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Servais A, Lundgren S, Bowman S, Stoller D, Burdorf A, Hyden M, Lowes B, Zolty R, Klepser D, Brink H. Preoperative Amiodarone and Primary Graft Dysfunction in Heart Transplantation. Ann Pharmacother 2024:10600280241232032. [PMID: 38361242 DOI: 10.1177/10600280241232032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Preoperative amiodarone effects on postorthotopic heart transplant (OHT) outcomes remain controversial. OBJECTIVE The purpose of this study was to determine the effect of cumulative pre-OHT amiodarone exposure on severe primary graft dysfunction (PGD). METHODS We retrospectively reviewed adult OHT recipients between August 2012 and June 2018. Primary outcome was severe PGD in patients receiving amiodarone at 3, 6, and 12 months prior to OHT compared with those not receiving amiodarone. Secondary outcomes included intensive care unit (ICU) and hospital length of stay, duration of mechanical ventilation, early graft failure (EGF), mortality at 3, 6, and 12 months post-OHT, and 30-day incidence of postoperative tachyarrhythmias, bradycardia, permanent pacemaker implantation, and rejection. RESULTS Incidence of severe PGD was 12.5% in those who received amiodarone compared to 6.8% in those who did not (14 vs 6, P = 0.18). Cumulative preoperative amiodarone significantly increased the odds of severe PGD at 3 months (odds ratio [OR]: 1.03; 95% confidence interval [CI]: 1.001-1.06; P = 0.044) and 6 months (OR: 1.02, 95% CI: 1.003-1.044; P = 0.024) in a multivariate logistic regression. Patients on amiodarone had significantly higher rates of postoperative bradycardia (13.4% vs 4.5%, P = 0.03). CONCLUSION AND RELEVANCE A trend toward increased PGD was present in patients receiving preoperative amiodarone. This finding combined with the regression showing significantly increased odds of PGD with increasing 3 and 6 month cumulative amiodarone dose is clinically concerning. Escalation of care with pacemaker implantation was required more frequently in patients on pre-OHT amiodarone.
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Affiliation(s)
- Abigail Servais
- Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, NE, USA
| | - Scott Lundgren
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Stephanie Bowman
- Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, NE, USA
| | - Douglas Stoller
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Adam Burdorf
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Marshall Hyden
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Brian Lowes
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ronald Zolty
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Don Klepser
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Heidi Brink
- Department of Pharmaceutical and Nutrition Care, Nebraska Medicine, Omaha, NE, USA
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Hofmeyer M, Haas GJ, Jordan E, Cao J, Kransdorf E, Ewald GA, Morris AA, Owens A, Lowes B, Stoller D, Tang WHW, Garg S, Trachtenberg BH, Shah P, Pamboukian SV, Sweitzer NK, Wheeler MT, Wilcox JE, Katz S, Pan S, Jimenez J, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Huggins GS, Kinnamon DD, Ni H, Hershberger RE. Rare Variant Genetics and Dilated Cardiomyopathy Severity: The DCM Precision Medicine Study. Circulation 2023; 148:872-881. [PMID: 37641966 PMCID: PMC10530109 DOI: 10.1161/circulationaha.123.064847] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) can lead to advanced disease, defined herein as necessitating a durable left ventricular assist device or a heart transplant (LVAD/HT). DCM is known to have a genetic basis, but the association of rare variant genetics with advanced DCM has not been studied. METHODS We analyzed clinical and genetic sequence data from patients enrolled between 2016 and 2021 in the US multisite DCM Precision Medicine Study, which was a geographically diverse, multiracial, multiethnic cohort. Clinical evaluation included standardized patient interview and medical record query forms. DCM severity was classified into 3 groups: patients with advanced disease with LVAD/HT; patients with an implantable cardioverter defibrillator (ICD) only; or patients with no ICD or LVAD/HT. Rare variants in 36 DCM genes were classified as pathogenic or likely pathogenic or variants of uncertain significance. Confounding factors we considered included demographic characteristics, lifestyle factors, access to care, DCM duration, and comorbidities. Crude and adjusted associations between DCM severity and rare variant genetic findings were assessed using multinomial models with generalized logit link. RESULTS Patients' mean (SD) age was 51.9 (13.6) years; 42% were of African ancestry, 56% were of European ancestry, and 44% were female. Of 1198 patients, 347 had LVAD/HT, 511 had an ICD, and 340 had no LVAD/HT or ICD. The percentage of patients with pathogenic or likely pathogenic variants was 26.2%, 15.9%, and 15.0% for those with LVAD/HT, ICD only, or neither, respectively. After controlling for sociodemographic characteristics and comorbidities, patients with DCM with LVAD/HT were more likely than those without LVAD/HT or ICD to have DCM-related pathogenic or likely pathogenic rare variants (odds ratio, 2.3 [95% CI, 1.5-3.6]). The association did not differ by ancestry. Rare variant genetic findings were similar between patients with DCM with an ICD and those without LVAD/HT or ICD. CONCLUSIONS Advanced DCM was associated with higher odds of rare variants in DCM genes adjudicated as pathogenic or likely pathogenic, compared with individuals with less severe DCM. This finding may help assess the risk of outcomes in management of patients with DCM and their at-risk family members. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03037632.
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Affiliation(s)
- Mark Hofmeyer
- MedStar Health Research Institute, Medstar Washington Hospital Center, Washington, DC
| | - Garrie J. Haas
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Elizabeth Jordan
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Jinwen Cao
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha, NE
| | | | - W. H. Wilson Tang
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Barry H. Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J.C. Walter Jr. Transplant Center, Houston TX
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, VA
| | - Salpy V. Pamboukian
- University of Alabama, Birmingham, AL during study conduct, current affiliation, University of Washington, Seattle, WA
| | - Nancy K. Sweitzer
- Sarver Heart Center, University of Arizona, Tucson, AZ during study conduct, current affiliation, Washington University, St. Louis, MO
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jane E. Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stuart Katz
- New York University Langone Medical Center, New York, NY
| | - Stephen Pan
- New York University Langone Medical Center, New York, NY
- current affiliation, Department of Cardiology, Westchester Medical Center & New York Medical College, Valhalla, NY
| | - Javier Jimenez
- Miami Cardiac & Vascular Institute, Baptist Health South, Miami, FL
| | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans, LA
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles, CA
| | | | | | | | - Gordon S. Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | - Daniel D. Kinnamon
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Hanyu Ni
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Ray E. Hershberger
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
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Jordan E, Kinnamon DD, Haas GJ, Hofmeyer M, Kransdorf E, Ewald GA, Morris AA, Owens A, Lowes B, Stoller D, Tang WHW, Garg S, Trachtenberg BH, Shah P, Pamboukian SV, Sweitzer NK, Wheeler MT, Wilcox JE, Katz S, Pan S, Jimenez J, Fishbein DP, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Mead JO, Hurst N, Cao J, Huggins GS, Cowan J, Ni H, Rehm HL, Jarvik GP, Vatta M, Burke W, Hershberger RE. Genetic Architecture of Dilated Cardiomyopathy in Individuals of African and European Ancestry. JAMA 2023; 330:432-441. [PMID: 37526719 PMCID: PMC10394581 DOI: 10.1001/jama.2023.11970] [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: 03/21/2023] [Accepted: 06/13/2023] [Indexed: 08/02/2023]
Abstract
Importance Black patients with dilated cardiomyopathy (DCM) have increased familial risk and worse outcomes than White patients, but most DCM genetic data are from White patients. Objective To compare the rare variant genetic architecture of DCM by genomic ancestry within a diverse population of patients with DCM. Design Cross-sectional study enrolling patients with DCM who self-identified as non-Hispanic Black, Hispanic, or non-Hispanic White from June 7, 2016, to March 15, 2020, at 25 US advanced heart failure programs. Variants in 36 DCM genes were adjudicated as pathogenic, likely pathogenic, or of uncertain significance. Exposure Presence of DCM. Main Outcomes and Measures Variants in DCM genes classified as pathogenic/likely pathogenic/uncertain significance and clinically actionable (pathogenic/likely pathogenic). Results A total of 505, 667, and 26 patients with DCM of predominantly African, European, or Native American genomic ancestry, respectively, were included. Compared with patients of European ancestry, a lower percentage of patients of African ancestry had clinically actionable variants (8.2% [95% CI, 5.2%-11.1%] vs 25.5% [95% CI, 21.3%-29.6%]), reflecting the lower odds of a clinically actionable variant for those with any pathogenic variant/likely pathogenic variant/variant of uncertain significance (odds ratio, 0.25 [95% CI, 0.17-0.37]). On average, patients of African ancestry had fewer clinically actionable variants in TTN (difference, -0.09 [95% CI, -0.14 to -0.05]) and other genes with predicted loss of function as a disease-causing mechanism (difference, -0.06 [95% CI, -0.11 to -0.02]). However, the number of pathogenic variants/likely pathogenic variants/variants of uncertain significance was more comparable between ancestry groups (difference, -0.07 [95% CI, -0.22 to 0.09]) due to a larger number of non-TTN non-predicted loss of function variants of uncertain significance, mostly missense, in patients of African ancestry (difference, 0.15 [95% CI, 0.00-0.30]). Published clinical case-based evidence supporting pathogenicity was less available for variants found only in patients of African ancestry (P < .001). Conclusion and Relevance Patients of African ancestry with DCM were less likely to have clinically actionable variants in DCM genes than those of European ancestry due to differences in genetic architecture and a lack of representation of African ancestry in clinical data sets.
