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Lu MT, Ribaudo H, Foldyna B, Zanni MV, Mayrhofer T, Karady J, Taron J, Fitch KV, McCallum S, Burdo TH, Paradis K, Hedgire SS, Meyersohn NM, DeFilippi C, Malvestutto CD, Sturniolo A, Diggs M, Siminski S, Bloomfield GS, Alston-Smith B, Desvigne-Nickens P, Overton ET, Currier JS, Aberg JA, Fichtenbaum CJ, Hoffmann U, Douglas PS, Grinspoon SK. Effects of Pitavastatin on Coronary Artery Disease and Inflammatory Biomarkers in HIV: Mechanistic Substudy of the REPRIEVE Randomized Clinical Trial. JAMA Cardiol 2024; 9:323-334. [PMID: 38381407 PMCID: PMC10882511 DOI: 10.1001/jamacardio.2023.5661] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/15/2023] [Indexed: 02/22/2024]
Abstract
Importance Cardiovascular disease (CVD) is increased in people with HIV (PWH) and is characterized by premature noncalcified coronary plaque. In the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), pitavastatin reduced major adverse cardiovascular events (MACE) by 35% over a median of 5.1 years. Objective To investigate the effects of pitavastatin on noncalcified coronary artery plaque by coronary computed tomography angiography (CTA) and on inflammatory biomarkers as potential mechanisms for MACE prevention. Design, Setting, and Participants This double-blind, placebo-controlled randomized clinical trial enrolled participants from April 2015 to February 2018 at 31 US clinical research sites. PWH without known CVD who were taking antiretroviral therapy and had low to moderate 10-year CVD risk were included. Data were analyzed from April to November 2023. Intervention Oral pitavastatin calcium, 4 mg per day. Main Outcomes and Measures Coronary CTA and inflammatory biomarkers at baseline and 24 months. The primary outcomes were change in noncalcified coronary plaque volume and progression of noncalcified plaque. Results Of 804 enrolled persons, 774 had at least 1 evaluable CTA. Plaque changes were assessed in 611 who completed both CT scans. Of 611 analyzed participants, 513 (84.0%) were male, the mean (SD) age was 51 (6) years, and the median (IQR) 10-year CVD risk was 4.5% (2.6-7.0). A total of 302 were included in the pitavastatin arm and 309 in the placebo arm. The mean noncalcified plaque volume decreased with pitavastatin compared with placebo (mean [SD] change, -1.7 [25.2] mm3 vs 2.6 [27.1] mm3; baseline adjusted difference, -4.3 mm3; 95% CI, -8.6 to -0.1; P = .04; 7% [95% CI, 1-12] greater reduction relative to placebo). A larger effect size was seen among the subgroup with plaque at baseline (-8.8 mm3 [95% CI, -17.9 to 0.4]). Progression of noncalcified plaque was 33% less likely with pitavastatin compared with placebo (relative risk, 0.67; 95% CI, 0.52-0.88; P = .003). Compared with placebo, the mean low-density lipoprotein cholesterol decreased with pitavastatin (mean change: pitavastatin, -28.5 mg/dL; 95% CI, -31.9 to -25.1; placebo, -0.8; 95% CI, -3.8 to 2.2). The pitavastatin arm had a reduction in both oxidized low-density lipoprotein (-29% [95% CI, -32 to -26] vs -13% [95% CI, -17 to -9]; P < .001) and lipoprotein-associated phospholipase A2 (-7% [95% CI, -11 to -4] vs 14% [95% CI, 10-18]; P < .001) compared with placebo at 24 months. Conclusions and Relevance In PWH at low to moderate CVD risk, 24 months of pitavastatin reduced noncalcified plaque volume and progression as well as markers of lipid oxidation and arterial inflammation. These changes may contribute to the observed MACE reduction in REPRIEVE. Trial Registration ClinicalTrials.gov Identifier: NCT02344290.
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Affiliation(s)
- Michael T. Lu
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Heather Ribaudo
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Borek Foldyna
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Markella V. Zanni
- Metabolism Unit, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Thomas Mayrhofer
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
- School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Julia Karady
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Jana Taron
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathleen V. Fitch
- Metabolism Unit, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sara McCallum
- Metabolism Unit, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Tricia H. Burdo
- Department of Microbiology, Immunology, and Inflammation, Center for NeuroVirology and Gene Editing, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Kayla Paradis
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Sandeep S. Hedgire
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Nandini M. Meyersohn
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | | | | | - Audra Sturniolo
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Marissa Diggs
- Metabolism Unit, Massachusetts General Hospital, Harvard Medical School, Boston
| | | | - Gerald S. Bloomfield
- Department of Medicine, Duke Global Health Institute, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Beverly Alston-Smith
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Edgar T. Overton
- Division of Infectious Diseases, University of Alabama at Birmingham
- ViiV Healthcare, Research Triangle Park, North Carolina
| | - Judith S. Currier
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles
| | - Judith A. Aberg
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Carl J. Fichtenbaum
- Division of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Pamela S. Douglas
- Duke University Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Steven K. Grinspoon
- Metabolism Unit, Massachusetts General Hospital, Harvard Medical School, Boston
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Barasch E, Gottdiener J, Buzkova P, Cappola A, Shah S, DeFilippi C, Gardin J, Kizer JR. Association of thyroid dysfunction in individuals ≥ 65 years of age with subclinical cardiac abnormalities. J Clin Endocrinol Metab 2024:dgae001. [PMID: 38183678 DOI: 10.1210/clinem/dgae001] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/01/2023] [Accepted: 01/05/2024] [Indexed: 01/08/2024]
Abstract
CONTEXT The relationship between thyroid dysfunction and measures of myocardial disease in older individuals remains to be defined. OBJECTIVE To evaluate the impact of thyroid dysfunction on structure and function of the left-heart chambers and blood markers of cardiac disease. DESIGN Cross-sectional analysis. SETTING The Cardiovascular Health Study, a community-based cohort of older individuals recruited from four urban areas in the United States. PATIENTS Of 3163 participants studied, 2477 were euthyroid, 465 had subclinical hypothyroidism (SCH), 47 overt hypothyroidism (OH), 45 endogenous (endo) subclinical hyperthyroidism (endo-SCT), and 129 had exogenous (exo) SCT due to thyroid hormone supplementation. INTERVENTIONS Clinical evaluation, blood sampling and biomarker measurement, 2-dimensional and speckle-tracking echocardiography. MAIN OUTCOME MEASURE(S) Left heart myocardial deformation, circulating biomarkers of diastolic overload (NT-proBNP), fibrosis (sST2, gal-3), and cardiomyocyte injury (hs-cTnT). RESULTS SCH was associated with higher NT-proBNP (beta = 0.17, p = 0.004), whereas OH was associated with higher hs-cTnT (beta = 0.29, p = 0.005). There were also suggestive associations of SCH with higher sST2, as well as endo-SCT with higher gal-3 and lower (worse) left atrial reservoir strain. Left ventricular longitudinal strain and end-diastolic strain rate did not differ significantly from euthyroid participants in SCH, OH, or exo-SCT. CONCLUSIONS In this free-living elderly cohort, subclinical and overt hypothyroidism were associated with abnormalities of blood biomarkers consistent with diastolic overload and myocardial necrosis respectively, whereas subclinical hyperthyroidism tended to be associated with myocardial fibrosis and decreased left atrial strain. Our findings could represent stage B heart failure and illuminate distinct aspects of the pathobiology of heart disease related to thyroid gland dysfunction with potential clinical implications.
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Affiliation(s)
- Eddy Barasch
- De Matteis Cardiovascular Institute, St. Francis Hospital. The Heart Center/SUNY at Stony Brook, Roslyn, NY
| | | | - Petra Buzkova
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Anne Cappola
- Division of Endocrinology, University of Pennsylvania, Philadelphia PA
| | - Sanjiv Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Julius Gardin
- Department of Medicine, Division of Cardiology, Rutgers New Jersey Medical School, Newark, NJ
| | - Jorge R Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System, and Departments of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
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Gottdiener JS, Buzkova P, Kahn PA, DeFilippi C, Shah S, Barasch E, Kizer JR, Psaty B, Gardin JM. Relation of Cigarette Smoking and Heart Failure in Adults ≥65 Years of Age (From the Cardiovascular Health Study). Am J Cardiol 2022; 168:90-98. [PMID: 35045935 PMCID: PMC8930705 DOI: 10.1016/j.amjcard.2021.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
Abstract
Cigarette smoking is associated with adverse cardiac outcomes, including incident heart failure (HF). However, key components of potential pathways from smoking to HF have not been evaluated in older adults. In a community-based study, we studied cross-sectional associations of smoking with blood and imaging biomarkers reflecting mechanisms of cardiac disease. Serial nested, multivariable Cox models were used to determine associations of smoking with HF, and to assess the influence of biochemical and functional (cardiac strain) phenotypes on these associations. Compared with never smokers, smokers had higher levels of inflammation (C-reactive protein and interleukin-6), cardiomyocyte injury (cardiac troponin T [hscTnT]), myocardial "stress"/fibrosis (soluble suppression of tumorigenicity 2 [sST2], galectin 3), and worse left ventricle systolic and diastolic function. In models adjusting for age, gender, and race (DEMO) and for clinical factors potentially in the causal pathway (CLIN), smoking exposures were associated with C-reactive protein and interleukin-6, sST2, hscTnT, and with N-terminal pro-brain natriuretic protein (in Whites). In DEMO adjusted models, the cumulative burden of smoking was associated with worse left ventricle systolic strain. Current smoking and former smoking were associated with HF in DEMO models (hazard ratio 1.41, 95% confidence interval 1.22 to 1.64 and hazard ratio 1.14, 95% confidence interval 1.03 to 1.25, respectively), and with current smoking after CLIN adjustment. Adjustment for time-varying myocardial infarction, inflammation, cardiac strain, hscTnT, sST2, and galectin 3 did not materially alter the associations. Smoking was associated with HF with preserved and decreased ejection fraction. In conclusion, in older adults, smoking is associated with multiple blood and imaging biomarker measures of pathophysiology previously linked to HF, and to incident HF even after adjustment for clinical intermediates.
