1
|
Jorde UP, Arfaras-Melainis A, Wan N, Uehara M, Castagna F, Vukelic S, Rochlani YM, Madan SA, Murthy S, Patel SR, Sims DB, Borgi J, Goldstein DJ, Forest SJ, Jakobleff WA, Saeed O. Use of Extracorporeal Membrane Oxygenation for Primary Graft Dysfunction After Cardiac Transplantation: Results of an A Priori Ventless Approach. ASAIO J 2024; 70:31-37. [PMID: 37797341 DOI: 10.1097/mat.0000000000002051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Primary graft dysfunction (PGD) after cardiac transplantation is a devastating complication with increasing frequency lately in the setting of donation after circulatory death (DCD). Severe PGD is commonly treated with extracorporeal membrane oxygenation (ECMO) using central or peripheral cannulation. We retrospectively reviewed the outcomes of PGD after cardiac transplantation requiring ECMO support at our center from 2015 to 2020, focused on our now preferential approach using peripheral cannulation without a priori venting. During the study period, 255 patients underwent heart transplantation at our center and 26 (10.2%) of them required ECMO for PGD. Of 24 patients cannulated peripherally 19 (79%) were alive at 30 days and 17 (71%) 1 year after transplant; two additional patients underwent central ECMO cannulation due to unfavorable size of femoral vessels and concern for limb ischemia. Successful decannulation with full graft function recovery occurred in 22 of 24 (92%) patients cannulated peripherally. Six of them had an indwelling intra-aortic balloon pump placed before the transplantation. None of the other 18 patients received a ventricular vent. In conclusion, the use of an a priori peripheral and ventless ECMO approach in patients with PGD after heart transplant is an effective strategy associated with high rates of graft recovery and survival.
Collapse
Affiliation(s)
- Ulrich P Jorde
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Angelos Arfaras-Melainis
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ningxin Wan
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Mayuko Uehara
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Francesco Castagna
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sasa Vukelic
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Yogita M Rochlani
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Shivank A Madan
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sandhya Murthy
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Snehal R Patel
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Daniel B Sims
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jamil Borgi
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Daniel J Goldstein
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Stephen J Forest
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - William A Jakobleff
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Omar Saeed
- From the Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
2
|
Seo J, Mangeshkar S, Farooq MU, Clark RM, Forest SJ, Sims DB, Tauras J, Murthy S. Exophiala dermatitidis fungal infective endocarditis on prosthetic mitral valve. BMJ Case Rep 2023; 16:e257224. [PMID: 38086571 PMCID: PMC10728942 DOI: 10.1136/bcr-2023-257224] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Fungal infective endocarditis, although rare, carries a high mortality risk. We present a case of successful multidisciplinary management of Exophiala dermatitidis infective endocarditis in an immunocompetent male with a bio-prosthetic mitral valve. This case highlights the clinical presentation and provides valuable treatment insights into this rare fungal entity. Prompt consideration of fungal pathogens in predisposed patients, expedited detection through non-culture-based tests, and a combined surgical and prolonged antifungal approach are pivotal.
Collapse
Affiliation(s)
- Jiyoung Seo
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Shaunak Mangeshkar
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Muhammad U Farooq
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rachel Marie Clark
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Stephen J Forest
- Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel B Sims
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - James Tauras
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sandhya Murthy
- Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
3
|
Castagna F, Viswanathan S, Chalhoub G, Ippolito P, Ovalle Ramos JA, Vukelic S, Sims DB, Madan S, Saeed O, Jorde UP. Predicting Hemodynamic Changes During Intra-Aortic Balloon Pump Support With a Longitudinal Evaluation. ASAIO J 2023; 69:977-983. [PMID: 37499684 PMCID: PMC10602221 DOI: 10.1097/mat.0000000000002014] [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] [Indexed: 07/29/2023] Open
Abstract
The use of intra-aortic balloon pump (IABP) has decreased in recent years due to negative outcome studies in cardiogenic shock complicating acute myocardial infarction, despite its favorable adverse-event profile. Acute hemodynamic response studies have identified potential super-responders with immediate improvements in cardiac index (CI) in heart failure patients. This single-center retrospective study aimed to predict CI and mean arterial pressure (MAP) changes throughout the entire duration of IABP support. The study analyzed 336 patients who received IABP between 2016 and 2022. Linear mixed-effect regression models were used to predict CI and MAP improvement during IABP support. The results showed that CI and MAP increases during the first days of support, and changes during IABP support varied with time and were associated with baseline parameters. Longitudinal CI change was associated with body surface area, baseline CI, baseline pulmonary artery pulsatility index, baseline need for pressors, and diabetes. Longitudinal MAP change was associated with baseline MAP, baseline heart rate, need for pressors, or inotropes. The study recommends considering these parameters when deciding if IABP is the most appropriate form of support for a specific patient. Further prospective studies are needed to validate the findings.
Collapse
Affiliation(s)
- Francesco Castagna
- From the Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Shankar Viswanathan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - George Chalhoub
- From the Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Paul Ippolito
- From the Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Julio Andres Ovalle Ramos
- From the Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Sasa Vukelic
- From the Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Daniel B. Sims
- From the Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Shivank Madan
- From the Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Omar Saeed
- From the Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Ulrich P. Jorde
- From the Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
4
|
Alhuarrat MAD, Alhuarrat MR, Varrias D, Patel SR, Sims DB, Latib A, Jorde UP, Saeed O. Outcomes of Non-ST-Segment Myocardial Infarction During Chronic Heart Failure and End-Stage Renal Disease. Am J Cardiol 2023; 200:1-7. [PMID: 37269688 DOI: 10.1016/j.amjcard.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/24/2023] [Accepted: 05/07/2023] [Indexed: 06/05/2023]
Abstract
Non-ST-segment myocardial infarction (NSTEMI) occurs frequently in a growing population of patients with chronic heart failure (HF) and end-stage renal disease (ESRD) but outcomes with invasive management approaches are unknown. We sought to determine in-hospital outcomes with percutaneous coronary intervention (PCI) in comparison with medical management only. The National Inpatient Sample was used to capture hospitalizations in the United States from 2006 to 2019. Admissions for NSTEMI in patients with chronic HF and ESRD were identified by International Classification of Diseases codes. The cohort was divided into those that received PCI or medical management only. In-hospital outcomes were compared by multivariable logistic regression and propensity matching. In 27,433 hospitalizations, 8,004 patients (29%) underwent PCI, and 19,429 (71%) were managed with medications only. PCI was associated with lower adjusted odds of death during hospitalization (adjusted odds ratio 0.59, 95% confidence interval 0.52 to 0.66, p <0.01). This association remained consistent after propensity matching (adjusted odds ratio 0.56, 95% confidence interval 0.49 to 0.64, p <0.01) and was apparent across all subtypes of HF. Patients with PCI had greater duration (5, 3, to 9 vs, 5, 3 to 8 days, p <0.01) and cost of hospitalization ($107,942, 70,230 to $173,182 vs, $44,156, 24,409 to $80,810, p <0.01). In conclusion, patients with HF and ESRD admitted for NSTEMI experienced lower in-hospital mortality with PCI in comparison with medical therapy only. Invasive percutaneous revascularization may be reasonable for appropriately selected patients with HF and ESRD but randomized controlled trials are needed to determine its safety and efficacy in this high-risk population.
Collapse
Affiliation(s)
- Majd Al Deen Alhuarrat
- Division of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | - Dimitrios Varrias
- Division of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Snehal R Patel
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Daniel B Sims
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ulrich P Jorde
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Omar Saeed
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
| |
Collapse
|
5
|
Madan S, Chan MAG, Saeed O, Hemmige V, Sims DB, Forest SJ, Goldstein DJ, Patel SR, Jorde UP. Early Outcomes of Adult Heart Transplantation From COVID-19 Infected Donors. J Am Coll Cardiol 2023; 81:2344-2357. [PMID: 37204379 PMCID: PMC10191151 DOI: 10.1016/j.jacc.2023.04.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/10/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND There is a paucity of data on heart transplantation (HT) using COVID-19 donors. OBJECTIVES This study investigated COVID-19 donor use, donor and recipient characteristics, and early post-HT outcomes. METHODS Between May 2020 and June 2022, study investigators identified 27,862 donors in the United Network for Organ Sharing, with 60,699 COVID-19 nucleic acid amplification testing (NAT) performed before procurement and with available organ disposition. Donors were considered "COVID-19 donors" if they were NAT positive at any time during terminal hospitalization. These donors were subclassified as "active COVID-19" (aCOV) donors if they were NAT positive within 2 days of organ procurement, or "recently resolved COVID-19" (rrCOV) donors if they were NAT positive initially but became NAT negative before procurement. Donors with NAT-positive status >2 days before procurement were considered aCOV unless there was evidence of a subsequent NAT-negative result ≥48 hours after the last NAT-positive result. HT outcomes were compared. RESULTS During the study period, 1,445 "COVID-19 donors" (COVID-19 NAT positive) were identified; 1,017 of these were aCOV, and 428 were rrCOV. Overall, 309 HTs used COVID-19 donors, and 239 adult HTs from COVID-19 donors (150 aCOV, 89 rrCOV) met study criteria. Compared with non-COV, COVID-19 donors used for adult HT were younger and mostly male (∼80%). Compared with HTs from non-COV donors, recipients of HTs from aCOV donors had increased mortality at 6 months (Cox HR: 1.74; 95% CI: 1.02-2.96; P = 0.043) and 1 year (Cox HR: 1.98; 95% CI: 1.22-3.22; P = 0.006). Recipients of HTs from rrCOV and non-COV donors had similar 6-month and 1-year mortality. Results were similar in propensity-matched cohorts. CONCLUSIONS In this early analysis, although HTs from aCOV donors had increased mortality at 6 months and 1 year, HTs from rrCOV donors had survival similar to that seen in recipients of HTs from non-COV donors. Continued evaluation and a more nuanced approach to this donor pool are needed.
Collapse
Affiliation(s)
- Shivank Madan
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.
| | | | - Omar Saeed
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Vagish Hemmige
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Daniel B Sims
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Stephen J Forest
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel J Goldstein
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Snehal R Patel
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ulrich P Jorde
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
6
|
Geller BJ, Sinha SS, Kapur NK, Bakitas M, Balsam LB, Chikwe J, Klein DG, Kochar A, Masri SC, Sims DB, Wong GC, Katz JN, van Diepen S. Escalating and De-escalating Temporary Mechanical Circulatory Support in Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e50-e68. [PMID: 35862152 DOI: 10.1161/cir.0000000000001076] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The use of temporary mechanical circulatory support in cardiogenic shock has increased dramatically despite a lack of randomized controlled trials or evidence guiding clinical decision-making. Recommendations from professional societies on temporary mechanical circulatory support escalation and de-escalation are limited. This scientific statement provides pragmatic suggestions on temporary mechanical circulatory support device selection, escalation, and weaning strategies in patients with common cardiogenic shock causes such as acute decompensated heart failure and acute myocardial infarction. The goal of this scientific statement is to serve as a resource for clinicians making temporary mechanical circulatory support management decisions and to propose standardized approaches for their use until more robust randomized clinical data are available.