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Affiliation(s)
- Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Daniel D. Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Garrie J. Haas
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
| | - Mark Hofmeyer
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, DC
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha
| | | | | | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas
| | - Barry H. Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J. C. Walter Jr Transplant Center, Houston, Texas
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Nancy K. Sweitzer
- Sarver Heart Center, University of Arizona, Tucson
- Now with Washington University, St Louis, Missouri
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Jane E. Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stuart Katz
- New York University Langone Medical Center, New York, New York
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla
| | - Javier Jimenez
- Miami Cardiac and Vascular Institute, Baptist Health South, Miami, Florida
| | | | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles
| | | | | | | | - Jonathan O. Mead
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Natalie Hurst
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Jinwen Cao
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Gordon S. Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Jason Cowan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Heidi L. Rehm
- Center for Genomic Medicine, Massachusetts General Hospital, Boston
| | - Gail P. Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle
- Department of Genome Sciences, University of Washington, Seattle
| | - Matteo Vatta
- Departments of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle
| | - Ray E. Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
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Ni H, Jordan E, Kinnamon DD, Cao J, Haas GJ, Hofmeyer M, Kransdorf E, Ewald GA, Morris AA, Owens A, Lowes B, Stoller D, Tang WHW, Garg S, Trachtenberg BH, Shah P, Pamboukian SV, Sweitzer NK, Wheeler MT, Wilcox JE, Katz S, Pan S, Jimenez J, Fishbein DP, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Huggins GS, Hershberger RE. Screening for Dilated Cardiomyopathy in At-Risk First-Degree Relatives. J Am Coll Cardiol 2023; 81:2059-2071. [PMID: 37225358 PMCID: PMC10563038 DOI: 10.1016/j.jacc.2023.03.419] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/20/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Cardiovascular screening is recommended for first-degree relatives (FDRs) of patients with dilated cardiomyopathy (DCM), but the yield of FDR screening is uncertain for DCM patients without known familial DCM, for non-White FDRs, or for DCM partial phenotypes of left ventricular enlargement (LVE) or left ventricular systolic dysfunction (LVSD). OBJECTIVES This study examined the yield of clinical screening among reportedly unaffected FDRs of DCM patients. METHODS Adult FDRs of DCM patients at 25 sites completed screening echocardiograms and ECGs. Mixed models accounting for site heterogeneity and intrafamilial correlation were used to compare screen-based percentages of DCM, LVSD, or LVE by FDR demographics, cardiovascular risk factors, and proband genetics results. RESULTS A total of 1,365 FDRs were included, with a mean age of 44.8 ± 16.9 years, 27.5% non-Hispanic Black, 9.8% Hispanic, and 61.7% women. Among screened FDRs, 14.1% had new diagnoses of DCM (2.1%), LVSD (3.6%), or LVE (8.4%). The percentage of FDRs with new diagnoses was higher for those aged 45 to 64 years than 18 to 44 years. The age-adjusted percentage of any finding was higher among FDRs with hypertension and obesity but did not differ statistically by race and ethnicity (16.2% for Hispanic, 15.2% for non-Hispanic Black, and 13.1% for non-Hispanic White) or sex (14.6% for women and 12.8% for men). FDRs whose probands carried clinically reportable variants were more likely to be identified with DCM. CONCLUSIONS Cardiovascular screening identified new DCM-related findings among 1 in 7 reportedly unaffected FDRs regardless of race and ethnicity, underscoring the value of clinical screening in all FDRs.
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Affiliation(s)
- Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA; The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA; The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Daniel D Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA; The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Jinwen Cao
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA; The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Garrie J Haas
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA; Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Mark Hofmeyer
- Medstar Research Institute, Washington Hospital Center, Washington, DC, USA
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Barry H Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J.C. Walter Jr Transplant Center, Houston Texas, USA
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | | | - Nancy K Sweitzer
- Sarver Heart Center, University of Arizona, Tucson, Arizona, USA (current address Division of Cardiology, Washington University, St Louis, Missouri, USA)
| | - Matthew T Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jane E Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stuart Katz
- New York University Langone Medical Center, New York, New York, USA
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Javier Jimenez
- Miami Cardiac and Vascular Institute, Baptist Health South, Miami, Florida, USA
| | | | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles, California, USA
| | | | - Daniel P Judge
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Charles K Moore
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Gordon S Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ray E Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA; The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA; Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA.
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Kinnamon DD, Jordan E, Haas GJ, Hofmeyer M, Kransdorf E, Ewald GA, Morris AA, Owens A, Lowes B, Stoller D, Tang WHW, Garg S, Trachtenberg BH, Shah P, Pamboukian SV, Sweitzer NK, Wheeler MT, Wilcox JE, Katz S, Pan S, Jimenez J, Aaronson KD, Fishbein DP, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Mead JO, Huggins GS, Ni H, Burke W, Hershberger RE. Effectiveness of the Family Heart Talk Communication Tool in Improving Family Member Screening for Dilated Cardiomyopathy: Results of a Randomized Trial. Circulation 2023; 147:1281-1290. [PMID: 36938756 PMCID: PMC10133091 DOI: 10.1161/circulationaha.122.062507] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/15/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Managing disease risk among first-degree relatives of probands diagnosed with a heritable disease is central to precision medicine. A critical component is often clinical screening, which is particularly important for conditions like dilated cardiomyopathy (DCM) that remain asymptomatic until severe disease develops. Nonetheless, probands are frequently ill-equipped to disseminate genetic risk information that motivates at-risk relatives to complete recommended clinical screening. An easily implemented remedy for this key issue has been elusive. METHODS The DCM Precision Medicine Study developed Family Heart Talk, a booklet designed to help probands with DCM communicate genetic risk and the need for cardiovascular screening to their relatives. The effectiveness of the Family Heart Talk booklet in increasing cardiovascular clinical screening uptake among first-degree relatives was assessed in a multicenter, open-label, cluster-randomized, controlled trial. The primary outcome measured in eligible first-degree relatives was completion of screening initiated within 12 months after proband enrollment. Because probands randomized to the intervention received the booklet at the enrollment visit, eligible first-degree relatives were limited to those who were alive the day after proband enrollment and not enrolled on the same day as the proband. RESULTS Between June 2016 and March 2020, 1241 probands were randomized (1:1) to receive Family Heart Talk (n=621) or not (n=620) within strata defined by site and self-identified race/ethnicity (non-Hispanic Black, non-Hispanic White, or Hispanic). Final analyses included 550 families (n=2230 eligible first-degree relatives) in the Family Heart Talk arm and 561 (n=2416) in the control arm. A higher percentage of eligible first-degree relatives completed screening in the Family Heart Talk arm (19.5% versus 16.0%), and the odds of screening completion among these first-degree relatives were higher in the Family Heart Talk arm after adjustment for proband randomization stratum, sex, and age quartile (odds ratio, 1.30 [1-sided 95% CI, 1.08-∞]). A prespecified subgroup analysis did not find evidence of heterogeneity in the adjusted intervention odds ratio across race/ethnicity strata (P=0.90). CONCLUSIONS Family Heart Talk, a booklet that can be provided to patients with DCM by clinicians with minimal additional time investment, was effective in increasing cardiovascular clinical screening among first-degree relatives of these patients. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03037632.
