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Nathan SD, Johri S, Joly JM, King CS, Raina A, McEvoy CA, Lee D, Shen E, Smith P, Deng C, Waxman AB. Survival analysis from the INCREASE study in PH-ILD: evaluating the impact of treatment crossover on overall mortality. Thorax 2024; 79:301-306. [PMID: 37979971 PMCID: PMC10958253 DOI: 10.1136/thorax-2023-220821] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/02/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE A post-hoc analysis of the INCREASE trial and its open-label extension (OLE) was performed to evaluate whether inhaled treprostinil has a long-term survival benefit in patients with pulmonary hypertension associated with interstitial lung disease (PH-ILD). METHODS Two different models of survival were employed; the inverse probability of censoring weighting (IPCW) and the rank-preserving structural failure time (RPSFT) models both allow construction of a pseudo-placebo group, thereby allowing for long-term survival evaluation of patients with PH-ILD receiving inhaled treprostinil. Time-varying stabilised weights were calculated by fitting Cox proportional hazards models based on the baseline and time-varying prognostic factors to generate weighted Cox regression models with associated adjusted HRs. RESULTS In the INCREASE trial, there were 10 and 12 deaths in the inhaled treprostinil and placebo arms, respectively, during the 16-week randomised trial. During the OLE, all patients received inhaled treprostinil and there were 29 and 33 deaths in the prior inhaled treprostinil arm and prior placebo arm, respectively. With a conventional analysis, the HR for death was 0.71 (95% CI 0.46 to 1.10; p=0.1227). Both models demonstrated significant reductions in death associated with inhaled treprostinil treatment with HRs of 0.62 (95% CI 0.39 to 0.99; p=0.0483) and 0.26 (95% CI 0.07 to 0.98; p=0.0473) for the IPCW and RPSFT methods, respectively. CONCLUSION Two independent modelling techniques that have been employed in the oncology literature both suggest a long-term survival benefit associated with inhaled treprostinil treatment in patients with PH-ILD.
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Affiliation(s)
- Steven D Nathan
- Advanced Lung Disease and Lung Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Shilpa Johri
- Pulmonary and Critical Care Medicine, Pulmonary Associates of Richmond Inc, Richmond, Virginia, USA
| | - Joanna M Joly
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christopher S King
- Advanced Lung Disease and Lung Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Amresh Raina
- Advanced Heart Failure and Transplant, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Colleen A McEvoy
- Division of Pulmonary and Critical Care Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Dasom Lee
- United Therapeutics, Research Triangle Park, North Carolina, USA
| | - Eric Shen
- United Therapeutics, Research Triangle Park, North Carolina, USA
| | - Peter Smith
- United Therapeutics, Research Triangle Park, North Carolina, USA
| | - Chunqin Deng
- United Therapeutics, Research Triangle Park, North Carolina, USA
| | - Aaron B Waxman
- Pulmonary Vascular Disease Program, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
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Brener MI, Kanwar MK, Lander MM, Hamid NB, Raina A, Sethi SS, Finn MT, Fried JA, Raikhelkar J, Masoumi A, Rosenblum HR, Maurer MS, Sayer G, Burkhoff D, Uriel N. Impact of Interventricular Interaction on Ventricular Function: Insights From Right Ventricular Pressure-Volume Analysis. JACC Heart Fail 2024:S2213-1779(23)00829-6. [PMID: 38206234 DOI: 10.1016/j.jchf.2023.12.001] [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] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/31/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Interventricular interactions may be responsible for the decline in ventricular performance observed in various disease states that primarily affect the contralateral ventricle. OBJECTIVES This study sought to quantify the impact of such interactions on right ventricular (RV) size and function using clinically stable individuals with left ventricular assist devices (LVADs) as a model for assessing RV hemodynamics while LV loading conditions were acutely manipulated by changing device speed during hemodynamic optimization studies (ie, ramp tests). METHODS The investigators recorded RV pressure-volume loops with a conductance catheter at various speeds during ramp tests in 20 clinically stable HeartMate3 recipients. RESULTS With faster LVAD speeds and greater LV unloading, indexed RV end-diastolic volume increased (72.28 ± 15.07 mL at low speed vs 75.95 ± 16.90 at high speed; P = 0.04) whereas indexed end-systolic volumes remained neutral. This resulted in larger RV stroke volumes and shallower end-diastolic pressure-volume relationships. Concurrently, RV end-systolic pressure decreased (31.58 ± 9.75 mL at low speed vs 29.58 ± 9.41 mL at high speed; P = 0.02), but contractility, as measured by end-systolic elastance, did not change significantly. The reduction in RV end-systolic pressure was associated with a reduction in effective arterial elastance from 0.65 ± 0.43 mm Hg/mL at low speed to 0.54 ± 0.33 mm Hg/mL at high speed (P = 0.02). CONCLUSIONS Interventricular interactions resulted in improved RV compliance, diminished afterload, and did not reduce RV contractility. These data challenge the prevailing view that interventricular interactions compromise RV function, which has important implications for the understanding of RV-LV interactions in various disease states, including post-LVAD RV dysfunction.
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Affiliation(s)
- Michael I Brener
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, USA
| | - Manreet K Kanwar
- Cardiovascular Institute at Alleghany Health Network, Pittsburgh, Pennsylvania, USA
| | - Matthew M Lander
- Cardiovascular Institute at Alleghany Health Network, Pittsburgh, Pennsylvania, USA
| | - Nadira B Hamid
- Division of Cardiology, Minneapolis Heart Institute, Minneapolis, Minnesota, USA
| | - Amresh Raina
- Cardiovascular Institute at Alleghany Health Network, Pittsburgh, Pennsylvania, USA
| | - Sanjum S Sethi
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, USA
| | - Matthew T Finn
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, USA
| | - Justin A Fried
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, USA
| | - Jayant Raikhelkar
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, USA
| | - Amirali Masoumi
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Hannah R Rosenblum
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, USA
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, USA
| | - Gabriel Sayer
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, USA
| | - Daniel Burkhoff
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Nir Uriel
- Division of Cardiology, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, USA.
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Gould CV, Free RJ, Bhatnagar J, Soto RA, Royer TL, Maley WR, Moss S, Berk MA, Craig-Shapiro R, Kodiyanplakkal RPL, Westblade LF, Muthukumar T, Puius YA, Raina A, Hadi A, Gyure KA, Trief D, Pereira M, Kuehnert MJ, Ballen V, Kessler DA, Dailey K, Omura C, Doan T, Miller S, Wilson MR, Lehman JA, Ritter JM, Lee E, Silva-Flannery L, Reagan-Steiner S, Velez JO, Laven JJ, Fitzpatrick KA, Panella A, Davis EH, Hughes HR, Brault AC, St George K, Dean AB, Ackelsberg J, Basavaraju SV, Chiu CY, Staples JE. Transmission of yellow fever vaccine virus through blood transfusion and organ transplantation in the USA in 2021: report of an investigation. Lancet Microbe 2023; 4:e711-e721. [PMID: 37544313 DOI: 10.1016/s2666-5247(23)00170-2] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND In 2021, four patients who had received solid organ transplants in the USA developed encephalitis beginning 2-6 weeks after transplantation from a common organ donor. We describe an investigation into the cause of encephalitis in these patients. METHODS From Nov 7, 2021, to Feb 24, 2022, we conducted a public health investigation involving 15 agencies and medical centres in the USA. We tested various specimens (blood, cerebrospinal fluid, intraocular fluid, serum, and tissues) from the organ donor and recipients by serology, RT-PCR, immunohistochemistry, metagenomic next-generation sequencing, and host gene expression, and conducted a traceback of blood transfusions received by the organ donor. FINDINGS We identified one read from yellow fever virus in cerebrospinal fluid from the recipient of a kidney using metagenomic next-generation sequencing. Recent infection with yellow fever virus was confirmed in all four organ recipients by identification of yellow fever virus RNA consistent with the 17D vaccine strain in brain tissue from one recipient and seroconversion after transplantation in three recipients. Two patients recovered and two patients had no neurological recovery and died. 3 days before organ procurement, the organ donor received a blood transfusion from a donor who had received a yellow fever vaccine 6 days before blood donation. INTERPRETATION This investigation substantiates the use of metagenomic next-generation sequencing for the broad-based detection of rare or unexpected pathogens. Health-care workers providing vaccinations should inform patients of the need to defer blood donation for at least 2 weeks after receiving a yellow fever vaccine. Despite mitigation strategies and safety interventions, a low risk of transfusion-transmitted infections remains. FUNDING US Centers for Disease Control and Prevention (CDC), the Biomedical Advanced Research and Development Authority, and the CDC Epidemiology and Laboratory Capacity Cooperative Agreement for Infectious Diseases.
