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Pinsino A, Gaudig A, Castagna F, Mondellini GM, McDonnell BJ, Stöhr EJ, Cockcroft J, Kormos RL, Sayer GT, Uriel N, Naka Y, Takeda K, Yuzefpolskaya M, Colombo PC. Noninvasive Estimation of Blood Pressure in HeartMate 3 Patients. ASAIO J 2024; 70:e18-e20. [PMID: 37429021 DOI: 10.1097/mat.0000000000002012] [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] [Indexed: 07/12/2023] Open
Affiliation(s)
- Alberto Pinsino
- From the Montefiore Medical Center, Division of Critical Care Medicine, Bronx, New York
- Columbia University Irving Medical Center, Division of Cardiology, New York
| | - Antonia Gaudig
- Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Francesco Castagna
- Columbia University Irving Medical Center, Division of Cardiology, New York
- Montefiore Medical Center, Division of Cardiology, Bronx, New York
| | - Giulio M Mondellini
- Columbia University Irving Medical Center, Division of Cardiology, New York
- Università degli Studi di Milano, Milan, Italy
| | - Barry J McDonnell
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Eric J Stöhr
- Columbia University Irving Medical Center, Division of Cardiology, New York
- Leibniz University Hannover, COR-HELIX (CardiOvascular Regulation and Human Exercise Laboratory - Integration and Xploration), Institute of Sports Science, Hannover, Germany
| | - John Cockcroft
- School of Sport & Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | | | - Gabriel T Sayer
- Columbia University Irving Medical Center, Division of Cardiology, New York
| | - Nir Uriel
- Columbia University Irving Medical Center, Division of Cardiology, New York
| | - Yoshifumi Naka
- Division of Heart Failure, Heart Transplantation, and Mechanical Circulatory Support Program, Weill Cornell Medicine, New York
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York
| | | | - Paolo C Colombo
- Columbia University Irving Medical Center, Division of Cardiology, New York
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Castagna F, McDonnell BJ, Mondellini GM, Gaudig A, Pinsino A, McEniery C, Stöhr EJ, Takeda K, Naka Y, Uriel N, Yuzefpolskaya M, Cockcroft J, Parati G, Colombo PC. Twenty-four-hour blood pressure and heart rate variability are reduced in patients on left ventricular assist device support. J Heart Lung Transplant 2022; 41:802-809. [PMID: 35422348 DOI: 10.1016/j.healun.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Limited data exist on the circadian blood pressure (BP) and heart rate (HR) variations that occur in heart failure (HF) patients on left ventricular assist device (LVAD) support. METHODS We prospectively recorded clinic and 24-hour ambulatory BP and HR data in patients on HeartMate II LVAD support. Results were compared to HF patients with ejection fraction ≤30% and controls with no history of cardiovascular disease. Physiologic nocturnal BP and HR dipping was defined as a ≥10% decline compared to daytime values. RESULT Twenty-nine LVAD patients (age 59 ± 15 years, 76% male, 38% ischemic etiology), 25 HF patients (age 64 ± 13 years, 84% male, 32% ischemic etiology) and 26 controls (age 56 ± 9 years, 62% male) were studied. Normal nocturnal BP dipping was less frequent in LVAD patients (10%) than in HF patients (28%) and controls (62%) and reversed BP dipping (BP increase at night) was more common in LVAD patients (24%), compared to HF (16%) and controls (8%), (p < 0.001, for all comparisons). Physiologic HR reduction was less frequent in LVAD patients (14%), compared to HF (16%) and controls (59%) (p < 0.001, for all comparisons). Among LVAD patients, 36% exhibited sustained hypertension over the 24-hours and 25% had white-coat hypertension. CONCLUSIONS Treatment of advanced HF with an LVAD does not restore physiologic circadian variability of BP and HR; additionally, BP was not adequately controlled in more than a third of LVAD patients, and a quarter of them exhibited white-coat hypertension. Future studies are warranted to confirm these findings and investigate prognostic and management implications in this population.
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Affiliation(s)
- Francesco Castagna
- Division of Cardiology, Columbia University Medical Center, New York, New York; Division of Cardiology, Montefiore Medical Center, New York, New York
| | - Barry J McDonnell
- Department of Biomedical Research, Cardiff Metropolitan University, School of Sport and Health Sciences, Cardiff, UK
| | - Giulio M Mondellini
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Antonia Gaudig
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Alberto Pinsino
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Carmel McEniery
- Clinical Pharmacology Unit, University of Cambridge, Cambridge, UK
| | - Eric J Stöhr
- Division of Cardiology, Columbia University Medical Center, New York, New York; Department of Biomedical Research, Cardiff Metropolitan University, School of Sport and Health Sciences, Cardiff, UK
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York
| | - Nir Uriel
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | | | - John Cockcroft
- Department of Biomedical Research, Cardiff Metropolitan University, School of Sport and Health Sciences, Cardiff, UK
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan, Italy
| | - Paolo C Colombo
- Division of Cardiology, Columbia University Medical Center, New York, New York.
