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Singh JP, Wariar R, Ruble S, Kwan B, Averina V, Stolen CM, Boehmer J. Prediction of Heart Failure Events With the HeartLogic Algorithm: Real-World Validation. J Card Fail 2024; 30:509-512. [PMID: 37972705 DOI: 10.1016/j.cardfail.2023.10.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Jagmeet P Singh
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Brian Kwan
- Boston Scientific, St Paul, Minnesota, USA
| | | | | | - John Boehmer
- Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
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2
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Boehmer J, Sauer AJ, Gardner R, Stolen CM, Kwan B, Wariar R, Ruble S. PRecision Event Monitoring for PatienTs with Heart Failure using HeartLogic (PREEMPT-HF) study design and enrolment. ESC Heart Fail 2023; 10:3690-3699. [PMID: 37740424 PMCID: PMC10682906 DOI: 10.1002/ehf2.14469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/22/2023] [Accepted: 06/21/2023] [Indexed: 09/24/2023] Open
Abstract
AIMS The HeartLogic multisensor index has been found to be a sensitive predictor of worsening heart failure (HF). However, there is limited data on this index's association and its constituent sensors with HF readmissions. METHODS AND RESULTS The PREEMPT-HF study is a global, multicentre, prospective, observational, single-arm, post-market study. HF patients with an implantable defibrillator device or cardiac resynchronization therapy with defibrillator with HeartLogic capabilities were eligible if sensor data collection was turned on and the HeartLogic feature was not enabled. Thus, the HeartLogic Index/alert and heart sounds sensor trends were unavailable via the LATITUDE remote monitoring system to clinicians (blinded). Evaluation of subject medical records at 6 months and a final in-clinic visit at 12 months was required for collection of all-cause hospitalizations and HF outpatient visits. The purpose of this study is exploratory, no formal hypothesis tests are planned, and no adjustment for multiple testing will be performed. A total of 2183 patients were enrolled at 103 sites between June 2018 and June 2020. A significant proportion of the patients were implanted with implantable defibrillator devices (39%) versus cardiac resynchronization therapy with defibrillator (61%); were female (27%); over 65 (61%); New York Heart Association class I (13%), II (53%), and III (33%); ejection fraction < 25% (21%); ischaemic (50%); and with a history of renal dysfunction (23%). CONCLUSIONS The PREEMPT study will provide clinical data and blinded sensor trends for the characterization of sensor changes with HF readmission, tachyarrhythmias, and event subgroups. These data may help to refine the clinical use of HeartLogic and to improve patient outcomes.
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Affiliation(s)
| | | | - Roy Gardner
- Scottish National Advanced Heart Failure Service, Golden Jubilee National HospitalGlasgowUK
| | - Craig M. Stolen
- Division of CardiologyBoston Scientific CorporationMarlboroughMAUSA
| | - Brian Kwan
- Division of CardiologyBoston Scientific CorporationMarlboroughMAUSA
| | - Ramesh Wariar
- Division of CardiologyBoston Scientific CorporationMarlboroughMAUSA
| | - Stephen Ruble
- Division of CardiologyBoston Scientific CorporationMarlboroughMAUSA
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Hernandez AF, Albert NM, Allen LA, Ahmed R, Averina V, Boehmer JP, Cowie MR, Chien CV, Galvao M, Klein L, Kwan B, Lam CSP, Ruble SB, Stolen CM, Stein K. Multiple cArdiac seNsors for mAnaGEment of Heart Failure (MANAGE-HF) - Phase I Evaluation of the Integration and Safety of the HeartLogic Multisensor Algorithm in Patients With Heart Failure. J Card Fail 2022; 28:1245-1254. [PMID: 35460884 DOI: 10.1016/j.cardfail.2022.03.349] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients with heart failure and reduced ejection fraction (HFrEF) suffer from a relapsing and remitting disease, where early treatment changes may improve outcomes. We assessed the clinical integration and safety of the HeartLogic multi-sensor index and alerts in