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Affiliation(s)
- Daniel D. Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Garrie J. Haas
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Mark Hofmeyer
- Medstar Research Institute, Washington Hospital Center, Washington, DC
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha, NE
| | | | - W. H. Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Barry H. Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J.C. Walter Jr. Transplant Center, Houston TX
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, VA
| | - Salpy V. Pamboukian
- University of Alabama, Birmingham, AL; current address, University of Washington, Seattle, WA
| | - Nancy K. Sweitzer
- Sarver Heart Center, University of Arizona, Tucson, AZ; current address, Division of Cardiology, Washington University, St. Louis, MO
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jane E. Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stuart Katz
- New York University Langone Medical Center, New York, NY
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center & New York Medical College, Valhalla, NY
| | - Javier Jimenez
- Miami Cardiac & Vascular Institute, Baptist Health South, Miami, FL
| | | | | | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans, LA
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles, CA
| | | | | | | | - Jonathan O. Mead
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Gordon S. Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | - Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, WA
| | - Ray E. Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
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Roberts S, Stoller D, Lundgren S, Zolty R, Dunbar Matos C, Hyden M, Urban M, Lowes B. Endomyocardial Biopsy Microscopic Molecular Profiling Correlates with Donor Derived Cell Free DNA and Histopathology. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Nickol J, Stoller D, Lowes B, Urban M, Lundgren S. Gene Expression Profiling and Steroid Weaning: Experience from One Transplant Center. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Hofmeyer M, Haas G, Kransdorf E, Ewald G, Morris A, Owens A, Lowes B, Stoller D, Tang W, Garg S, Trachtenberg B, Shah P, Pamboukian S, Sweitzer N, Wheeler M, Wilcox J, Katz S, Pan S, Jimenez J, Smart F, Wang J, Gottlieb S, Judge D, Moore C, Huggins G, Jordan E, Kinnamon D, Ni H, Hershberger R. Genetic Signature of Dilated Cardiomyopathy Severity: The DCM Precision Medicine Study. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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9
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Urban M, Castleberry A, Um J, Stoller D, Lundgren S, Hyden M, Moody M, Oreschak K, Lowes B. Acute Rejection Following Donation after Circulatory Death Versus Brain Death Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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10
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Sundaravel S, Zolty R, Stoller D, Lowes B, Lundgren S. Safety and Efficacy of SGLT2i Post Orthotopic Heart Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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11
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Stoller D, Zolty R, Burdorf A, Hyden M, Lundgren S, Qui F, Gajanan G, Malik S, Lowes B. The Impact of Evolocumab in Cardiac Transplant Patients with Coronary Allograft Vasculopathy. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.025] [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: 11/15/2022] Open
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12
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Huggins GS, Kinnamon DD, Haas GJ, Jordan E, Hofmeyer M, Kransdorf E, Ewald GA, Morris AA, Owens A, Lowes B, Stoller D, Tang WHW, Garg S, Trachtenberg BH, Shah P, Pamboukian SV, Sweitzer NK, Wheeler MT, Wilcox JE, Katz S, Pan S, Jimenez J, Aaronson KD, Fishbein DP, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Mead JO, Ni H, Burke W, Hershberger RE. Prevalence and Cumulative Risk of Familial Idiopathic Dilated Cardiomyopathy. JAMA 2022; 327:454-463. [PMID: 35103767 PMCID: PMC8808323 DOI: 10.1001/jama.2021.24674] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 09/24/2021] [Accepted: 12/22/2021] [Indexed: 12/19/2022]
Abstract
Importance Idiopathic dilated cardiomyopathy (DCM) aggregates in families, and early detection in at-risk family members can provide opportunity to initiate treatment prior to late-phase disease. Most studies have included only White patients, yet Black patients with DCM have higher risk of heart failure-related hospitalization and death. Objective To estimate the prevalence of familial DCM among DCM probands and the age-specific cumulative risk of DCM in first-degree relatives across race and ethnicity groups. Design, Setting, and Participants A family-based, cross-sectional study conducted by a multisite consortium of 25 US heart failure programs. Participants included patients with DCM (probands), defined as left ventricular systolic dysfunction and left ventricular enlargement after excluding usual clinical causes, and their first-degree relatives. Enrollment commenced June 7, 2016; proband and family member enrollment concluded March 15, 2020, and April 1, 2021, respectively. Exposures The presence of DCM in a proband. Main Outcomes and Measures Familial DCM defined by DCM in at least 1 first-degree relative; expanded familial DCM defined by the presence of DCM or either left ventricular enlargement or left ventricular systolic dysfunction without known cause in at least 1 first-degree relative. Results The study enrolled 1220 probands (median age, 52.8 years [IQR, 42.4-61.8]; 43.8% female; 43.1% Black and 8.3% Hispanic) and screened 1693 first-degree relatives for DCM. A median of 28% (IQR, 0%-60%) of living first-degree relatives were screened per family. The crude prevalence of familial DCM among probands was 11.6% overall. The model-based estimate of the prevalence of familial DCM among probands at a typical US advanced heart failure program if all living first-degree relatives were screened was 29.7% (95% CI, 23.5% to 36.0%) overall. The estimated prevalence of familial DCM was higher in Black probands than in White probands (difference, 11.3% [95% CI, 1.9% to 20.8%]) but did not differ significantly between Hispanic probands and non-Hispanic probands (difference, -1.4% [95% CI, -15.9% to 13.1%]). The estimated prevalence of expanded familial DCM was 56.9% (95% CI, 50.8% to 63.0%) overall. Based on age-specific disease status at enrollment, estimated cumulative risks in first-degree relatives at a typical US advanced heart failure program reached 19% (95% CI, 13% to 24%) by age 80 years for DCM and 33% (95% CI, 27% to 40%) for expanded DCM inclusive of partial phenotypes. The DCM hazard was higher in first-degree relatives of non-Hispanic Black probands than non-Hispanic White probands (hazard ratio, 1.89 [95% CI, 1.26 to 2.83]). Conclusions and Relevance In a US cross-sectional study, there was substantial estimated prevalence of familial DCM among probands and modeled cumulative risk of DCM among their first-degree relatives. Trial Registration ClinicalTrials.gov Identifier: NCT03037632.