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Affiliation(s)
- Carolyn V Gould
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA.
| | - Rebecca J Free
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julu Bhatnagar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Raymond A Soto
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tricia L Royer
- Division of Infectious Diseases, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Warren R Maley
- Division of Transplantation, Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Sean Moss
- Division of Infectious Diseases, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew A Berk
- Department of Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Rebecca Craig-Shapiro
- Division of Transplant Surgery, Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | | | - Lars F Westblade
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Thangamani Muthukumar
- Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Yoram A Puius
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, New York, NY, USA
| | - Amresh Raina
- Section of Advanced Heart Failure, Transplant, Mechanical Circulatory Support, and Pulmonary Hypertension, Cardiovascular Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Azam Hadi
- Section of Advanced Heart Failure, Transplant, Mechanical Circulatory Support, and Pulmonary Hypertension, Cardiovascular Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Kymberly A Gyure
- Department of Pathology and Laboratory Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Danielle Trief
- Department of Ophthalmology, Edward S Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Marcus Pereira
- Transplant Infectious Disease Program, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - Matthew J Kuehnert
- Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | - Vennus Ballen
- Bureau of Public Health Clinics, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Debra A Kessler
- Medical Programs and Services, New York Blood Center, New York, NY, USA
| | - Kimberly Dailey
- Division of Infectious Disease and Epidemiology, West Virginia Department of Health, Charleston, WV, USA
| | - Charles Omura
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Thuy Doan
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Steve Miller
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Michael R Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer A Lehman
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Jana M Ritter
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth Lee
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Luciana Silva-Flannery
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah Reagan-Steiner
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jason O Velez
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Janeen J Laven
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Kelly A Fitzpatrick
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Amanda Panella
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Emily H Davis
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Holly R Hughes
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Aaron C Brault
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Kirsten St George
- Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health, Albany, NY, USA; Department of Biomedical Science, Graduate School of Public Health, State University of New York at Albany, Albany, NY, USA
| | - Amy B Dean
- Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Joel Ackelsberg
- Bureau of Communicable Diseases, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Charles Y Chiu
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - J Erin Staples
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
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Brener M, Kanwar M, Lander M, Hamid N, Raina A, Sethi S, Finn M, Fried J, Raikhelkar J, Masoumi A, Sayer G, Burkhoff D, Uriel N. Interventricular Interactions in LVAD Recipients: Insights from PV Loop Analysis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.854] [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: 04/05/2023] Open
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5
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Madgula A, Brocious J, Lander M, Raina A, Kanwar M. Chronic Renal Replacement Therapy in Patients with Durable Left Ventricular Assist Devices. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.784] [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: 04/05/2023] Open
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Noory AJ, Al-Adwan SA, Link CB, Lasorda DM, Raina A. TIGHT SQUEEZE: LEFT MAIN CORONARY ARTERY COMPRESSION IN SEVERE PULMONARY ARTERIAL HYPERTENSION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03894-9] [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: 03/06/2023]
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Dahiya G, Kyvernitakis A, Elhamdani A, Begg A, Doyle M, Elsayed M, Bailey S, Raina A, Kanwar M, Biederman RWW, Benza RL. Prognostic role of pulmonary hemodynamics before transcatheter aortic valve replacement among patients with severe aortic stenosis. J Heart Lung Transplant 2023; 42:275-282. [PMID: 36437170 DOI: 10.1016/j.healun.2022.10.001] [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: 03/21/2022] [Revised: 08/17/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) frequently co-exists in patients with severe aortic stenosis (AS). In this study, we sought to identify the implications of invasive pulmonary hemodynamics on major adverse cardiac events (MACE), biventricular function and NYHA functional class after transcatheter aortic valve replacement (TAVR). METHODS Invasive hemodynamics via right heart catheterization (RHC) were performed pre-TAVR. Patients were stratified per mean PA pressure (mPAP), diastolic pulmonary gradient (DPG) and pulmonary vascular resistance (PVR), and followed at 1-month and 1-year intervals up to 6 years. MACE outcomes included cardiovascular death and heart failure hospitalizations post-TAVR. RESULTS Among 215 patients, Kaplan-Meir estimates demonstrated an increased 1-year risk of MACE from 8% among those without pre-TAVR PH to 27% among patients with pre-existing PH. Specifically, the MACE risk was 32% among PH patients with PVR ≥ 3WU (p = .04) and 53% among PH patients with DPG ≥ 7 mm Hg (p < .01). On univariate Cox regression, RV stroke work index (RVSWI) (HR,1.02; p = .02), and pulmonary hemodynamic index (PHI) (HR,1.27; p = .047) were identified as additional predictors of MACE post-TAVR. On multivariable Cox regression analysis, SvO2 (HR, 0.95; p = .01) and PVR (HR, 1.2; p = .04) were demonstrated as predictive of MACE post-TAVR. A significant improvement in LVEF (2-Factor ANOVA, p < .01) and RV fractional area change (RVFAC%) (p < .01) was noted as assessed at baseline, 1-month and 1-year follow up post-TAVR. There was a significant interaction between pre-TAVR PH status and time post procedure with respect to NYHA functional class (p = .03), that is, the manner and degree of change in NYHA class over time depended on pre-TAVR PH status. CONCLUSIONS Defining invasive pulmonary hemodynamics, such as mPAP, PVR, and DPG among patients with severe AS undergoing TAVR has significant prognostic implications. Routine risk stratification by utilizing invasive hemodynamics can better identify patients who will have functional improvement and improved outcomes post-TAVR.
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Affiliation(s)
- Garima Dahiya
- Division of Cardiovascular Disease, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Andreas Kyvernitakis
- Division of Cardiovascular Disease, Department of Medicine, Allegheny Health Network Education Consortium, Pittsburgh, Pennsylvania
| | - Adee Elhamdani
- Department of Internal Medicine, Allegheny Health Network Education Consortium, Pittsburgh, Pennsylvania
| | - Andrew Begg
- Department of Internal Medicine, Allegheny Health Network Education Consortium, Pittsburgh, Pennsylvania
| | - Mark Doyle
- Division of Cardiovascular Disease, Department of Medicine, Allegheny Health Network Education Consortium, Pittsburgh, Pennsylvania
| | - Mahmoud Elsayed
- Division of Cardiovascular Disease, Department of Medicine, Allegheny Health Network Education Consortium, Pittsburgh, Pennsylvania
| | - Stephen Bailey
- Department of Thoracic and Cardiovascular Surgery, Allegheny Health Network Education Consortium, Pittsburgh, Pennsylvania
| | - Amresh Raina
- Division of Cardiovascular Disease, Department of Medicine, Allegheny Health Network Education Consortium, Pittsburgh, Pennsylvania
| | - Manreet Kanwar
- Division of Cardiovascular Disease, Department of Medicine, Allegheny Health Network Education Consortium, Pittsburgh, Pennsylvania
| | - Robert W W Biederman
- Division of Cardiovascular Disease, Department of Medicine, Allegheny Health Network Education Consortium, Pittsburgh, Pennsylvania
| | - Raymond L Benza
- Division of Cardiovascular Medicine and Pulmonary Hypertension, Department of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio.
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Deicke M, Alhuneafat L, Obaid O, Adeniyi A, Raina A, Kassis‐George H. Rapidly progressive pulmonary hypertension and right ventricular failure in a heart and kidney transplant recipient. Clin Case Rep 2022; 10:e6631. [PMID: 36483880 PMCID: PMC9723255 DOI: 10.1002/ccr3.6631] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/04/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022] Open
Abstract
A 54-year-old man status post heart and kidney transplant presented with dyspnea. Imaging was consistent with lymphangitic carcinomatosis (LC), in the setting of biopsy proven adenocarcinoma. He developed pulmonary hypertension (PH) and died of right ventricular failure (RVF) 3 weeks later. Acute PH with radiographic features of LC in a high-risk patient warrants expedited malignancy investigation.
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Affiliation(s)
- Matthew Deicke
- Department of Internal Medicine, Allegheny Health NetworkAllegheny General HospitalPittsburghPennsylvaniaUSA
| | - Laith Alhuneafat
- Department of Internal Medicine, Allegheny Health NetworkAllegheny General HospitalPittsburghPennsylvaniaUSA
| | - Omar Obaid
- Department of CardiologySt. Mary Medical CenterHobartIndianaUSA
| | - Aderonke Adeniyi
- Alice Hyde Medical CenterUniversity of Vermont Health NetworkMaloneNew YorkUSA
| | - Amresh Raina
- Section of Advanced Heart Failure and Pulmonary HypertensionCardiovascular Institute, Allegheny Health Network, Allegheny General HospitalPittsburghPennsylvaniaUSA
| | - Hayah Kassis‐George
- Section of Advanced Heart Failure and Pulmonary HypertensionCardiovascular Institute, Allegheny Health Network, Allegheny General HospitalPittsburghPennsylvaniaUSA
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Frantz RP, Shlobin OA, Raina A, Wu B, Broderick M, Classi P, Sketch MR. Change in REVEAL Lite 2 and COMPERA 2.0 risk status in patients with pulmonary arterial hypertension initiating oral treprostinil on dual background therapy: a retrospective chart review. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1919] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Post-hoc analyses of the FREEDOM-EV study demonstrated that addition of oral treprostinil (ORE) to background monotherapy improves risk in patients with pulmonary arterial hypertension (PAH). Evidence is needed to understand the incremental effect of ORE added to dual background therapy with an endothelin receptor antagonist (ERA) and phosphodiesterase-5 inhibitor (PDE5)/soluble guanylate cyclase stimulator (sGC).