heart failure care. METHODS The Multiple cArdiac seNsors for mAnaGEment of Heart Failure (MANAGE-HF) study enrolled 200 patients with HFrEF (< 35%), NYHA class II-III symptoms, implanted with a CRT-D or ICD, who had either a hospitalization for HF within 12 months or unscheduled visit for HF exacerbation within 90 days or an elevated natriuretic peptide concentration (BNP≥150 pg/mL or NT-proBNP≥600 pg/mL). This phase included development of an alert management guide and evaluated changes in medical treatment, natriuretic peptide levels, and safety. RESULTS Mean age of participants was 67 years, 68% were men, 81% were white, and 61% had a HF hospitalization in prior 12 months. During follow-up there were 585 alert cases with an average of 1.76 alert cases/pt-yr. HF medications were augmented during 74% of the alert cases. HF treatment augmentation within 2 weeks from an initial alert was associated with more rapid recovery of the HeartLogic Index. Five SAEs (0.015 per pt-year) occurred in relation to alert-prompted medication change. NTproBNP levels decreased from median of 1316 pg/mL at baseline to 743 pg/mL at 12 months (p<0.001). CONCLUSIONS HeartLogic alert management was safely implemented in HF care and may optimize HF management. This phase supports further evaluation in larger studies. TRIAL REGISTRATION ClinicalTrials.gov (NCT03237858).
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Affiliation(s)
- Adrian F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
| | - Nancy M Albert
- Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - John P Boehmer
- Division of Cardiology, Department of Medicine Penn State University College of Medicine, Hershey, Pennsylvania
| | - Martin R Cowie
- Royal Brompton Hospital & Faculty of Lifesciences & Medicine, King's College London, London, United Kingdom
| | - Christopher V Chien
- Division of Cardiology, Department of Medicine University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Marie Galvao
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Liviu Klein
- Division of Cardiology, Department of Medicine, UC San Francisco, San Francisco, CA
| | | | - Carolyn S P Lam
- National Heart Centre Singapore & Duke National University of Singapore, Singapore
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Gardner RS, Capodilupo RC, Ahmed R, Stolen CM, An Q, Averina V, Hernandez AF, Boehmer JP. Multiparameter diagnostic sensor measurements in heart failure patients presenting with SARS-CoV-2 infection. ESC Heart Fail 2021; 8:4026-4036. [PMID: 34184428 PMCID: PMC8426935 DOI: 10.1002/ehf2.13500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/13/2021] [Accepted: 06/16/2021] [Indexed: 12/23/2022] Open
Abstract
Aims Implantable device‐based sensor measurements including heart sounds, markers of ventilation, and thoracic impedance have been shown to predict heart failure (HF) hospitalizations. We sought to assess how these parameters changed prior to COVID‐19 (Cov‐19) and how these compared with those presenting with decompensated HF or pneumonia. Methods and results This retrospective analysis explores patterns of changes in daily measurements by implantable sensors in 10 patients with Cov‐19 and compares these findings with those observed prior to HF (n = 88) and pneumonia (n = 12) hospitalizations from the MultiSENSE, PREEMPT‐HF, and MANAGE‐HF trials. The earliest sensor changes prior to Cov‐19 were observed in respiratory rate (6 days) and temperature (5 days). There was a three‐fold to four‐fold greater increase in respiratory rate, rapid shallow breathing index, and night heart rate compared with those presenting with HF or pneumonia. Furthermore, activity levels fell more in those presenting with Cov‐19, a change that was often sustained for some time. In contrast, there were no significant changes in 1st or 3rd heart sound (S1 and S3) amplitude in those presenting with Cov‐19 or pneumonia compared with the known changes that occur in HF decompensation. Conclusions Multi‐sensor device diagnostics may provide early detection of Cov‐19, distinguishable from worsening HF by an extreme and fast rise in respiratory rate along with no changes in S3.