Collapse
|
7
|
Kishino Y, Kuno T, Malik AH, Lanier GM, Sims DB, Ruiz Duque E, Briasoulis A. Effect of pulmonary artery pressure-guided therapy on heart failure readmission in a nationally representative cohort. ESC Heart Fail 2022; 9:2511-2517. [PMID: 35560987 PMCID: PMC9288808 DOI: 10.1002/ehf2.13956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/28/2022] [Accepted: 04/14/2022] [Indexed: 11/05/2022] Open
Abstract
AIMS Pulmonary artery pressure (PAP)-guided therapy in patients with heart failure (HF) using the CardioMEMS (CMM) device, an implantable PAP sensor, has been shown to reduce HF hospitalizations in previous studies. We sought to evaluate the clinical benefit of the CMM device in regard to 30, 90, and 180 day readmission rates in real-world usage. METHODS AND RESULTS We queried the Nationwide Readmissions Database (NRD) to identify patients who underwent CMM implantation (International Classification of Diseases 9 and 10 codes) between the years 2014 and 2019 and studied their HF readmissions. Moreover, we compared CMM patients and their readmissions with a matched cohort of patients with HF but without CMM. Multivariable Cox regression analysis was performed to adjust for other predictors of readmissions. Prior to matching, we identified 5 326 530 weighted HF patients without CMM and 1842 patients with CMM. After propensity score matching for several patients and hospital-related characteristics, the cohort consisted of 1839 patients with CMM and 1924 with HF without CMM. Before matching, CMM patients were younger (67.0 ± 13.5 years vs. 72.3 ± 14.1 years, P < 0.001), more frequently male (62.7% vs. 51.5%, P < 0.001), with higher rates of prior percutaneous coronary intervention (16.9% vs. 13.2%, P = 0.002), peripheral vascular disease (29.6% vs. 17.8%, P < 0.001), pulmonary circulatory disorder (38.7% vs. 23.2%, P < 0.001), atrial fibrillation (51.2% vs. 45.3%, P = 0.002), prior left ventricular assist device (1.8% vs. 0.2%, P < 0.001), high income (32.2% vs. 16.4%, P < 0.001), and acute kidney disease (43.8% vs. 29.9%, P < 0.001). Readmission rates at 30 days were 17.3% vs. 20.9% for patients with vs. without CMM, respectively, and remained statistically significant after matching (17.3% vs. 21.5%, P = 0.002). The rates of 90 day (29.6% vs. 36.5%, P = 0.002) and 180 day (39.6% vs. 46.6%, P = 0.009) readmissions were lower in the CMM group. In a multivariable regression model, CMM was associated with lower risk of readmissions (hazard ratio 0.75, 95% confidence interval 0.63-0.89, P = 0.001). CONCLUSIONS The CMM device was associated with reduced HF rehospitalization rates in a nationally representative cohort of HF patients, validating the clinical trial that led to the approval of this device and its utilization in the treatment of HF.
Collapse
Affiliation(s)
- Yoshikazu Kishino
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center, New York, NY, USA
| | - Gregg M Lanier
- Department of Cardiology, Westchester Medical Center, New York, NY, USA
| | - Daniel B Sims
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Ernesto Ruiz Duque
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa, IA, USA
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa, IA, USA
| |
Collapse
|
8
|
Daraz Y, Nnani D, Small K, Sims DB. Abstract 55: Statin Type Does Matter: Decreasing Incorrect Statin Administration For Hospitalized Heart Transplant Patients. Circ Cardiovasc Qual Outcomes 2022. [DOI: 10.1161/circoutcomes.15.suppl_1.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Statin therapy has been shown to prevent the development of transplant coronary artery disease (TCAD) in heart transplant (HT) patients. Pravastatin is used in HT patients as it does not depend on CYP3A4 metabolism. Other widely used statins, such as simvastatin, have significant drug-drug interactions with the calcineurin inhibitors, which are used as standard immunosuppression therapy for all HT patients.
Objective:
Our goal was to increase correct statin administration for HT patients from 41-43% to 80% by June 2021 through electronic medical record (EMR) modification and interprofessional communication with the pharmacy department.
Methods:
Previous to our intervention, the EMR would recommend ordering simvastatin when ordering pravastatin, due to simvastatin being the hospital formulary preferred statin. The EMR did not cross reference HT status, and that pravastatin should be ordered instead. Our intervention was to remove the EMR notification for HT patients recommending simvastatin, as well as working with the clinical heart transplant pharmacists to mediate communication with primary teams. Monthly data was obtained through retrospective chart review.
Results:
Following our intervention in March 2021, pravastatin was ordered for 67%, 78%, and 81% of heart transplant readmissions in April, May, and June 2021, respectively (Table 1).
Conclusion:
Our intervention of EMR modification as well as interprofessional communication has almost doubled the correct administration of pravastatin in HT admissions from 41% to 81% over the course of seven months. Prescribing the proper statin for HT patients prevents unwanted toxicities, as well as TCAD - a major limitation to longevity amongst HT patients. Further educational interventions will be implemented for providers to achieve 100% correct statin administration to patients with heart transplant.
Collapse
|
9
|
Wengrofsky AJ, Guo S, Vlismas P, Sims DB. Jugular Venous Pressure Measurement Is Accurate When Performed By Attending Physicians On Internal Medicine Wards. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
10
|
Castagna F, Xue X, Saeed O, Kataria R, Puius YA, Patel SR, Garcia MJ, Racine AD, Sims DB, Jorde UP. Hospital bed occupancy rate is an independent risk factor for COVID-19 inpatient mortality: a pandemic epicentre cohort study. BMJ Open 2022; 12:e058171. [PMID: 35168984 PMCID: PMC8852235 DOI: 10.1136/bmjopen-2021-058171] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 01/26/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION COVID-19 first struck New York City in the spring of 2020, resulting in an unprecedented strain on our healthcare system and triggering multiple changes in public health policy governing hospital operations as well as therapeutic approaches to COVID-19. We examined inpatient mortality at our centre throughout the course of the pandemic. METHODS This is a retrospective chart review of clinical characteristics, treatments and outcome data of all patients admitted with COVID-19 from 1 March 2020 to 28 February 2021. Patients were grouped into 3-month quartiles. Hospital strain was assessed as per cent of occupied beds based on a normal bed capacity of 1491. RESULTS Inpatient mortality decreased from 25.0% in spring to 10.8% over the course of the year. During this time, use of remdesivir, steroids and anticoagulants increased; use of hydroxychloroquine and other antibiotics decreased. Daily bed occupancy ranged from 62% to 118%. In a multivariate model with all year's data controlling for demographics, comorbidities and acuity of illness, percentage of bed occupancy was associated with increased 30-day in-hospital mortality of patients with COVID-19 (0.7% mortality increase for each 1% increase in bed occupancy; HR 1.007, CI 1.001 to 1.013, p=0.004) CONCLUSION: Inpatient mortality from COVID-19 was associated with bed occupancy. Early reduction in epicentre hospital bed occupancy to accommodate acutely ill and resource-intensive patients should be a critical component in the strategic planning for future pandemics.
Collapse
Affiliation(s)
- Francesco Castagna
- Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Omar Saeed
- Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Rachna Kataria
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yoram A Puius
- Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Infectious Diseases, Montefiore Medical Center, Bronx, New York, USA
| | - Snehal R Patel
- Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Mario J Garcia
- Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Andrew D Racine
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Pediatrics, Montefiore Medical Center, Bronx, New York, USA
| | - Daniel B Sims
- Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Ulrich P Jorde
- Albert Einstein College of Medicine, Bronx, New York, USA
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| |
Collapse
|
11
|
Kumar S, Derbala MH, Nguyen DT, Ferrall J, Cefalu M, Rivas-Lasarte M, Rashid SMI, Joseph DT, Graviss EA, Goldstein D, Jorde UP, Bhimaraj A, Suarez EE, Smith SA, Sims DB, Guha A. A multi-institutional retrospective analysis on impact of RV acute mechanical support timing after LVAD implantation on 1-year mortality and predictors of RV acute mechanical support weaning. J Heart Lung Transplant 2021; 41:244-254. [PMID: 34802875 DOI: 10.1016/j.healun.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/31/2021] [Accepted: 10/08/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There is little insight into which patients can be weaned off right ventricular (RV) acute mechanical circulatory support (AMCS) after left ventricular assist device (LVAD) implantation. We hypothesize that concomitant RV AMCS insertion instead of postoperative implantation will improve 1-year survival and increase the likelihood of RV AMCS weaning. METHODS A multicenter retrospective database of 826 consecutive patients who received a HeartMate II or HVAD between January 2007 and December 2016 was analyzed. We identified 91 patients who had early RV AMCS on index admission. Cox proportional-hazards model was constructed to identify predictors of 1-year mortality post-RV AMCS implantation and competing risk modeling identified RV AMCS weaning predictors. RESULTS There were 91 of 826 patients (11%) who required RV AMCS after CF-LVAD implantation with 51 (56%) receiving a concomitant RV AMCS and 40 (44%) implanted with a postoperative RV AMCS during their ICU stay; 48 (53%) patients were weaned from RV AMCS support. Concomitant RV AMCS with CF-LVAD insertion was associated with lower mortality (HR 0.45 [95% CI 0.26-0.80], p = 0.01) in multivariable model (which included age, BMI, angiotensin-converting enzyme inhibitor use, and heart transplantation as a time-varying covariate). In the multivariate competing risk analysis, a TPG < 12 (SHR 2.19 [95% CI 1.02-4.70], p = 0.04) and concomitant RV AMCS insertion (SHR 3.35 [95% CI 1.73-6.48], p < 0.001) were associated with a successful wean. CONCLUSIONS In patients with RVF after LVAD implantation, concomitant RV AMCS insertion at the time of LVAD was associated with improved 1-year survival and increased chances of RV support weaning compared to postoperative insertion.
Collapse
Affiliation(s)
- Salil Kumar
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Mohamed H Derbala
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Institute for Academic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Joel Ferrall
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Matthew Cefalu
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Mercedes Rivas-Lasarte
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; Advanced Heart Failure and Heart Transplant Unit, Hospital Univesitario Puerta de Hierro, Madrid, Spain
| | - Syed Muhammad Ibrahim Rashid
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Denny T Joseph
- Department of Internal Medicine, Houston Methodist Hospital, Houston, Texas
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Institute for Academic Medicine, Houston Methodist Hospital, Houston, Texas; Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Daniel Goldstein
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ulrich P Jorde
- Department of Pathology and Genomic Medicine, Institute for Academic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Arvind Bhimaraj
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Erik E Suarez
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Sakima A Smith
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Daniel B Sims
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ashrith Guha
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.
| |
Collapse
|
12
|
Sims DB, Kim Y, Kalininskiy A, Yanamandala M, Josephs J, Rivas-Lasarte M, Ahmed N, Assa A, Jahufar F, Kumar S, Sun E, Rahgozar K, Ali SZ, Zhang M, Patel S, Edwards P, Saeed O, Shin JJ, Murthy S, Patel S, Shah A, Jorde UP. Full-Time Cardiac Intensive Care Unit Staffing by Heart Failure Specialists and its Association with Mortality Rates. J Card Fail 2021; 28:394-402. [PMID: 34634449 DOI: 10.1016/j.cardfail.2021.09.013] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cardiac intensive care units (CICUs) serve medically complex patients with multiorgan dysfunction. Whether a CICU that is staffed full time by heart failure (HF) specialists is associated with decreased mortality is unclear. METHODS AND RESULTS A retrospective review of consecutive CICU admissions from January 1, 2012, to December 31, 2016, was performed. In January 2014, the CICU changed from an open unit staffed by any cardiologist to a closed unit managed by HF specialists. Patients' baseline characteristics were determined, and a multivariate regression analysis was performed to ascertain mortality rates in the CICU. Baseline severity of illness was higher in the closed/HF specialist CICU model (P< 0.001). Death occurred in 101 of 1185 patients admitted to the CICU (8.5%) in the open-unit model and in 139 of 2163 patients (6.4%) admitted to the closed/HF specialist model (absolute risk reduction 2.1%, 95% confidence interval [CI] 0.1-4.0%; P = 0.01). The transition from an open to a closed/HF specialist model was associated with a lower overall CICU mortality rate (odds ratio [OR] 0.63; 95% CI 0.43-0.93). Prespecified interaction with a mechanical circulatory support device and unit model showed that treatment with such a device was associated with lower mortality rates in the closed/HF specialist model of a CICU (OR 0.6; 95% CI 0.18-0.78; P for interaction <0.01). CONCLUSION Transition to a closed unit model staffed by a dedicated HF specialist is associated with lower CICU mortality rates.