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Affiliation(s)
- John S Gottdiener
- Department of Medicine (Cardiology), University of Maryland School of Medicine, Baltimore, Maryland; Departments of.
| | | | - Peter A Kahn
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Sanjiv Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eddy Barasch
- Division of Cardiology, St. Francis Hospital, Roslyn, New York
| | - Jorge R Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System, San Francisco, California; Departments of; Medicine and of; Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Bruce Psaty
- Medicine; Epidemiology, and; Health Services, University of Washington, Seattle, Washington; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; and
| | - Julius M Gardin
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
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Aurora L, McCord J, Nowak R, Giannitsis E, Christenson R, DeFilippi C, Lindahl B, Christ M, Body R, Jacobsen G, Mueller C. Prognostic Utility of a Modified HEART Score When Different Troponin Cut Points Are Used. Crit Pathw Cardiol 2021; 20:134-139. [PMID: 33988541 DOI: 10.1097/hpc.0000000000000262] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although the recommended cut point for cardiac troponin (cTn) is the 99th percentile, many institutions use cut points that are multiples higher than the 99th percentile for diagnosing acute myocardial infarction (AMI). Prior studies have shown that patients with a HEART score (HS) ≤ 3 and normal serial cTn values (modified HS) are at low risk for adverse events. This study aimed to evaluate the prognostic utility of the HS when various cTn cut points are used. METHODS This was a substudy of High Sensitivity Cardiac Troponin T assay for RAPID Rule-out of Acute Myocardial Infarction (TRAPID-AMI), a multicenter, international trial evaluating a rapid rule-out AMI study using high-sensitivity cardiac troponin T (hs-cTnT). One-thousand two-hundred eighty-two patients were evaluated for AMI from 12 centers in Europe, United States, and Australia from 2011 to 2013. Blood samples of hs-cTnT were collected at presentation and 2 hours, and each patient had a HS calculated. The US Food and Drug Administration approved 99th percentile for hs-cTnT (19 ng/L) was used. RESULTS There were 213 (17%) AMIs. Within 30 days, there were an additional 2 AMIs and 8 deaths. The adverse event rates at 30 days (death/AMI) for a HS ≤ 3 and nonelevated hs-cTnT over 2 hours using increasing hs-cTnT cut points ranged from 0.6% to 5.1%. CONCLUSIONS Using the recommended 99th percentile cut point for hs-cTnT, the combination of a HS ≤ 3 with nonelevated hs-cTnT values over 2 hours identifies a low-risk cohort who can be considered for discharge from the emergency department without further testing. The prognostic utility of this strategy is greatly lessened as higher hs-cTnT cut points are used.
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Affiliation(s)
- Lindsey Aurora
- From the Heart and Vascular Institute, Henry Ford Health System, Detroit, MI
| | - James McCord
- From the Heart and Vascular Institute, Henry Ford Health System, Detroit, MI
| | - Richard Nowak
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI
| | - Evangelos Giannitsis
- Depar Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Robert Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD
| | | | - Bertil Lindahl
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Michael Christ
- Department of Emergency Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Richard Body
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Gordon Jacobsen
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
| | - Christian Mueller
- Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland
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5
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Rao A, Ranka S, Ayers C, Hendren N, Rosenblatt A, Alger HM, Rutan C, Omar W, Khera R, Gupta K, Mody P, DeFilippi C, Das SR, Hedayati SS, de Lemos JA. Association of Kidney Disease With Outcomes in COVID-19: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry. J Am Heart Assoc 2021; 10:e020910. [PMID: 34107743 PMCID: PMC8477855 DOI: 10.1161/jaha.121.020910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/08/2023]
Abstract
Background Emerging evidence links acute kidney injury (AKI) in patients with COVID‐19 with higher mortality and respiratory morbidity, but the relationship of AKI with cardiovascular disease outcomes has not been reported in this population. We sought to evaluate associations between chronic kidney disease (CKD), AKI, and mortality and cardiovascular outcomes in patients hospitalized with COVID‐19. Methods and Results In a large multicenter registry including 8574 patients with COVID‐19 from 88 US hospitals, data were collected on baseline characteristics and serial laboratory data during index hospitalization. Primary exposure variables were CKD (categorized as no CKD, CKD, and end‐stage kidney disease) and AKI (classified into no AKI or stages 1, 2, or 3 using a modification of the Kidney Disease Improving Global Outcomes guideline definition). The primary outcome was all‐cause mortality. The key secondary outcome was major adverse cardiac events, defined as cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, new‐onset nonfatal heart failure, and nonfatal cardiogenic shock. CKD and end‐stage kidney disease were not associated with mortality or major adverse cardiac events after multivariate adjustment. In contrast, AKI was significantly associated with mortality (stage 1 hazard ratio [HR], 1.72 [95% CI, 1.46–2.03]; stage 2 HR, 1.83 [95% CI, 1.52–2.20]; stage 3 HR, 1.69 [95% CI, 1.44–1.98]; versus no AKI) and major adverse cardiac events (stage 1 HR, 2.17 [95% CI, 1.74–2.71]; stage 2 HR, 2.70 [95% CI, 2.07–3.51]; stage 3 HR, 3.06 [95% CI, 2.52–3.72]; versus no AKI). Conclusions This large study demonstrates a significant association between AKI and all‐cause mortality and, for the first time, major adverse cardiovascular events in patients hospitalized with COVID‐19.