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Affiliation(s)
- Roy S Gardner
- Golden Jubilee National Hospital, Clydebank, Glasgow, UK
| | - Robert C Capodilupo
- New England Heart and Vascular Institute, Catholic Medical Center, Manchester, NH, USA
| | | | | | - Qi An
- Boston Scientific, Arden Hills, MN, USA
| | | | | | - John P Boehmer
- Penn State Milton S Hershey Medical Center, Hershey, PA, USA
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5
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Shumway JL, Stolen CM, Ahmed R, Plumer M, Capodilupo RC. Case Reports of Implantable Cardiac Device Physiologic Sensor Changes in Subjects with Coronavirus Disease-2019 Infection. J Card Fail 2020; 27:373-378. [PMID: 33385524 PMCID: PMC7837250 DOI: 10.1016/j.cardfail.2020.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/02/2020] [Accepted: 12/21/2020] [Indexed: 01/08/2023]
Abstract
The severe acute respiratory syndrome novel coronavirus-2 pandemic has established a new set of challenges to health care delivery. Remotely monitored physiologic sensors on implantable cardiac devices can provide insight into the differential diagnosis of dyspnea in the heart failure population. We report on a unique pattern of sensor deviations that seem to occur specifically with severe acute respiratory syndrome novel coronavirus-2 infection.
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Affiliation(s)
- Jessica L Shumway
- New England Heart and Vascular Institute, Catholic Medical Center, Manchester, New Hampshire
| | | | | | - Marie Plumer
- New England Heart and Vascular Institute, Catholic Medical Center, Manchester, New Hampshire
| | - Robert C Capodilupo
- New England Heart and Vascular Institute, Catholic Medical Center, Manchester, New Hampshire
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6
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Spinale FG, Meyer TE, Stolen CM, Van Eyk JE, Gold MR, Mittal S, DeSantis SM, Wold N, Beshai JF, Stein KM, Ellenbogen KA. Development of a biomarker panel to predict cardiac resynchronization therapy response: Results from the SMART-AV trial. Heart Rhythm 2018; 16:743-753. [PMID: 30476543 DOI: 10.1016/j.hrthm.2018.11.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Predicting a favorable cardiac resynchronization therapy (CRT) response holds great clinical importance. OBJECTIVE The purpose of this study was to examine proteins from broad biological pathways and develop a prediction tool for response to CRT. METHODS Plasma was collected from patients before CRT (SMART-AV [SmartDelay Determined AV Optimization: A Comparison to Other AV Delay Methods Used in Cardiac Resynchronization Therapy] trial). A CRT response was prespecified as a ≥15-mL reduction in left ventricular end-systolic volume at 6 months, which resulted in a binary CRT response (responders 52%, nonresponders 48%; n = 758). RESULTS Candidate proteins (n = 74) were evaluated from the inflammatory, signaling, and structural domains, which yielded 12 candidate biomarkers, but only a subset of these demonstrated predictive value for CRT response: soluble suppressor of tumorgenicity-2, soluble tumor necrosis factor receptor-II, matrix metalloproteinase-2, and C-reactive protein. These biomarkers were used in a composite categorical scoring algorithm (Biomarker CRT Score), which identified patients with a high/low probability of a response to CRT (P <.001) when adjusted for a number of clinical covariates. For example, a Biomarker CRT Score of 0 yielded 5 times higher odds of a response to CRT compared to a Biomarker CRT Score of 4 (P <.001). The Biomarker CRT Score demonstrated additive predictive value when considered against a composite of clinical variables. CONCLUSION These unique findings demonstrate that developing a biomarker panel for predicting individual response to CRT is feasible and holds potential for point-of-care testing and integration into evaluation algorithms for patients presenting for CRT.
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Affiliation(s)
- Francis G Spinale
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and Dorn VA Medical Center, Columbia, South Carolina; Medical University of South Carolina, Charleston, South Carolina.