Purpose
To describe longitudinal changes in REVEAL Lite 2 and COMPERA 2.0 risk status in patients initiating ORE on dual background therapy.
Methods
A multisite, double-blind retrospective chart review of PAH patients was conducted by US PAH-treating physicians and included patients meeting prior diagnostic PAH criteria (mPAP ≥25 mmHg/PAWP ≤15 mmHg/PVR >3 WU), age ≥18 at diagnosis, began a PAH treatment 01/2014–03/2017, and had NT-proBNP/BNP, WHO functional class (FC), and 6-minute walk distance (6MWD) at baseline visit. Baseline was most recent assessment prior to ORE initiation. This analysis included a subset of patients on dual background therapy at time of ORE initiation without prior prostacyclin use. Follow-up was evaluated in 0–6 and 6–12 months after ORE initiation.
Results
30 (61.2%) of 49 ORE patients were on dual background therapy at time of ORE start; 23 had baseline assessments while on dual background therapy and were included in this analysis. At baseline, mean (SD) 6MWD was 140.9 (49.8) m and 21 (91.3%) patients were FC III. Prior to ORE, median (IQR) time on ERA was 6.6 (5.5–7.6) months and PDE5/sGC was 3.7 (3.3–5.7) months. After ORE start, median (IQR) time to follow-up was 4.3 (3.4–5.6) months in 0–6 months and 10.9 (9.6–11.6) months in 6–12 months. Using REVEAL Lite 2, baseline mean (SD) REVEAL Lite 2 risk score was 7.9 (0.8); 1 (4.4%), 2 (8.7%), and 20 (87%) patients were in the low, intermediate, and high risk strata, respectively. In 0–6 months (n=22), 13 (59.1%) patients improved and 9 (40.9%) stabilized REVEAL Lite 2 risk strata from baseline. In 6–12 months (n=22), mean (SD) REVEAL Lite 2 risk score was 6.5 (1.1); 15 patients (68.2%) improved, 6 (27.3%) stabilized, and 1 (4.6%) worsened REVEAL Lite 2 risk strata from baseline. Using COMPERA 2.0, at baseline, 1 (4.4%) patient was in the intermediate-low and 22 (95.7%) patients were in the intermediate-high risk strata. In 0–6 months (n=15), 10 (66.7%) patients improved and 5 (33.3%) patients stabilized COMPERA 2.0 risk strata from baseline. In 6–12 months (n=17), 15 (88.2%) patients improved and 2 (11.8%) stabilized COMPERA 2.0 risk strata from baseline.
Conclusion
Of patients initiating oral treprostinil in this study, most were on dual background therapy and at high risk by REVEAL Lite 2 or intermediate-high risk by COMPERA 2.0. This analysis suggests adding ORE to dual background therapy can improve risk status in patients, with clinical benefit attained within 6 months and continued incremental improvement through first year of therapy.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): United Therapeutics Corporation
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Affiliation(s)
- R P Frantz
- Mayo Clinic , Rochester , United States of America
| | - O A Shlobin
- Inova Heart and Vascular Institute , Falls Church , United States of America
| | - A Raina
- Allegheny General Hospital , Pittsburgh , United States of America
| | - B Wu
- United Therapeutics Corporation , Research Triangle Park , United States of America
| | - M Broderick
- United Therapeutics Corporation , Research Triangle Park , United States of America
| | - P Classi
- United Therapeutics Corporation , Research Triangle Park , United States of America
| | - M R Sketch
- United Therapeutics Corporation , Research Triangle Park , United States of America
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Lander MM, McGregor WE, Lasorda D, Chakravarthy M, Raina A. Candidacy For Transcatheter Edge-to-edge Mitral Valve Repair Despite Low Cardiac Index A Single Center Experience. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.164] [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: 10/18/2022]
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11
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Link C, Veasey T, Sorci S, Raina A, Uber P, Mohney K, Kanwar M. Photopheresis in Antibody Mediated Rejection: A Single Center Experience. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1144] [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: 11/29/2022] Open
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12
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Thangavel S, Kanwar M, Benza R, Raina A. Long Term Safety and Outcomes Utilizing the CardioMEMS Device in Patients with Pulmonary Arterial Hypertension. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.330] [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: 10/18/2022] Open
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13
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Fu S, Mian T, Radhakrishnan S, Joseph NR, Khalif A, Hughes-Doichev R, Lasorda D, Chakravarthy M, Radhakrishnan AU, Raina A. CHARACTERISTICS AND OUTCOMES OF PATIENTS UNDERGOING ENDOVASCULAR REMOVAL OF TRICUSPID VALVE VEGETATIONS VS. CATHETER-RELATED MASSES USING THE ANGIOVAC SYSTEM. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01586-8] [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: 11/29/2022]
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14
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Morland K, Raina A, Nails A, Classi P, Etschmaier M, Frantz RP. Reasons for refusing parenteral therapy: a qualitative study of patients with pulmonary arterial hypertension. Pulm Circ 2022; 11:20458940211046761. [PMID: 35024138 PMCID: PMC8743947 DOI: 10.1177/20458940211046761] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/15/2021] [Indexed: 11/16/2022] Open
Abstract
While parenteral prostacyclin (pPCY) therapy, delivered either subcutaneously or intravenously, is recommended for pulmonary arterial hypertension patients with severe or rapidly developing disease, some patients refuse this treatment. This study aimed to understand, directly from patients with pulmonary arterial hypertension, why pPCY was refused and, in some cases, later accepted. Interviews were conducted with 25 pulmonary arterial hypertension patients who previously refused pPCY therapy (Group A: Refused/Never initiated (n = 9) and Group B: Refused/Initiated (n = 16)). Patients in both groups believed that pPCY could improve their symptoms, slow disease progression, and provide them a greater ability to perform activities. Reasons for refusal included concern over side effects and the perceived limitations of pPCY on daily activities. Group A perceived their decision as a balance between quality of life and prolonging life and most acknowledged they would reconsider pPCY if other treatment options were exhausted. Group B cited they initiated therapy due to a worsening of symptoms, disease progression, to improve quality of life, to be there for their family, or a desire to live. Following initiation, Group B indicated their experience met expectations with reduced symptoms, slowed disease progression, and perception of improved survival; concerns related to pPCY were described as manageable. Given the efficacy of pPCY therapy, clinicians should apply knowledge of these findings in clinical practice. Patients noted improvements to parenteral pump technologies to include smaller size, water resistance, and implantability may increase their acceptance of this modality. Development efforts should focus on technologies that increase the acceptance of pPCY when indicated.
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Affiliation(s)
- Kellie Morland
- United Therapeutics Corporation, Research Triangle Park, USA
| | | | - Abigail Nails
- United Therapeutics Corporation, Research Triangle Park, USA
| | - Peter Classi
- United Therapeutics Corporation, Research Triangle Park, USA
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15
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Kassis-George H, Raina A. Normal resting and exercise hemodynamics in pulmonary arterial hypertension: The roadmap to prostacyclin withdrawal? Int J Cardiol 2021; 350:109-110. [PMID: 34963644 DOI: 10.1016/j.ijcard.2021.12.034] [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] [Received: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | - Amresh Raina
- Cardiovascular Institute, Allegheny General Hospital, USA.