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Affiliation(s)
- Anjali Rao
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | - Sagar Ranka
- Department of Cardiovascular Medicine University of Kansas Kansas City KS
| | - Colby Ayers
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Nicholas Hendren
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | - Anna Rosenblatt
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | | | | | - Wally Omar
- Department of Internal Medicine Beth Israel Deaconess Medical Center Boston MA
| | - Rohan Khera
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Kamal Gupta
- Department of Cardiovascular Medicine University of Kansas Kansas City KS
| | - Purav Mody
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | | | - Sandeep R Das
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | - S Susan Hedayati
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - James A de Lemos
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
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Bansal N, Zelnick LR, Soliman EZ, Anderson A, Christenson R, DeFilippi C, Deo R, Feldman HI, He J, Ky B, Kusek J, Lash J, Seliger S, Shafi T, Wolf M, Go AS, Shlipak MG, Appel LJ, Rao PS, Rahman M, Townsend RR. Change in Cardiac Biomarkers and Risk of Incident Heart Failure and Atrial Fibrillation in CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2021; 77:907-919. [DOI: 10.1053/j.ajkd.2020.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/26/2020] [Indexed: 12/16/2022]
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Pasala S, Emaminia R, DeFilippi C. CHRONIC CHAGAS DISEASE PRESENTING AS FOUR-CHAMBER INTRACARDIAC THROMBI. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03565-8] [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: 10/21/2022]
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Ekanem E, McCarthy C, Neumann J, Shah P, Magaret C, Barnes G, Rhyne R, Westermann D, DeFilippi C, Januzzi J. PERFORMANCE OF A NOVEL MULTI-BIOMARKER BASED SCORING MODEL FOR THE PREDICTION OF INCIDENT CARDIOVASCULAR EVENTS: A POOLED MULTI-NATIONAL VALIDATION STUDY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01379-6] [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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Bakhshi H, Bagchi P, Sun J, Seliger S, Diao G, Venkatesh BA, Varadarajan V, Lima J, DeFilippi C. CARDIOVASCULAR PROTEOMICS PROFILES IN REPLACEMENT AND INTERSTITIAL MYOCARDIAL FIBROSIS: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01922-7] [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: 10/21/2022]
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Nowak R, McCord J, Christenson R, Jacobsen G, Apple F, Limkakeng A, Peacock W, DeFilippi C. 5 Adverse Outcomes 30 Days After Emergency Department Evaluation for Myocardial Infarction Determined Solely by High Sensitivity Troponin I Values for a 1-Hour Rule-Out/Rule-In Acute Myocardial Infarction Algorithm. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.008] [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: 10/25/2022]
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Aurora L, Nowak R, Mueller C, Evangelos G, Christenson R, DeFilippi C, Lindahl B, Christ M, Body R, Jacobsen G, McCord J. PROGNOSTIC UTILITY OF A MODIFIED HEART SCORE WHEN DIFFERENT TROPONIN CUT-POINTS ARE USED. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30686-2] [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: 11/30/2022]
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Gibbs J, Peacock WF, Mahler S, Nowak R, DeFilippi C, Christenson R, Apple F, Jacobsen G, McCord J. RISK STRATIFICATION OF CHEST PAIN IN THE EMERGENCY DEPARTMENT: INCORPORATING A HIGH-SENSITIVITY TROPONIN ASSAY INTO EXISTING RISK TOOLS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30810-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nowak RM, McCord J, Christenson R, Jacobsen G, Apple F, DeFilippi C. PERFORMANCE OF A NOVEL HIGH SENSITIVITY CARDIAC TROPONIN I ASSAY FOR A ONE HOUR ALGORITHM FOR EVALUATION OF NON ST SEGMENT ELEVATION MYOCARDIAL INFARCTION IN THE UNITED STATES. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30743-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ekanem E, Shah P, Latta F, Barnes G, Adams E, Magaret CA, Peters C, Rhyne RF, DeFilippi C. VALIDATION OF A NOVEL BIOMARKER-CLINICAL SCORE TO PREDICT THE PRESENCE OF OBSTRUCTIVE CORONARY DISEASE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30768-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Beri N, Daniels LB, Jaffe A, Mueller C, Anand I, Peacock WF, Hollander JE, DeFilippi C, Schreiber D, McCord J, Limkakeng AT, Wu AHB, Apple FS, Diercks DB, Nagurney JT, Nowak RM, Cannon CM, Clopton P, Neath SX, Christenson RH, Hogan C, Vilke G, Maisel A. Copeptin to rule out myocardial infarction in Blacks versus Caucasians. European Heart Journal: Acute Cardiovascular Care 2018; 8:395-403. [DOI: 10.1177/2048872618772500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Copeptin in combination with troponin has been shown to have incremental value for the early rule-out of myocardial infarction, but its performance in Black patients specifically has never been examined. In light of a potential for wider use, data on copeptin in different relevant cohorts are needed. This is the first study to determine whether copeptin is equally effective at ruling out myocardial infarction in Black and Caucasian races. Methods: This analysis of the CHOPIN trial included 792 Black and 1075 Caucasian patients who presented to the emergency department with chest pain and had troponin-I and copeptin levels drawn. Results: One hundred and forty-nine patients were diagnosed with myocardial infarction (54 Black and 95 Caucasian). The negative predictive value of copeptin at a cut-off of 14 pmol/l (as in the CHOPIN study) for myocardial infarction was higher in Blacks (98.0%, 95% confidence interval (CI) 96.2–99.1%) than Caucasians (94.1%, 95% CI 92.1–95.7%). The sensitivity at 14 pmol/l was higher in Blacks (83.3%, 95% CI 70.7–92.1%) than Caucasians (53.7%, 95% CI 43.2–64.0%). After controlling for age, hypertension, heart failure, chronic kidney disease and body mass index in a logistic regression model, the interaction term had a P value of 0.03. A cut-off of 6 pmol/l showed similar sensitivity in Caucasians as 14 pmol/l in Blacks. Conclusions: This is the first study to identify a difference in the performance of copeptin to rule out myocardial infarction between Blacks and Caucasians, with increased negative predictive value and sensitivity in the Black population at a cut-off of 14 pmol/l. This also holds true for non-ST-segment elevation myocardial infarction and, although numbers were small, similar trends exist in the normal troponin population. This may have significant implications for early rule-out strategies using copeptin.
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Affiliation(s)
- Neil Beri
- Department of Internal Medicine, University of California, USA
| | | | | | | | - Inder Anand
- Department of Cardiology, Veterans Affairs Medical Center, USA
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, USA
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University, USA
| | | | | | - James McCord
- Department of Cardiology, Henry Ford Health System, USA
| | | | - Alan H B Wu
- Department of Pathology and Laboratory Medicine, University of California, USA
| | - Fred S Apple
- Department of Pathology, Hennepin County Medical Center and University of Minnesota, USA
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas Southwestern, USA
| | - John T Nagurney
- Department of Emergency Medicine, Massachusetts General Hospital, USA
| | - Richard M Nowak
- Department of Emergency Medicine, Henry Ford Health System, USA
| | - Chad M Cannon
- Department of Emergency Medicine, University of Kansas, USA
| | - Paul Clopton
- Department of Research, Veterans Affairs Medical Center, USA
| | | | | | | | - Gary Vilke
- Department of Emergency Medicine, University of California, USA
| | - Alan Maisel
- Department of Cardiology, University of California, USA
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16
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Nowak R, Mueller C, Giannitsis E, Christ M, Ordonez-Llanos J, DeFilippi C, McCord J, Body R, Panteghini M, Jernberg T, Plebani M, Verschuren F, French JK, Christenson R, Jacobsen G, Dinkel C, Lindahl B. High sensitivity cardiac troponin T in patients not having an acute coronary syndrome: results from the TRAPID-AMI study. Biomarkers 2017; 22:709-714. [PMID: 28532247 DOI: 10.1080/1354750x.2017.1334154] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe the baseline, 1 hr and delta high sensitivity cardiac troponin (hs-cTnT) values in patients with suspected acute myocardial infarction (AMI) but without a final acute coronary syndrome (ACS) diagnosis. MATERIALS AND METHODS hs-cTnT assay for RAPID rule out of acute myocardial infarction (TRAPID-AMI) was a prospective diagnostic trial that enrolled emergency department (ED) patients with suspected AMI. Final patient diagnoses were adjudicated by a clinical events committee and subjects placed in different clinical groups: AMI, unstable angina, non-ACS cardiac, non-cardiac and unknown origin. The baseline, 1 hr and delta hs-cTnT values were analysed in the 902 non-ACS patients. RESULTS Amongst the 1282 studied the patient groups were 213 (17%) AMI, 167 (13%) unstable angina, 113 (9%) non-ACS cardiac, 288 (22%) non-cardiac and 501 (39%) unknown origin. The hs-cTnT values in the non-cardiac and unknown origin groups were combined. The median hs-cTnT values (ng/L) were higher (p < 0.001) in the non-ACS cardiac compared to the non-cardiac/unknown origin group at baseline (11.8, <5) and 1 hr (12.3, <5). Their negative predictive values were 0.955 (baseline) and 0.954 (1 hr) for predicting non-ACS cardiac versus non-cardiac/unknown origin diagnoses. CONCLUSIONS Hs-cTnT may help predict whether non-ACS ED patients have a final non-ACS cardiac or non-cardiac/unknown origin diagnoses.
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Affiliation(s)
- Richard Nowak
- a Emergency Medicine , Henry Ford Hospital , Detroit , MI , USA
| | - Christian Mueller
- b Department of Cardiology & Cardiovascular Research Institute Basel , University Hospital Base , Basel , Switzerland
| | - Evangelos Giannitsis
- c Department of Internal Medicine, Cardiology, Angiology & Pulmonary , University Hospital Heidelberg , Heidelberg , Germany
| | - Michael Christ
- d Department of Emergency and Critical Care Medicine , Paracelsus Medical University , Germany , Nuernberg
| | | | | | - James McCord
- g Cardiology , Henry Ford Hospital , Detroit , MI , USA
| | - Richard Body
- h Emergency Medicine , Central Manchester University NHS Foundation Trust , Manchester , UK
| | - Mauro Panteghini
- i Laboratorio Analisi Chimico Cliniche , Azienda Ospedaliera Luigi Sacco , Milan , Italy
| | - Tomas Jernberg
- j Cardiology , Karolinska University Hospital , Stockholm , Sweden
| | - Mario Plebani
- k Servizio Medicina di Laboratorio Azienda Ospedaliera , Universita di Padova Via Giustinianeo , Padova , Italy
| | - Franck Verschuren
- l Department of Acute Medicine , Cliniques Universitaires St-Luc Universite Catholiques de Louvain , Brussels , Belgium
| | - John K French
- m Cardiology , Liverpool Hospital , Liverpool , NSW , Australia
| | - Robert Christenson
- n Department of Pathology , University of Maryland , Baltimore , MD , USA
| | - Gordon Jacobsen
- o Department of Public Health Sciences , Henry Ford Hospital , Detroit , MI , USA
| | - Carina Dinkel
- p Department of Statistics , Roche Diagnostics , Penzberg , Germany
| | - Bertil Lindahl
- q Uppsala Clinical Research Center , Uppsala University , Uppsala , Sweden
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17
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Mishra RK, Judson G, Christenson RH, DeFilippi C, Wu AH, Whooley MA. The Association of Five-Year Changes in the Levels of N-Terminal Fragment of the Prohormone Brain-Type Natriuretic Peptide (NT-proBNP) with Subsequent Heart Failure and Death in Patients with Stable Coronary Artery Disease: The Heart and Soul Study. Cardiology 2017; 137:201-206. [DOI: 10.1159/000466682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/25/2017] [Indexed: 12/16/2022]
Abstract
Background: The N-terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) is a powerful predictor of adverse outcomes in patients with coronary artery disease (CAD). However, little is known regarding the prognostic significance of longitudinal changes in NT-proBNP levels. Methods: We evaluated the ability of 5-year changes in NT-proBNP levels to predict subsequent heart failure (HF) hospitalization or cardiovascular (CV) death in 635 participants with stable CAD enrolled in the Heart and Soul Study. Results: The median (IQR) 5-year change in NT-proBNP was 50 pg/mL (-5 to +222). During an average of 4.0 ± 1.4 years follow-up (i.e., 9 years from the baseline measurement), there were 67 events. Participants with 5-year changes in the highest quartile (≥ 223 pg/mL increase in NT-proBNP) had an almost 4-fold greater risk of subsequent HF or CV death than those in the lowest quartile of ≤-5 pg/mL (HR 3.8; 95% CI 2.0-7.3; p < 0.001). This association remained strong after adjustment for demographic variables, comorbidities, left ventricular mass index, systolic and diastolic function, and baseline and follow-up NT-proBNP levels (HR 3.9; 95% CI 1.1-13.4; p = 0.01). Conclusion: Changes in NT-proBNP levels at 5 years predict subsequent HF or CV death in patients with stable CAD, independent of other prognostic markers, including baseline and follow-up NT-proBNP levels. A stable NT-proBNP level predicts a low risk of subsequent events.