Collapse
Affiliation(s)
| | - Yekaterina Kim
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | | | | | - Joshua Josephs
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | | | - Navid Ahmed
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Andrei Assa
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Fathima Jahufar
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Salil Kumar
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Eric Sun
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Kusha Rahgozar
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Syed Zain Ali
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Ming Zhang
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | - Shreyans Patel
- Department of Medicine, Montefiore Medical Center, Bronx, New York
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
Outcomes for cardiogenic shock (CS) patients remain relatively poor despite significant advancements in primary percutaneous coronary interventions (PCI) and temporary circulatory support (TCS) technologies. Mortality from CS shows great disparities that seem to reflect large variations in access to care and physician practice patterns. Recent reports of different models to standardize care in CS have shown considerable potential at improving outcomes. The creation of regional, integrated, 3-tiered systems, would facilitate standardized interventions and equitable access to care. Multidisciplinary CS teams at Level I centers would direct care in a hub-and-spoke model through jointly developed protocols and real-time shared decision making. Levels II and III centers would provide early access to life-saving therapies and safe transfer to designated hub centers. In regions with large geographical distances, the implementation of telemedicine-cardiac intensive care unit (CICU) care can be an important resource for the creation of effective systems of care.
Collapse
Affiliation(s)
- Miguel Alvarez Villela
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States.,Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Rachel Clark
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Preethi William
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States.,Division of Cardiology, Banner University Medical Center, Tucson, University of Arizona, Tucson, AZ, United States
| | - Daniel B Sims
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Ulrich P Jorde
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| |
Collapse
|
14
|
Castagna F, Kataria R, Madan S, Ali SZ, Diab K, Leyton C, Arfaras-Melainis A, Kim P, Giorgi FM, Vukelic S, Saeed O, Patel SR, Sims DB, Jorde UP. A History of Heart Failure Is an Independent Risk Factor for Death in Patients Admitted with Coronavirus 19 Disease. J Cardiovasc Dev Dis 2021; 8:jcdd8070077. [PMID: 34209143 PMCID: PMC8307512 DOI: 10.3390/jcdd8070077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 01/10/2023] Open
Abstract
Aims: The association between cardiovascular diseases, such as coronary artery disease and hypertension, and worse outcomes in COVID-19 patients has been previously demonstrated. However, the effect of a prior diagnosis of heart failure (HF) with reduced or preserved left ventricular ejection fraction on COVID-19 outcomes has not yet been established. Methods and Results: We retrospectively studied all adult patients with COVID-19 admitted to our institution from March 1st to 2nd May 2020. Patients were grouped based on the presence or absence of HF. We used competing events survival models to examine the association between HF and death, need for intubation, or need for dialysis during hospitalization. Of 4043 patients admitted with COVID-19, 335 patients (8.3%) had a prior diagnosis of HF. Patients with HF were older, had lower body mass index, and a significantly higher burden of co-morbidities compared to patients without HF, yet the two groups presented to the hospital with similar clinical severity and similar markers of systemic inflammation. Patients with HF had a higher cumulative in-hospital mortality compared to patients without HF (49.0% vs. 27.2%, p < 0.001) that remained statistically significant (HR = 1.383, p = 0.001) after adjustment for age, body mass index, and comorbidities, as well as after propensity score matching (HR = 1.528, p = 0.001). Notably, no differences in mortality, need for mechanical ventilation, or renal replacement therapy were observed among HF patients with preserved or reduced ejection fraction. Conclusions: The presence of HF is a risk factor of death, substantially increasing in-hospital mortality in patients admitted with COVID-19.
Collapse
Affiliation(s)
- Francesco Castagna
- Montefiore Medical Center, Division of Cardiology, Albert Einstein College of Medicine, New York, NY 10467, USA; (F.C.); (R.K.); (S.M.); (S.V.); (O.S.); (S.R.P.); (D.B.S.)
| | - Rachna Kataria
- Montefiore Medical Center, Division of Cardiology, Albert Einstein College of Medicine, New York, NY 10467, USA; (F.C.); (R.K.); (S.M.); (S.V.); (O.S.); (S.R.P.); (D.B.S.)
| | - Shivank Madan
- Montefiore Medical Center, Division of Cardiology, Albert Einstein College of Medicine, New York, NY 10467, USA; (F.C.); (R.K.); (S.M.); (S.V.); (O.S.); (S.R.P.); (D.B.S.)
| | - Syed Zain Ali
- Montefiore Medical Center, Department of Medicine, Albert Einstein College of Medicine, New York, NY 10467, USA; (S.Z.A.); (K.D.); (C.L.); (P.K.)
| | - Karim Diab
- Montefiore Medical Center, Department of Medicine, Albert Einstein College of Medicine, New York, NY 10467, USA; (S.Z.A.); (K.D.); (C.L.); (P.K.)
| | - Christopher Leyton
- Montefiore Medical Center, Department of Medicine, Albert Einstein College of Medicine, New York, NY 10467, USA; (S.Z.A.); (K.D.); (C.L.); (P.K.)
| | - Angelos Arfaras-Melainis
- Department of Medicine, NYC Health & Hospitals/Jacobi, Albert Einstein College of Medicine, New York, NY 10461, USA;
| | - Paul Kim
- Montefiore Medical Center, Department of Medicine, Albert Einstein College of Medicine, New York, NY 10467, USA; (S.Z.A.); (K.D.); (C.L.); (P.K.)
| | - Federico M. Giorgi
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy;
| | - Sasa Vukelic
- Montefiore Medical Center, Division of Cardiology, Albert Einstein College of Medicine, New York, NY 10467, USA; (F.C.); (R.K.); (S.M.); (S.V.); (O.S.); (S.R.P.); (D.B.S.)
| | - Omar Saeed
- Montefiore Medical Center, Division of Cardiology, Albert Einstein College of Medicine, New York, NY 10467, USA; (F.C.); (R.K.); (S.M.); (S.V.); (O.S.); (S.R.P.); (D.B.S.)
| | - Snehal R. Patel
- Montefiore Medical Center, Division of Cardiology, Albert Einstein College of Medicine, New York, NY 10467, USA; (F.C.); (R.K.); (S.M.); (S.V.); (O.S.); (S.R.P.); (D.B.S.)
| | - Daniel B. Sims
- Montefiore Medical Center, Division of Cardiology, Albert Einstein College of Medicine, New York, NY 10467, USA; (F.C.); (R.K.); (S.M.); (S.V.); (O.S.); (S.R.P.); (D.B.S.)
| | - Ulrich P. Jorde
- Montefiore Medical Center, Division of Cardiology, Albert Einstein College of Medicine, New York, NY 10467, USA; (F.C.); (R.K.); (S.M.); (S.V.); (O.S.); (S.R.P.); (D.B.S.)
- Correspondence: ; Tel.: +1-212-718-920-2626
| |
Collapse
|
15
|
Rivas-Lasarte M, Kumar S, Derbala MH, Ferrall J, Cefalu M, Rashid SMI, Joseph DT, Goldstein DJ, Jorde UP, Guha A, Bhimaraj A, Suarez EE, Smith SA, Sims DB. Prediction of right heart failure after left ventricular assist implantation: external validation of the EUROMACS right-sided heart failure risk score. Eur Heart J Acute Cardiovasc Care 2021; 10:723-732. [PMID: 34050652 DOI: 10.1093/ehjacc/zuab029] [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] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/21/2021] [Indexed: 11/13/2022]
Abstract
AIMS Prediction of right heart failure (RHF) after left ventricular assist device (LVAD) implant remains a challenge. The EUROMACS right-sided heart failure (EUROMACS-RHF) risk score was proposed as a prediction tool for post-LVAD RHF but lacks from large external validation. The aim of our study was to externally validate the score. METHODS AND RESULTS From January 2007 to December 2017, 878 continuous-flow LVADs were implanted at three tertiary centres. We calculated the EUROMACS-RHF score in 662 patients with complete data. We evaluated its predictive performance for early RHF defined as either (i) need for short- or long-term right-sided circulatory support, (ii) continuous inotropic support for ≥14 days, or (iii) nitric oxide for ≥48 h post-operatively. Right heart failure occurred in 211 patients (32%). When compared with non-RHF patients, pre-operatively they had higher creatinine, bilirubin, right atrial pressure, and lower INTERMACS class (P < 0.05); length of stay and in-hospital mortality were higher. Area under the ROC curve for RHF prediction of the EUROMACS-RHF score was 0.64 [95% confidence interval (CI) 0.60-0.68]. Reclassification of patients with RHF was significantly better when applying the EUROMACS-RHF risk score on top of previous published scores. Patients in the high-risk category had significantly higher in-hospital and 2-year mortality [hazard ratio: 1.64 (95% CI 1.16-2.32) P = 0.005]. CONCLUSION In an external cohort, the EUROMACS-RHF had limited discrimination predicting RHF. The clinical utility of this score remains to be determined.
Collapse
Affiliation(s)
- Mercedes Rivas-Lasarte
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY 10467, USA.,Advanced Heart Failure and Transplant Unit, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, Majadahonda, Madrid, Spain
| | - Salil Kumar
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY 10467, USA.,Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Mohamed H Derbala
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joel Ferrall
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Matthew Cefalu
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Syed Muhammad Ibrahim Rashid
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY 10467, USA
| | - Denny T Joseph
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Daniel J Goldstein
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ulrich P Jorde
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY 10467, USA
| | - Ashrith Guha
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Arvind Bhimaraj
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Erik E Suarez
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Sakima A Smith
- Department of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel B Sims
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY 10467, USA
| |
Collapse
|
16
|
Milwidsky A, Alvarez Villela M, Wiley J, Sanina C, Patel SR, Sutton N, Latib A, Sims DB, Forest SJ, Shin JJ, Farooq MU, Goldstein DJ, Jorde UP. Outflow graft obstruction in patients with the HM 3 LVAD: A percutaneous approach. Catheter Cardiovasc Interv 2021; 98:1383-1390. [PMID: 34047456 DOI: 10.1002/ccd.29785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/04/2021] [Accepted: 05/09/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND The use of the HeartMate 3 (HM3) left ventricular assist device (LVAD) is expanding. Despite being associated with lower rates of adverse events and increased survival, outflow graft obstruction (OGO) has been reported in patients with HM3. The incidence and best management of this serious complication remain unclear. METHODS We describe six cases of HM3 OGO occurring in five patients in our institutional HM3 cohort. Four cases underwent computed tomography angiography and in two percutaneous angiography was directly performed to confirm the diagnosis. In four cases, percutaneous repair of the OG was performed using common interventional cardiology (IC) techniques. RESULTS Our institutional incidence of OGO was 7% (event rate of 0.05 per patient year); much higher than the previously reported incidence of 1.6%. All cases occurred in the bend relief covered segment. Only two patients had apparent OG twisting, and in two, OGO occurred despite placement of an anti-twist clip at the time of implant. External compression seems to play a role in most cases. Balloon "graftoplasty" and stent deployment via the femoral artery alleviated the obstruction and normalized LVAD flow in all patients who underwent percutaneous repair. The use of self-expanding stents allowed for downsizing of the procedural access site to 10 Fr. No serious procedure-related complications occurred. CONCLUSION OGO is common in HM3 patients, external compression due to biomaterial accumulated surrounding the OG is a common etiology. Percutaneous repair using standard IC techniques is safe and feasible in cases of compression with or without partial twisting.