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16
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Chaturvedi A, Khoury F, Vashistha K, Patel K, Mareda P, Veasey T, Link C, Raina A. Incidence of Post-Heart Transplant Chronic Thyroiditis and Its Association With Pretransplant Amiodarone Use. Transplant Proc 2021; 53:3045-3050. [PMID: 34728077 DOI: 10.1016/j.transproceed.2021.09.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/15/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic thyroiditis (CT) is a common cause of thyroid dysfunction and could therefore adversely affect outcomes in patients undergoing heart transplant (HT). The incidence of post-HT CT and whether amiodarone, a commonly used anti-arrhythmic drug in patients with heart failure during pre-HT period, is associated with the development of post-HT CT are unknown. METHODS A retrospective review of HT recipients from February 2, 2010 to October 16, 2018 was performed. Patients who lacked relevant pre-/post-HT records, underwent thyroidectomy, had pre-HT thyroid dysfunction or thyroiditis within 15 days post-HT, and those on amiodarone during the post-HT period were excluded, yielding a final cohort of 75 patients. RESULTS Patients had a mean age of 63.3 ± 1.4 years and were predominantly male (90.7%) and white (80%). The incidence of post-HT CT was 32% with the majority (83.3%) manifesting as hypothyroidism. Median time to diagnosis of CT after transplant was 10.2 months (interquartile range, 4-27.4). Additionally, the CT group had higher pre-HT use of amiodarone (non-CT vs CT: 21.6% vs 50%, P = .01), higher prevalence of atrial fibrillation (non-CT vs CT: 23.5% vs 45.8%; P = .05), and more stage IV/V chronic kidney disease (non-CT vs CT: 2% vs 16.7%, P = .02). On multivariate analysis, pre-HT amiodarone use was associated with the development of post-HT CT after adjustment for age, sex, and chronic kidney disease (odds ratio, 3.65; 95% CI, 1.17-11.44; P = .03). CONCLUSION The incidence of post-HT CT is high and is strongly associated with pre-HT amiodarone use underpinning the importance of closely following the post-HT thyroid profile in these patients.
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Affiliation(s)
- Abhishek Chaturvedi
- Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States; Medicine Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | - Fadi Khoury
- Medicine Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | | | - Kinjalben Patel
- Medicine Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | - Patricia Mareda
- Department of Endocrinology, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | - Tara Veasey
- Department of Pharmacy, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | - Christopher Link
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | - Amresh Raina
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States.
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17
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Aldweib N, Verlinden NJ, Kassis-George H, Raina A. Transition from parenteral prostacyclins to selexipag: safety and feasibility in selected patients. Pulm Circ 2021; 11:20458940211036623. [PMID: 34646497 PMCID: PMC8504235 DOI: 10.1177/20458940211036623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022] Open
Abstract
There are limited data regarding the feasibility of transitioning from intravenous prostacyclins to selexipag in pulmonary arterial hypertension patients. We present a case series of successful transitions from intravenous prostacyclins to selexipag in the majority of carefully selected five stable pulmonary arterial hypertension patients using a standardized protocol in the outpatient setting.
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Affiliation(s)
- Nael Aldweib
- Section of Advanced Heart Failure and Pulmonary Hypertension, Cardiovascular Institute, Allegheny General Hospital, Allegheny Health Network, Allegheny General Hospital, Pittsburgh, USA.,Adult Congenital Heart Disease Program, Knight Cardiovascular Institute, Oregon Health Science University, Portland, USA
| | - Nathan J Verlinden
- Section of Advanced Heart Failure and Pulmonary Hypertension, Cardiovascular Institute, Allegheny General Hospital, Allegheny Health Network, Allegheny General Hospital, Pittsburgh, USA
| | - Hayah Kassis-George
- Section of Advanced Heart Failure and Pulmonary Hypertension, Cardiovascular Institute, Allegheny General Hospital, Allegheny Health Network, Allegheny General Hospital, Pittsburgh, USA
| | - Amresh Raina
- Section of Advanced Heart Failure and Pulmonary Hypertension, Cardiovascular Institute, Allegheny General Hospital, Allegheny Health Network, Allegheny General Hospital, Pittsburgh, USA
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Joseph NR, Fu S, Raina A. LEFT ATRIUM-FEMORAL ARTERY BYPASS WITH A PERCUTANEOUS VENTRICULAR ASSIST DEVICE AS BRIDGE TO TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATIENTS WITH CRITICAL AORTIC STENOSIS AND CARDIOGENIC SHOCK. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03615-9] [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: 11/28/2022]
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19
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Raina A. When more speaks to less: New insights into arrhythmias in pulmonary hypertension from long term continuous monitoring. Int J Cardiol 2021; 334:123-124. [PMID: 33945803 DOI: 10.1016/j.ijcard.2021.04.054] [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] [Received: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Amresh Raina
- Director, Advanced Heart Failure & Pulmonary Hypertension Programs, Section of Heart Failure/Transplant/MCS & Pulmonary Hypertension, Echocardiography Staff, Allegheny General Hospital, Associate Professor of Medicine, Drexel University College of Medicine, 320 East North Avenue, Pittsburgh, PA 15212-4772, United States.
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20
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Joshi AA, Hajjali RH, Gokhale AV, Smith T, Dey AK, Dahiya G, Lerman JB, Sajja AP, Kanwar M, Raina A. Outcomes of patients hospitalized for acute pulmonary embolism by obstructive sleep apnea status. Pulm Circ 2021; 11:2045894021996224. [PMID: 33854766 PMCID: PMC8013707 DOI: 10.1177/2045894021996224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/24/2021] [Indexed: 12/31/2022] Open
Abstract
Pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Obstructive sleep apnea (OSA) is increasingly recognized in the aging population, especially with the rising obesity epidemic. The impact of OSA on inpatient mortality in PE is not well understood. We used the Nationwide Inpatient Sample databases from 2005 to 2016 to identify 755,532 acute PE patients (age≥18 years). Among these, 61,050 (8.1%) were OSA+. Temporal trends in length of stay, inpatient mortality, and its association with OSA in PE patients were analyzed. The proportion of PE patients who were OSA+ increased from 2005 to 2016. OSA+ PE patients were younger and predominantly men. Despite a higher prevalence of traditional risk factors for inpatient mortality in OSA+ patients, OSA was associated with a lower risk of mortality in PE patients (odds ratio, 95% confidence interval; p: unadjusted 0.56, 0.53–0.58; p < 0.0001 and adjusted 0.55, 0.52–0.58; p < 0.0001). Overall mortality and length of stay in PE patients decreased over time. Relative to OSA– patients, there was a slight increase in mortality among OSA+ PE patients over time, although the length of stay remained unchanged between the two groups. In conclusion, OSA+ PE patients had a lower inpatient mortality compared to OSA– patients despite a higher prevalence of traditional mortality risk factors. Secondary pulmonary hypertension related to OSA with preconditioning of the right ventricle to elevated afterload may potentially explain the protective effect of OSA on mortality in PE. However, mechanistic studies need to further elucidate the links behind this association.
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Affiliation(s)
- Aditya A Joshi
- Institute of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, USA.,Department of Cardiology, St. Luke's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Avantee V Gokhale
- Department of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Triston Smith
- Department of Cardiology, Wheeling Hospital, Wheeling, WV, USA
| | - Amit K Dey
- Department of Internal Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Garima Dahiya
- Institute of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Joseph B Lerman
- Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - Aparna P Sajja
- Department of Internal Medicine, Johns Hopkins University Medical Center, Baltimore, MD, USA
| | - Manreet Kanwar
- Institute of Cardiovascular Medicine, Section of Advanced Heart Failure/Transplant/MCS and Pulmonary Hypertension, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Amresh Raina
- Institute of Cardiovascular Medicine, Section of Advanced Heart Failure/Transplant/MCS and Pulmonary Hypertension, Allegheny General Hospital, Pittsburgh, PA, USA
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21
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Benza RL, Kanwar MK, Raina A, Scott JV, Zhao CL, Selej M, Elliott CG, Farber HW. Development and Validation of an Abridged Version of the REVEAL 2.0 Risk Score Calculator, REVEAL Lite 2, for Use in Patients With Pulmonary Arterial Hypertension. Chest 2021. [PMID: 32882243 DOI: 10.1016/j.chest.2020.08.2069)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Achievement of low-risk status is a treatment goal in pulmonary arterial hypertension (PAH). Risk assessment often is performed using multiparameter tools, such as the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) risk calculator. Risk calculators that assess fewer variables without compromising validity may expedite risk assessment in the routine clinic setting. We describe the development and validation of REVEAL Lite 2, an abridged version of REVEAL 2.0. RESEARCH QUESTION Can a simplified version of the REVEAL 2.0 risk assessment calculator for patients with PAH be developed and validated? STUDY DESIGN AND METHODS REVEAL Lite 2 includes six noninvasive variables-functional class (FC), vital signs (systolic BP [SBP] and heart rate), 6-min walk distance (6MWD), brain natriuretic peptide (BNP)/N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and renal insufficiency (by estimated glomerular filtration rate [eGFR])-and was validated in a series of analyses (Kaplan-Meier, concordance index, Cox proportional hazard model, and multivariate analysis). RESULTS REVEAL Lite 2 approximates REVEAL 2.0 at discriminating low, intermediate, and high risk for 1-year mortality in patients in the REVEAL registry. The model indicated that the most highly predictive REVEAL Lite 2 parameter was BNP/NT-proBNP, followed by 6MWD and FC. Even if multiple, less predictive variables (heart rate, SBP, eGFR) were missing, REVEAL Lite 2 still discriminated among risk groups. INTERPRETATION REVEAL Lite 2, an abridged version of REVEAL 2.0, provides a simplified method of risk assessment that can be implemented routinely in daily clinical practice. REVEAL Lite 2 is a robust tool that provides discrimination among patients at low, intermediate, and high risk of 1-year mortality. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00370214; URL: www.clinicaltrials.gov.