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18
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Peters MN, DeFilippi C, Hong-Zohlman S, Christenson R, Lima J, Bertoni A, Daniels L, Seliger S. IMPACT OF MALIGNANT LEFT VENTRICULAR FUNCTION ON INCIDENT HEART FAILURE IN OLDER ADULTS: THE MESA STUDY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34113-x] [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: 11/17/2022]
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19
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Vasudevan A, Singer AJ, DeFilippi C, Headden G, Schussler JM, Daniels LB, Reed M, Than MP, Birkhahn R, Smith SW, Barrett TW, Arnold W, Peacock WF, McCullough PA. Renal Function and Scaled Troponin in Patients Presenting to the Emergency Department with Symptoms of Myocardial Infarction. Am J Nephrol 2017; 45:304-309. [PMID: 28192777 DOI: 10.1159/000458451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 11/02/2016] [Accepted: 12/28/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiac troponins are often found to be elevated in patients with renal dysfunction, even in the absence of acute myocardial injury. The objective of this report was to characterize the scaled troponin values and proportion of adjudicated acute myocardial infarction (AMI) among patients with and without renal dysfunction. METHODS The data was from a multicenter prospective study including patients presenting to the emergency department with symptoms of AMI. Troponin measurements were standardized across various assays by calculating the observed results as multiples of the assay-specific 99th percentile upper limit of normal. Patients with an estimated glomerular filtration rate (eGFR; calculated by the Chronic Kidney Disease Epidemiology Collaboration formula) <60 mL/min/1.73 m2 were considered to have renal dysfunction. RESULTS Of 430 included patients, 249 (58%) were male and 181 (42%) were female, with a mean age of 55.9 ± 12.3 and 57.3 ± 12.8 years, respectively. Eighty-seven (20.2%) had renal dysfunction. The proportions of patients with at least one scaled troponin value above the 99th percentile cut-off point among patients with and without renal dysfunction were 40 (45.9%) and 81 (23.6%) respectively (p < 0.001). The proportions of patients with an adjudicated diagnosis of AMI among those with and without renal dysfunction were 20.7 and 18.7%, respectively (p = 0.67). Using scaled troponins, by the second test there was >5X and by the third test >15X separation in the excursion of troponin among those with AMI compared to those without. CONCLUSIONS One or more elevated troponin values are common in those with renal dysfunction. Scaled troponins for eGFR groups were similar, indicating that the use of this interpretative technique is applicable in discerning AMI for those with and without renal dysfunction.
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20
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Tecson KM, Arnold W, Barrett T, Birkhahn R, Daniels LB, DeFilippi C, Headden G, Peacock WF, Reed M, Singer AJ, Schussler JM, Smith S, Than MP, McCullough PA. Interpretation of positive troponin results among patients with and without myocardial infarction. Proc (Bayl Univ Med Cent) 2017; 30:11-15. [PMID: 28127121 DOI: 10.1080/08998280.2017.11929513] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Measuring cardiac troponins is integral to diagnosing acute myocardial infarction (AMI); however, troponins may be elevated without AMI, and the use of multiple different assays confounds comparisons. We considered characteristics and serial troponin values in emergency department chest pain patients with and without AMI to interpret troponin excursions. We compared serial troponin in 124 AMI and non-AMI patients from the observational Performance of Triage Cardiac Markers in the Clinical Setting (PEARL) study who presented with chest pain and had at least one troponin value exceeding the 99th percentile of normal. Because 8 assays were used during data collection, we employed a method of scaling the troponin value to the corresponding assay's 99th percentile upper reference limit to standardize the results. In 81 AMI patients, 96% had elevated troponin at the first test following initial elevation, compared to 73% of the 43 non-AMI patients (P < 0.001). Scaling troponin to the 99th percentile of normal yielded a median value that was 4.8 [2.2, 14.1] times higher than the 99th percentile cutpoint among AMI patients, compared to 2.3 [1.5, 6.5] times higher among non-AMI patients (P = 0.04). The rise in serial scaled troponin values distinguished the AMI patients. Scaling to the 99th percentile was useful for comparing troponin when different assays were utilized.
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Affiliation(s)
- Kristen M Tecson
- Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough)
| | - William Arnold
- Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough)
| | - Tyler Barrett
- Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough)
| | - Robert Birkhahn
- Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough)
| | - Lori B Daniels
- Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough)
| | - Christopher DeFilippi
- Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough)
| | - Gary Headden
- Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough)
| | - W Frank Peacock
- Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough)
| | - Michael Reed
- Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough)
| | - Adam J Singer
- Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough)
| | - Jeffrey M Schussler
- Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough)
| | - Stephen Smith
- Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough)
| | - Martin P Than
- Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough)
| | - Peter A McCullough
- Baylor Heart and Vascular Institute, Dallas, Texas (Tecson, McCullough); Baylor Scott & White Research Institute, Dallas, Texas (Tecson); Texas A&M Health Science Center College of Medicine, Dallas, Texas (Tecson, Schussler, McCullough); Department of Clinical Affairs, Alere Inc., San Diego, California (Arnold); Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Barrett); New York Methodist Hospital, Brooklyn, New York (Birkhahn); Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, California (Daniels); Inova Heart and Vascular Institute, Falls Church, Virginia (DeFilippi); Medical University of South Carolina, Charleston, South Carolina (Headden); Baylor University Ben Taub Hospital, Houston, Texas (Peacock); International Heart Institute of Montana, Missoula, Montana (Reed); Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, New York (Singer); Division of Cardiology, Baylor University Medical Center, Dallas, Texas (Schussler, McCullough); Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas (Schussler, McCullough); Hennepin County Medical Center Emergency Department, Minneapolis, Minnesota (Smith); Emergency Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand (Than); and The Heart Hospital Baylor Plano, Plano, Texas (McCullough)
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21
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Spahillari A, Mukamal KJ, DeFilippi C, Kizer JR, Gottdiener JS, Djoussé L, Lyles MF, Bartz TM, Murthy VL, Shah RV. The association of lean and fat mass with all-cause mortality in older adults: The Cardiovascular Health Study. Nutr Metab Cardiovasc Dis 2016; 26:1039-1047. [PMID: 27484755 PMCID: PMC5079822 DOI: 10.1016/j.numecd.2016.06.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Understanding contributions of lean and fat tissue to cardiovascular and non-cardiovascular mortality may help clarify areas of prevention in older adults. We aimed to define distributions of lean and fat tissue in older adults and their contributions to cause-specific mortality. METHODS AND RESULTS A total of 1335 participants of the Cardiovascular Health Study (CHS) who underwent dual-energy x-ray absorptiometry (DEXA) scans were included. We used principal components analysis (PCA) to define two independent sources of variation in DEXA-derived body composition, corresponding to principal components composed of lean ("lean PC") and fat ("fat PC") tissue. We used Cox proportional hazards regression using these PCs to investigate the relationship between body composition with cardiovascular and non-cardiovascular mortality. Mean age was 76.2 ± 4.8 years (56% women) with mean body mass index 27.1 ± 4.4 kg/m2. A greater lean PC was associated with lower all-cause (HR = 0.91, 95% CI 0.84-0.98, P = 0.01) and cardiovascular mortality (HR = 0.84, 95% CI 0.74-0.95, P = 0.005). The lowest quartile of the fat PC (least adiposity) was associated with a greater hazard of all-cause mortality (HR = 1.24, 95% CI 1.04-1.48, P = 0.02) relative to fat PCs between the 25th-75th percentile, but the highest quartile did not have a significantly greater hazard (P = 0.70). CONCLUSION Greater lean tissue mass is associated with improved cardiovascular and overall mortality in the elderly. The lowest levels of fat tissue mass are linked with adverse prognosis, but the highest levels show no significant mortality protection. Prevention efforts in the elderly frail may be best targeted toward improvements in lean muscle mass.