Collapse
Affiliation(s)
- Assi Milwidsky
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.,Division of Cardiology Tel-Aviv Medical Center affiliated with Sackler School of Medicine in Tel-Aviv University, New York, New York, USA
| | - Miguel Alvarez Villela
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jose Wiley
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Cristina Sanina
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Snehal R Patel
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nicole Sutton
- Division of Pediatric Cardiology, Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel B Sims
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Stephen J Forest
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Julia J Shin
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Muhammad U Farooq
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel J Goldstein
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ulrich P Jorde
- Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
17
|
Rivas-Lasarte M, Scatola A, Sims DB, Forest SJ, Goldstein DJ, Jorde UP. Un nuevo giro en un caso de alarmas por bajo flujo en una asistencia HeartMate 3. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.09.019] [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: 10/22/2022]
|
18
|
Vlismas PP, Wiesenfeld E, Oh KT, Murthy S, Vukelic S, Saeed O, Patel S, Shin JJ, Jorde UP, Sims DB. Relation of Peripheral Venous Pressure to Central Venous Pressure in Patients With Heart Failure, Heart Transplant, and Left Ventricular Assist Device. Am J Cardiol 2021; 138:80-84. [PMID: 33058805 DOI: 10.1016/j.amjcard.2020.09.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 12/21/2022]
Abstract
Peripheral venous pressure (PVP) monitoring is a noninvasive method to assess volume status. We investigated the correlation between PVP and central venous pressure (CVP) in heart failure (HF), heart transplant (HTx), and left ventricular assist device (LVAD) patients undergoing right heart catheterization (RHC). A prospective, cross-sectional study examining PVP in 100 patients from October 2018 to January 2020 was conducted. The analysis included patients undergoing RHC admitted for HF, post-HTx monitoring, or LVAD hemodynamic testing. Sixty percent of patients had HF, 30% were HTx patients, and 10% were LVAD patients. The mean PVP was 9.4 ± 5.3 mm Hg, and the mean CVP was 9.2 ± 5.8 mm Hg. The PVP and CVP were found to be highly correlated (r = 0.93, p < 0.00001). High correlation was also noted when broken down by HF (r = 0.93, p < 0.00001), HTx (r = 0.93, p < 0.00001), and LVAD groups (r = 0.94, p < 0.00005). In conclusion, there is a high degree of correlation between PVP and CVP in HF, HTx, and LVAD patients. PVP measurements can be used as a rapid, reliable, noninvasive estimate of volume status in these patient populations.
Collapse
|
19
|
Saeed O, Castagna F, Agalliu I, Xue X, Patel SR, Rochlani Y, Kataria R, Vukelic S, Sims DB, Alvarez C, Rivas‐Lasarte M, Garcia MJ, Jorde UP. Statin Use and In-Hospital Mortality in Patients With Diabetes Mellitus and COVID-19. J Am Heart Assoc 2020; 9:e018475. [PMID: 33092446 PMCID: PMC7955378 DOI: 10.1161/jaha.120.018475] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023]
Abstract
Background Severe coronavirus disease 2019 (COVID-19) is characterized by a proinflammatory state with high mortality. Statins have anti-inflammatory effects and may attenuate the severity of COVID-19. Methods and Results An observational study of all consecutive adult patients with COVID-19 admitted to a single center located in Bronx, New York, was conducted from March 1, 2020, to May 2, 2020. Patients were grouped as those who did and those who did not receive a statin, and in-hospital mortality was compared by competing events regression. In addition, propensity score matching and inverse probability treatment weighting were used in survival models to examine the association between statin use and death during hospitalization. A total of 4252 patients were admitted with COVID-19. Diabetes mellitus modified the association between statin use and in-hospital mortality. Patients with diabetes mellitus on a statin (n=983) were older (69±11 versus 67±14 years; P<0.01), had lower inflammatory markers (C-reactive protein, 10.2; interquartile range, 4.5-18.4 versus 12.9; interquartile range, 5.9-21.4 mg/dL; P<0.01) and reduced cumulative in-hospital mortality (24% versus 39%; P<0.01) than those not on a statin (n=1283). No difference in hospital mortality was noted in patients without diabetes mellitus on or off statin (20% versus 21%; P=0.82). Propensity score matching (hazard ratio, 0.88; 95% CI, 0.83-0.94; P<0.01) and inverse probability treatment weighting (HR, 0.88; 95% CI, 0.84-0.92; P<0.01) showed a 12% lower risk of death during hospitalization for statin users than for nonusers. Conclusions Statin use was associated with reduced in-hospital mortality from COVID-19 in patients with diabetes mellitus. These findings, if validated, may further reemphasize administration of statins to patients with diabetes mellitus during the COVID-19 era.
Collapse
Affiliation(s)
- Omar Saeed
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Francesco Castagna
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Ilir Agalliu
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineNew YorkNY
| | - Xiaonan Xue
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineNew YorkNY
| | - Snehal R. Patel
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Yogita Rochlani
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Rachna Kataria
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Sasa Vukelic
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Daniel B. Sims
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Chikezie Alvarez
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Mercedes Rivas‐Lasarte
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Mario J. Garcia
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| | - Ulrich P. Jorde
- Division of CardiologyDepartment of MedicineMontefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY
| |
Collapse
|
20
|
Fordyce CB, Katz JN, Alviar CL, Arslanian-Engoren C, Bohula EA, Geller BJ, Hollenberg SM, Jentzer JC, Sims DB, Washam JB, van Diepen S. Prevention of Complications in the Cardiac Intensive Care Unit: A Scientific Statement From the American Heart Association. Circulation 2020; 142:e379-e406. [DOI: 10.1161/cir.0000000000000909] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Contemporary cardiac intensive care units (CICUs) have an increasing prevalence of noncardiovascular comorbidities and multisystem organ dysfunction. However, little guidance exists to support the development of best-practice principles specific to the CICU. This scientific statement evaluates strategies to avoid the potentially preventable complications encountered within contemporary CICUs, focusing on those that are most applicable to the CICU environment. This scientific statement reviews evidence-based practices derived in non–CICU populations, assesses their relevance to CICU practice, and highlights key knowledge gaps warranting further investigation to attenuate patient risk.
Collapse
|
21
|
Alvarez Villela M, Chinnadurai T, Salkey K, Furlani A, Yanamandala M, Vukelic S, Sims DB, Shin JJ, Saeed O, Jorde UP, Patel SR. Feasibility of high-intensity interval training in patients with left ventricular assist devices: a pilot study. ESC Heart Fail 2020; 8:498-507. [PMID: 33205573 PMCID: PMC7835573 DOI: 10.1002/ehf2.13106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/03/2020] [Accepted: 10/22/2020] [Indexed: 01/27/2023] Open
Abstract
Aims Patients with left ventricular assist device (LVAD) suffer from persistent exercise limitation despite improvement of their heart failure syndrome. Exercise training (ET) programmes to improve aerobic capacity have shown modest efficacy. High‐intensity interval training (HIIT), as an alternative to moderate continuous training, has not been systematically tested in this population. We examine the feasibility of a short, personalized HIIT programme in patients with LVAD and describe its effects on aerobic capacity and left ventricular remodelling. Methods and results Patients on durable LVAD support were prospectively enrolled in a 15‐session, 5 week HIIT programme. Turndown echocardiogram, Kansas City Cardiomyopathy Questionnaire, and cardiopulmonary exercise test were performed before and after HIIT. Training workloads for each subject were based on pretraining peak cardiopulmonary exercise test work rate (W). Percentage of prescribed training workload completed and adverse events were recorded for each subject. Fifteen subjects were enrolled [10 men, age = 51 (29–71) years, HeartMate II = 12, HeartMate 3 = 3, and time on LVAD = 18 (3–64) months]. Twelve completed post‐training testing. HIIT was well tolerated, and 90% (inter‐quartile range: 78, 99%) of the prescribed workload (W) was completed with no major adverse events. Improvements were seen in aV̇O2 at ventilatory threshold [7.1 (6.5, 9.1) to 8.5 (7.7, 9.3) mL/kg/min, P = 0.04], work rate at ventilatory threshold [44 (14, 54) to 55 (21, 66) W, P = 0.05], and left ventricular end‐diastolic volume [168 (144, 216) to 159 (124, 212) mL, n = 7, P = 0.02]. HIIT had no effect on maximal oxygen consumption (V̇O2peak) or Kansas City Cardiomyopathy Questionnaire score. Conclusions Cardiopulmonary exercise test‐guided HIIT is feasible and can improve submaximal aerobic capacity in stable patients with chronic LVAD support. Further studies are needed on its effects on the myocardium and its potential role in cardiac rehabilitation programmes.
Collapse
Affiliation(s)
- Miguel Alvarez Villela
- Department of Medicine, Montefiore Einstein Center for Heart and Vascular Care, New York, NY, USA.,Division of Cardiology, Department of Medicine, Jacobi Medical Center, New York, NY, USA
| | - Thiru Chinnadurai
- Department of Medicine, Montefiore Einstein Center for Heart and Vascular Care, New York, NY, USA
| | - Kalil Salkey
- Department of Medicine, Montefiore Einstein Center for Heart and Vascular Care, New York, NY, USA
| | - Andrea Furlani
- Department of Medicine, Montefiore Einstein Center for Heart and Vascular Care, New York, NY, USA
| | - Mounica Yanamandala
- Brigham and Women's Hospital, Heart and Vascular Center, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Sasha Vukelic
- Department of Medicine, Montefiore Einstein Center for Heart and Vascular Care, New York, NY, USA
| | - Daniel B Sims
- Department of Medicine, Montefiore Einstein Center for Heart and Vascular Care, New York, NY, USA
| | - Jooyoung J Shin
- Department of Medicine, Montefiore Einstein Center for Heart and Vascular Care, New York, NY, USA
| | - Omar Saeed
- Department of Medicine, Montefiore Einstein Center for Heart and Vascular Care, New York, NY, USA
| | - Ulrich P Jorde
- Department of Medicine, Montefiore Einstein Center for Heart and Vascular Care, New York, NY, USA
| | - Snehal R Patel
- Department of Medicine, Montefiore Einstein Center for Heart and Vascular Care, New York, NY, USA
| |
Collapse
|
22
|
Rivas-Lasarte M, Scatola A, Sims DB, Forest SJ, Goldstein DJ, Jorde UP. A new twist to HeartMate 3 low flow alarms. ACTA ACUST UNITED AC 2020; 74:349-351. [PMID: 33097443 DOI: 10.1016/j.rec.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Mercedes Rivas-Lasarte
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Andrew Scatola
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Daniel B Sims
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Stephen J Forest
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Daniel J Goldstein
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Ulrich P Jorde
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
| |
Collapse
|
23
|
Alvarez CK, Alvarez Villela M, Wiley JM, Taveras JM, Goldstein DJ, Sims DB, Jorde UP. Axillary Intra-Aortic Balloon Pump Migration Into the Left Ventricle During Peripheral Venoarterial Extracorporeal Membrane Oxygenation Support. Circ Heart Fail 2020; 13:e007017. [PMID: 32354279 DOI: 10.1161/circheartfailure.120.007017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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)
| | | | - Jose M Wiley
- Division of Cardiology, Montefiore Medical Center, Bronx, NY
| | - Jose M Taveras
- Division of Cardiology, Montefiore Medical Center, Bronx, NY
| | | | - Daniel B Sims
- Division of Cardiology, Montefiore Medical Center, Bronx, NY
| | - Ulrich P Jorde
- Division of Cardiology, Montefiore Medical Center, Bronx, NY
| |
Collapse
|
24
|
Kociol RD, Cooper LT, Fang JC, Moslehi JJ, Pang PS, Sabe MA, Shah RV, Sims DB, Thiene G, Vardeny O. Recognition and Initial Management of Fulminant Myocarditis: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e69-e92. [PMID: 31902242 DOI: 10.1161/cir.0000000000000745] [Citation(s) in RCA: 303] [Impact Index Per Article: 75.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Fulminant myocarditis (FM) is an uncommon syndrome characterized by sudden and severe diffuse cardiac inflammation often leading to death resulting from cardiogenic shock, ventricular arrhythmias, or multiorgan system failure. Historically, FM was almost exclusively diagnosed at autopsy. By definition, all patients with FM will need some form of inotropic or mechanical circulatory support to maintain end-organ perfusion until transplantation or recovery. Specific subtypes of FM may respond to immunomodulatory therapy in addition to guideline-directed medical care. Despite the increasing availability of circulatory support, orthotopic heart transplantation, and disease-specific treatments, patients with FM experience significant morbidity and mortality as a result of a delay in diagnosis and initiation of circulatory support and lack of appropriately trained specialists to manage the condition. This scientific statement outlines the resources necessary to manage the spectrum of FM, including extracorporeal life support, percutaneous and durable ventricular assist devices, transplantation capabilities, and specialists in advanced heart failure, cardiothoracic surgery, cardiac pathology, immunology, and infectious disease. Education of frontline providers who are most likely to encounter FM first is essential to increase timely access to appropriately resourced facilities, to prevent multiorgan system failure, and to tailor disease-specific therapy as early as possible in the disease process.