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Affiliation(s)
- Gordon S. Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Daniel D. Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Garrie J. Haas
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
| | - Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Mark Hofmeyer
- Medstar Research Institute, Washington Hospital Center, Washington, DC
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha
| | | | | | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas
| | - Barry H. Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J.C. Walter Jr. Transplant Center, Houston, Texas
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | | | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Jane E. Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stuart Katz
- New York University Langone Medical Center, New York
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla
| | - Javier Jimenez
- Miami Cardiac & Vascular Institute, Baptist Health South, Miami, Florida
| | | | | | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles
| | | | | | | | - Jonathan O. Mead
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle
| | - Ray E. Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
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13
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Muellner M, Siddique A, Castleberry A, Um J, Lowes B, Stoller D, Moulton M, Urban M. Donor Transient Myocardial Dysfunction - Structural versus Hypoxic Brain Injury. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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14
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Hardin EA, Stoller D, Lawley J, Howden EJ, Hieda M, Pawelczyk J, Jarvis S, Prisk K, Sarma S, Levine BD. Noninvasive Assessment of Cardiac Output: Accuracy and Precision of the Closed-Circuit Acetylene Rebreathing Technique for Cardiac Output Measurement. J Am Heart Assoc 2020; 9:e015794. [PMID: 32851906 PMCID: PMC7660774 DOI: 10.1161/jaha.120.015794] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Accurate assessment of cardiac output is critical to the diagnosis and management of various cardiac disease states; however, clinical standards of direct Fick and thermodilution are invasive. Noninvasive alternatives, such as closed‐circuit acetylene (C2H2) rebreathing, warrant validation. Methods and Results We analyzed 10 clinical studies and all available cardiopulmonary stress tests performed in our laboratory that included a rebreathing method and direct Fick or thermodilution. Studies included healthy individuals and patients with clinical disease. Simultaneous cardiac output measurements were obtained under normovolemic, hypovolemic, and hypervolemic conditions, along with submaximal and maximal exercise. A total of 3198 measurements in 519 patients were analyzed (mean age, 59 years; 48% women). The C2H2 method was more precise than thermodilution in healthy individuals with half the typical error (TE; 0.34 L/min [r=0.92] and coefficient of variation, 7.2%) versus thermodilution (TE=0.67 [r=0.70] and coefficient of variation, 13.2%). In healthy individuals during supine rest and upright exercise, C2H2 correlated well with thermodilution (supine: r=0.84, TE=1.02; exercise: r=0.82, TE=2.36). In patients with clinical disease during supine rest, C2H2 correlated with thermodilution (r=0.85, TE=1.43). C2H2 was similar to thermodilution and nitrous oxide (N2O) rebreathing technique compared with Fick in healthy adults (C2H2 rest: r=0.85, TE=0.84; C2H2 exercise: r=0.87, TE=2.39; thermodilution rest: r=0.72, TE=1.11; thermodilution exercise: r=0.73, TE=2.87; N2O rest: r=0.82, TE=0.94; N2O exercise: r=0.84, TE=2.18). The accuracy of the C2H2 and N2O methods was excellent (r=0.99, TE=0.58). Conclusions The C2H2 rebreathing method is more precise than, and as accurate as, the thermodilution method in a variety of patients, with accuracy similar to an N2O rebreathing method approved by the US Food and Drug Administration.
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Affiliation(s)
- E Ashley Hardin
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Douglas Stoller
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Justin Lawley
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Erin J Howden
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Michinari Hieda
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - James Pawelczyk
- Department of Physiology Pennsylvania State University University Park and Hershey PA
| | - Sara Jarvis
- Department of Biological Sciences Northern Arizona University Flagstaff AZ
| | - Kim Prisk
- Department of Medicine University of California at San Diego La Jolla CA
| | - Satyam Sarma
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
| | - Benjamin D Levine
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Institute for Exercise and Environmental Medicine Texas Health Presbyterian Hospital Dallas TX
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15
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Albulushi A, Zolty R, Lowes B, Duhacheck-Stapleman AL, Sandler T, Sullivan JN, Stoller D. Perioperative Management of Pheochromocytoma Resection in a Patient with a Continuous Flow Left Ventricular Assist Device. J Saudi Heart Assoc 2020; 32:233-235. [PMID: 33154922 PMCID: PMC7640556 DOI: 10.37616/2212-5043.1026] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Arif Albulushi
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Corresponding author at: Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, 68198-1164, USA. E-mail address: (A. Albulushi)
| | - Ronald Zolty
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Brian Lowes
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Tal Sandler
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - James N. Sullivan
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Douglas Stoller
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Lundgren S, Lowes B, Lyden E, Zolty R, Hyden M, Burdorf A, Um J, Stoller D. Pre-Heart Transplant Spirometry Predicts Post-Transplant Survival. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.616] [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: 10/24/2022] Open
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17
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Sarma S, Stoller D, Hendrix J, Howden E, Lawley J, Livingston S, Adams-Huet B, Holmes C, Goldstein DS, Levine BD. Mechanisms of Chronotropic Incompetence in Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2020; 13:e006331. [PMID: 32164435 DOI: 10.1161/circheartfailure.119.006331] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Chronotropic incompetence is common in heart failure with preserved ejection fraction (HFpEF) and is associated with impaired aerobic capacity. We investigated the integrity of cardiac β-receptor responsiveness, an important mechanism involved in exertional increases in HR, in HFpEF and control subjects. METHODS Thirteen carefully screened patients with HFpEF and 13 senior controls underwent exercise testing and graded isoproterenol infusion to quantify cardiac β-receptor-mediated HR responses. To limit autonomic neural influences on heart rate (HR) during isoproterenol, dexmedetomidine and glycopyrrolate were given. Isoproterenol doses were increased incrementally until HR increased by 30 beats per minute. Plasma levels of isoproterenol at each increment were measured by liquid chromatography with electrochemical detection and plotted against HR. RESULTS Peak VO2 and HR (117±15 versus 156±15 beats per minute; P<0.001) were lower in HFpEF than senior controls. Cardiac β-receptor sensitivity was lower in HFpEF compared to controls (0.156±0.133 versus 0.254±0.166 beats per minute/[isoproterenol ng/mL]; P<0.001). Seven of 13 HFpEF subjects had β-receptor sensitivity similar to senior controls but still had lower peak HRs (122±14 versus 156±15 beats per minute; P<0.001). CONCLUSIONS Contrary to our hypothesis, patients with HFpEF displayed impaired cardiac β-receptor sensitivity compared with senior controls. In the 7 out of 13 patients with HFpEF with age-appropriate β-receptor sensitivity, peak HR remained low, suggesting impaired sinus node β-receptor function may not fully account for low exercise HR response. Rather in some patients with HFpEF, chronotropic incompetence might reflect premature cessation of exercise before maximal sinus node activation. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02524145.
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Affiliation(s)
- Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (S.S., D.S., S.L., B.D.L.).,Department of Internal Medicine (S.S., D.S., B.D.L.), University of Texas Southwestern Medical Center Dallas
| | - Douglas Stoller
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (S.S., D.S., S.L., B.D.L.).,Department of Internal Medicine (S.S., D.S., B.D.L.), University of Texas Southwestern Medical Center Dallas
| | - Joseph Hendrix
- Department of Anesthesiology (J.H.), University of Texas Southwestern Medical Center Dallas
| | - Erin Howden
- Baker Heart and Diabetes Institute, Melbourne, Australia (E.H.)
| | - Justin Lawley
- University of Innsbruck, Department Sport Science, Innsbruck, Austria (J.L.)
| | - Sheryl Livingston
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (S.S., D.S., S.L., B.D.L.)
| | - Beverley Adams-Huet
- Department of Population and Data Sciences (B.A.-H.), University of Texas Southwestern Medical Center Dallas
| | - Courtney Holmes
- Autonomic Medicine Section (formerly Clinical Neurocardiology Section), CNP/DIR/NINDS, National Institutes of Health, Bethesda, MD (C.H., D.S.G.)
| | - David S Goldstein
- Autonomic Medicine Section (formerly Clinical Neurocardiology Section), CNP/DIR/NINDS, National Institutes of Health, Bethesda, MD (C.H., D.S.G.)