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Affiliation(s)
| | | | | | | | - Carol L Zhao
- Janssen Pharmaceuticals, Inc, South San Francisco, CA
| | - Mona Selej
- Janssen Pharmaceuticals, Inc, South San Francisco, CA
| | - C Greg Elliott
- Intermountain Medical Center and the University of Utah, Salt Lake City, UT
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22
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Verlinden NJ, Benza RL, Raina A. Safety and efficacy of transitioning from the combination of bosentan and sildenafil to alternative therapy in patients with pulmonary arterial hypertension. Pulm Circ 2020; 10:2045894020945523. [PMID: 33354314 PMCID: PMC7734516 DOI: 10.1177/2045894020945523] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/06/2020] [Indexed: 11/15/2022] Open
Abstract
The combination of bosentan and sildenafil is commonly used to treat patients with pulmonary arterial hypertension (PAH); however, there is evidence of a significant drug interaction between these two medications. We sought to evaluate the safety and efficacy of transitioning patients with PAH from the combination of bosentan and sildenafil to alternative therapy. A retrospective database review was performed on 16 patients with PAH who were treated with the combination of bosentan and sildenafil and transitioned to alternative treatment at our center. Invasive and non-invasive patient parameters were collected at baseline and after transition. 56.3% of patients were in World Health Organization functional class (WHO FC) III and a majority of patients (68.7%) were on background prostacyclin therapy. The most common reason for transition was concern for a drug interaction in seven patients (43.8%). The most common transition was bosentan to macitentan in eight patients (50%). Fifteen patients (93.8%) tolerated the transition after a median follow-up of 6.5 months with minor adverse events occurring in four patients (25%). In 11 patients, 6-min walk distance (6MWD) was unchanged comparing baseline to post transition measurements with a median change of +8 m (range: −50 to + 70; P = 0.39). Nine patients (81.8%) had stable (within 15% margin) or significant improvement (increase by ≥15%) in 6MWD after transition. All patients demonstrated stable or improved WHO FC after transition. There were no significant changes after transition in hemodynamics, N-terminal pro-brain natriuretic peptide (NT-proBNP) values, or Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) risk scores. In our study, transitioning patients from bosentan and sildenafil to alternative therapy was safe and resulted in clinical stability.
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Affiliation(s)
- Nathan J. Verlinden
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA
- Nathan J. Verlinden, Cardiology Clinical Pharmacy Specialist, Allegheny General Hospital, 320 E North Avenue, Pittsburgh, PA 15212, USA.
| | - Raymond L. Benza
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amresh Raina
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA
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Chaturvedi A, Kanwar M, Chandrika P, Thenappan T, Raina A, Benza RL. Data on clinical and economic burden associated with pulmonary arterial hypertension related hospitalizations in the United States. Data Brief 2020; 32:106303. [PMID: 32995395 PMCID: PMC7502330 DOI: 10.1016/j.dib.2020.106303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 11/12/2022] Open
Abstract
A comprehensive description of the contemporary trends in pulmonary arterial hypertension (PAH) related hospitalizations, associated inpatient outcomes and predictors of worse outcomes were reported in our paper recently published in the International Journal of Cardiology [1]. Our observational analysis utilized ten year of national inpatient sample from January 1st 2007 through December 31st 2016. This Data in Brief companion paper aims to report the specific statistical highlights of the entire ten-year PAH cohort including demographics, hospital characteristics, regional variation, prevalence of comorbidities, and multivariable regression analysis used to examine the factors associated with increased inpatient mortality and prolonged length of stay. Additionally, we report trends in the cost (the actual amount of money reimbursed to the hospitals) of PAH related hospitalizations over the past ten years.
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Affiliation(s)
- Abhishek Chaturvedi
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Manreet Kanwar
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Parul Chandrika
- Department of Internal Medicine, Vidant Medical Center, Brody School of Medicine, Greenville, NC, United States
| | - Thenappan Thenappan
- Department of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Amresh Raina
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Raymond L Benza
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, United States
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24
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Benza RL, Corris PA, Klinger JR, Langleben D, Naeije R, Simonneau G, Ghofrani HA, Jansa P, Rosenkranz S, Scelsi L, Thenappan T, Raina A, Meier C, Busse D, Hoeper MM. Identifying potential parameters associated with response to switching from a PDE5i to riociguat in RESPITE. Int J Cardiol 2020; 317:188-192. [DOI: 10.1016/j.ijcard.2020.05.044] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 04/14/2020] [Accepted: 05/14/2020] [Indexed: 12/14/2022]
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Verlinden NJ, Walter C, Raina A, Benza RL. A Case Report of a Patient With Pulmonary Arterial Hypertension Transitioned From Inhaled Iloprost to Selexipag. J Pharm Pract 2020; 34:980-983. [PMID: 32912036 DOI: 10.1177/0897190020958242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a progressive disease characterized by elevated pulmonary vascular resistance that can lead to right ventricular failure and death. The use of medications that affect the prostacyclin pathway is an important treatment strategy in PAH. Inhaled iloprost is a prostacyclin analogue, and selexipag is an oral, non-prostanoid, prostacyclin IP receptor agonist. Data are limited on transitioning patients from inhaled iloprost to selexipag. In this case report, we describe the successful transition of a 57-year-old female with heritable PAH from inhaled iloprost to selexipag over 8 weeks in an out-patient setting. After initiation of selexipag, the patient's inhaled iloprost dose was gradually reduced and eventually discontinued. The patient tolerated the transition well with stable symptoms, 6-minute walk distance, and pulmonary hemodynamics. Additional studies are needed to better define the comparative efficacy and safety of inhaled iloprost and selexipag.
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Affiliation(s)
- Nathan J Verlinden
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Claire Walter
- Department of Pharmacy, University of Michigan Health System, Ann Arbor, MI, USA
| | - Amresh Raina
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Raymond L Benza
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Dahiya G, Kyvernitakis A, Joshi AA, Lasorda DM, Bailey SH, Raina A, Biederman RWW, Kanwar MK. Impact of transcatheter aortic valve replacement on left ventricular hypertrophy, diastolic dysfunction and quality of life in patients with preserved left ventricular function. Int J Cardiovasc Imaging 2020; 37:485-492. [DOI: 10.1007/s10554-020-02015-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
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Po JR, Tong M, Meeran T, Potluri A, Raina A, Doyle M, Biederman R. Quantification of Cardiac Output with Phase Contrast Magnetic Resonance Imaging in Patients with Pulmonary Hypertension. J Clin Imaging Sci 2020; 10:26. [PMID: 32363088 PMCID: PMC7193209 DOI: 10.25259/jcis_36_2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/13/2020] [Indexed: 11/04/2022] Open
Abstract
Objective The purpose of the study is to compare phase contrast (PC) imaging with invasive measurements of cardiac output (CO) in patients with pulmonary hypertension (PH). Materials and Methods We analyzed 81 cases with PH who underwent cardiac magnetic resonance imaging and right heart catheterization (RHC). Measurement of CO and stroke volume (SV) by cardiac magnetic resonance (CMR) was performed by PC imaging of the proximal aorta (Ao) and pulmonary artery (Pa) and by RHC using the Fick and thermodilution (TD) methods. Results There was good correlation in CO measurements between PC and RHC; however, there was better correlation with SV measurements; Fick-TD (r=0.85), PC-TD (Ao r=0.77, Pa r=0.79), and PC-Fick (Ao r = 0.73, Pa r = 0.78). Bland-Altman analysis of SV showed that Pa PC had slightly lower standard deviation than Ao PC; PC-Fick (Pa SD = 15.11 vs. Ao SD = 16.4 ml) and PC-TD (Pa SD = 16.99 ml vs. Ao SD = 17.4 ml) while Fick-TD had the lowest (SD = 14.4 ml). Compared to Fick, measurement of SV with Ao PC (‒4.12 ml) and Pa PC (0.22 ml) both had lower mean difference than TD (‒11.1 ml). Conclusion Non-invasive measurement of CO and SV using PC-CMR correlates well with invasive measurement using RHC. Our study showed that PC-CMR had high accuracy and precision when compared to Fick. Among all the modalities, PC-CMR contributed the least amount of variation in measurements.