Collapse
|
25
|
Madan S, Sims DB, Vlismas P, Patel SR, Saeed O, Murthy S, Forest S, Jakobleff W, Shin JJ, Goldstein DJ, Jorde UP. Cardiac Transplantation Using Hearts With Transient Dysfunction: Role of Takotsubo-Like Phenotype. Ann Thorac Surg 2019; 110:76-84. [PMID: 31816283 DOI: 10.1016/j.athoracsur.2019.09.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/16/2018] [Revised: 09/09/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The impact of different types of regional wall motion abnormalities (RWMAs), including the Takotsubo syndrome-like (TTS-like) phenotype, on posttransplant outcomes when using donor hearts with transient left ventricular systolic dysfunction (LVSD) is unknown. We evaluated the prevalence, clinical characteristics, and prognostic association of different RWMAs including TTS-like hypokinesis and posttransplant outcomes when using donor hearts with transient LVSD. METHODS From all adult (≥18 years) heart transplants in United Network of Organ Sharing between January 2007 and September 2015, we identified 472 donor hearts with improving or transient LVSD, defined as left ventricular ejection fraction ≤ 40% on initial transthoracic echocardiogram (TTE) that improved to ≥50% on follow-up TTE during donor evaluation. These improved LVSD donors were then subdivided into 3 groups based on RWMAs on the initial TTE, TTS-like (49, 10.38%), non-TTS RWMAs (74, 15.68%), and diffuse global hypokinesis (349, 73.94%), and compared for baseline characteristics and posttransplant outcomes with follow up until June 2018. RESULTS Donors with TTS-like LVSD were older and more likely to be female. The type of RWMA on initial TTE (including TTS-like) of transient LVSD donor hearts was not associated with 1-year or 5-year posttransplant mortality. Posttransplant functional status scores of recipients (at 1 year) and donor left ventricular ejection fraction (at median follow-up of 3.6 years) improved in all 3 subgroups. Rates of stroke or pacemaker predischarge were also similar. CONCLUSIONS In the largest analysis of transplanted donor hearts with transient LVSD, 1 in 4 had RWMAs on the initial TTE, but this was not associated with adverse posttransplant outcomes. Donor hearts with initial LVSD should be pursued irrespective of TTS-like hypokinesis or other RWMAs.
Collapse
Affiliation(s)
- Shivank Madan
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Daniel B Sims
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Peter Vlismas
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Snehal R Patel
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Omar Saeed
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sandhya Murthy
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Stephen Forest
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - William Jakobleff
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jooyoung Julia Shin
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Daniel J Goldstein
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ulrich P Jorde
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
| |
Collapse
|
26
|
Affiliation(s)
| | - Ulrich P. Jorde
- Division of Cardiology, Montefiore Medical Center, Bronx, NY
| | - Daniel B. Sims
- Division of Cardiology, Montefiore Medical Center, Bronx, NY
| |
Collapse
|
27
|
Uriel N, Imamura T, Sayer G, Agarwal R, Sims DB, Takayama H, John R, Pagani FD, Naka Y, Sundareswaran KS, Farrar DJ, Jorde UP. High Transpulmonary Artery Gradient Obtained at the Time of Left Ventricular Assist Device Implantation Negatively Affects Survival After Cardiac Transplantation. J Card Fail 2019; 25:777-784. [DOI: 10.1016/j.cardfail.2019.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/19/2019] [Accepted: 03/18/2019] [Indexed: 01/06/2023]
|
28
|
Saeed O, Jakobleff WA, Forest SJ, Chinnadurai T, Mellas N, Rangasamy S, Xia Y, Madan S, Acharya P, Algodi M, Patel SR, Shin J, Vukelic S, Sims DB, Reyes Gil M, Billett HH, Kizer JR, Goldstein DJ, Jorde UP. Hemolysis and Nonhemorrhagic Stroke During Venoarterial Extracorporeal Membrane Oxygenation. Ann Thorac Surg 2019; 108:756-763. [PMID: 30980824 PMCID: PMC6708732 DOI: 10.1016/j.athoracsur.2019.03.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 09/06/2018] [Revised: 01/24/2019] [Accepted: 03/07/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hemolysis, even at low levels, activates platelets to create a prothrombotic state and is common during mechanical circulatory support. We examined the association of low-level hemolysis (LLH) and nonhemorrhagic stroke during venoarterial extracorporeal membrane oxygenation (VA ECMO) support. METHODS A single-center retrospective review of all adult patients placed on VA ECMO from January 2012 to September 2017 was conducted. To determine the association between LLH and nonhemorrhagic stroke, patients were categorized as those with and without LLH. LLH was defined by 48-hour plasma free hemoglobin (PFHb) of 11 to 50 mg/dL after VA ECMO implantation. RESULTS Of 201 patients who underwent VA ECMO placement, 150 (75%) met inclusion criteria and comprised the study population. They were 55 ± 14 years of age and 50 (33%) were women. Sixty-two (41%) patients had LLH. Patients with LLH had a higher likelihood of incident nonhemorrhagic stroke during VA ECMO support (20 [32%] versus 4 [5%]; adjusted hazard ratio [HR], 7.6; 95% confidence interval [CI], 2.2 to 25.9; p = 0.001). The severity of LLH was associated with an incrementally higher likelihood of a nonhemorrhagic stroke (PFHb 26 to 50 mg/dL: HR, 11.3; 95% CI, 3.6 to 35.1; p = 0.001; PFHb 11 to 25 mg/dL: HR, 4.4; 95% CI, 1.36 to 14.85; p = 0.014) in comparison with no LLH. Those with LLH had a 2-fold greater increase in mean platelet volume after VA ECMO placement (0.98 ± 1.1 fL versus 0.49 ± 0.96 fL; p = 0.03). Patients with a nonhemorrhagic stroke had a higher operative mortality (20 [83%] versus 57 [45%]; adjusted HR, 3.1; 95% CI, 1.8 to 5.3; p < 0.001). CONCLUSIONS Hemolysis at low levels during VA ECMO support is associated with subsequent nonhemorrhagic stroke.
Collapse
Affiliation(s)
- Omar Saeed
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
| | - William A Jakobleff
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Stephen J Forest
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Thiru Chinnadurai
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Nicolas Mellas
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sabarivinoth Rangasamy
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Yu Xia
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Shivank Madan
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Prakash Acharya
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Mohammad Algodi
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Snehal R Patel
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Julia Shin
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sasa Vukelic
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Daniel B Sims
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Morayma Reyes Gil
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Henny H Billett
- Division of Hematology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jorge R Kizer
- Section of Cardiology, San Francisco Veterans Affairs Health Care System, San Francisco, California; Department of Medicine, University of California, San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Daniel J Goldstein
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ulrich P Jorde
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
29
|
Geocadin RG, Callaway CW, Fink EL, Golan E, Greer DM, Ko NU, Lang E, Licht DJ, Marino BS, McNair ND, Peberdy MA, Perman SM, Sims DB, Soar J, Sandroni C. Standards for Studies of Neurological Prognostication in Comatose Survivors of Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation 2019; 140:e517-e542. [DOI: 10.1161/cir.0000000000000702] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Significant improvements have been achieved in cardiac arrest resuscitation and postarrest resuscitation care, but mortality remains high. Most of the poor outcomes and deaths of cardiac arrest survivors have been attributed to widespread brain injury. This brain injury, commonly manifested as a comatose state, is a marker of poor outcome and a major basis for unfavorable neurological prognostication. Accurate prognostication is important to avoid pursuing futile treatments when poor outcome is inevitable but also to avoid an inappropriate withdrawal of life-sustaining treatment in patients who may otherwise have a chance of achieving meaningful neurological recovery. Inaccurate neurological prognostication leading to withdrawal of life-sustaining treatment and deaths may significantly bias clinical studies, leading to failure in detecting the true study outcomes. The American Heart Association Emergency Cardiovascular Care Science Subcommittee organized a writing group composed of adult and pediatric experts from neurology, cardiology, emergency medicine, intensive care medicine, and nursing to review existing neurological prognostication studies, the practice of neurological prognostication, and withdrawal of life-sustaining treatment. The writing group determined that the overall quality of existing neurological prognostication studies is low. As a consequence, the degree of confidence in the predictors and the subsequent outcomes is also low. Therefore, the writing group suggests that neurological prognostication parameters need to be approached as index tests based on relevant neurological functions that are directly related to the functional outcome and contribute to the quality of life of cardiac arrest survivors. Suggestions to improve the quality of adult and pediatric neurological prognostication studies are provided.
Collapse
|
30
|
Wiesenfeld E, Vlismas P, Merritt Z, Rashid SMI, Saeed O, Murthy S, Vukelic S, Patel S, Shin JJ, Jorde UP, Sims DB. Peripheral Venous Pressure to Predict Congestive Heart Failure Readmission. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
31
|
Wiesenfeld E, Sims DB, Hickey J. Case Study: Dilated Cardiomyopathy Evolves into Apical-Variant Hypertrophic Cardiomyopathy. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
32
|
Madan S, Patel SR, Saeed O, Sims DB, Shin JJ, Goldstein DJ, Jorde UP. Outcomes of heart transplantation in patients with human immunodeficiency virus. Am J Transplant 2019; 19:1529-1535. [PMID: 30614612 DOI: 10.1111/ajt.15257] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 10/28/2018] [Revised: 12/02/2018] [Accepted: 12/27/2018] [Indexed: 01/25/2023]
Abstract
Human immunodeficiency virus-positive (HIV+) patients are not routinely offered heart transplantation (HT) due to lack of adequate outcomes data. Between January 2004 and March 2017, we identified 41 adult (≥18 years) HT recipients with known HIV+ serostatus at the time of transplant in UNOS and evaluated post-HT outcomes. Overall, Kaplan-Meier (KM) estimates of survival at 1 and 5 years were 85.9% and 77.3%, respectively, with no significant difference in bridge-to-transplant ventricular-assist device (BTT-VAD, n = 22) and no-BTT-VAD (n = 19). KM estimates of cardiac allograft vasculopathy (CAV) and malignancy at 5 years were 32% and 19%, respectively. Using propensity scores, 41 HIV+ HT recipients were matched to 41 HIV- HT recipients for idiopathic dilated-cardiomyopathy; and there was no significant difference in post-HT survival up to 5 years. Furthermore, only 24 centers in the United States had performed HIV+ HT during the study period, indicating that >80% of HT centers in the United States had not performed any HIV+ HT. In a cohort representative of the current status of HIV+ HTs in the United States, we found that the posttransplant survival was excellent and rates of CAV and malignancy were comparable to the overall HT population. These results should encourage greater number of centers to offer HT to suitable HIV+ candidates and help reduce unequal access to HT for HIV+ patients.