| | | | | | - Jennifer E Van Eyk
- Departments of Medicine, Biol. Chem and Biomed. Eng, Johns Hopkins University, Baltimore, Maryland
| | - Michael R Gold
- Medical University of South Carolina, Charleston, South Carolina
| | - Suneet Mittal
- The Valley Hospital Health System, Ridgewood, New Jersey
| | - Stacia M DeSantis
- Cardiovascular Translational Research Center, University of South Carolina School of Medicine and Dorn VA Medical Center, Columbia, South Carolina
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Cao M, Schloss EJ, Lobban JH, Ahmed R, Stolen CM, Boehmer JP. Reduced LV Pacing Percentages are Associated with Progressively Worse Measures of Heart Failure Physiology in CRT Patients. J Card Fail 2018. [DOI: 10.1016/j.cardfail.2018.07.282] [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: 10/28/2022]
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8
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Skali H, Gerwien R, Meyer TE, Snider JV, Solomon SD, Stolen CM. Soluble ST2 and Risk of Arrhythmias, Heart Failure, or Death in Patients with Mildly Symptomatic Heart Failure: Results from MADIT-CRT. J Cardiovasc Transl Res 2016; 9:421-428. [PMID: 27798759 DOI: 10.1007/s12265-016-9713-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 06/21/2016] [Accepted: 10/04/2016] [Indexed: 12/17/2022]
Abstract
Soluble ST2 is an established biomarker of heart failure (HF) progression. Data about its prognostic implications in patients with mildly symptomatic HF eligible to receive cardiac resynchronization therapy defibrillators (CRT-D) are limited. In a cohort of 684 patients enrolled in Multicenter Automated Defibrillator Implantation Trial (MADIT)-CRT, levels of soluble ST2 (sST2) were serially assessed at baseline and 1 year (n = 410). In multivariable-adjusted models, elevated baseline sST2 was associated with an increased risk of death, death or HF, and death or ventricular arrhythmia (VA) even when adjusting for baseline brain natriuretic protein (BNP) levels. In addition, patients with lower baseline sST2 levels had greater risk reduction with CRT-D (p = 0.006). Serial assessment revealed increased risk of VA and death or VA (HR per 10 % increase in sST2 1.11 (1.04-1.20), p = 0.004). Among patients with mildly symptomatic HF and eligibility for CRT-D, baseline and serial assessments sST2 may provide important information for risk stratification.
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Affiliation(s)
- Hicham Skali
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
| | | | | | | | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
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Agarwal R, Mokelke E, Ruble SB, Stolen CM. Vagal Nerve Stimulation Evoked Heart Rate Changes and Protection from Cardiac Remodeling. J Cardiovasc Transl Res 2016; 9:67-76. [PMID: 26746408 DOI: 10.1007/s12265-015-9668-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 09/24/2015] [Accepted: 12/22/2015] [Indexed: 12/20/2022]
Abstract
This study investigated whether vagal nerve stimulation (VNS) leads to improvements in ischemic heart failure via heart rate modulation. At 7 ± 1 days post left anterior descending artery (LAD) ligation, 63 rats with myocardial infarctions (MI) were implanted with ECG transmitters and VNS devices (MI + VNS, N = 44) or just ECG transmitters (MI, N = 17). VNS stimulation was active from 14 ± 1 days to 8 ± 1 weeks post MI. The average left ventricular (LV) end diastolic volumes at 8 ± 1 weeks were MI = 672.40 μl and MI + VNS = 519.35 μl, p = 0.03. The average heart weights, normalized to body weight (± std) at 14 ± 1 weeks were MI = 3.2 ± 0.6 g*kg(-1) and MI + VNS = 2.9 ± 0.3 g*kg(-1), p = 0.03. The degree of cardiac remodeling was correlated with the magnitude of acute VNS-evoked heart rate (HR) changes. Further research is required to determine if the acute heart rate response to VNS activation is useful as a heart failure biomarker or as a tool for VNS therapy characterization.
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Affiliation(s)
- Rahul Agarwal
- Boston Scientific Corporation, 4100 Hamline Ave. North, St. Paul, MN, 55112, USA
| | - Eric Mokelke
- Boston Scientific Corporation, 4100 Hamline Ave. North, St. Paul, MN, 55112, USA
| | - Stephen B Ruble
- Boston Scientific Corporation, 4100 Hamline Ave. North, St. Paul, MN, 55112, USA
| | - Craig M Stolen
- Boston Scientific Corporation, 4100 Hamline Ave. North, St. Paul, MN, 55112, USA.
