED SYSTOLIC HEART FAILURE: AN ANALYSIS FROM THE FUNCTIONAL IMPACT OF GLP-1 FOR HEART FAILURE TREATMENT STUDY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34248-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vest AR, Mistak SM, Hachamovitch R, Mountis MM, Moazami N, Young JB. Outcomes for Patients With Diabetes After Continuous-Flow Left Ventricular Assist Device Implantation. J Card Fail 2016; 22:789-96. [DOI: 10.1016/j.cardfail.2016.02.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 02/07/2016] [Accepted: 02/22/2016] [Indexed: 01/14/2023]
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Sundararajan S, Kiernan MS, DeNofrio D, Vest AR. Cachexia Is Common in Ventricular Assist Device Recipients but Not Predictive Of Mortality. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Brinkley DM, DeNofrio D, Ruthazer R, Vest AR, Couper GS, Kapur NK, Kiernan MS. Outcomes Following Continuous-Flow Left Ventricular Assist Device at Transplant Versus Non-Transplant Centers. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Esposito ML, Annamalai S, O'Kelly R, Zisa D, Kuchibhotla S, Pham DT, Kiernan M, DeNofrio D, Vest AR, Kapur NK. Defining Hemodynamic Profiles and Outcomes Associated with Cardiogenic Shock and Acute Mechanical Circulatory Support. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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