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Affiliation(s)
- Jose Ricardo Po
- Borgess Heart Institute, Ascension Borgess Hospital, 1722 Shaffer St., Kalamazoo, Michigan, United States
| | - Matthew Tong
- Department of Cardiovascular Medicine, Wexner Medical Center, 410 W 10th Ave, Columbus, Ohio, United States
| | - Talha Meeran
- Department of Cardiology, Fortis Hospital Mulund, Mumbai, Maharashtra, India
| | - Alekhya Potluri
- Department of Cardiology, Einstein Medical Center, 5401 Old York Road, Philadelphia, United States
| | - Amresh Raina
- Cardiovascular Institute, Allegheny General Hospital, 320 E North Ave., Pittsburgh, Pennsylvania, United States
| | - Mark Doyle
- Cardiovascular Institute, Allegheny General Hospital, 320 E North Ave., Pittsburgh, Pennsylvania, United States
| | - Robert Biederman
- Cardiovascular Institute, Allegheny General Hospital, 320 E North Ave., Pittsburgh, Pennsylvania, United States
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Chaturvedi A, Patel K, Vashistha K, Kanwar M, Raina A. Post-Cardiac Transplant Lymphocytic Thyroiditis Secondary to Amiodarone Use in the Pre-Transplant Period. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1124] [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: 11/28/2022] Open
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29
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Kanwar M, Khan M, Raina A, Badagliacca R, Antaki J, Amin E, Benza R. Role of Echocardiogram in Predicting Prognosis in Pulmonary Arterial Hypertension: A Meta-Analysis. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.121] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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30
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Dahiya G, Begg A, Kyvernitakis A, Doyle M, Lasorda D, Bailey S, Raina A, Biederman R, Benza R. IMPACT OF PULMONARY HEMODYNAMICS ON CARDIAC EVENTS AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT AMONG PATIENTS WITH SEVERE AORTIC STENOSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32720-0] [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: 10/24/2022]
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31
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Begg AS, Dahiya G, Kyvernitakis A, Doyle M, Lasorda D, Bailey S, Raina A, Biederman R, Benza R. IS PRE-EXISTING PULMONARY HYPERTENSION A PREDICTOR OF LEFT VENTRICLE SYSTOLIC FUNCTION AND FUNCTIONAL OUTCOMES AMONG PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT? J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32816-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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32
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Sokos GG, Raina A. Understanding the early mortality benefit observed in the PARADIGM-HF trial: considerations for the management of heart failure with sacubitril/valsartan. Vasc Health Risk Manag 2020; 16:41-51. [PMID: 32021227 PMCID: PMC6972579 DOI: 10.2147/vhrm.s197291] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 08/02/2019] [Indexed: 12/11/2022] Open
Abstract
This review aims to elucidate the optimal dosing of angiotensin receptor-neprilysin inhibitor (ARNI) therapy in the heart failure (HF) treatment paradigm through examination of the trial population characteristics and the mortality benefit observed in the Prospective Comparison of ARNI with angiotensin-converting enzyme inhibitor (ACEI) to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF; NCT01035255) trial. Considerations regarding the initiation and titration of sacubitril/valsartan, a first-in-class ARNI, will also be addressed. The approval of sacubitril/valsartan heralded the first novel pharmacological class in over a decade for the treatment of heart failure with reduced ejection fraction (HFrEF). The PARADIGM-HF trial showed that treatment with valsartan/valsartan reduced the risk of first occurrence of either cardiovascular death or HF-related hospitalization (composite primary endpoint) by 20% compared with enalapril in patients with HFrEF. The incremental benefits of treatment with valsartan/valsartan over enalapril demonstrated in the PARADIGM-HF trial led to strong recommendations for its use over ACEIs or angiotensin receptor blockers to further reduce morbidity and mortality in the 2016 and 2017 American College of Cardiology/American Heart Association/Heart Failure Society of America updates to the guidelines for the management of HF. Although the optimal timing for the initiation of valsartan/valsartan has yet to be determined, its early use is likely to have a positive impact on patient outcomes.
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Affiliation(s)
- George G Sokos
- Department of Medicine, Division of Cardiology, West Virginia School of Medicine, Morgantown, WV, USA
| | - Amresh Raina
- Pulmonary Hypertension Program, Section of Heart Failure/Transplant/MCS & Pulmonary Hypertension, Allegheny General Hospital, AGH McGinnis Cardiovascular Institute, Pittsburgh, PA, USA
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33
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Thosani A, Raina A, Liu E, Lasorda D, Chenarides J. Malpositioned endocardial left ventricular pacing lead extraction with transcatheter cerebral embolic protection in the setting of multiple prior embolic strokes. HeartRhythm Case Rep 2019; 5:552-554. [PMID: 31890572 PMCID: PMC6926233 DOI: 10.1016/j.hrcr.2019.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/09/2019] [Accepted: 08/19/2019] [Indexed: 12/03/2022] Open
Affiliation(s)
- Amit Thosani
- Address reprint requests and correspondence: Dr Amit Thosani, Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA 15212.
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34
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Joshi AA, Lerman JB, Sajja AP, Dahiya G, Gokhale AV, Dey AK, Kyvernitakis A, Halbreiner MS, Bailey S, Alpert CM, Poornima IG, Murali S, Benza RL, Kanwar M, Raina A. Sex-Based Differences in Left Ventricular Assist Device Utilization. Circ Heart Fail 2019; 12:e006082. [DOI: 10.1161/circheartfailure.119.006082] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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] [Indexed: 12/20/2022]
Abstract
Background:
Women comprise approximately one-third of the advanced heart failure population but may receive fewer advanced heart failure therapies including left ventricular assist devices (LVADs). During the early pulsatile-flow device era, women had higher post-LVAD mortality and increased complications. However, knowledge about these differences in the continuous-flow device era is limited. Therefore, we sought to explore temporal trends in LVAD utilization and post-LVAD mortality by sex.
Methods and Results:
Patients with LVAD implantation from 2004 to 2016 were identified using the Nationwide Inpatient Sample. Trends in LVAD utilization and post-LVAD inpatient mortality were compared by sex and device era. Although LVADs are being increasingly utilized for patients with advanced systolic heart failure, women continue to represent a smaller proportion of LVAD recipients—25.8% in 2004 to 21.9% in 2016 (
P
for trend, 0.91). Women had increased inpatient mortality after LVAD implantation compared with men in the pulsatile-flow era (46.9% versus 31.1%,
P
<0.0001) but not in the continuous-flow era (13.3% versus 12.1%,
P
=0.27;
P
for interaction=0.0002). Inpatient mortality decreased for both sexes over time after LVAD, with a sharp fall in 2008 to 2009. Female sex was independently associated with increased post-LVAD inpatient mortality beyond adjustment for demographics and risk factors during the pulsatile-flow era (odds ratio, 2.13; 95% CI, 1.45–3.10;
P
<0.0001) but not during the continuous-flow era (1.18; 0.93–1.48;
P
=0.16).
Conclusions:
Although utilization of LVAD therapy increased over time for both sexes, LVAD implantation remains stably lower in women, which may suggest a potential underutilization of this potentially life-saving therapy. Prospective studies are needed to confirm these findings.
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Affiliation(s)
- Aditya A. Joshi
- Institute of Internal Medicine (A.A.J., G.D.), Allegheny General Hospital, Pittsburgh, PA
- Cardiovascular Institute (A.A.J., A.K., C.M.A., I.G.P., S.M., R.L.B., M.K., A.R.), Allegheny General Hospital, Pittsburgh, PA
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart at Mount Sinai St Luke’s Hospital, New York, NY (A.A.J.)
| | - Joseph B. Lerman
- Department of Internal Medicine, Duke University Medical Center, Durham, NC (J.B.L.)
| | - Aparna P. Sajja
- Department of Internal Medicine, Johns Hopkins University Medical Center, Baltimore, MD (A.P.S.)
| | - Garima Dahiya
- Institute of Internal Medicine (A.A.J., G.D.), Allegheny General Hospital, Pittsburgh, PA
| | - Avantee V. Gokhale
- Department of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY (A.V.G.)
| | - Amit K. Dey
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (A.K.D.)