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (S.S., D.S., S.L., B.D.L.).,Department of Internal Medicine (S.S., D.S., B.D.L.), University of Texas Southwestern Medical Center Dallas
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Albulushi A, Zolty D, Dhar K, Burdorf A, Stoller D, Hyden M, Hyden M, Lowes B, Zolty R. CGMP LEVEL IN PULMONARY ARTERIAL HYPERTENSION VS. PULMONARY HYPERTENSION DUE TO HEART FAILURE WITH PRESERVED EJECTION FRACTION, BOTH AT REST AND AT PEAK EXERCISE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32730-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Albulushi A, Goldsweig AM, Stoller D, Delaney JW, Um J, Lowes B, Zolty R. Percutaneous Deactivation of Left Ventricular Assist Devices. Semin Thorac Cardiovasc Surg 2020; 32:467-472. [DOI: 10.1053/j.semtcvs.2020.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/11/2020] [Indexed: 11/11/2022]
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Urban M, Um J, Moulton M, Stoller D, Zolty R, Lowes B, Macdonald C, McCain N, Siddique A. Recurrent pump thrombosis is common after axial continuous-flow left ventricular assist device exchange. Int J Artif Organs 2019; 43:109-118. [PMID: 31530254 DOI: 10.1177/0391398819876293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In selected patients with left ventricular assist device-associated infection or malfunction, pump exchange may become necessary after conservative treatment options fail and heart transplantation is not readily available. We examined the survival and complication rate in patients (⩾19 years of age) who underwent HeartMate II to HeartMate II exchange at our institution from 1 January 2010 to 28 February 2018. Clinical outcomes were analyzed and compared for patients who underwent exchange for pump thrombosis (14 patients), breach of driveline integrity (5 patients), and device-associated infection (2 patients). There were no differences in 30-day mortality (p = 0.58), need for temporary renal replacement therapy (p = 0.58), right ventricular mechanical support (p = 0.11), and postoperative stroke (p = 0.80) among groups. Survival at 1 year was 90% ± 7% for the whole cohort and 85% ± 10% for those who underwent exchange for pump thrombosis. In patients exchanged for device thrombosis, freedom from re-thrombosis and survival free from pump re-thrombosis at 1 year were 49% ± 16% and 42% ± 15%, respectively. No association of demographic and clinical variables with the risk of recurrent pump thrombosis after the first exchange was identified. Survival after left ventricular assist device exchange compares well with published results after primary left ventricular assist device implantation. However, recurrence of thrombosis was common among patients who required a left ventricular assist device exchange due to pump thrombosis. In this sub-group, consideration should be given to alternative strategies to improve the outcomes.
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Affiliation(s)
- Marian Urban
- University of Nebraska Medical Center, Omaha, NE, USA
| | - John Um
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | | | - Ronald Zolty
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha, NE, USA
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Lundgren S, Lyden E, Hyden M, Burdorf A, Zolty R, Lowes B, Um J, Stoller D. Impact of Heart Rate and Left Ventricular Mass on Survival Following Heart Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Albulushi A, Patel A, Stoller D, Hyden M, Burdorf A, Brian L, Zolty R. Comparison of Endothelin-1 Level in Group I Pulmonary Hypertension vs. Group II Pulmonary Hypertension Both at Rest and at Peak Exercise. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Lundgren S, Lyden E, Hyden M, Burdorf A, Zolty R, Lowes B, Um J, Stoller D. Impact of Heart Rate and Left Ventricular Mass on Survival Following Heart Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.829] [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: 12/01/2022] Open
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Macdonald C, Urban M, Moulton M, McCain N, Stoller D, Zolty R, Um J, Siddique A. Recurrent Pump Thrombosis is Common after Axial Continuous Flow LVAD Exchange. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lundgren S, Lyden E, Hyden M, Burdorf A, Zolty R, Lowes B, Um J, Stoller D. Trends in Exercise Capacity Following Heart Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Albulushi A, Patel A, Stoller D, Hyden M, Burdorf A, Lowes B, Zolty R. ENDOTHELIN-1 LEVEL IN HEART FAILURE WITH PRESERVED EJECTION FRACTION WITH PULMONARY HYPERTENSION VERSUS PULMONARY ARTERIAL HYPERTENSION BOTH AT REST AND AT PEAK EXERCISE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31500-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Albulushi A, Hyden M, Stoller D, Burdorf A, Zolty R, Lowes B, Um J, Delaney J. TCT-176 Catheter based percutaneous left ventricular assist device deactivation: A case series from a Tertiary care center. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lundgren S, Lyden E, Stoller D, Hyden M, Burdorf A, Zolty R, Um J, Lowes B. Prior Median Sternotomy Results in Increased Mortality Following LVAD Implantation. J Card Fail 2018. [DOI: 10.1016/j.cardfail.2018.07.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lundgren S, Lyden E, Burdorf A, Hyden M, Stoller D, Zolty R, Um J, Lowes B. PRE-LVAD UTILIZATION OF AMIODARONE AND ITS IMPACT ON POST-LVAD OUTCOMES. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31490-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lundgren S, Lyden E, Burdorf A, Hyden M, Stoller D, Zolty R, Um J, Lowes B. POST-LEFT VENTRICULAR ASSIST DEVICE INOTROPIC SCORE PREDICTS SHORT- AND LONG-TERM MORTALITY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31492-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Howden EJ, Sarma S, Lawley JS, Opondo M, Cornwell W, Stoller D, Urey MA, Adams-Huet B, Levine BD. Reversing the Cardiac Effects of Sedentary Aging in Middle Age-A Randomized Controlled Trial: Implications For Heart Failure Prevention. Circulation 2018; 137:1549-1560. [PMID: 29311053 DOI: 10.1161/circulationaha.117.030617] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Poor fitness in middle age is a risk factor for heart failure, particularly heart failure with a preserved ejection fraction. The development of heart failure with a preserved ejection fraction is likely mediated through increased left ventricular (LV) stiffness, a consequence of sedentary aging. In a prospective, parallel group, randomized controlled trial, we examined the effect of 2 years of supervised high-intensity exercise training on LV stiffness. METHODS Sixty-one (48% male) healthy, sedentary, middle-aged participants (53±5 years) were randomly assigned to either 2 years of exercise training (n=34) or attention control (control; n=27). Right heart catheterization and 3-dimensional echocardiography were performed with preload manipulations to define LV end-diastolic pressure-volume relationships and Frank-Starling curves. LV stiffness was calculated by curve fit of the diastolic pressure-volume curve. Maximal oxygen uptake (Vo2max) was measured to quantify changes in fitness. RESULTS Fifty-three participants completed the study. Adherence to prescribed exercise sessions was 88±11%. Vo2max increased by 18% (exercise training: pre 29.0±4.8 to post 34.4±6.4; control: pre 29.5±5.3 to post 28.7±5.4, group×time P<0.001) and LV stiffness was reduced (right/downward shift in the end-diastolic pressure-volume relationships; preexercise training stiffness constant 0.072±0.037 to postexercise training 0.051±0.0268, P=0.0018), whereas there was no change in controls (group×time P<0.001; pre stiffness constant 0.0635±0.026 to post 0.062±0.031, P=0.83). Exercise increased LV end-diastolic volume (group×time P<0.001), whereas pulmonary capillary wedge pressure was unchanged, providing greater stroke volume for any given filling pressure (loading×group×time P=0.007). CONCLUSIONS In previously sedentary healthy middle-aged adults, 2 years of exercise training improved maximal oxygen uptake and decreased cardiac stiffness. Regular exercise training may provide protection against the future risk of heart failure with a preserved ejection fraction by preventing the increase in cardiac stiffness attributable to sedentary aging. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02039154.
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Affiliation(s)
- Erin J Howden
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (E.J.H., S.S., J.S.L., M.O., W.C., D.S., M.A.U., B.D.L.).,University of Texas Southwestern Medical Center, Dallas (E.J.H., S.S., J.S.L., D.S., M.A.U., B.A.-H., B.D.L.).,The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (E.J.H.)
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (E.J.H., S.S., J.S.L., M.O., W.C., D.S., M.A.U., B.D.L.).,University of Texas Southwestern Medical Center, Dallas (E.J.H., S.S., J.S.L., D.S., M.A.U., B.A.-H., B.D.L.)
| | - Justin S Lawley
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (E.J.H., S.S., J.S.L., M.O., W.C., D.S., M.A.U., B.D.L.).,University of Texas Southwestern Medical Center, Dallas (E.J.H., S.S., J.S.L., D.S., M.A.U., B.A.-H., B.D.L.)
| | - Mildred Opondo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (E.J.H., S.S., J.S.L., M.O., W.C., D.S., M.A.U., B.D.L.).,Stanford University, CA (M.O.)
| | - William Cornwell
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (E.J.H., S.S., J.S.L., M.O., W.C., D.S., M.A.U., B.D.L.).,University of Colorado Anschutz Medical Campus, Aurora (W.C.)
| | - Douglas Stoller
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (E.J.H., S.S., J.S.L., M.O., W.C., D.S., M.A.U., B.D.L.).,University of Texas Southwestern Medical Center, Dallas (E.J.H., S.S., J.S.L., D.S., M.A.U., B.A.-H., B.D.L.)
| | - Marcus A Urey
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (E.J.H., S.S., J.S.L., M.O., W.C., D.S., M.A.U., B.D.L.).,University of Texas Southwestern Medical Center, Dallas (E.J.H., S.S., J.S.L., D.S., M.A.U., B.A.-H., B.D.L.)
| | - Beverley Adams-Huet
- University of Texas Southwestern Medical Center, Dallas (E.J.H., S.S., J.S.L., D.S., M.A.U., B.A.-H., B.D.L.)