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Gaudig A, Pinsino A, Braghieri L, Wang Y, Mondellini G, Hastie J, Panzer O, Takeda K, Naka Y, Sayer G, Uriel N, Yuzefpolskaya M, Colombo P. Non-Invasive Estimation of Pulse Pressure in HeartMate 3 Patients. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Pinsino A, Mondellini G, Castagna F, Gaudig A, Yuzefpolskaya M, Uriel N, Sayer G, Takeda K, Naka Y, Cockcroft J, Stohr E, McDonnell B, Colombo P. Estimation of Mean Arterial Pressure Using Doppler and Pump Parameters in HeartMate 3 Patients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1099] [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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Castagna F, Mondellini G, Pinsino A, McDonnell B, Stöhr E, Gaudig A, Amlani A, Nwokocha J, Te-Frey R, Takeda K, Takayama H, Naka Y, Willey J, Yuzefpolskaya M, Parati G, Cockcroft J, Colombo P. Lack of Nocturnal Blood Pressure Reduction Increases the Risk of Stroke in Patients on Left Ventricular Assist Device Support. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Yuzefpolskaya M, Bohn B, Nasiri M, Zuver AM, Onat DD, Royzman EA, Nwokocha J, Mabasa M, Pinsino A, Brunjes D, Gaudig A, Clemons A, Trinh P, Stump S, Giddins MJ, Topkara VK, Garan AR, Takeda K, Takayama H, Naka Y, Farr MA, Nandakumar R, Uhlemann AC, Colombo PC, Demmer RT. Gut microbiota, endotoxemia, inflammation, and oxidative stress in patients with heart failure, left ventricular assist device, and transplant. J Heart Lung Transplant 2020; 39:880-890. [PMID: 32139154 DOI: 10.1016/j.healun.2020.02.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [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: 06/11/2019] [Revised: 01/13/2020] [Accepted: 02/06/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Gut microbial imbalance may contribute to endotoxemia, inflammation, and oxidative stress in heart failure (HF). Changes occurring in the intestinal microbiota and inflammatory/oxidative milieu during HF progression and following left ventricular assist device (LVAD) or heart transplantation (HT) are unknown. We aimed to investigate variation in gut microbiota and circulating biomarkers of endotoxemia, inflammation, and oxidative stress in patients with HF (New York Heart Association, Class I-IV), LVAD, and HT. METHODS We enrolled 452 patients. Biomarkers of endotoxemia (lipopolysaccharide and soluble [sCD14]), inflammation (C-reactive protein, interleukin-6, tumor necrosis factor-α, and endothelin-1 adiponectin), and oxidative stress (isoprostane) were measured in 644 blood samples. A total of 304 stool samples were analyzed using 16S rRNA sequencing. RESULTS Gut microbial community measures of alpha diversity were progressively lower across worsening HF class and were similarly reduced in patients with LVAD and HT (p < 0.05). Inflammation and oxidative stress were elevated in patients with Class IV HF vs all other groups (all p < 0.05). Lipopolysaccharide was elevated in patients with Class IV HF (vs Class I-III) as well as in patients with LVAD and HT (p < 0.05). sCD14 was elevated in patients with Class IV HF and LVAD (vs Class I-III, p < 0.05) but not in patients with HT. CONCLUSIONS Reduced gut microbial diversity and increased endotoxemia, inflammation, and oxidative stress are present in patients with Class IV HF. Inflammation and oxidative stress are lower among patients with LVAD and HT relative to patients with Class IV HF, whereas reduced gut diversity and endotoxemia persist in LVAD and HT.
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Affiliation(s)
- Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Bruno Bohn
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Mojdeh Nasiri
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Amelia M Zuver
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Drew D Onat
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Eugene A Royzman
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Joseph Nwokocha
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Melissa Mabasa
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Alberto Pinsino
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Danielle Brunjes
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Antonia Gaudig
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Autumn Clemons
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Pauline Trinh
- Department of Environmental and Occupational Health Sciences, University of Washington, School of Public Health, Seattle, Washington
| | - Stephania Stump
- Department of Medicine, Division of Infectious Diseases and Microbiome and Pathogen Genomics Core, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Marla J Giddins
- Department of Medicine, Division of Infectious Diseases and Microbiome and Pathogen Genomics Core, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - A Reshad Garan
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Maryjane A Farr
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Renu Nandakumar
- Biomarkers Core Laboratory, Irving Institute for Clinical and Translational Research, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Anne-Catrin Uhlemann
- Department of Medicine, Division of Infectious Diseases and Microbiome and Pathogen Genomics Core, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Division of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York.