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Affiliation(s)
- A Spahillari
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - K J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - C DeFilippi
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - J R Kizer
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA.
| | - J S Gottdiener
- Department of Medicine, University of Maryland Medical School, Baltimore, MD, USA.
| | - L Djoussé
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - M F Lyles
- Department of Medicine, Section on Gerontology and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - T M Bartz
- Department of Biostatistics, University of Washington, Seattle, WA, USA.
| | - V L Murthy
- Frankel Cardiovascular Center and Department of Medicine (Cardiovascular Medicine Division), University of Michigan, Ann Arbor, MI, USA.
| | - R V Shah
- Department of Medicine (Division of Cardiology), Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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22
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Beri N, Marston NA, Daniels LB, Nowak RM, Schreiber D, Mueller C, Jaffe A, Diercks DB, Wettersten N, DeFilippi C, Peacock WF, Limkakeng AT, Anand I, McCord J, Hollander JE, Wu AHB, Apple FS, Nagurney JT, Berardi C, Cannon CM, Clopton P, Neath SX, Christenson RH, Hogan C, Vilke G, Maisel A. Necessity of hospitalization and stress testing in low risk chest pain patients. Am J Emerg Med 2016; 35:274-280. [PMID: 27847253 DOI: 10.1016/j.ajem.2016.10.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/10/2016] [Accepted: 10/28/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Copeptin is a marker of endogenous stress including early myocardial infarction(MI) and has value in early rule out of MI when used with cardiac troponin I(cTnI). OBJECTIVES The goal of this study was to demonstrate that patients with a normal electrocardiogram and cTnI<0.040μg/l and copeptin<14pmol/l at presentation and after 2 h may be candidates for early discharge with outpatient follow-up potentially including stress testing. METHODS This study uses data from the CHOPIN trial which enrolled 2071 patients with acute chest pain. Of those, 475 patients with normal electrocardiogram and normal cTnI(<0.040μg/l) and copeptin<14pmol/l at presentation and after 2 h were considered "low risk" and selected for further analysis. RESULTS None of the 475 "low risk" patients were diagnosed with MI during the 180day follow-up period (including presentation). The negative predictive value of this strategy was 100% (95% confidence interval(CI):99.2%-100.0%). Furthermore no one died during follow up. 287 (60.4%) patients in the low risk group were hospitalized. In the "low risk" group, the only difference in outcomes (MI, death, revascularization, cardiac rehospitalization) was those hospitalized underwent revascularization more often (6.3%[95%CI:3.8%-9.7%] versus 0.5%[95%CI:0.0%-2.9%], p=.002). The hospitalized patients were tested significantly more via stress testing or angiogram (68.6%[95%CI:62.9%-74.0%] vs 22.9%[95%CI:17.1%-29.6%], p<.001). Those tested had less cardiac rehospitalizations during follow-up (1.7% vs 5.1%, p=.040). CONCLUSIONS In conclusion, patients with a normal electrocardiogram, troponin and copeptin at presentation and after 2 h are at low risk for MI and death over 180days. These low risk patients may be candidates for early outpatient testing and cardiology follow-up thereby reducing hospitalization.
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Affiliation(s)
- Neil Beri
- Department of Internal Medicine, University of California, San Diego, La Jolla, CA, United States.
| | - Nicholas A Marston
- Department of Internal Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Lori B Daniels
- Division of Cardiology, Department of Internal Medicine, University of California, San Diego, La Jolla, California, United States
| | - Richard M Nowak
- Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, United States
| | - Donald Schreiber
- Department of Emergency Medicine, Stanford University, Palo Alto, CA, United States
| | - Christian Mueller
- Division of Cardiology, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Allan Jaffe
- Division of Cardiology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX, United States
| | - Nicholas Wettersten
- Division of Cardiology, Department of Internal Medicine, University of California, San Diego, La Jolla, California, United States
| | - Christopher DeFilippi
- Division of Cardiology, Department of Internal Medicine, University of Maryland, Baltimore, MD, United States
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States
| | | | - Inder Anand
- Division of Cardiology, Department of Internal Medicine, Veterans Affairs Medical Center, Minneapolis, MN, United States
| | - James McCord
- Division of Cardiology, Department of Internal Medicine, Henry Ford Health System, Detroit, MI, United States
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States
| | - Alan H B Wu
- Department of Pathology and Laboratory Medicine, University of California, San Francisco, CA, United States
| | - Fred S Apple
- Department of Pathology, Hennepin County Medical Center and University of Minnesota, Minneapolis, United States
| | - John T Nagurney
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Cecilia Berardi
- School of Medicine, "La Sapienza" University of Rome, Rome, Italy
| | - Chad M Cannon
- Department of Emergency Medicine, University of Kansas, Kansas City, KS, United States
| | - Paul Clopton
- Statistics, Veterans Affairs Medical Center, San Diego, CA, United States
| | - Sean-Xavier Neath
- Department of Emergency Medicine, University of California, San Diego, La Jolla, CA, United States
| | | | - Christopher Hogan
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, United States
| | - Gary Vilke
- Department of Emergency Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Alan Maisel
- Division of Cardiology, Department of Internal Medicine, University of California, San Diego, La Jolla, California, United States
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Beri N, Marston N, Clopton P, Daniels L, Schreiber D, Mueller C, Jaffe A, DeFilippi C, Peacock WF, Anand I, McCord J, Limkakeng A, Hollander J, Wu A, Apple F, Diercks D, Nagurney J, Cannon C, Neath SX, Christenson R, Nowak R, Hogan C, Vilke G, Maisel A. HOSPITALIZATION OF LOW RISK CHEST PAIN PATIENTS WITH NORMAL TROPONIN AND COPEPTIN. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30524-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Muller CC, McCord J, Michaels A, Nowak R, Giannitsis E, Body R, Christ M, Lindahl B, DeFilippi C, Christenson R, Bendig G, Jacobsen G, Mueller C. SYMPTOMS PREDICTIVE OF ACUTE MYOCARDIAL INFARCTION IN THE TROPONIN ERA: ANALYSIS FROM THE TRAPID-AMI STUDY. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30519-8] [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: 10/22/2022]
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25
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Beri N, Clopton P, Daniels L, DeFilippi C, Mueller C, Jaffe A, Peacock WF, Anand I, Limkakeng A, McCord J, Schreiber D, Wu A, Apple F, Hollander J, Diercks D, Nagurney J, Cannon C, Neath SX, Christenson R, Nowak R, Hogan C, Vilke G, Maisel A. BIOMARKER MODEL FOR CORONARY ARTERY DISEASE. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32142-8] [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: 10/22/2022]
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26
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Pollock JS, Al-Talib T, DeFilippi C. ACUTE HYPOXIC RESPIRATORY FAILURE SECONDARY TO ACUTE PAPILLARY MUSCLE RUPTURE. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31040-3] [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: 10/22/2022]
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Parikh R, Golwala H, Garg S, Pandey A, El Sabbagh A, DeFilippi C. OPTIMAL DURATION OF DUAL ANTIPLATELET THERAPY AMONG PATIENTS UNDERGOING DRUG ELUTING STENT PLACEMENT: A BAYESIAN NETWORK META-ANALYSIS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30542-3] [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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Bansal N, Katz R, Seliger S, DeFilippi C, Sarnak MJ, Delaney JA, Christenson R, de Boer IH, Kestenbaum B, Robinson-Cohen C, Ix JH, Shlipak MG. Galectin-3 and Soluble ST2 and Kidney Function Decline in Older Adults: The Cardiovascular Health Study (CHS). Am J Kidney Dis 2016; 67:994-6. [PMID: 26830253 DOI: 10.1053/j.ajkd.2015.12.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 12/14/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | - Ronit Katz
- University of Washington, Seattle, Washington
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Cross AS, Greenberg N, Billington M, Zhang L, DeFilippi C, May RC, Bajwa KK. Phase 1 testing of detoxified LPS/group B meningococcal outer membrane protein vaccine with and without synthetic CPG 7909 adjuvant for the prevention and treatment of sepsis. Vaccine 2015; 33:6719-26. [PMID: 26514420 PMCID: PMC4679452 DOI: 10.1016/j.vaccine.2015.10.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 08/28/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gram-negative bacteria (GNB) are a leading cause of nosocomial infection and sepsis. Increasing multi-antibiotic resistance has left clinicians with fewer therapeutic options. Antibodies to GNB lipopolysaccharide (LPS, or endotoxin) have reduced morbidity and mortality as a result of infection and are not subject to the resistance mechanisms deployed by bacteria against antibiotics. In this phase 1 study, we administered a vaccine that elicits antibodies against a highly conserved portion of LPS with and without a CpG oligodeoxynucleotide (ODN) TLR9 agonist as adjuvant. METHODS A vaccine composed of the detoxified LPS (dLPS) from E. coli O111:B4 (J5 mutant) non-covalently complexed to group B meningococcal outer membrane protein (OMP). Twenty healthy adult subjects received three doses at 0, 29 and 59 days of antigen (10 μg dLPS) with or without CPG 7909 (250 or 500 μg). Subjects were evaluated for local and systemic adverse effects and laboratory findings. Anti-J5 LPS IgG and IgM antibody levels were measured by electrochemiluminesence. Due to premature study termination, not all subjects received all three doses. RESULTS All vaccine formulations were well-tolerated with no local or systemic events of greater than moderate severity. The vaccine alone group achieved a ≥ 4-fold "responder" response in IgG and IgM antibody in only one of 6 subjects. In contrast, the vaccine plus CPG 7909 groups appeared to have earlier and more sustained (to 180 days) responses, greater mean-fold increases, and a higher proportion of "responders" achieving ≥ 4-fold increases over baseline. CONCLUSIONS Although the study was halted before all enrolled subjects received all three doses, the J5dLPS/OMP vaccine, with or without CpG adjuvant, was safe and well-tolerated. The inclusion of CpG increased the number of subjects with a ≥ 4-fold antibody response, evident even after the second of three planned doses. A vaccine comprising J5dLPS/OMP antigen with CpG adjuvant merits further investigation. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov Identifier: NCT01164514.