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (E.J.H., S.S., J.S.L., M.O., W.C., D.S., M.A.U., B.D.L.). .,University of Texas Southwestern Medical Center, Dallas (E.J.H., S.S., J.S.L., D.S., M.A.U., B.A.-H., B.D.L.)
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Gagnon D, Romero SA, Ngo H, Sarma S, Cornwell WK, Poh PYS, Stoller D, Levine BD, Crandall CG. Volume loading augments cutaneous vasodilatation and cardiac output of heat stressed older adults. J Physiol 2017; 595:6489-6498. [PMID: 28833129 DOI: 10.1113/jp274742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/11/2017] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Age-related changes in cutaneous microvascular and cardiac functions limit the extent of cutaneous vasodilatation and the increase in cardiac output that healthy older adults can achieve during passive heat stress. However, it is unclear if these age-related changes in microvascular and cardiac functions maximally restrain the levels of cutaneous vasodilatation and cardiac output that healthy older adults can achieve during heat stress. We observed that rapid volume loading, performed during passive heat stress, augments both cutaneous vasodilatation and cardiac output in healthy older humans. These findings demonstrate that the microcirculation of healthy aged skin can further dilate during passive heat exposure, despite peripheral limitations to vasodilatation. Furthermore, healthy older humans can augment cardiac output when cardiac pre-load is increased during heat stress. ABSTRACT Primary ageing markedly attenuates cutaneous vasodilatation and the increase in cardiac output during passive heating. However, it remains unclear if these responses are maximally restrained by age-related changes in cutaneous microvascular and cardiac functions. We hypothesized that rapid volume loading performed during heat stress would increase cardiac output in older adults without parallel increases in cutaneous vasodilatation. Twelve young (Y: 26 ± 5 years) and ten older (O: 69 ± 3 years) healthy adults were passively heated until core temperature increased by 1.5°C. Cardiac output (thermodilution), forearm vascular conductance (FVC, venous occlusion plethysmography) and cutaneous vascular conductance (CVC, laser-Doppler) were measured before and after rapid infusion of warmed saline (15 mL kg-1 , ∼7 min). While heat stressed, but prior to saline infusion, cardiac output (O: 6.8 ± 0.4 vs. Y: 9.4 ± 0.6 L min-1 ), FVC (O: 0.08 ± 0.01 vs. Y: 0.17 ± 0.02 mL (100 mL min-1 mmHg-1 )-1 ), and CVC (O: 1.29 ± 0.34 vs. Y: 1.93 ± 0.30 units mmHg-1 ) were lower in older adults (all P < 0.01). Rapid saline infusion increased cardiac output (O: +1.9 ± 0.3, Y: +1.8 ± 0.7 L min-1 ), FVC (O: +0.015 ± 0.007, Y: +0.048 ± 0.013 mL (100 mL min-1 mmHg-1 )-1 ), and CVC (O: +0.28 ± 0.10, Y: +0.29 ± 0.16 units mmHg-1 ) in both groups (all P < 0.01). The absolute increase in cardiac output and CVC were similar between groups, whereas FVC increased to a greater extent in young adults (P < 0.01). These results demonstrate that healthy older adults can achieve greater levels of cutaneous vasodilatation and cardiac output during passive heating.
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Affiliation(s)
- Daniel Gagnon
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA.,Cardiovascular Prevention and Rehabilitation Centre, Montreal Heart Institute Research Centre, Montréal, QC, Canada.,Département de pharmacologie et physiologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Steven A Romero
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hai Ngo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William K Cornwell
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Medicine-Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Paula Y S Poh
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Douglas Stoller
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX, USA
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Stoller D, Araj F, Amin A, Fitzsimmons C, Morlend R, Thibodeau JT, Ramaciotti C, Drazner MH, Meyer DM, Mammen PPA. Implantation of a left ventricular assist device to provide long-term support for end-stage Duchenne muscular dystrophy-associated cardiomyopathy. ESC Heart Fail 2017; 4:379-383. [PMID: 28772036 PMCID: PMC5542741 DOI: 10.1002/ehf2.12160] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/13/2017] [Accepted: 03/05/2017] [Indexed: 01/16/2023] Open
Abstract
A young man with Duchenne muscular dystrophy presented to the UT Southwestern Neuromuscular Cardiomyopathy Clinic with advanced heart failure. Despite maximal medical therapy, his cardiac function continued to decline requiring initiation of inotrope therapy. Given the patient's clinical deterioration, a left ventricular assist device (LVAD) was implanted as destination therapy after undergoing a multidisciplinary assessment. The patient tolerated the surgical implantation of the LVAD without any significant complications, and he has had a relatively unremarkable course 38 months post‐LVAD implantation. A critical factor contributing to the long‐term success of this patient was the decision to select an LVAD that would not disrupt the diaphragm and thus preserve the respiratory muscle strength. This case demonstrates that permanent mechanical LVADs should be considered for appropriately selected Duchenne muscular dystrophy patients with medically refractory end‐stage cardiomyopathy.
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Affiliation(s)
- Douglas Stoller
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA.,Heart Failure, Ventricular Assist Device and Heart Transplant Program, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA
| | - Faris Araj
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA.,Heart Failure, Ventricular Assist Device and Heart Transplant Program, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA
| | - Alpesh Amin
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA.,Heart Failure, Ventricular Assist Device and Heart Transplant Program, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA
| | - Catherine Fitzsimmons
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA.,Heart Failure, Ventricular Assist Device and Heart Transplant Program, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA
| | - Robert Morlend
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA.,Heart Failure, Ventricular Assist Device and Heart Transplant Program, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA
| | - Jennifer T Thibodeau
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA.,Heart Failure, Ventricular Assist Device and Heart Transplant Program, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA
| | - Claudio Ramaciotti
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA
| | - Mark H Drazner
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA.,Heart Failure, Ventricular Assist Device and Heart Transplant Program, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA
| | - Dan M Meyer
- Lung and Vascular Services, Methodist Health System, Dallas, 75203, TX, USA
| | - Pradeep P A Mammen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA.,Heart Failure, Ventricular Assist Device and Heart Transplant Program, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA.,Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA.,UT Southwestern Senator Paul D. Wellstone Muscular Dystrophy Cooperative Research Center, University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA
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Urey MA, Darden D, Stoller D, Drazner MH, Horn V, Sarma S, Levine BD. Stiff Left Atrial Syndrome After Multiple Percutaneous Catheter Ablations. Circ Heart Fail 2017; 10:e003885. [DOI: 10.1161/circheartfailure.117.003885] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 01/19/2017] [Accepted: 04/10/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Marcus A. Urey
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX (M.A.U., D.S., S.S., B.D.L.); and Department of Internal Medicine, University of Texas Southwestern Medical Center Dallas (M.A.U., D.D., D.S., M.H.D., S.S., B.D.L.)
| | - Douglas Darden
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX (M.A.U., D.S., S.S., B.D.L.); and Department of Internal Medicine, University of Texas Southwestern Medical Center Dallas (M.A.U., D.D., D.S., M.H.D., S.S., B.D.L.)
| | - Douglas Stoller
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX (M.A.U., D.S., S.S., B.D.L.); and Department of Internal Medicine, University of Texas Southwestern Medical Center Dallas (M.A.U., D.D., D.S., M.H.D., S.S., B.D.L.)
| | - Mark H. Drazner
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX (M.A.U., D.S., S.S., B.D.L.); and Department of Internal Medicine, University of Texas Southwestern Medical Center Dallas (M.A.U., D.D., D.S., M.H.D., S.S., B.D.L.)
| | - Vernon Horn
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX (M.A.U., D.S., S.S., B.D.L.); and Department of Internal Medicine, University of Texas Southwestern Medical Center Dallas (M.A.U., D.D., D.S., M.H.D., S.S., B.D.L.)
| | - Satyam Sarma
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX (M.A.U., D.S., S.S., B.D.L.); and Department of Internal Medicine, University of Texas Southwestern Medical Center Dallas (M.A.U., D.D., D.S., M.H.D., S.S., B.D.L.)
| | - Benjamin D. Levine
- From the Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, TX (M.A.U., D.S., S.S., B.D.L.); and Department of Internal Medicine, University of Texas Southwestern Medical Center Dallas (M.A.U., D.D., D.S., M.H.D., S.S., B.D.L.)