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10
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Barbato E, Barton PJ, Bartunek J, Huber S, Ibanez B, Judge DP, Lara-Pezzi E, Stolen CM, Taylor A, Hall JL. Review and Updates in Regenerative and Personalized Medicine, Preclinical Animal Models, and Clinical Care in Cardiovascular Medicine. J Cardiovasc Transl Res 2015; 8:466-74. [DOI: 10.1007/s12265-015-9657-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 09/28/2015] [Indexed: 12/22/2022]
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11
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Stolen CM, Adourian A, Meyer TE, Stein KM, Solomon SD. Plasma galectin-3 and heart failure outcomes in MADIT-CRT (multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy). J Card Fail 2014; 20:793-9. [PMID: 25106783 DOI: 10.1016/j.cardfail.2014.07.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 07/25/2014] [Accepted: 07/29/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND Elevated circulating levels of the protein galectin-3, a mediator of fibrogenesis, have previously been associated with adverse outcomes in heart failure (HF) patients and appear to modify response to certain pharmacologic therapies. This study investigated the relationship between galectin-3 level and clinical outcomes in HF patients randomized to implantable cardioverter defibrillator (ICD-only) or cardiac resynchronization therapy (CRT-D). METHODS AND RESULTS Plasma galectin-3 concentrations were measured in 654 New York Heart Association functional class I/II patients participating in the MADIT-CRT trial. A heterogeneity of response was detected between pre-implantation galectin-3 and randomization group (CRT-D or ICD-only) on the primary MADIT-CRT trial end point of nonfatal HF event or death (P = .045). Among patients with baseline galectin-3 levels in the top quartile of the distribution, CRT-D was associated with a 65% reduction in risk of the primary end point (hazard ratio [HR] 0.35, 95% confidence interval [CI] 0.19-0.67), whereas among patients with lower baseline galectin-3 values CRT-D was associated with a 25% decrease in risk (HR 0.75, 95% CI. 0.51-1.11). Baseline galectin-3 level also was observed to be an independent predictor of the primary end point (multivariable adjusted HR per log unit increase: 1.55; 95% CI 1.01-2.38; P = .043). CONCLUSIONS Elevated galectin-3 was found to be an independent predictor of adverse HF outcome in patients with mildly symptomatic HF. A significant interaction of device randomization group with pre-implantation galectin-3 level was detected, with HF patients with the highest baseline galectin-3 levels deriving a disproportionately larger benefit from CRT-D.
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Affiliation(s)
| | | | | | | | - Scott D Solomon
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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13
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Stolen CM, Lam YM, Siu CW, Lau CP, Parker JA, Hauser TH, Tse HF. Pacing to reduce refractory angina in patients with severe coronary artery disease: a crossover pilot trial. J Cardiovasc Transl Res 2011; 5:84-91. [PMID: 22038623 DOI: 10.1007/s12265-011-9326-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 10/12/2011] [Indexed: 11/27/2022]
Abstract
Biventricular pacing (BiV) has been shown to reduce wall stress and workload in regions near the pacing sites. This trial investigated if BiV near the ischemic region would reduce chest pain in patients with refractory angina due to severe coronary artery disease (CAD). Eleven patients were implanted with BiV devices with leads positioned at or adjacent to their ischemic regions as detected by single-photon emission computed tomography (SPECT) and randomized to either pacing turned ON or OFF for 3 months, and then crossed over for 3 months. With pacing turned ON, a Dynamic atrioventricular (AV) delay was set for approximately 90% and 70% of the intrinsic AV delay at the resting heart rate and at the onset of symptoms, respectively. One patient was excluded from the analysis due to a large amount of RV pacing during the OFF periods (24-64%) and due to an inability to properly deliver therapy because of an excessive number of ventricular premature complexes. Overall, with the device ON vs. OFF, the number of angina episodes (0.8 ± 0.4 vs. 1.2 ± 0.7 per week, P = 0.03) and amount of nitroglycerin used (0.2 ± 0.1 vs. 1.0 ± 0.7 per week, P = 0.11) was lower with BiV pacing. Furthermore, the treadmill exercise time to symptoms trended higher (427 ± 65 vs. 408 ± 64 s, P = 0.19), and the sum of fluorodeoxyglucose-positron emission tomography (FDG-PET) scores trended lower (7.9 ± 3.5 vs. 12.0 ± 4.0, P = 0.11) with the device ON vs. OFF. Nevertheless, there were no significant differences in SPECT myocardial perfusion scores, left ventricle ejection fraction, wall motion score index, and quality of life scores with device programmed ON vs. OFF (all P > 0.05). In conclusion, this pilot study demonstrated that BiV-P at or near the ischemic region was feasible and associated with significant reductions in angina in patients with severe CAD. Adequately powered prospective studies are needed to confirm these findings.