| | - Andreas Kyvernitakis
- Cardiovascular Institute (A.A.J., A.K., C.M.A., I.G.P., S.M., R.L.B., M.K., A.R.), Allegheny General Hospital, Pittsburgh, PA
| | - M. Scott Halbreiner
- Division of Cardiac Surgery (M.S.H., S.B.), Allegheny General Hospital, Pittsburgh, PA
| | - Stephen Bailey
- Division of Cardiac Surgery (M.S.H., S.B.), Allegheny General Hospital, Pittsburgh, PA
| | - Craig M. Alpert
- Cardiovascular Institute (A.A.J., A.K., C.M.A., I.G.P., S.M., R.L.B., M.K., A.R.), Allegheny General Hospital, Pittsburgh, PA
| | - Indu G. Poornima
- Cardiovascular Institute (A.A.J., A.K., C.M.A., I.G.P., S.M., R.L.B., M.K., A.R.), Allegheny General Hospital, Pittsburgh, PA
| | - Srinivas Murali
- Cardiovascular Institute (A.A.J., A.K., C.M.A., I.G.P., S.M., R.L.B., M.K., A.R.), Allegheny General Hospital, Pittsburgh, PA
| | - Raymond L. Benza
- Cardiovascular Institute (A.A.J., A.K., C.M.A., I.G.P., S.M., R.L.B., M.K., A.R.), Allegheny General Hospital, Pittsburgh, PA
| | - Manreet Kanwar
- Cardiovascular Institute (A.A.J., A.K., C.M.A., I.G.P., S.M., R.L.B., M.K., A.R.), Allegheny General Hospital, Pittsburgh, PA
| | - Amresh Raina
- Cardiovascular Institute (A.A.J., A.K., C.M.A., I.G.P., S.M., R.L.B., M.K., A.R.), Allegheny General Hospital, Pittsburgh, PA
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35
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Naik M, Chaturvedi A, Kanwar M, Benza RL, Raina A. A Comparative Analysis of Clinical Variables Associated with Hospitalization in Pulmonary Arterial Hypertension. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.139] [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: 10/26/2022]
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36
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Naik M, Chaturvedi A, Raina A. Clinical Characteristics, Inpatient Management and Variables Associated with Post-Discharge Mortality in Pulmonary Arterial Hypertension; Patients Hospitalized with Right Heart Failure. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.137] [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: 11/28/2022]
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37
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Benza RL, Doyle M, Lasorda D, Parikh KS, Correa-Jaque P, Badie N, Ginn G, Airhart S, Franco V, Kanwar MK, Murali S, Raina A, Agarwal R, Rajagopal S, White J, Biederman R. Monitoring Pulmonary Arterial Hypertension Using an Implantable Hemodynamic Sensor. Chest 2019; 156:1176-1186. [PMID: 31265832 DOI: 10.1016/j.chest.2019.06.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 01/17/2019] [Revised: 05/23/2019] [Accepted: 06/18/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a chronic disease that ultimately progresses to right-sided heart failure (HF) and death. Close monitoring of pulmonary artery pressure (PAP) and right ventricular (RV) function allows clinicians to appropriately guide therapy. However, the burden of commonly used methods to assess RV hemodynamics, such as right heart catheterization, precludes frequent monitoring. The CardioMEMS HF System (Abbott) is an ambulatory implantable hemodynamic monitor, previously only used in patients with New York Heart Association (NYHA) class III HF. In this study, we evaluate the feasibility and early safety of monitoring patients with PAH and right-sided HF using the CardioMEMS HF System. METHODS The CardioMEMS HF sensors were implanted in 26 patients with PAH with NYHA class III or IV right-sided HF (51.3 ± 18.3 years of age, 92% women, 81% NYHA class III). PAH therapy was tracked using a minimum of weekly reviews of CardioMEMS HF daily hemodynamic measurements. Safety, functional response, and hemodynamic response were tracked up to 4 years with in-clinic follow-ups. RESULTS The CardioMEMS HF System was safely used to monitor PAH therapy, with no device-related serious adverse events observed and a single preimplant serious adverse event. Significant PAP reduction and cardiac output elevation were observed as early as 1 month postimplant using trends of CardioMEMS HF data, coupled with significant NYHA class and quality of life improvements within 1 year. CONCLUSIONS The CardioMEMS HF System provided useful information to monitor PAH therapy, and demonstrated short- and long-term safety. Larger clinical trials are needed before its widespread use to guide therapy in patients with severe PAH with right-sided HF.
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Affiliation(s)
- Raymond L Benza
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA.
| | - Mark Doyle
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA
| | - David Lasorda
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA
| | | | | | | | | | | | | | - Manreet K Kanwar
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA
| | - Srinivas Murali
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA
| | - Amresh Raina
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA
| | | | | | | | - Robert Biederman
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA
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38
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Kanwar M, Raina A, Lohmueller L, Kraisangka J, Benza R. The Use of Risk Assessment Tools and Prognostic Scores in Managing Patients with Pulmonary Arterial Hypertension. Curr Hypertens Rep 2019; 21:45. [PMID: 31025123 PMCID: PMC6756754 DOI: 10.1007/s11906-019-0950-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Pulmonary arterial hypertension (PAH) is a chronic, progressive, and incurable disease with significant morbidity and mortality. Despite increasingly available treatment options, PAH patients continue to experience disease progression and increased rates of hospitalizations due to right heart failure. Physician's ability to comprehensively assess PAH patients, determine prognosis, and monitor disease progression and response to treatment remains critical in optimizing outcomes. RECENT FINDINGS Risk assessment in PAH should include a range of clinical, hemodynamic, and exercise parameters, performed in a serial fashion over the course of treatment. Approaches to risk assessment in PAH patients include the use of risk variables, scores, and equations that stratify the impact of both modifiable (e.g., 6-min walk distance, functional class, brain natriuretic peptide), and non-modifiable (e.g., age, gender, PAH etiology) risk factors. Such tools allow physicians to better determine prognosis, allocate treatment resources, and enhance the consistency of treatment approaches across providers. Comprehensive and accurate risk prediction is essential to make individualized treatment decisions and optimizing outcomes in PAH.
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Affiliation(s)
- Manreet Kanwar
- Department of Cardiovascular Disease, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA
| | - Amresh Raina
- Department of Cardiovascular Disease, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA
| | | | | | - Raymond Benza
- Department of Cardiovascular Disease, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA.
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39
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Verlinden NJ, Walter C, Kanwar M, Raina A. Transition From Oral Treprostinil to Selexipag in a Patient With Pulmonary Arterial Hypertension. Ann Pharmacother 2019; 53:764-765. [DOI: 10.1177/1060028019843665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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40
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Hadi A, Alpert C, Murali S, Khoo C, Williams G, Benza R, Raina A, Lander M, Kanwar M. Intra-Aortic Balloon Pump Use before Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1159] [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: 11/17/2022] Open
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41
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Chaturvedi A, Naik M, Joshi A, PO J, Meeran T, Raina A. Determinants of Right Ventricular Dysfunction in Pulmonary Arterial Hypertension: Beyond Pulmonary Vascular Resistance. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1233] [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: 11/28/2022] Open
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42
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Mirza S, Khalif A, Khodjaev S, Alpert C, Raina A, Kanwar M, Murali S, Benza R, Hadi A. Echocardiographic Estimation of Pulmonary Artery Pulsatility Index in Pulmonary Hypertension. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1252] [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: 11/17/2022] Open
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43
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Joshi AA, Lerman J, Sajja A, Dey A, Patarroyo M, Raina A. TEMPORAL TRENDS IN CLINICAL AND FINANCIAL BURDEN OF HEART FAILURE HOSPITALIZATIONS IN CHRONIC INFLAMMATORY DISEASES: INSIGHTS FROM NATIONWIDE INPATIENT SAMPLE 2004-2016. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31596-7] [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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44
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Chaturvedi A, Naik M, Po JR, Meeran T, Raina A. DISCORDANT TRICUSPID ANNULAR PLANE SYSTOLIC EXCURSION AND GLOBAL RIGHT VENTRICULAR FUNCTION IN PULMONARY ARTERIAL HYPERTENSION: IMPACT OF RIGHT VENTRICULAR GEOMETRY AND TRICUSPID REGURGITATION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32538-0] [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: 10/27/2022]
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45
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Chaturvedi A, Joshi A, Chandrika P, Sharma T, Castagnaro M, Alpert C, Poornima I, Raina A. INCREASED CLINICAL BURDEN OF HEART FAILURE IN PATIENTS WITH DEPRESSION: INSIGHTS FROM THE NATIONAL INPATIENT SAMPLE DATABASE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31522-0] [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: 12/01/2022]
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46
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Benza RL, Corris PA, Ghofrani HA, Kanwar M, McLaughlin VV, Raina A, Simonneau G. EXPRESS: Switching to riociguat: A potential treatment strategy for the management of CTEPH and PAH. Pulm Circ 2019; 10:2045894019837849. [PMID: 30803329 PMCID: PMC7074518 DOI: 10.1177/2045894019837849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 02/08/2019] [Indexed: 12/22/2022] Open
Abstract
Currently, five classes of drug are approved for the treatment of pulmonary arterial hypertension (PAH): phosphodiesterase 5 inhibitors (PDE5i); endothelin receptor antagonists; prostacyclin analogs; the IP receptor agonist selexipag; and the soluble guanylate cyclase (sGC) stimulator riociguat. For patients with inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH), riociguat is currently the only approved pharmacotherapy. Despite the development of evidence-based guidelines on appropriate use of specific drugs, in clinical practice patients are often prescribed PAH-targeted therapies off label or at inadequate doses. PDE5i are the most often prescribed class of drugs as initial therapy, either alone or in combination with other drug classes. However, a proportion of patients receiving PAH therapies do not reach or maintain treatment goals. As PDE5i and riociguat target different molecules in the nitric oxide-sGC-cyclic guanosine monophosphate (NO-sGC-cGMP) signaling pathway, for patients with PAH without an initial or sustained response to PDE5i, there is a biological rationale for switching to riociguat. However, robust data from randomized controlled trials on the safety and efficacy of switching are lacking, as is formal guidance for clinicians. Here we review studies of sequential combination therapy, and trial data and case studies that have investigated switching between PAH-approved therapies, particularly from PDE5i to riociguat in patients with PAH with an insufficient response to PDE5i, and in patients with CTEPH who were receiving off-label treatment. These studies summarize the current evidence and practical real-life experience on the concept of switching treatments.