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Darden D, Urey M, Stoller D, Drazner M, Sarma S, Levine B. STIFF LEFT ATRIAL SYNDROME FOLLOWING MULTIPLE ABLATIONS DIAGNOSED WITH INVASIVE HEMODYNAMIC EXERCISE TESTING. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35687-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gagnon D, Romero SA, Ngo H, Sarma S, Cornwell WK, Poh PYS, Stoller D, Levine BD, Crandall CG. Healthy aging does not compromise the augmentation of cardiac function during heat stress. J Appl Physiol (1985) 2016; 121:885-892. [PMID: 27609201 DOI: 10.1152/japplphysiol.00643.2016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 07/15/2016] [Accepted: 09/06/2016] [Indexed: 11/22/2022] Open
Abstract
During heat stress, stroke volume is maintained in young adults despite reductions in cardiac filling pressures. This is achieved by a general augmentation of cardiac function, highlighted by a left and upward shift of the Frank-Starling relation. In contrast, healthy aged adults are unable to maintain stroke volume during heat stress. We hypothesized that this would be associated with a lack of shift in the Frank-Starling relation. Frank-Starling relations were examined in 11 aged [69 ± 4 (SD) yr, 4 men/7 women] and 12 young (26 ± 5 yr, 6 men/6 women) adults during normothermic and heat stress (1.5°C increase in core temperature) conditions. During heat stress, increases in cardiac output were attenuated in aged adults (+2.5 ± 0.3 (95% CI) vs. young: +4.5 ± 0.5 l/min, P < 0.01) because of an attenuated chronotropic response (+30 ± 4 vs. young: +42 ± 5 beats/min, P < 0.01). In contrast to our hypothesis, a leftward shift of the Frank-Starling relation maintained stroke volume during heat stress in aged adults (76 ± 8 vs. normothermic: 74 ± 8 ml, P = 0.38) despite reductions in cardiac filling pressure (6.6 ± 1.0 vs. normothermic: 8.9 ± 1.1 mmHg, P < 0.01). In a subset of participants, volume loading was used to return cardiac filling pressure during heat stress to normothermic values, which resulted in a greater stroke volume for a given cardiac filling pressure in both groups. These results demonstrate that the Frank-Starling relation shifts during heat stress in healthy young and aged adults, thereby preserving stroke volume despite reductions in cardiac filling pressures.
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Affiliation(s)
- Daniel Gagnon
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas; Cardiovascular Prevention and Rehabilitation Centre (ÉPIC), Montreal Heart Institute Research Centre, Montreal, Quebec, Canada; and Département de physiologie moléculaire et intégrative, Faculté de Médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Steven A Romero
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hai Ngo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - William K Cornwell
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Paula Y S Poh
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Douglas Stoller
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, Texas;
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Stoller D, Sarma S, Lawley J, Howden E, Levine BD. Better Thanthermodiluation: Validation of Foreign Gas Rebreathing for Noninvasive Measurement of Cardiac Output in Clinical Practice. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.060] [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: 11/15/2022]
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Stoller D, French C, Mammen PP. Circulating MicroRNAs in Myotonic Dystrophy-Associated Cardiomyopathy. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gagnon D, Romero SA, Ngo H, Sarma S, Cornwell WK, Poh PYS, Stoller D, Levine BD, Crandall CG. Attenuated Increases In Cardiac Output Limit Cutaneous Vasodilation During Heat Stress In Healthy Aged Humans. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000487427.99136.80] [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: 11/21/2022]
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Gagnon D, Romero SA, Ngo H, Sarma S, Cornwell WK, Poh PYS, Stoller D, Levine BD, Crandall CG. Frank‐Starling Responses during Heat Stress in Healthy Aged Humans. FASEB J 2016. [DOI: 10.1096/fasebj.30.1_supplement.1290.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel Gagnon
- Institute for Exercise and Environmental MedicineDallasTX
| | | | - Hai Ngo
- Institute for Exercise and Environmental MedicineDallasTX
| | - Satyam Sarma
- Institute for Exercise and Environmental MedicineDallasTX
| | | | - Paula YS Poh
- Institute for Exercise and Environmental MedicineDallasTX
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Fahrenbach JP, Stoller D, Kim G, Aggarwal N, Yerokun B, Earley JU, Hadhazy M, Shi NQ, Makielski JC, McNally EM. Abcc9 is required for the transition to oxidative metabolism in the newborn heart. FASEB J 2014; 28:2804-15. [PMID: 24648545 DOI: 10.1096/fj.13-244459] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The newborn heart adapts to postnatal life by shifting from a fetal glycolytic metabolism to a mitochondrial oxidative metabolism. Abcc9, an ATP-binding cassette family member, increases expression concomitant with this metabolic shift. Abcc9 encodes a membrane-associated receptor that partners with a potassium channel to become the major potassium-sensitive ATP channel in the heart. Abcc9 also encodes a smaller protein enriched in the mitochondria. We now deleted exon 5 of Abcc9 to ablate expression of both plasma membrane and mitochondria-associated Abcc9-encoded proteins, and found that the myocardium failed to acquire normal mature metabolism, resulting in neonatal cardiomyopathy. Unlike wild-type neonatal cardiomyocytes, mitochondria from Ex5 cardiomyocytes were unresponsive to the KATP agonist diazoxide, consistent with loss of KATP activity. When exposed to hydrogen peroxide to induce cell stress, Ex5 neonatal cardiomyocytes displayed a rapid collapse of mitochondria membrane potential, distinct from wild-type cardiomyocytes. Ex5 cardiomyocytes had reduced fatty acid oxidation, reduced oxygen consumption and reserve. Morphologically, Ex5 cardiac mitochondria exhibited an immature pattern with reduced cross-sectional area and intermitochondrial contacts. In the absence of Abcc9, the newborn heart fails to transition normally from fetal to mature myocardial metabolism.-Fahrenbach, J. P., Stoller, D., Kim, G., Aggarwal, N., Yerokun, B., Earley, J. U., Hadhazy, M., Shi, N.-Q., Makielski, J. C., McNally, E. M. Abcc9 is required for the transition to oxidative metabolism in the newborn heart.