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14
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Chung ES, Dan D, Solomon SD, Bank AJ, Pastore J, Iyer A, Berger RD, Franklin JO, Jones G, Machado C, Stolen CM. Effect of Peri-Infarct Pacing Early After Myocardial Infarction. Circ Heart Fail 2010; 3:650-8. [PMID: 20852059 DOI: 10.1161/circheartfailure.110.945881] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eugene S. Chung
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Dan Dan
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Scott D. Solomon
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Alan J. Bank
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Joseph Pastore
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Anand Iyer
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Ronald D. Berger
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Jay O. Franklin
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Gregory Jones
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Christian Machado
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
| | - Craig M. Stolen
- From the Christ Hospital (E.S.C.), Cincinnati, Ohio; Piedmont Hospital (D.D.), Atlanta, Ga; Brigham and Women's Hospital (S.D.S.), Boston, Mass; The St Paul Heart Clinic (A.J.B.), St Paul, Minn; Boston Scientific Corporation (J.P., A.I., C.M.S.), St Paul, Minn; Johns Hopkins Hospital (R.D.B.), Baltimore, Md; Baylor University Medical Center (J.O.F.), Dallas, Tex; Wellmont Holston Valley Medical Center (G.J.), Kingsport, Tenn; and Providence Hospital (C.M.), Southfield, Mich
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15
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Qu J, Mains B, Stolen CM. P1-36 PACING IMPROVES AUTOLOGOUS BONE MARROW CELL RETENTION IN SWINE HEARTS WITH ACUTE MYOCARDIAL INFARCTIONS. Int J Cardiol 2007. [DOI: 10.1016/s0167-5273(08)70562-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: 11/25/2022]
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16
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Kirton CM, Laukkanen ML, Nieminen A, Merinen M, Stolen CM, Armour K, Smith DJ, Salmi M, Jalkanen S, Clark MR. Function-blocking antibodies to human vascular adhesion protein-1: a potential anti-inflammatory therapy. Eur J Immunol 2005; 35:3119-30. [PMID: 16224816 DOI: 10.1002/eji.200535300] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Human vascular adhesion protein-1 (VAP-1) is a homodimeric 170-kDa sialoglycoprotein that is expressed on the surface of endothelial cells and functions as a semicarbazide-sensitive amine oxidase and as an adhesion molecule. Blockade of VAP-1 has been shown to reduce leukocyte adhesion and transmigration in in vivo and in vitro models, suggesting that VAP-1 is a potential target for anti-inflammatory therapy. In this study we have constructed mouse-human chimeric antibodies by genetic engineering in order to circumvent the potential problems involved in using murine antibodies in man. Our chimeric anti-VAP-1 antibodies, which were designed to lack Fc-dependent effector functions, bound specifically to cell surface-expressed recombinant human VAP-1 and recognized VAP-1 in different cell types in tonsil. Furthermore, the chimeric antibodies prevented leukocyte adhesion and transmigration in vitro and in vivo. Hence, these chimeric antibodies have the potential to be used as a new anti-inflammatory therapy.
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Affiliation(s)
- Christopher M Kirton
- Immunology Division, Department of Pathology, Cambridge University, Cambridge, UK.