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Affiliation(s)
- Alan S Cross
- Center for Vaccine Development, University of Maryland School of Medicine, 685 West Baltimore Street, HSF 1, Suite 480, Baltimore, MD 21201, United States.
| | - Nancy Greenberg
- Center for Vaccine Development, University of Maryland School of Medicine, 685 West Baltimore Street, HSF 1, Suite 480, Baltimore, MD 21201, United States.
| | - Melissa Billington
- Center for Vaccine Development, University of Maryland School of Medicine, 685 West Baltimore Street, HSF 1, Suite 480, Baltimore, MD 21201, United States.
| | - Lei Zhang
- Center for Vaccine Development, University of Maryland School of Medicine, 685 West Baltimore Street, HSF 1, Suite 480, Baltimore, MD 21201, United States.
| | - Christopher DeFilippi
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, United States.
| | - Ryan C May
- The Emmes Corporation, 401 N. Washington Street, Rockville, MD 20850, United States.
| | - Kanwaldeep K Bajwa
- The Emmes Corporation, 401 N. Washington Street, Rockville, MD 20850, United States.
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30
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Mishra RK, Yang W, Roy J, Anderson AH, Bansal N, Chen J, DeFilippi C, Delafontaine P, Feldman HI, Kallem R, Kusek JW, Lora CM, Rosas SE, Go AS, Shlipak MG. Kansas City Cardiomyopathy Questionnaire Score Is Associated With Incident Heart Failure Hospitalization in Patients With Chronic Kidney Disease Without Previously Diagnosed Heart Failure: Chronic Renal Insufficiency Cohort Study. Circ Heart Fail 2015; 8:702-8. [PMID: 25985796 DOI: 10.1161/circheartfailure.115.002097] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 05/15/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Chronic kidney disease is a risk factor for heart failure (HF). Patients with chronic kidney disease without diagnosed HF have an increased burden of symptoms characteristic of HF. It is not known whether these symptoms are associated with occurrence of new onset HF. METHODS AND RESULTS We studied the association of a modified Kansas City Cardiomyopathy Questionnaire with newly identified cases of hospitalized HF among 3093 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study who did not report HF at baseline. The annually updated Kansas City Cardiomyopathy Questionnaire score was categorized into quartiles (Q1-4) with the lower scores representing the worse symptoms. Multivariable-adjusted repeated measure logistic regression models were adjusted for demographic characteristics, clinical risk factors for HF, N-terminal probrain natriuretic peptide level and left ventricular hypertrophy, left ventricular systolic and diastolic dysfunction. Over a mean (±SD) follow-up period of 4.3±1.6 years, there were 211 new cases of HF hospitalizations. The risk of HF hospitalization increased with increasing symptom quartiles; 2.62, 1.85, 1.14, and 0.74 events per 100 person-years, respectively. The median number of annual Kansas City Cardiomyopathy Questionnaire assessments per participant was 5 (interquartile range, 3-6). The annually updated Kansas City Cardiomyopathy Questionnaire score was independently associated with higher risk of incident HF hospitalization in multivariable-adjusted models (odds ratio, 3.30 [1.66-6.52]; P=0.001 for Q1 compared with Q4). CONCLUSIONS Symptoms characteristic of HF are common in patients with chronic kidney disease and are associated with higher short-term risk for new hospitalization for HF, independent of level of kidney function, and other known HF risk factors.
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Affiliation(s)
- Rakesh K Mishra
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Wei Yang
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Jason Roy
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Amanda H Anderson
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Nisha Bansal
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Jing Chen
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Christopher DeFilippi
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Patrice Delafontaine
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Harold I Feldman
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Radhakrishna Kallem
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - John W Kusek
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Claudia M Lora
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Sylvia E Rosas
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Alan S Go
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.)
| | - Michael G Shlipak
- From the Division of Cardiology (R.K.M.) and Department of Epidemiology and Biostatistics (M.G.S.), University of California, San Francisco; Department of Biostatistics and Epidemiology (W.Y., J.R., A.H.A., H.I.F.), Renal, Electrolyte and Hypertension Division (R.K.), University of Pennsylvania, Philadelphia; Division of Nephrology, University of Washington, Seattle (N.B.); Departments of Nephrology and Hypertension (J.C.) and Medicine (P.D.), Tulane University, New Orleans, LA; Department of Medicine, University of Maryland, College Park (C.D.F.); National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.W.K.); Division of Nephrology, University of Illinois, Champaign (C.M.L.); Joslin Diabetes Center and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (S.E.R.); Kaiser Permanente Division of Research, Oakland, CA (A.S.G.); and Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (R.K.M., M.G.S.).
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Cabrera R, McCord J, Evans K, Nowak R, Frisoli T, Giannitsis E, Dilba P, Body R, Christ M, Lindahl B, DeFilippi C, Christenson R, Jacobsen G, Mueller C. THE PROGNOSTIC UTILITY OF A MODIFIED HEART SCORE IN PATIENTS WITH CHEST PAIN IN THE EMERGENCY DEPARTMENT APPLIED TO THE TRAPID-AMI STUDY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60132-2] [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: 10/23/2022]
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Maisel A, Xue Y, Greene SJ, Pang PS, Januzzi JL, Piña IL, DeFilippi C, Butler J. The Potential Role of Natriuretic Peptide–Guided Management for Patients Hospitalized for Heart Failure. J Card Fail 2015; 21:233-9. [DOI: 10.1016/j.cardfail.2014.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 10/11/2014] [Accepted: 11/17/2014] [Indexed: 12/22/2022]
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Bansal N, Katz R, Dalrymple L, de Boer I, DeFilippi C, Kestenbaum B, Park M, Sarnak M, Seliger S, Shlipak M. NT-proBNP and troponin T and risk of rapid kidney function decline and incident CKD in elderly adults. Clin J Am Soc Nephrol 2015; 10:205-14. [PMID: 25605700 DOI: 10.2215/cjn.04910514] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [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: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Elevations in N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T are associated with poor cardiovascular outcomes. Whether elevations in these cardiac biomarkers are associated with decline in kidney function was evaluated. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS N-terminal pro-B-type natriuretic peptide and troponin T were measured at baseline in 3752 participants free of heart failure in the Cardiovascular Health Study. eGFR was determined from the Chronic Kidney Disease Epidemiology Collaboration equation using serum cystatin C. Rapid decline in kidney function was defined as decline in serum cystatin C eGFR≥30%, and incident CKD was defined as the onset of serum cystatin C eGFR<60 among those without CKD at baseline (n=2786). Cox regression models were used to examine the associations of each biomarker with kidney function decline adjusting for demographics, baseline serum cystatin C eGFR, diabetes, and other CKD risk factors. RESULTS In total, 503 participants had rapid decline in serum cystatin C eGFR over a mean follow-up time of 6.41 (1.81) years, and 685 participants developed incident CKD over a mean follow-up time of 6.41 (1.74) years. Participants in the highest quartile of N-terminal pro-B-type natriuretic peptide (>237 pg/ml) had an 67% higher risk of rapid decline and 38% higher adjusted risk of incident CKD compared with participants in the lowest quartile (adjusted hazard ratio for serum cystatin C eGFR rapid decline, 1.67; 95% confidence interval, 1.25 to 2.23; hazard ratio for incident CKD, 1.38; 95% confidence interval, 1.08 to 1.76). Participants in the highest category of troponin T (>10.58 pg/ml) had 80% greater risk of rapid decline compared with participants in the lowest category (adjusted hazard ratio, 1.80; 95% confidence interval, 1.35 to 2.40). The association of troponin T with incident CKD was not statistically significant (hazard ratio, 1.17; 95% confidence interval, 0.92 to 1.50). CONCLUSIONS Elevated N-terminal pro-B-type natriuretic peptide and troponin T are associated with rapid decline of kidney function and incident CKD. Additional studies are needed to evaluate the mechanisms that may explain this association.