Collapse
Affiliation(s)
- Shivank Madan
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Snehal R Patel
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Omar Saeed
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Daniel B Sims
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jooyoung Julia Shin
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Daniel J Goldstein
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ulrich P Jorde
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
33
|
Jorde UP, Shah AM, Sims DB, Madan S, Siddiqi N, Luke A, Saeed O, Patel SR, Murthy S, Shin J, Oviedo J, Watts S, Jakobleff W, Forest S, Vukelic S, Belov D, Puius Y, Minamoto G, Muggia V, Carlese A, Leung S, Rahmanian M, Leff J, Goldstein D. Continuous-Flow Left Ventricular Assist Device Survival Improves With Multidisciplinary Approach. Ann Thorac Surg 2019; 108:508-516. [PMID: 30853587 DOI: 10.1016/j.athoracsur.2019.01.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/01/2018] [Revised: 01/14/2019] [Accepted: 01/21/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Continuous-flow left ventricular assist devices have revolutionized the management of advanced heart failure. Device complications continue to limit survival, but enhanced management strategies have shown promise. This study compared outcomes for HeartMate II recipients before and after implementation of a multidisciplinary continuous support heart team (HTMCS) strategy. METHODS Between January 2012 and December 2016, 124 consecutive patients underwent primary HeartMate II implantation at our institution. In January 2015, we instituted a HTMCS approach consisting of (1) daily simultaneous cardiology/cardiac surgery/critical care/pharmacy/coordinator rounds, (2) pharmacist-directed anticoagulation, (3) speed optimization echocardiogram before discharge, (4) comprehensive device thrombosis screening and early intervention, (5) blood pressure clinic with pulsatility-adjusted goals, (6) early follow-up after discharge and individual long-term coordinator/cardiologist assignment, and (7) systematic basic/advanced/expert training and credentialing of ancillary in-hospital providers. All patients completed 1-year of follow-up. RESULTS Demographic characteristics for pre-HTMCS (n = 71) and HTMCS (n = 53) groups, including age (55.8 ± 12.1 versus 52.5 ± 14.1 years, p = not significant), percentage of men (77.5% versus 71.7%, p = not significant), and Interagency Registry for Mechanically Assisted Circulatory Support class 3 (84.5% versus 83.0%, p = not significant), were comparable. One-year survival was 74.6% versus 100% for the pre-HTMCS and HTMCS groups, respectively (p = 0.0002). One-year survival free of serious adverse events (reoperation to replace device or disabling stroke) was 70.4% versus 84.9% for the pre-HTMCS and HTMCS groups, respectively (p = 0.059). Event per patient-year rates for disabling stroke (0.15 versus 0, p = 0.019), gastrointestinal bleeding (0.87 versus 0.51, p = 0.11), and driveline infection (0.24 versus 0.10, p = 0.18) were lower for the HTMCS group, whereas pump thrombosis requiring device exchange was higher (0.09 versus 0.18, p = 0.14). CONCLUSIONS Implementing a comprehensive multidisciplinary approach substantially improved outcomes for recipients of continuous-flow left ventricular assist devices.
Collapse
Affiliation(s)
- Ulrich P Jorde
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
| | - Aman M Shah
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Daniel B Sims
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Shivank Madan
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Nida Siddiqi
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Anne Luke
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Omar Saeed
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Snehal R Patel
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Sandhya Murthy
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Jooyoung Shin
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Johanna Oviedo
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Sade Watts
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - William Jakobleff
- Department of Surgery, Division of Cardiothoracic and Vascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Stephen Forest
- Department of Surgery, Division of Cardiothoracic and Vascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Sasa Vukelic
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Dimitri Belov
- Department of Internal Medicine, Division of Cardiovascular Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Yoram Puius
- Department of Internal Medicine, Division of Infectious Disease, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Grace Minamoto
- Department of Internal Medicine, Division of Infectious Disease, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Victoria Muggia
- Department of Internal Medicine, Division of Infectious Disease, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Anthony Carlese
- Department of Internal Medicine, Division of Critical Care Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Sharon Leung
- Department of Internal Medicine, Division of Critical Care Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Marjan Rahmanian
- Department of Internal Medicine, Division of Critical Care Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Jonathan Leff
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Daniel Goldstein
- Department of Surgery, Division of Cardiothoracic and Vascular Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| |
Collapse
|
34
|
Sims DB, Kataria R, Rangasamy S, Jorde UP. Seroreversion of positive anti-hepatitis C virus antibodies in left ventricular assist device recipients: Now you see them, now you don't. Artif Organs 2019; 43:791-795. [PMID: 30725485 DOI: 10.1111/aor.13433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/05/2019] [Accepted: 01/28/2019] [Indexed: 01/04/2023]
Abstract
The clinical significance of positive anti-hepatitis C virus (anti-HCV) antibody tests in recipients of left ventricular assist devices remains unclear. In light of emerging evidence suggesting the possibility of persistent low-level HCV infection in patients with positive anti-HCV antibody test but negative HCV ribonucleic acid, it is very important to distinguish the truly false positive HCV antibodies, in recipients of continuous flow left ventricular assist devices, from those suggestive of a prior clinically resolved infection or one where a low-level viremia may have persisted. We conducted a retrospective analysis of left ventricular assist device recipients at our institution. While the total incidence of positive HCV antibody with concomitantly negative HCV ribonucleic acid test (19.2%) was in keeping with the incidences reported in prior cross-sectional studies, we longitudinally followed our patients and observed a 100% seroreversion. Seroreversion, which has not been reported in other studies, occurred either during continued left ventricular assist device support (10 out of 26) or after heart transplant (7 out of 26). Hundred percent seroreversion strongly suggested that the anti-HCV antibodies were truly false positive.
Collapse
Affiliation(s)
- Daniel B Sims
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Rachna Kataria
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sabarivinoth Rangasamy
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ulrich P Jorde
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
35
|
Vukelic S, Vlismas PP, Patel SR, Xue X, Shitole SG, Saeed O, Sims DB, Chinnadurai T, Shin JJ, Forest SJ, Goldstein DJ, Jorde UP. Digoxin Is Associated With a Decreased Incidence of Angiodysplasia-Related Gastrointestinal Bleeding in Patients With Continuous-Flow Left Ventricular Assist Devices. Circ Heart Fail 2018; 11:e004899. [DOI: 10.1161/circheartfailure.118.004899] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 01/09/2023]
Affiliation(s)
- Sasa Vukelic
- Division of Cardiology, Department of Medicine (S.V., P.P.V., S.R.P., S.G.S., O.S., D.B.S., T.C., J.J.S., U.P.J.)
| | - Peter P. Vlismas
- Division of Cardiology, Department of Medicine (S.V., P.P.V., S.R.P., S.G.S., O.S., D.B.S., T.C., J.J.S., U.P.J.)
| | - Snehal R. Patel
- Division of Cardiology, Department of Medicine (S.V., P.P.V., S.R.P., S.G.S., O.S., D.B.S., T.C., J.J.S., U.P.J.)
| | - Xiaonan Xue
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (X.X.)
| | - Sanyog G. Shitole
- Division of Cardiology, Department of Medicine (S.V., P.P.V., S.R.P., S.G.S., O.S., D.B.S., T.C., J.J.S., U.P.J.)
| | - Omar Saeed
- Division of Cardiology, Department of Medicine (S.V., P.P.V., S.R.P., S.G.S., O.S., D.B.S., T.C., J.J.S., U.P.J.)
| | - Daniel B. Sims
- Division of Cardiology, Department of Medicine (S.V., P.P.V., S.R.P., S.G.S., O.S., D.B.S., T.C., J.J.S., U.P.J.)
| | - Thiru Chinnadurai
- Division of Cardiology, Department of Medicine (S.V., P.P.V., S.R.P., S.G.S., O.S., D.B.S., T.C., J.J.S., U.P.J.)
| | - Julia J. Shin
- Division of Cardiology, Department of Medicine (S.V., P.P.V., S.R.P., S.G.S., O.S., D.B.S., T.C., J.J.S., U.P.J.)
| | | | | | - Ulrich P. Jorde
- Division of Cardiology, Department of Medicine (S.V., P.P.V., S.R.P., S.G.S., O.S., D.B.S., T.C., J.J.S., U.P.J.)
| |
Collapse
|
36
|
Kumar S, Rahman A, Josephs JS, Peltzer B, Saeed O, Patel S, Murthy S, Shin JJ, Vukelic S, Forest S, Goldstein DJ, Jorde UP, Sims DB. Preoperative Ascites Predicts Right Ventricular Failure post-LVAD Implantation. J Card Fail 2018. [DOI: 10.1016/j.cardfail.2018.07.408] [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]
|
37
|
Kumar S, Smith SA, Derbala MH, Pinkhas D, Lee B, Josephs JS, Murthy S, Patel S, Saeed O, Shin JJ, Forest S, Goldstein DJ, Jorde UP, Sims DB. A Multi-Institutional Retrospective Cohort Study of the Pulmonary Artery Pulsatility Index's Ability to Predict post-LVAD Implant Right Ventricular Failure and 1-Year Mortality. J Card Fail 2018. [DOI: 10.1016/j.cardfail.2018.07.457] [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]
|
38
|
Ahmed N, Gandhi H, Sims DB. Case Report: My lung broke my heart! Takotsubo cardiomyopathy due to pneumonia. F1000Res 2018; 7:518. [PMID: 36274794 PMCID: PMC9568678 DOI: 10.12688/f1000research.14546.1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 11/20/2022] Open
Abstract
Takotsubo cardiomyopathy (TTC), also known as stress-induced cardiomyopathy, is a cardiac syndrome that often mimics acute myocardial infarction. TTC is commonly triggered by physical or emotional stress; however, acute infection is a rarer etiology. This report concerns the case of an 82-year-old female who presented with non-positional and non-pleuritic chest pain, with an associated fever and cough and chest x-ray findings consistent with pneumonia. Cardiac enzymes and ECG findings were consistent with acute coronary syndrome (ACS); however, during coronary angiography, no coronary artery disease could explain the patient’s ACS. A post-catheterization echocardiogram revealed an ejection fraction of 25%, with apical akinesis. A repeat echocardiogram 4 weeks after presentation showed a normal EF and normal wall motion, confirming a diagnosis of TTC.
Collapse
Affiliation(s)
- Navid Ahmed
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, 10467, USA
| | - Himali Gandhi
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, 10467, USA
| | - Daniel B. Sims
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, 10467, USA
| |
Collapse
|
39
|
Saeed O, Rangasamy S, Selevany I, Madan S, Fertel J, Eisenberg R, Aljoudi M, Patel SR, Shin J, Sims DB, Reyes Gil M, Goldstein DJ, Slepian MJ, Billett HH, Jorde UP. Sildenafil Is Associated With Reduced Device Thrombosis and Ischemic Stroke Despite Low-Level Hemolysis on Heart Mate II Support. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.004222. [DOI: 10.1161/circheartfailure.117.004222] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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] [Received: 05/17/2017] [Accepted: 09/20/2017] [Indexed: 11/16/2022]
Abstract
Background:
Persistent low-level hemolysis (LLH) during continuous-flow mechanical circulatory support is associated with subsequent thrombosis. Free hemoglobin from ongoing hemolysis scavenges nitric oxide (NO) to create an NO deficiency which can augment platelet function leading to a prothrombotic state. The phosphodiesterase-5 inhibitor, sildenafil, potentiates NO signaling to inhibit platelet function. Accordingly, we investigated the association of sildenafil administration and thrombotic events in patients with LLH during Heart Mate II support.