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Pinsino A, Mondellini GM, Royzman EA, Hoffman KL, D'Angelo D, Mabasa M, Gaudig A, Zuver AM, Masoumi A, Garan AR, Mohan S, Husain SA, Toma K, Faillace RT, Giles JT, Takeda K, Takayama H, Naka Y, Topkara VK, Demmer RT, Radhakrishnan J, Colombo PC, Yuzefpolskaya M. Cystatin C- Versus Creatinine-Based Assessment of Renal Function and Prediction of Early Outcomes Among Patients With a Left Ventricular Assist Device. Circ Heart Fail 2020; 13:e006326. [PMID: 31959016 DOI: 10.1161/circheartfailure.119.006326] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Estimated glomerular filtration rate (eGFR) based on serum creatinine (sCr) improves early after left ventricular assist device (LVAD) implantation but subsequently declines. Although sCr is a commonly accepted clinical standard, cystatin C (CysC) has shown superiority in assessment of renal function in disease states characterized by muscle wasting. Among patients with an LVAD, we aimed to (1) longitudinally compare CysC-eGFR and sCr-eGFR, (2) assess their predictive value for early postoperative outcomes, and (3) investigate mechanisms which might explain potential discrepancies. METHODS A prospective cohort (n=116) with CysC and sCr concurrently measured at serial time points, and a retrospective cohort (n=91) with chest computed tomography performed within 40 days post-LVAD were studied. In the prospective cohort, the primary end point was a composite of in-hospital mortality, renal replacement therapy, or severe right ventricular failure. In the retrospective cohort, muscle mass was estimated using pectoralis muscle area indexed to body surface area (pectoralis muscle index). RESULTS In the prospective cohort, sCr-eGFR significantly improved early post-LVAD and subsequently declined, whereas CysC-eGFR remained stable. CysC-eGFR but not sCr-eGFR predicted the primary end point: odds ratio per 5 mL/(min·1.73 m2) decrease 1.16 (1.02-1.31) versus 0.99 (0.94-1.05). In retrospective cohort, for every 5 days post-LVAD, a 6% decrease in pectoralis muscle index was observed (95% CI, 2%-9%, P=0.003). After adjusting for time on LVAD, for every 1 cm2/m2 decrease in pectoralis muscle index, there was a 4% decrease in 30-day post-LVAD sCr (95% CI, 1%-6%, P=0.004). CONCLUSIONS Initial improvement in sCr-eGFR is likely due to muscle wasting following LVAD surgery. CysC may improve assessment of renal function and prediction of early postoperative outcomes in patients with an LVAD.
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Affiliation(s)
- Alberto Pinsino
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY.,Department of Medicine, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, NY (A.P., R.T.F.)
| | - Giulio M Mondellini
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Eugene A Royzman
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Katherine L Hoffman
- Department of Healthcare Policy & Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY (K.L.H., D.D.)
| | - Debra D'Angelo
- Department of Healthcare Policy & Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY (K.L.H., D.D.)
| | - Melissa Mabasa
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Antonia Gaudig
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Amelia M Zuver
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Amirali Masoumi
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - A Reshad Garan
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine (S.M., S.A.H., K.T., J.R.), Columbia University Irving Medical Center, New York, NY.,Department of Epidemiology, Mailman School of Public Health (S.M.), Columbia University Irving Medical Center, New York, NY
| | - Syed A Husain
- Division of Nephrology, Department of Medicine (S.M., S.A.H., K.T., J.R.), Columbia University Irving Medical Center, New York, NY
| | - Katherine Toma
- Division of Nephrology, Department of Medicine (S.M., S.A.H., K.T., J.R.), Columbia University Irving Medical Center, New York, NY
| | - Robert T Faillace
- Department of Medicine, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, NY (A.P., R.T.F.)
| | - Jon T Giles
- Division of Rheumatology, Department of Medicine (J.T.G.), Columbia University Irving Medical Center, New York, NY
| | - Koji Takeda
- Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University Irving Medical Center, New York, NY
| | - Hiroo Takayama
- Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University Irving Medical Center, New York, NY
| | - Yoshifumi Naka
- Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University Irving Medical Center, New York, NY
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (R.T.D.)