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17
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Stolen CM, Marttila-Ichihara F, Koskinen K, Yegutkin GG, Turja R, Bono P, Skurnik M, Hänninen A, Jalkanen S, Salmi M. Absence of the endothelial oxidase AOC3 leads to abnormal leukocyte traffic in vivo. Immunity 2005; 22:105-15. [PMID: 15664163 DOI: 10.1016/j.immuni.2004.12.006] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [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: 05/13/2004] [Revised: 11/24/2004] [Accepted: 12/01/2004] [Indexed: 10/25/2022]
Abstract
Leukocyte migration from the blood to tissues is a prerequisite for normal immune responses. We produced mice deficient in an endothelial cell-surface oxidase (amine oxidase, copper containing-3 [AOC3], also known as vascular adhesion protein-1 [VAP-1]) and found that this enzyme is needed for leukocyte extravasation in vivo. Real-time imaging shows that AOC3 mediates slow rolling, firm adhesion, and transmigration of leukocytes in vessels at inflammatory sites and lymphoid tissues. Absence of AOC3 results in reduced lymphocyte homing into lymphoid organs and in attenuated inflammatory response in peritonitis. These data alter the paradigm of leukocyte extravasation cascade by providing the first physiological proof for the concept that endothelial cell surface enzymes regulate the development of inflammatory reactions in vivo and suggest that this enzyme should be useful as an anti-inflammatory target.
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Affiliation(s)
- Craig M Stolen
- Department of Medical Microbiology, MediCity Research Laboratory, National Public Health Institute, Turku University, 20520 Turku, Finland
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18
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Abstract
Semicarbazide-sensitive amine oxidases (SSAO) are enzymes that are capable of deaminating primary amines to produce aldehyde, ammonia, and hydrogen peroxide. This activity has been associated with vascular adhesion protein-1 (VAP-1) and is found in the serum, endothelium, adipose, and smooth muscle of mammals. Circulating SSAO activity is increased in congestive heart failure, diabetes, and inflammatory liver diseases. To investigate the origin of circulating SSAO activity, two transgenic mouse models were created with full-length human VAP-1 (hVAP-1) expressed on either endothelial (mTIEhVAP-1) or adipose tissues (aP2hVAP-1), with tie-1 and adipocyte P2 promoters, respectively. Under normal conditions a circulating form of hVAP-1 was found at high levels in the serum of mice with endothelium-specific expression and at low levels in the serum of mice with adipose specific expression. The level of circulating hVAP-1 in the transgenic mice varied with gender, transgene zygosity, diabetes, and fasting. Serum SSAO activity was absent from VAP-1 knockout mice and endothelial cell-specific expression of human VAP-1 restored SSAO activity to the serum of VAP-1 knockout mice. Together, these experiments show that in the mouse VAP-1 is the only source of serum SSAO, that under physiological conditions vascular endothelial cells can be a major source of circulating VAP-1 protein and SSAO, and that serum VAP-1 can originate from both endothelial cells and adipocytes during experimental diabetes. An increased endothelial cell capacity for lymphocyte binding and altered expression of redox-sensitive proteins was also associated with the mTIEhVAP-1 transgene.
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Affiliation(s)
- Craig M Stolen
- MediCity Research Laboratory, University of Turku and National Public Health Institute, Tykistökatu 6A, FIN-20520, Turku, Finland.
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19
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Stolen CM, Madanat R, Marti L, Kari S, Yegutkin GG, Sariola H, Zorzano A, Jalkanen S. Semicarbazide sensitive amine oxidase overexpression has dual consequences: insulin mimicry and diabetes-like complications. FASEB J 2004; 18:702-4. [PMID: 14977883 DOI: 10.1096/fj.03-0562fje] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Semicarbazide-sensitive amine oxidases (SSAO) are copper-containing enzymes that oxidatively deaminate primary amines to produce hydrogen peroxide, ammonium, and specific aldehydes. Vascular adhesion protein-1 (VAP-1) is a cell surface and soluble molecule that possesses SSAO activity. VAP-1 protein, SSAO activity, and SSAO reaction products are elevated in the serum of patients with diabetes, congestive heart failure, and specific inflammatory liver diseases. By expressing human VAP-1/SSAO on mouse endothelial cells and subsequently in the serum, and by chronically treating the transgenic mice for 15 months with a high-fat diet and a physiological substrate for SSAO, methylamine, the in vivo roles of SSAO were assessed. The VAP-1 transgene increased the mouse body mass index and subcutaneous abdominal fat pad weights in a manner independent of food consumption. The transgene together with increased SSAO substrate availability enhanced glucose uptake in an SSAO-dependent manner. The increased SSAO activity also led to diabetes-like complications, including advanced glycation end product formation, elevated blood pressure, altered atherosclerosis progression, and nephropathy. These findings suggest that, although manipulation of VAP-1/SSAO has potential to serve as a therapeutic treatment in insulin-resistant conditions, care must be taken to fully understand its impact on obesity and vascular damage.