Methods and Results:
A single-center review of all patients implanted with a Heart Mate II who survived to discharge (n=144). LLH was defined by a discharge lactate dehydrogenase level of 400 to 700 U/L. Patients were categorized as (1) LLH not on sildenafil, (2) LLH on sildenafil, (3) no LLH not on sildenafil, and (4) no LLH on sildenafil. Age, sex, platelet count, and mean platelet volume were similar between groups. Seventeen patients had either device thrombosis or ischemic stroke. Presence of LLH was associated with a greater risk of thrombosis (adjusted hazard ratio, 15; 95% confidence interval, 4.5–50;
P
<0.001 versus no LLH, not on sildenafil). This risk was reduced in patients with LLH on sildenafil (adjusted hazard ratio, 1.7; 95% confidence interval, 0.2–16.1;
P
=0.61). Device thrombosis and ischemic stroke were associated with an increase in mean platelet volume (9.6±0.5 to 10.9±0.8 fL,
P
<0.001). Patients with LLH not on sildenafil had a greater increase in mean platelet volume in comparison to those with LLH on sildenafil (
P
<0.001).
Conclusions:
Sildenafil is associated with reduced device thrombosis and ischemic stroke during ongoing LLH on Heart Mate II support.
Collapse
Affiliation(s)
- Omar Saeed
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center (O.S., S.R., I.S., S.M., J.F., M.A., S.R.P., J.S., D.B.S., U.P.J.), Department of Epidemiology and Population Health (R.E.), Department of Pathology, Montefiore Medical Center (M.R.G.) Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center (D.J.G.), and Division of Hematology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (H.H.B.).; and
| | - Sabarivinoth Rangasamy
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center (O.S., S.R., I.S., S.M., J.F., M.A., S.R.P., J.S., D.B.S., U.P.J.), Department of Epidemiology and Population Health (R.E.), Department of Pathology, Montefiore Medical Center (M.R.G.) Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center (D.J.G.), and Division of Hematology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (H.H.B.).; and
| | - Ibrahim Selevany
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center (O.S., S.R., I.S., S.M., J.F., M.A., S.R.P., J.S., D.B.S., U.P.J.), Department of Epidemiology and Population Health (R.E.), Department of Pathology, Montefiore Medical Center (M.R.G.) Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center (D.J.G.), and Division of Hematology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (H.H.B.).; and
| | - Shivank Madan
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center (O.S., S.R., I.S., S.M., J.F., M.A., S.R.P., J.S., D.B.S., U.P.J.), Department of Epidemiology and Population Health (R.E.), Department of Pathology, Montefiore Medical Center (M.R.G.) Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center (D.J.G.), and Division of Hematology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (H.H.B.).; and
| | - Jeremy Fertel
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center (O.S., S.R., I.S., S.M., J.F., M.A., S.R.P., J.S., D.B.S., U.P.J.), Department of Epidemiology and Population Health (R.E.), Department of Pathology, Montefiore Medical Center (M.R.G.) Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center (D.J.G.), and Division of Hematology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (H.H.B.).; and
| | - Ruth Eisenberg
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center (O.S., S.R., I.S., S.M., J.F., M.A., S.R.P., J.S., D.B.S., U.P.J.), Department of Epidemiology and Population Health (R.E.), Department of Pathology, Montefiore Medical Center (M.R.G.) Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center (D.J.G.), and Division of Hematology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (H.H.B.).; and
| | - Mohammad Aljoudi
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center (O.S., S.R., I.S., S.M., J.F., M.A., S.R.P., J.S., D.B.S., U.P.J.), Department of Epidemiology and Population Health (R.E.), Department of Pathology, Montefiore Medical Center (M.R.G.) Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center (D.J.G.), and Division of Hematology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (H.H.B.).; and
| | - Snehal R. Patel
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center (O.S., S.R., I.S., S.M., J.F., M.A., S.R.P., J.S., D.B.S., U.P.J.), Department of Epidemiology and Population Health (R.E.), Department of Pathology, Montefiore Medical Center (M.R.G.) Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center (D.J.G.), and Division of Hematology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (H.H.B.).; and
| | - Julia Shin
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center (O.S., S.R., I.S., S.M., J.F., M.A., S.R.P., J.S., D.B.S., U.P.J.), Department of Epidemiology and Population Health (R.E.), Department of Pathology, Montefiore Medical Center (M.R.G.) Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center (D.J.G.), and Division of Hematology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (H.H.B.).; and
| | - Daniel B. Sims
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center (O.S., S.R., I.S., S.M., J.F., M.A., S.R.P., J.S., D.B.S., U.P.J.), Department of Epidemiology and Population Health (R.E.), Department of Pathology, Montefiore Medical Center (M.R.G.) Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center (D.J.G.), and Division of Hematology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (H.H.B.).; and
| | - Morayma Reyes Gil
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center (O.S., S.R., I.S., S.M., J.F., M.A., S.R.P., J.S., D.B.S., U.P.J.), Department of Epidemiology and Population Health (R.E.), Department of Pathology, Montefiore Medical Center (M.R.G.) Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center (D.J.G.), and Division of Hematology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (H.H.B.).; and
| | - Daniel J. Goldstein
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center (O.S., S.R., I.S., S.M., J.F., M.A., S.R.P., J.S., D.B.S., U.P.J.), Department of Epidemiology and Population Health (R.E.), Department of Pathology, Montefiore Medical Center (M.R.G.) Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center (D.J.G.), and Division of Hematology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (H.H.B.).; and
| | - Marvin J. Slepian
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center (O.S., S.R., I.S., S.M., J.F., M.A., S.R.P., J.S., D.B.S., U.P.J.), Department of Epidemiology and Population Health (R.E.), Department of Pathology, Montefiore Medical Center (M.R.G.) Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center (D.J.G.), and Division of Hematology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (H.H.B.).; and
| | - Henny H. Billett
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center (O.S., S.R., I.S., S.M., J.F., M.A., S.R.P., J.S., D.B.S., U.P.J.), Department of Epidemiology and Population Health (R.E.), Department of Pathology, Montefiore Medical Center (M.R.G.) Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center (D.J.G.), and Division of Hematology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (H.H.B.).; and
| | - Ulrich P. Jorde
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center (O.S., S.R., I.S., S.M., J.F., M.A., S.R.P., J.S., D.B.S., U.P.J.), Department of Epidemiology and Population Health (R.E.), Department of Pathology, Montefiore Medical Center (M.R.G.) Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center (D.J.G.), and Division of Hematology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (H.H.B.).; and
| |
Collapse
|
40
|
Madan S, Saeed O, Vlismas P, Katsa I, Patel SR, Shin JJ, Jakobleff WA, Goldstein DJ, Sims DB, Jorde UP. Outcomes After Transplantation of Donor Hearts With Improving Left Ventricular Systolic Dysfunction. J Am Coll Cardiol 2017; 70:1248-1258. [DOI: 10.1016/j.jacc.2017.07.728] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 07/03/2017] [Accepted: 07/10/2017] [Indexed: 01/07/2023]
|
41
|
Oh KT, Gonzalez W, Garcia MJ, Shin JJ, Patel SR, Saeed O, Jorde UP, Sims DB. QRS Voltage Increases during Recovery from Fulminant Myocarditis. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
42
|
Levin AP, Saeed O, Willey JZ, Levin CJ, Fried JA, Patel SR, Sims DB, Nguyen JD, Shin JJ, Topkara VK, Colombo PC, Goldstein DJ, Naka Y, Takayama H, Uriel N, Jorde UP. Watchful Waiting in Continuous-Flow Left Ventricular Assist Device Patients With Ongoing Hemolysis Is Associated With an Increased Risk for Cerebrovascular Accident or Death. Circ Heart Fail 2016; 9:CIRCHEARTFAILURE.115.002896. [DOI: 10.1161/circheartfailure.115.002896] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 03/18/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Allison P. Levin
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (A.P.L., O.S., S.R.P., D.B.S., J.D.N., J.J.S., U.P.J.); Division of Cardiology, Department of Medicine, Columbia University, New York, NY (A.P.L., J.Z.W., C.J.L., J.A.F., V.K.T., P.C.C.); Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (D.J.G.); Department of Cardiothoracic Surgery, Columbia University,
| | - Omar Saeed
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (A.P.L., O.S., S.R.P., D.B.S., J.D.N., J.J.S., U.P.J.); Division of Cardiology, Department of Medicine, Columbia University, New York, NY (A.P.L., J.Z.W., C.J.L., J.A.F., V.K.T., P.C.C.); Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (D.J.G.); Department of Cardiothoracic Surgery, Columbia University,
| | - Joshua Z. Willey
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (A.P.L., O.S., S.R.P., D.B.S., J.D.N., J.J.S., U.P.J.); Division of Cardiology, Department of Medicine, Columbia University, New York, NY (A.P.L., J.Z.W., C.J.L., J.A.F., V.K.T., P.C.C.); Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (D.J.G.); Department of Cardiothoracic Surgery, Columbia University,
| | - Charles J. Levin
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (A.P.L., O.S., S.R.P., D.B.S., J.D.N., J.J.S., U.P.J.); Division of Cardiology, Department of Medicine, Columbia University, New York, NY (A.P.L., J.Z.W., C.J.L., J.A.F., V.K.T., P.C.C.); Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (D.J.G.); Department of Cardiothoracic Surgery, Columbia University,
| | - Justin A. Fried
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (A.P.L., O.S., S.R.P., D.B.S., J.D.N., J.J.S., U.P.J.); Division of Cardiology, Department of Medicine, Columbia University, New York, NY (A.P.L., J.Z.W., C.J.L., J.A.F., V.K.T., P.C.C.); Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (D.J.G.); Department of Cardiothoracic Surgery, Columbia University,
| | - Snehal R. Patel
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (A.P.L., O.S., S.R.P., D.B.S., J.D.N., J.J.S., U.P.J.); Division of Cardiology, Department of Medicine, Columbia University, New York, NY (A.P.L., J.Z.W., C.J.L., J.A.F., V.K.T., P.C.C.); Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (D.J.G.); Department of Cardiothoracic Surgery, Columbia University,
| | - Daniel B. Sims
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (A.P.L., O.S., S.R.P., D.B.S., J.D.N., J.J.S., U.P.J.); Division of Cardiology, Department of Medicine, Columbia University, New York, NY (A.P.L., J.Z.W., C.J.L., J.A.F., V.K.T., P.C.C.); Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (D.J.G.); Department of Cardiothoracic Surgery, Columbia University,
| | - Jenni D. Nguyen
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (A.P.L., O.S., S.R.P., D.B.S., J.D.N., J.J.S., U.P.J.); Division of Cardiology, Department of Medicine, Columbia University, New York, NY (A.P.L., J.Z.W., C.J.L., J.A.F., V.K.T., P.C.C.); Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (D.J.G.); Department of Cardiothoracic Surgery, Columbia University,
| | - Julia J. Shin
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (A.P.L., O.S., S.R.P., D.B.S., J.D.N., J.J.S., U.P.J.); Division of Cardiology, Department of Medicine, Columbia University, New York, NY (A.P.L., J.Z.W., C.J.L., J.A.F., V.K.T., P.C.C.); Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (D.J.G.); Department of Cardiothoracic Surgery, Columbia University,
| | - Veli K. Topkara
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (A.P.L., O.S., S.R.P., D.B.S., J.D.N., J.J.S., U.P.J.); Division of Cardiology, Department of Medicine, Columbia University, New York, NY (A.P.L., J.Z.W., C.J.L., J.A.F., V.K.T., P.C.C.); Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (D.J.G.); Department of Cardiothoracic Surgery, Columbia University,
| | - Paolo C. Colombo
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (A.P.L., O.S., S.R.P., D.B.S., J.D.N., J.J.S., U.P.J.); Division of Cardiology, Department of Medicine, Columbia University, New York, NY (A.P.L., J.Z.W., C.J.L., J.A.F., V.K.T., P.C.C.); Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (D.J.G.); Department of Cardiothoracic Surgery, Columbia University,
| | - Daniel J. Goldstein
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (A.P.L., O.S., S.R.P., D.B.S., J.D.N., J.J.S., U.P.J.); Division of Cardiology, Department of Medicine, Columbia University, New York, NY (A.P.L., J.Z.W., C.J.L., J.A.F., V.K.T., P.C.C.); Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (D.J.G.); Department of Cardiothoracic Surgery, Columbia University,
| | - Yoshifumi Naka
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (A.P.L., O.S., S.R.P., D.B.S., J.D.N., J.J.S., U.P.J.); Division of Cardiology, Department of Medicine, Columbia University, New York, NY (A.P.L., J.Z.W., C.J.L., J.A.F., V.K.T., P.C.C.); Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (D.J.G.); Department of Cardiothoracic Surgery, Columbia University,
| | - Hiroo Takayama
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (A.P.L., O.S., S.R.P., D.B.S., J.D.N., J.J.S., U.P.J.); Division of Cardiology, Department of Medicine, Columbia University, New York, NY (A.P.L., J.Z.W., C.J.L., J.A.F., V.K.T., P.C.C.); Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (D.J.G.); Department of Cardiothoracic Surgery, Columbia University,
| | - Nir Uriel
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (A.P.L., O.S., S.R.P., D.B.S., J.D.N., J.J.S., U.P.J.); Division of Cardiology, Department of Medicine, Columbia University, New York, NY (A.P.L., J.Z.W., C.J.L., J.A.F., V.K.T., P.C.C.); Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (D.J.G.); Department of Cardiothoracic Surgery, Columbia University,
| | - Ulrich P. Jorde
- From the Division of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (A.P.L., O.S., S.R.P., D.B.S., J.D.N., J.J.S., U.P.J.); Division of Cardiology, Department of Medicine, Columbia University, New York, NY (A.P.L., J.Z.W., C.J.L., J.A.F., V.K.T., P.C.C.); Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY (D.J.G.); Department of Cardiothoracic Surgery, Columbia University,
| |
Collapse
|
43
|
Saeed O, Shah A, Kargoli F, Madan S, Levin AP, Patel SR, Jermyn R, Guerrero C, Nguyen J, Sims DB, Shin J, D’Alessandro D, Goldstein DJ, Jorde UP. Antiplatelet Therapy and Adverse Hematologic Events During Heart Mate II Support. Circ Heart Fail 2016; 9:e002296. [DOI: 10.1161/circheartfailure.115.002296] [Citation(s) in RCA: 17] [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] [Indexed: 11/16/2022]
Abstract
Background
—
Hematologic adverse events are common during continuous flow left ventricular assist device support; yet, their relation to antiplatelet therapy, including aspirin (ASA) dosing, is uncertain.