| | - Jai Radhakrishnan
- Division of Nephrology, Department of Medicine (S.M., S.A.H., K.T., J.R.), Columbia University Irving Medical Center, New York, NY
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
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Gaudig A, Mondellini G, Toma K, Pinsino A, Te-Frey R, Parkis G, Dominguez M, Masoumi A, Garan A, Takayama H, Takeda K, Naka Y, Demmer R, Colombo P, Radhakrishnan J, Yuzefpolskaya M. Long- and Short-Term Changes in Serum Creatinine Prior to LVAD Surgery are Associated with Postoperative Outcomes. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1153] [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: 11/24/2022] Open
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Kiyatkin M, Zuver A, Gaudig A, Tiburcio M, McDonnell B, Yuzefpolskaya M, Colombo P, Stöhr E, Willey J. Carotid Artery Blood Flow and Its Association with Stroke during Left Ventricular Assist Device Support. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.411] [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: 11/27/2022] Open
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Rosenblum H, Pinsino A, Demmer R, Colombo P, Yuzefpolskaya M, Garan A, Topkara V, Gaudig A, Pineda M, Naka Y, Takayama H, Takeda K, Castagna F, Willey J, McDonnell B, Cockcroft J, Stöhr E. Increased Aortic Stiffness is Associated with Higher Rates of Stroke, GI-bleeding and Pump Thrombosis in Continuous-Flow Left Ventricular Assist Device Patients. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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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Stöhr E, Gaudig A, Pinsino A, Castagna F, Colombo P, Yuzefspolskaya M, Garan A, Topkara V, Takayama H, Takeda K, Naka Y, Cockroft J, McDonnell B, Willey J. Laterality of Cerebral Artery Hemodynamics in Continuous-Flow LVAD Patients: A Pilot Study in Relation to Stroke. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.714] [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: 10/17/2022] Open
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Germeshausen M, Schulze H, Gaudig A, Krukemeier S, Strauss G, Welte K, Ballmaier M. [Congenital amegakaryocytic thrombocytopenia (CAMT) - a defect of the thrombopoietin receptor c-Mpl]. Klin Padiatr 2001; 213:155-61. [PMID: 11528548 DOI: 10.1055/s-2001-16846] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Congenital amegakaryocytic thrombocytopenia (CAMT) is a very rare bone marrow failure syndrome presenting with isolated hypomegakaryocytic thrombocytopenia at birth developing into a pancytopenia during the first years of life. Bone marrow transplantation is the only curative therapy for this disease so far. Thrombopoietin (TPO) is the most important hematopoietic growth factor for the regulation of megakaryopoiesis and thrombopoiesis. We investigated TPO production and reactivity in CAMT patients. TPO plasma levels were high like in other forms of thrombocytopenia due to ineffective megakaryopoiesis. However, we found a defective reactivity to TPO: Neither hematopoietic progenitor cells in the bone marrow nor platelets from the peripheral blood did respond to TPO. Flow cytometric investigations demonstrated a lack of expression of the TPO receptor c-Mpl on the surface of platelets. Accordingly, we found mutations in the c-mpl gene, which are predicted to lead to a complete or at least partial loss of function of the TPO receptor. TPO is not only involved in the regulation of megakaryocytopoiesis but also in early hematopoiesis. This seems to be the reason for the general defect in hematopoiesis in CAMT leading to the development of pancytopenia.
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Affiliation(s)
- M Germeshausen
- Abt. Pädiatrische Hämatologie und Onkologie, Medizinische Hochschule Hannover, Germany.
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Ballmaier M, Germeshausen M, Schulze H, Cherkaoui K, Lang S, Gaudig A, Krukemeier S, Eilers M, Strauss G, Welte K. c-mpl mutations are the cause of congenital amegakaryocytic thrombocytopenia. Blood 2001; 97:139-46. [PMID: 11133753 DOI: 10.1182/blood.v97.1.139] [Citation(s) in RCA: 227] [Impact Index Per Article: 9.9] [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: 12/27/2022] Open
Abstract
Congenital amegakaryocytic thrombocytopenia (CAMT) is a rare disease presenting with isolated thrombocytopenia in infancy and developing into a pancytopenia in later childhood. Thrombopoietin (TPO) is the main regulator of thrombocytopoiesis and has also been demonstrated to be an important factor in early hematopoiesis. We analyzed 9 patients with CAMT for defects in TPO production and reactivity. We found high levels of TPO in the sera of all patients. However, platelets and hematopoietic progenitor cells of patients with CAMT did not show any reactivity to TPO, as measured by testing TPO-synergism to adenosine diphosphate in platelet activation or by megakaryocyte colony assays. Flow cytometric analysis revealed absent surface expression of the TPO receptor c-Mpl in 3 of 3 patients. Sequence analysis of the c-mpl gene revealed point mutations in 8 of 8 patients: We found frameshift or nonsense mutations that are predicted to result in a complete loss of c-Mpl function in 5 patients. Heterozygous or homozygous missense mutations predicted to lead to amino acid exchanges in the extracellular domain of the receptor were found in 3 other patients. The type of mutations correlated with the clinical course of the disease. We propose a defective c-Mpl expression due to c-mpl mutations as the cause for thrombocytopenia and progression into pancytopenia seen in patients with CAMT.
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Affiliation(s)
- M Ballmaier
- Department of Pediatric Hematology and Oncology, Medizinische Hochschule Hannover, Germany.
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