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Affiliation(s)
- Craig M Stolen
- MediCity Research Laboratory, University of Turku and National Public Health Institute, Turku, Finland.
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20
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Stolen CM, Griep AE. Disruption of lens fiber cell differentiation and survival at multiple stages by region-specific expression of truncated FGF receptors. Dev Biol 2000; 217:205-20. [PMID: 10625547 DOI: 10.1006/dbio.1999.9557] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To determine if fibroblast growth factor signaling mechanisms are required for terminal differentiation and survival of lens fiber cells, we evaluated the effects of expressing truncated fibroblast growth factor receptors (tFGFRs) in different regions of the developing lens. Two sets of transgenic mice were generated, one expressing tFGFRs from the alphaA-crystallin promoter (alphaA-tFGFR), which expresses linked genes in fiber cells throughout their differentiation program, and the other expressing tFGFRs from the gammaF-crystallin promoter (gammaF-tFGFR), which expresses linked genes beginning later during their differentiation. Histological and TUNEL analyses of lenses from alphaA-tFGFR and gammaF-tFGFR transgenic mice suggest that FGFR signaling is required for both early and late fiber cell differentiation and/or survival of the terminally differentiated cells. Additionally, multilayering and increased levels of apoptosis were observed in the anterior epithelium after the onset of fiber cell abnormalities. In situ hybridizations suggest that tFGFR transgenes were not expressed at significant levels in the epithelium. Combined with TUNEL and X-gal analyses on the lens epithelium from gammaF-tFGFR/Rosabeta-geo26 and nontransgenic/Rosabeta-geo26 chimeras, these results suggest that the organization and survival of the epithelial cells depend on appropriate structure and/or function of the differentiated fiber cells.
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Affiliation(s)
- C M Stolen
- Department of Anatomy, University of Wisconsin Medical School, Madison, Wisconsin, 53706, USA
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21
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Abstract
During mammalian embryogenesis, the ocular lens forms through a temporally and spatially regulated pattern of differentiation which is thought to be coordinated at least in part by the FGF-1 and FGF-2 members of the fibroblast growth factor (FGF) family. Previous transgenic experiments in which FGF-1 or dominant negative FGF receptors were overexpressed in the lens indicated that FGF-1 could induce differentiation while differentiated lens cells rely upon FGF signaling for their survival. In this study, we asked if the 17.5 kDa FGF-2 protein was capable of inducing differentiation of lens cells in transgenic mice. Unexpectedly, differentiation was inhibited by lens-specific expression of a transgene encoding a secreted form of the 17.5 kDa bovine FGF-2 protein under the transcriptional control of the murine alphaA-crystallin promoter (alphaAIgFGF-2 transgenic mice). To address the possibility that FGF-2 functions as a modulator of fiber cell survival, alphaAIgFGF-2 transgenic mice were crossed to transgenic mice exhibiting extensive apoptosis in the lens due to the functional inactivation of the retinoblastoma protein (alphaAE7 transgenic mice). The level of apoptosis in the lenses of double transgenic mice was substantially reduced as compared to the level in lenses from alphaAE7 only mice. These studies indicate that FGF-2 can act as a modulator of the later stages of differentiation including fiber cell survival. Additionally, they imply that control of lens development by FGFs is a complex process in which FGF-1 and FGF-2 play distinct roles.
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Affiliation(s)
- C M Stolen
- Department of Anatomy, University of Wisconsin Medical School, Madison 53706, USA
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