Methods and Results—
A single-center retrospective review of all patients supported by a continuous flow left ventricular assist device (Heart Mate II) from June 2006 to November 2014 was conducted. Patients were categorized into 3 groups: (1) ASA 81 mg+dipyridamole 75 mg daily (n=26) with a target international normalized ratio (INR) of 2 to 3 from June 2006 to August 2009; (2) ASA 81 mg daily (n=18) from September 2009 to August 2011 with a target INR of 1.5 to 2; and (3) ASA 325 mg daily from September 2011 to November 2014 with a target INR of 2 to 3 (n=70). Hemorrhagic and thrombotic outcomes were retrieved ≤365 days after implantation. Cumulative survival free from adverse events was calculated using Kaplan–Meier curves and Cox proportional hazard ratios were generated. Hemorrhagic events occurred in 6 patients on ASA 81 mg+dipyridamole (26%; 0.42 events per patient year; mean INR at event, 2.2), 4 patients on ASA 81 mg (22%; 0.38 events per patient year; mean INR at event, 2.0), and in 38 patients on ASA 325 mg (54%; 1.4 events per patient year; mean INR at event, 2.2);
P
=0.004. Patients on ASA 325 mg had a higher adjusted hazard ratio of 2.9 (95% confidence interval, 1.2–7.0 versus ASA 81 mg+dipyridamole;
P
=0.02) and 3.4 (95% confidence interval, 1.2–9.5 versus ASA 81 mg;
P
=0.02) for hemorrhagic events. Thrombotic events rates were not different between groups.
Conclusions—
High-dose ASA in Heart Mate II patients treated concomitantly with warfarin is associated with an increased hazard of bleeding but does not reduce thrombotic events.
Collapse
Affiliation(s)
- Omar Saeed
- From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Aman Shah
- From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Faraj Kargoli
- From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Shivank Madan
- From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Allison P. Levin
- From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Snehal R. Patel
- From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Rita Jermyn
- From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Cesar Guerrero
- From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Jenni Nguyen
- From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Daniel B. Sims
- From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Julia Shin
- From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - David D’Alessandro
- From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Daniel J. Goldstein
- From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Ulrich P. Jorde
- From the Division of Cardiology, Department of Medicine (A.P.L., S.R.P., R.J., C.G., J.N., D.B.S., J.S., U.P.J.) and Division of Cardiothoracic Surgery, Department of Surgery (D.D., D.J.G.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| |
Collapse
|
44
|
Affiliation(s)
- Peter Vlismas
- From the Division of Cardiology (P. Villablanca, A.K., S.P, J.J.S., U.P.J, D.B.S.), Department of Medicine (P. Vlismas), Montefiore Medical Center, Bronx, NY.
| | - Pedro Villablanca
- From the Division of Cardiology (P. Villablanca, A.K., S.P, J.J.S., U.P.J, D.B.S.), Department of Medicine (P. Vlismas), Montefiore Medical Center, Bronx, NY
| | - Andrew Krumerman
- From the Division of Cardiology (P. Villablanca, A.K., S.P, J.J.S., U.P.J, D.B.S.), Department of Medicine (P. Vlismas), Montefiore Medical Center, Bronx, NY
| | - Snehal Patel
- From the Division of Cardiology (P. Villablanca, A.K., S.P, J.J.S., U.P.J, D.B.S.), Department of Medicine (P. Vlismas), Montefiore Medical Center, Bronx, NY
| | - J Julia Shin
- From the Division of Cardiology (P. Villablanca, A.K., S.P, J.J.S., U.P.J, D.B.S.), Department of Medicine (P. Vlismas), Montefiore Medical Center, Bronx, NY
| | - Ulrich P Jorde
- From the Division of Cardiology (P. Villablanca, A.K., S.P, J.J.S., U.P.J, D.B.S.), Department of Medicine (P. Vlismas), Montefiore Medical Center, Bronx, NY
| | - Daniel B Sims
- From the Division of Cardiology (P. Villablanca, A.K., S.P, J.J.S., U.P.J, D.B.S.), Department of Medicine (P. Vlismas), Montefiore Medical Center, Bronx, NY
| |
Collapse
|
45
|
Affiliation(s)
- Salim Hayek
- Division of Cardiology, Emory University, Atlanta, GA
| | | | | | | | | |
Collapse
|
46
|
Kay J, Pekarek A, Wittersheim K, Cole RT, Laskar SR, Nguyen D, Vega JD, Sims DB. Low Prevalence of Left Ventricular Thrombus in Patients Undergoing Ventricular Assist Device Evaluation. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
47
|
Murray LK, González-Costello J, Jonas SN, Sims DB, Morrison KA, Colombo PC, Mancini DM, Restaino SW, Joye E, Horn E, Takayama H, Marboe CC, Naka Y, Jorde UP, Uriel N. Ventricular assist device support as a bridge to heart transplantation in patients with giant cell myocarditis. Eur J Heart Fail 2014; 14:312-8. [DOI: 10.1093/eurjhf/hfr174] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Evan Joye
- Medicine; Columbia University; New York NY10032 USA
| | - Evelyn Horn
- Medicine; Columbia University; New York NY10032 USA
| | | | - Charles C. Marboe
- Department of Pathology and Cell Biology; Columbia University; New York NY 10032 USA
| | | | | | - Nir Uriel
- Medicine; Columbia University; New York NY10032 USA
| |
Collapse
|
48
|
Morris AA, Veledar E, Cole RT, Gupta D, Sims DB, Book W, Smith AL, Butler J. Wait List Mortality Is Higher for Female Heart Transplant Candidates. J Card Fail 2013. [DOI: 10.1016/j.cardfail.2013.06.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
49
|
Hirsh BJ, Mignatti A, Garan AR, Uriel N, Colombo P, Sims DB, Jorde UP. Effect of β-blocker cessation on chronotropic incompetence and exercise tolerance in patients with advanced heart failure. Circ Heart Fail 2012; 5:560-5. [PMID: 22855557 DOI: 10.1161/circheartfailure.112.967695] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronotropic incompetence is defined as the inability to reach 80% of heart rate (HR) reserve or 80% of the maximally predicted HR during exercise. The presence of chronotropic incompetence is associated with reduced peak oxygen consumption, and rate-responsive pacing therapy is under investigation to improve exercise capacity in heart failure (HF). However, uncertainty exists about whether chronotropic incompetence and reduced exercise tolerance in HF are attributable to β-blockade. METHODS AND RESULTS Subjects with HF and receiving long-term β-blocker therapy underwent cardiopulmonary exercise tolerance testing under 2 conditions in random sequence: (1) after a 27-hour washout period (Off-BB) and (2) 3 hours after β-blocker ingestion (On-BB). Norepinephrine levels were drawn at rest and at peak exercise. β1-response to norepinephrine was assessed using the chronotropic responsiveness index: ΔHR/Δlog norepinephrine. Nineteen patients with systolic HF (left ventricular ejection fraction, 22.8±7.7%) were enrolled. Mean age was 49.4±12.3 years. Average carvedilol equivalent dose was 29.1±17.0 mg daily. Peak HR off/on β-blockers was 62.7±18.7% and 51.4±18.2% HR reserve (P<0.01) and 79.1±11.0% and 70.3±12.3% maximally predicted HR (P<0.01). For the Off-BB and On-BB conditions, the respiratory exchange ratios were 1.05±0.06 and 1.05±0.10 (P=0.77), respectively, confirming maximal and near identical effort in both conditions. The peak oxygen consumption was 16.6±3.34 and 15.9±3.31 mL/kg/min (P=0.03), and the chronotropic responsiveness index was 19.3±7.2 and 16.2±7.1 (P=0.18). CONCLUSIONS Acute β-blocker cessation does not normalize the chronotropic response to exercise in patients with advanced HF and chronotropic incompetence.
Collapse
Affiliation(s)
- Benjamin J Hirsh
- Cardiovascular Division, Columbia University Medical Center, New York, NY 10032, USA
| | | | | | | | | | | | | |
Collapse
|
50
|
Sims DB, Vink J, Uriel N, Cleary KL, Smiley RM, Jorde UP, Restaino SW. A successful pregnancy during mechanical circulatory device support. J Heart Lung Transplant 2011; 30:1065-7. [DOI: 10.1016/j.healun.2011.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 06/01/2011] [Accepted: 06/13/2011] [Indexed: 11/28/2022] Open
|