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Affiliation(s)
- Nisha Bansal
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington;
| | - Ronit Katz
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington
| | - Lorien Dalrymple
- Division of Nephrology, University of California, Davis, Sacramento, California
| | - Ian de Boer
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington
| | | | - Bryan Kestenbaum
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington
| | | | - Mark Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts; and
| | | | - Michael Shlipak
- Departments of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, California; Division of General Internal Medicine, San Francisco Veterans Affair Medical Center, San Francisco, California
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Ginsberg E, Seliger S, Gottdiener J, Christenson R, End C, DeFilippi C. SOLUBLE ST2 PREDICTS INCIDENT HEART FAILURE AND CARDIOVASCULAR DEATH IN OLDER ADULTS. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60768-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Marston N, Shah K, Mueller C, Neath SX, Christenson R, McCord J, Nowak R, Daniels L, Hollander J, Apple F, Cannon C, Nagurney J, Schreiber D, DeFilippi C, Hogan C, Diercks D, Limkakeng A, Anand I, Wu A, Jaffe A, Peacock WF, Maisel A. COPEPTIN PROVIDES PROGNOSTIC VALUE IN PATIENTS WITH ACUTE CHEST PAIN. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60058-9] [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: 10/25/2022]
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Shah K, Marston N, Mueller C, Neath SX, Christenson R, McCord J, Hollander J, Apple F, Cannon C, Nagurney J, Schreiber D, Hogan C, Diercks D, Limkakeng A, Anand I, Jaffe A, Peacock WF, Nowak R, Daniels L, DeFilippi C, Wu AH, Maisel A. MID-REGIONAL PROADRENOMEDULLIN PREDICTS LONG-TERM MORTALITY IN PATIENTS WITH CHEST PAIN. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60266-7] [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: 10/25/2022]
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Ginsberg E, DeFilippi C, Gottdiener J, Christenson R, End C, Seliger S. GALECTIN-3 PREDICTS CARDIOVASCULAR EVENTS IN OLDER ADULTS. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60771-3] [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: 11/17/2022]
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Seliger SL, Ginsberg E, Gottdiener J, Christenson R, DeFilippi C. SOLUBLE ST2 AND GALECTIN-3 ARE ASSOCIATED WITH SUBCLINICAL DIASTOLIC DYSFUNCTION IN OLDER ADULTS. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60769-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Marston N, Shah K, Mueller C, Neath SX, Christenson R, McCord J, Nowak R, Vilke G, Daniels L, Hollander J, Apple F, Cannon C, Nagurney J, Schreiber D, DeFilippi C, Hogan C, Diercks D, Limkakeng A, Anand I, Jaffe A, Peacock WF, Maisel A, Wu A. CAN A SECOND MEASUREMENT OF COPEPTIN IMPROVE ACUTE MYOCARDIAL INFARCTION RULE OUT? J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60202-3] [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: 10/25/2022]
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Hussein AA, Gottdiener JS, Bartz TM, Sotoodehnia N, DeFilippi C, See V, Deo R, Siscovick D, Stein PK, Lloyd-Jones D. Inflammation and sudden cardiac death in a community-based population of older adults: The Cardiovascular Health Study. Heart Rhythm 2013; 10:1425-32. [DOI: 10.1016/j.hrthm.2013.07.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Indexed: 11/28/2022]
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Wei X, Li T, Li S, Son HS, Sanchez PG, Sanchez P, Niu S, Watkins AC, DeFilippi C, Jarvik R, Wu ZJ, Griffith BP. Pre-clinical evaluation of the infant Jarvik 2000 heart in a neonate piglet model. J Heart Lung Transplant 2013; 32:112-9. [PMID: 23260711 DOI: 10.1016/j.healun.2012.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 09/17/2012] [Accepted: 10/17/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The infant Jarvik 2000 heart is a very small, hermetically sealed, intracorporeal, axial-flow ventricular assist device (VAD) designed for circulatory support in neonates and infants. The anatomic fit, short-term biocompatibility and hemodynamic performance of the device were evaluated in a neonate piglet model. METHODS The infant Jarvik 2000 heart with two different blade profiles (low- or high-flow blade design) was tested in 6 piglets (8.8 ± 0.9 kg). Using a median sternotomy, the pump was placed in the left ventricle through the apex without cardiopulmonary bypass. An outflow graft was anastomosed to the ascending aorta. Hemodynamics and biocompatibility were studied for 6 hours. RESULTS All 6 pumps were implanted without complication. Optimal anatomic positioning was found with the pump body inserted 2.4 cm into the left ventricle. Hemodynamics demonstrated stability throughout the 6-hour duration. The pump flow increased from 0.27 to 0.95 liter/min at increasing speeds from 18 to 31 krpm for the low-flow blade design, whereas the pump flow increased from 0.54 liter/min to 1.12 liters/min at increasing speeds from 16 krpm to 31 krpm for the high-flow blade design. At higher speeds, >80% of flow could be supplied by the device. Blood chemistry and final pathology demonstrated no acute organ injury or thrombosis for either blade design. CONCLUSIONS The infant Jarvik 2000 heart is anatomically and biologically compatible with an short-term neonate piglet model. This in vivo study demonstrates the future feasibility of this device for clinical use.
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Affiliation(s)
- Xufeng Wei
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
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Wei X, Li T, Hagen B, Zhang P, Sanchez PG, Williams K, Li S, Bianchi G, Son HS, Wu C, DeFilippi C, Xu K, Lederer WJ, Wu ZJ, Griffith BP. Short-term mechanical unloading with left ventricular assist devices after acute myocardial infarction conserves calcium cycling and improves heart function. JACC Cardiovasc Interv 2013; 6:406-15. [PMID: 23523452 DOI: 10.1016/j.jcin.2012.12.122] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 10/26/2012] [Accepted: 12/07/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study sought to demonstrate that short-term cardiac unloading with a left ventricular (LV) assist device (LVAD) after acute myocardial infarction (MI) can conserve calcium cycling and improve heart function. BACKGROUND Heart failure secondary to MI remains a major source of morbidity and mortality. Alterations in calcium cycling are linked to cardiac dysfunction in the failing heart. METHODS Adult Dorsett hybrid sheep underwent acute MI and were mechanically unloaded with an axial-flow LVAD (Impella 5.0) for 2 weeks (n = 6). Six sheep with MI only and 4 sham sheep were used as controls. All animals were followed for 12 weeks post-MI. Regional strains in the LV were measured by sonomicrometry. Major calcium-handling proteins (CHPs), including sarco-/endoplasmic reticulum calcium ATPase-2α (SERCA-2α), Na(+)-Ca(2+) exchanger-1, and phospholamban, and Ca(2+)-ATPase activity were investigated. The electrophysiological calcium cycling in single isolated cardiomyocytes was measured with the patch-clamp technique. The related ultrastructures were studied with electron microscopy. RESULTS LVAD unloading alleviated LV dilation and improved global cardiac function and regional contractility compared with the MI group. The regional myocardial strain (stretch) was minimized during the unloading period and even attenuated compared with the MI group at 12 weeks. Impaired calcium cycling was evident in the adjacent noninfarcted zone in the MI group, whereas CHP expression was normalized and Ca(2+)-ATPase activity was preserved in the LVAD unloading group. The electrophysiological calcium cycling was also conserved, and the ultrastructural damage was ameliorated in the unloaded animals. CONCLUSIONS Short-term LVAD unloading may conserve calcium cycling and improve heart function during the post-infarct period.
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Affiliation(s)
- Xufeng Wei
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland21201, USA
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Mishra RK, Li Y, Ricardo AC, Yang W, Keane M, Cuevas M, Christenson R, DeFilippi C, Chen J, He J, Kallem RR, Raj DS, Schelling JR, Wright J, Go AS, Shlipak MG. Association of N-terminal pro-B-type natriuretic peptide with left ventricular structure and function in chronic kidney disease (from the Chronic Renal Insufficiency Cohort [CRIC]). Am J Cardiol 2013. [PMID: 23178053 DOI: 10.1016/j.amjcard.2012.10.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We evaluated the cross-sectional associations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) with cardiac structural and functional abnormalities in a cohort of patients with chronic kidney disease without clinical heart failure, the Chronic Renal Insufficiency Cohort (n = 3,232). The associations of NT-proBNP with echocardiographically determined left ventricular (LV) mass and LV systolic and diastolic function were evaluated using multivariate logistic and linear regression models. Reclassification of participants' predicted risk of LV hypertrophy (LVH), systolic and diastolic dysfunction was performed using a category-free net reclassification improvement index that compared a clinical model with and without NT-proBNP. The median NT-proBNP was 126.6 pg/ml (interquartile range 55.5 to 303.7). The greatest quartile of NT-proBNP was associated with a nearly threefold odds of LVH (odds ratio 2.7, 95% confidence interval [CI] 1.8 to 4.0) and LV systolic dysfunction (odds ratio 2.7, 95% CI 1.7 to 4.5) and a twofold odds of diastolic dysfunction (odds ratio 2.0, 95% CI 1.3 to 2.9) in the fully adjusted models. When evaluated alone as a screening test, NT-proBNP functioned modestly for the detection of LVH (area under the curve 0.66) and LV systolic dysfunction (area under the curve 0.62) and poorly for the detection of diastolic dysfunction (area under the curve 0.51). However, when added to the clinical model, NT-proBNP significantly reclassified participants' likelihood of having LVH (net reclassification improvement 0.14, 95% CI 0.13-0.15; p <0.001) and LV systolic dysfunction (net reclassification improvement 0.28, 95% CI 0.27 to 0.30; p <0.001) but not diastolic dysfunction (net reclassification improvement 0.10, 95% CI 0.10 to 0.11; p = 0.07). In conclusion, in this large chronic kidney disease cohort without heart failure, NT-proBNP had strong associations with prevalent LVH and LV systolic dysfunction.