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Affiliation(s)
- Raymond L. Benza
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Paul A. Corris
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Hossein-Ardeschir Ghofrani
- University of Giessen and Marburg Lung Centre, Giessen, Germany, member of the German Centre for Lung Research (DZL)
- Department of Medicine, Imperial College London, London, UK
| | - Manreet Kanwar
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Amresh Raina
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Gérald Simonneau
- Assistance Publique–Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre, Université Paris-Sud, Laboratoire d’Excellence en Recherche sur le Médicament et Innovation Thérapeutique, and INSERM Unité 999, Le Kremlin–Bicêtre, France
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Abstract
PURPOSE In patients with left-sided HF, there has been less emphasis on the pathophysiology of the RV in terms of diagnostic evaluation and treatment, versus focus on structural abnormalities of the LV. This review seeks to delineate the importance of RV dysfunction in terms of its contribution to symptomatic limitations and cardiovascular outcomes in patients with left-sided HF. RECENT FINDINGS Recent studies have demonstrated that RV dysfunction is common in both HFpEF and HFrEF, but more pronounced in HFrEF. LV dysfunction and atrial fibrillation are most commonly associated with RV dysfunction in left-sided HF. RV dysfunction may develop due to afterload-dependent and afterload-independent pathways. Regardless, RV dysfunction is strongly associated with functional limitations and worsened survival in patients with left-sided HF. In patients with HFpEF, a recent study showed that RV failure was the most common cause of overall mortality. Among LVAD patients and patients post-cardiac transplantation, RV dysfunction is also strongly associated with survival. Despite a number of previous and ongoing clinical trials that target the RV directly or decrease RV afterload in left-sided HF, there are no definitive therapies specifically targeting RV dysfunction in left-sided HF patients CONCLUSIONS: RV dysfunction is an important determinant of symptomatic limitations and cardiovascular outcomes in patients with left-sided HF. Further research is needed to developed pharmacotherapy that may target the RV specifically in left-sided HF patients.
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Affiliation(s)
- Amresh Raina
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA. .,Pulmonary Hypertension Program, Section of Heart Failure/Transplant/MCS & Pulmonary Hypertension, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212-4772, USA.
| | - Talha Meeran
- Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA
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48
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Joshi AA, Davey R, Rao Y, Shen K, Benza RL, Raina A. Association between cytokines and functional, hemodynamic parameters, and clinical outcomes in pulmonary arterial hypertension. Pulm Circ 2018; 8:2045894018794051. [PMID: 30036135 PMCID: PMC6153541 DOI: 10.1177/2045894018794051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
To assess the relationship of cytokines with functional and clinical outcomes in
pulmonary arterial hypertension (PAH). Endothelial dysfunction and vascular
inflammation are characteristic of PAH. We investigated whether markers of
angiogenesis and inflammation associated with functional, hemodynamic
parameters, and clinical outcomes in PAH. PAH patients (n = 206) were pooled
from two clinical trials: TRUST-1 and FREEDOM-C2. Baseline and post-treatment
cytokine levels were correlated to baseline clinical and hemodynamic parameters,
were assessed in clinical subgroups, and were associated with clinical outcomes.
In 206 patients (mean age = 48 years; 74% women) with WHO group-1 PAH, most
cytokine levels were higher in those with 6-min walking distance
(6MWD) < median (335 m) vs. those above median, including Ang-1 (11.9 ± 10.1
vs. 5.9 ± 6.0 ng/mL), Ang-2 (14.3 ± 11.8 vs. 12.2 ± 11.2 ng/mL), and MMP-9
(221 ± 262.3 vs. 119 ± 171 ng/mL). Baseline 6MWD inversely correlated with Ang-1
(r = −0.27, P < 0.0001), Ang-2 (r = −0.20,
P = 0.004), and MMP-9 (r = −0.27,
P < 0.0001). MMP-9 levels differed significantly by NYHA
functional class (P = 0.001) suggesting an association between
MMP-9 and subjective PAH severity. Mean Ang-2 levels were higher in those with
baseline right atrial pressure (RAP) > 15 mmHg compared to those with
RAP < 15 mmHg (23,841 vs. 11,020 pg/mL). Baseline RAP was associated with
change in MMP-9 levels (r = −0.53, P = 0.03). Finally, baseline
Ang-1, VEGF and MMP-9 levels were associated with risk of death and
hospitalization at 16-week follow-up. Inflammatory cytokines and vascular
angiogenesis markers are associated with baseline functional, hemodynamic
parameters in PAH, and predict death and hospitalization. Larger prospective
studies are needed to confirm the utility of cytokines in PAH.
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Affiliation(s)
- Aditya A Joshi
- 1 Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Ryan Davey
- 2 Division of Cardiology, Western University, London, ON, Canada
| | - Youlan Rao
- 3 United Therapeutics Corporation, Research Triangle, NC, USA
| | - Kai Shen
- 3 United Therapeutics Corporation, Research Triangle, NC, USA
| | - Raymond L Benza
- 4 Section of Heart Failure/Transplant/MCS & Pulmonary Hypertension, Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Amresh Raina
- 4 Section of Heart Failure/Transplant/MCS & Pulmonary Hypertension, Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA
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49
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Abstract
Left ventricular assist devices (LVAD) are increasingly used for the treatment of end-stage heart failure. Right ventricular (RV) failure after LVAD implantation is an increasingly common clinical problem, occurring in patients early after continuous flow LVAD implant. RV failure is associated with a substantial increase in post-LVAD morbidity and mortality. RV failure can be predicted using preoperative hemodynamic, clinical, and echocardiographic variables and a variety of risk prediction algorithms. However, RV failure may also develop due to unanticipated intraoperative or perioperative factors. Early recognition and treatment are critical in terms of mitigating the impact of RV failure on post-LVAD outcomes.
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Affiliation(s)
- Amresh Raina
- Cardiovascular Institute, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212-4772, USA.
| | - Maria Patarroyo-Aponte
- Cardiovascular Institute, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212-4772, USA
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50
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Frontini L, Candido P, Cattaneo MT, Zonato S, Piatto E, Scapaticci R, Isa L, Raina A, Lanzetti V, Pavia G, Legnani W, Filipazzi V, Rho B, Piazza E. Cisplatin-Vinorelbine Combination Chemotherapy in Locally Advanced Non-Small Cell Lung Cancer. Tumori 2018; 82:57-60. [PMID: 8623506 DOI: 10.1177/030089169608200112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim The North Milan Group presents the results of a phase II study on a cisplatin-vinorelbine combination schedule in the treatment of locally advanced non-small cell lung cancer to evaluate its activity and tolerability. Methods Seventy-six consecutive patients entered the study. Patients’ characteristics were the following: males/females 69/7; median age, 61.4 years (range, 40-73); ECOG performance status, 0-1; 17 stage IIIa and 59 stage IIIb. There were 49 squamous cell carcinomas, 20 adenocarcinomas, and 7 large cell carcinomas. All patients had not been previously treated and showed measurable disease. Treatment consisted of vinorelbine, 25 mg/m2 on days 1 and 8, plus cisplatin, 80 mg/m2 on day 1, administered intravenously every 21 days for three standard courses. Results Seventy-four patients were evaluable for response. Objective responses were documented in 42/74 patients with an overall response rate (CR+PR) of 56.7%; 18/74 patients (24.3%) showed stable disease and the remaining 14/74 (18.9%) went into progression. Twelve patients (16.2%) were suitable for a subsequent surgery. The median duration of response was 13.3 months. Survival time ranged from 4 to 36 months: it was 14.6 months for PR patients, 8.6 months for NC and 5 months for PD. Mean survival time is presently 12.85 months (SE, 1.2 months). Toxicity evaluated on 222 cycles administered was acceptable, and it was necessary to use G-CSF or delay the treatment because of severe leukopenia in only a few cases. Conclusions The regimen is active and safe: the slight survival increase is likely due to the small amenability to surgery achieved (16.2%). However, our results are fully comparable to others obtained with vinorelbine in two/three drug combination chemotherapy regimens.
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Affiliation(s)
- L Frontini
- Oncology Department, San Paolo Hospital, Milano, Italy
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