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Mishra RK, Li Y, DeFilippi C, Fischer MJ, Yang W, Keane M, Chen J, He J, Kallem R, Horwitz EJ, Rafey M, Raj DS, Go AS, Shlipak MG. Association of cardiac troponin T with left ventricular structure and function in CKD. Am J Kidney Dis 2013; 61:701-9. [PMID: 23291148 DOI: 10.1053/j.ajkd.2012.11.034] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 11/06/2012] [Indexed: 01/12/2023]
Abstract
BACKGROUND Serum cardiac troponin T (cTnT) is associated with increased risk of heart failure and cardiovascular death in several population settings. We evaluated associations of cTnT levels with cardiac structural and functional abnormalities in a cohort of patients with chronic kidney disease (CKD) without heart failure. STUDY DESIGN Cross-sectional. SETTING & PARTICIPANTS Chronic Renal Insufficiency Cohort (CRIC; N=3,243). PREDICTOR The primary predictor was cTnT level. Secondary predictors included demographic and clinical characteristics, hemoglobin level, high-sensitivity C-reactive protein level, and estimated glomerular filtration rate using cystatin C. OUTCOMES Echocardiography was used to determine left ventricular (LV) mass and LV systolic and diastolic function. MEASUREMENTS Circulating cTnT was measured in stored sera using the highly sensitive assay. Logistic and linear regression models were used to examine associations of cTnT level with each echocardiographic outcome. RESULTS cTnT was detectable in 2,735 (84%) persons; median level was 13.3 (IQR, 7.7-23.8) pg/mL. Compared with undetectable cTnT (<3.0 pg/mL), the highest quartile (23.9-738.7 pg/mL) was approximately 2 times as likely to have LV hypertrophy (OR, 2.43; 95% CI, 1.44-4.09) in the fully adjusted model. cTnT level had a more modest association with LV systolic dysfunction; as a log-linear variable, a significant association was present in the fully adjusted model (OR of 1.4 [95% CI, 1.2-1.7] per 1-log unit; P < 0.001). There was no significant independent association between cTnT level and LV diastolic dysfunction. When evaluated as a screening test, cTnT level functioned only modestly for LV hypertrophy and concentric hypertrophy detection (area under the curve, 0.64 for both), with weaker areas under the curve for the other outcomes. LIMITATIONS The presence of coronary artery disease was not formally assessed using either noninvasive or angiographic techniques in this study. CONCLUSIONS In this large CKD cohort without heart failure, detectable cTnT had a strong association with LV hypertrophy, a more modest association with LV systolic dysfunction, and no association with diastolic dysfunction. These findings indicate that circulating cTnT levels in patients with CKD are predominantly an indicator of pathologic LV hypertrophy.
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Januzzi JL, Maisel AS, Silver M, Xue Y, DeFilippi C. Natriuretic Peptide Testing for Predicting Adverse Events Following Heart Failure Hospitalization. ACTA ACUST UNITED AC 2012; 18 Suppl 1:S9-S13. [DOI: 10.1111/j.1751-7133.2012.00306.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shah KB, Christenson R, DeFilippi C. SERUM ST2 IS A STRONGER PROGNOSTIC MARKER THAN HIGH SENSITIVITY TROPONIN-I IN ACUTE DYSPNEA PATIENTS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60944-9] [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: 10/28/2022]
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Gottdiener JS, Bartz T, DeFilippi C, Kop W, Lloyd-Jones D. CLINICAL AND DEMOGRAPHIC CHARACTERISTICS OF HEART FAILURE WITH PRESERVED EJECTION FRACTION IN COMPARISON TO HYPERTENSION WITHOUT HEART FAILURE, ELDERLY WITH RISK FACTORS, AND HEALTHY AGING IN POPULATION DWELLING INDIVIDUALS = 65 YEARS OF AGE. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61016-x] [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: 10/28/2022]
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Patton KK, Sotoodehnia N, DeFilippi C, Siscovick DS, Gottdiener JS, Kronmal RA. N-terminal pro-B-type natriuretic peptide is associated with sudden cardiac death risk: the Cardiovascular Health Study. Heart Rhythm 2010; 8:228-33. [PMID: 21044699 DOI: 10.1016/j.hrthm.2010.10.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 10/27/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Sudden cardiac death (SCD), the cause of 250,000-450,000 deaths per year, is a major public health problem. The majority of those affected do not have a prior cardiovascular diagnosis. Elevated B-type natriuretic peptide levels have been associated with the risk of heart failure and mortality as well as with sudden death in women. OBJECTIVE The purpose of this study was to examine the relationship between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and SCD in the Cardiovascular Health Study population. METHODS The risk of SCD associated with baseline NT-proBNP was examined in 5,447 participants. Covariate-adjusted Cox model regressions were used to estimate the hazard ratios of developing SCD as a function of baseline NT-proBNP. RESULTS Over a median follow-up of 12.5 years (maximum 16), there were 289 cases of SCD. Higher NT-proBNP levels were strongly associated with SCD, with an unadjusted hazard ratio of 4.2 (95% confidence interval [2.9, 6.1]; P <.001) in the highest quintile compared with in the lowest. NT-proBNP remained associated with SCD even after adjustment for numerous clinical characteristics and risk factors (age, sex, race, and other associated conditions), with an adjusted hazard ratio for the fifth versus the first quintile of 2.5 (95% confidence interval [1.6, 3.8]; P <.001). CONCLUSION NT-proBNP provides information regarding the risk of SCD in a community-based population of older adults, beyond other traditional risk factors. This biomarker may ultimately prove useful in targeting the population at risk with aggressive medical management of comorbid conditions.
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Affiliation(s)
- Kristen K Patton
- Division of Cardiology, University of Washington, Seattle, Washington 98115, USA
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Patton KK, Ellinor PT, Heckbert SR, Christenson RH, DeFilippi C, Gottdiener JS, Kronmal RA. N-terminal pro-B-type natriuretic peptide is a major predictor of the development of atrial fibrillation: the Cardiovascular Health Study. Circulation 2009; 120:1768-74. [PMID: 19841297 DOI: 10.1161/circulationaha.109.873265] [Citation(s) in RCA: 235] [Impact Index Per Article: 15.7] [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: 01/14/2023]
Abstract
BACKGROUND Atrial fibrillation (AF), the most common cardiac rhythm abnormality, is associated with significant morbidity, mortality, and healthcare expenditures. Elevated B-type natriuretic peptide levels have been associated with the risk of heart failure, AF, and mortality. METHODS AND RESULTS The relation between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and AF was studied in 5445 Cardiovascular Health Study participants with the use of relative risk regression for predicting prevalent AF and Cox proportional hazards for predicting incident AF. NT-proBNP levels were strongly associated with prevalent AF, with an unadjusted prevalence ratio of 128 for the highest quintile (95% confidence interval, 17.9 to 913.3; P<0.001) and adjusted prevalence ratio of 147 for the highest quintile (95% confidence interval, 20.4 to 1064.3; P<0.001) compared with the lowest. After a median follow-up of 10 years (maximum of 16 years), there were 1126 cases of incident AF (a rate of 2.2 per 100 person-years). NT-proBNP was highly predictive of incident AF, with an unadjusted hazard ratio of 5.2 (95% confidence interval, 4.3 to 6.4; P<0.001) for the development of AF for the highest quintile compared with the lowest; for the same contrast, NT-proBNP remained the strongest predictor of incident AF after adjustment for an extensive number of covariates, including age, sex, medication use, blood pressure, echocardiographic parameters, diabetes mellitus, and heart failure, with an adjusted hazard ratio of 4.0 (95% confidence interval, 3.2 to 5.0; P<0.001). CONCLUSIONS In a community-based population of older adults, NT-proBNP was a remarkable predictor of incident AF, independent of any other previously described risk factor.
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Affiliation(s)
- Kristen K Patton
- Division of Cardiology, University of Washington, Seattle, WA 98115, USA
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