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Affiliation(s)
| | - Douglas Stoller
- Department of Medicine, Division of Cardiovascular Medicine, and
| | - Gene Kim
- Department of Medicine, Division of Cardiovascular Medicine, and
| | - Nitin Aggarwal
- Department of Medicine, Division of Cardiology, University of Wisconsin, Madison, Wisconsin, USA
| | | | - Judy U Earley
- Department of Medicine, Division of Cardiovascular Medicine, and
| | - Michele Hadhazy
- Department of Medicine, Division of Cardiovascular Medicine, and
| | - Nian-Qing Shi
- Department of Medicine, Division of Cardiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Jonathan C Makielski
- Department of Medicine, Division of Cardiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Elizabeth M McNally
- Department of Medicine, Division of Cardiovascular Medicine, and Department of Human Genetics, The University of Chicago, Chicago, Illinois, USA; and
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Stoller D, Pytel P, Katz S, Earley JU, Collins K, Metcalfe J, Lang RM, McNally EM. Impaired exercise tolerance and skeletal muscle myopathy in sulfonylurea receptor-2 mutant mice. Am J Physiol Regul Integr Comp Physiol 2009; 297:R1144-53. [PMID: 19675276 DOI: 10.1152/ajpregu.00081.2009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
By sensing intracellular energy levels, ATP-sensitive potassium (K(ATP)) channels help regulate vascular tone, glucose metabolism, and cardioprotection. SUR2 mutant mice lack full-length K(ATP) channels in striated and smooth muscle and display a complex phenotype of hypertension and coronary vasospasm. SUR2 mutant mice also display baseline cardioprotection and can withstand acute sympathetic stress better than normal mice. We now studied response to a form of chronic stress, namely that induced by 4 wk of daily exercise on SUR2 mutant mice. Control mice increased exercise capacity by 400% over the training period, while SUR2 mutant mice showed little increase in exercise capacity. Unexercised SUR2 mutant showed necrotic and regenerating fibers in multiple muscle skeletal muscles, including quadriceps, tibialis anterior, and diaphragm muscles. Unlike exercised control animals, SUR2 mutant mice did not lose weight, presumably due to less overall exertion. Unexercised SUR2 mutant mice showed a trend of mildly reduced cardiac function, measured by fractional shortening, (46 +/- 4% vs. 57 +/- 7% for SUR2 mutant and control, respectively), and this decrease was not exacerbated by chronic exercise exposure. Despite an improved response to acute sympathetic stress and baseline cardioprotection, exercise intolerance results from lack of SUR2 K(ATP) channels in mice.
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Affiliation(s)
- Douglas Stoller
- Committee on Cellular and Molecular Physiology, The University of Chicago, Chicago, Illinois 60637, USA
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Stoller D, Kakkar R, Smelley M, Chalupsky K, Earley JU, Shi NQ, Makielski JC, McNally EM. Mice lacking sulfonylurea receptor 2 (SUR2) ATP-sensitive potassium channels are resistant to acute cardiovascular stress. J Mol Cell Cardiol 2007; 43:445-54. [PMID: 17765261 PMCID: PMC2745323 DOI: 10.1016/j.yjmcc.2007.07.058] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [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: 03/25/2007] [Revised: 07/16/2007] [Accepted: 07/19/2007] [Indexed: 11/24/2022]
Abstract
Adenosine triphosphate-sensitive potassium (K(ATP)) channels are thought to mediate the stress response by sensing intracellular ATP concentration. Cardiomyocyte K(ATP) channels are composed of the pore-forming Kir6.2 subunit and the regulatory sulfonylurea receptor 2 (SUR2). We studied the response to acute isoproterenol in SUR2 null mice as a model of acute adrenergic stress and found that the episodic coronary vasospasm observed at baseline in SUR2 null mice was alleviated. Similar results were observed following administration of a nitric oxide donor consistent with a vasodilatory role. Langendorff-perfused hearts were subjected to global ischemia, and hearts from SUR2 null mice exhibited significantly reduced infarct size (54+/-4 versus 30+/-3%) and improved cardiac function compared to control mice. SUR2 null mice have hypertension and develop cardiac hypertrophy. However, despite longstanding hypertension, fibrosis was absent in SUR2 null mice. SUR2 null mice were administered nifedipine to block baseline coronary vasospasm, and hearts from nifedipine-treated SUR2 null mice exhibited increased infarct size compared to untreated SUR2 null mice (42+/-3% versus 54+/-3%). We conclude that conventional sarcolemmal cardiomyocyte K(ATP) channels containing full-length SUR2 are not required for mediating the response to acute cardiovascular stress.
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Affiliation(s)
- Douglas Stoller
- Committee on Cell Physiology, The University of Chicago, Chicago, IL 60637, USA
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Stoller D. Prenatal genetic screening: the enigma of selective abortion. J Law Health 1996; 12:121-140. [PMID: 10182027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- D Stoller
- United States Department of Justice, Immigration and Naturalization Service, Miami, FL, USA
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Abstract
We reviewed the films of 1760 patients who had magnetic resonance image scanning of the knee joint to assess the most common pathologic changes associated with an incidental finding of a Baker's cyst. Of the 1760 knees scanned, Baker's cysts were noted in 238. The cysts were classified as small (55%), medium (30%), or large (15%) and were primarily found on the medial side of the knee (94%). The menisci were evaluated and changes were classified as complete tears, where signal contacts the surface, or degenerative intrasubstance tears. One hundred eleven (47%) complete meniscal tears were found, and 88 (37%) degenerative tears. The majority of tears were found in the posterior horn of the medial meniscus (65 complete tears and 45 degenerative tears). Thus, 199 tears were found in 170 knees, and 106 of the 170 knees (62%) had tears of the posterior horn of the medial meniscus. Baker's cysts are frequent findings on physical examinations and on magnetic resonance imaging scans of the knee. They are thought to be due to intraarticular pathologic changes, usually posterior meniscal tears. This study documents the association between Baker's cysts and meniscal tears and notes that a complete tear is not necessary for the cyst to be present.
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Affiliation(s)
- K R Stone
- Stone Clinic, San Francisco, CA 94123, USA
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Abstract
The report describes a case in which routine prescreening procedures were found to be inadequate for an adolescent patient referred for MR imaging. Recommendations are provided to correct this potential problem.
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Affiliation(s)
- C Elmquist
- California Advanced Imaging, San Francisco, USA
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Heuck A, Steinbach L, Neumann C, Stoller D, Genant H. [Possibilities of MR tomography of diseases of the hand and wrist]. Radiologe 1989; 29:53-60. [PMID: 2928507] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
MRI studies of 63 patients with various abnormalities of the hand and wrist were analyzed. Studies were performed on scanners with a field strength of 0.35, 0.5, or 1.5 T. Imaging parameters included T1- and T2-weighted sequences in the coronal and transverse planes and contiguous slices 3-5 mm thick. In 37 patients with post-traumatic disorders, MRI revealed carpal avascular necrosis, tendon abnormalities and, in some cases, abnormalities of interosseous ligaments and the triangular fibrocartilage. In 15 patients with such inflammatory diseases as arthritis, tenosynovitis and carpal tunnel syndrome and in 11 patients with tumors, MRI provided clear delineation of osseous and soft tissue abnormalities. The current role of MRI in the diagnosis of hand and wrist abnormalities is discussed on the basis of these results.
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Affiliation(s)
- A Heuck
- Department of Radiology, University of California San Francisco
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Lang P, Genant HK, Chafetz N, Steiger P, Stoller D. [Magnetic resonance tomography in the determination of the functional stability of posterolateral lumbar spondylodeses]. ROFO-FORTSCHR RONTG 1987; 147:420-6. [PMID: 2825265 DOI: 10.1055/s-2008-1048668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 01/02/2023]
Abstract
MR tomography was used to assess functional lumbar stability in 30 patients with posterolateral fusions. The vertebral bodies of 9 of the 12 patients with unstable lumbar fusions presented with areas of decreased signal intensity on T1- and intermediately weighted images, which increased on T2-weighting. The vertebrae of 15 of the 18 patients with stable fusions demonstrated zones of increased signal intensity on T1- and intermediately weighted images, which were less intense or invisible on T2-weighing. Surgical correlation was available in 11 of the 30 patients studied. Hyperemia and inflammation appear to be responsible for the abnormal signal intensities in the patients with stable fusions, whereas an increase in adipose marrow due to decreased biomechanical stress is thought to account for the atypical signal intensities in the vertebral bodies of the patients with stable fusions. MR tomography seems to be a potential method for evaluating functional lumbar fusion stability. MR tomography may be particularly helpful in those patients with multiple back surgeries and possible instability, recurrent disc herniation, or postoperative fibrosis. MR is recommended in the patient, who appears clinically unstable, whose radiographs and CT, however, do not demonstrate fusion failure.
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Affiliation(s)
- P Lang
- Department of Radiology, University of California, San Francisco
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Lang P, Hedtmann A, Steiger P, Genant HK, Krämer J, Stoller D. [Three-dimensional computerized tomography of diseases of the bones and joints]. Z Orthop Ihre Grenzgeb 1987; 125:418-26. [PMID: 3673197 DOI: 10.1055/s-2008-1044934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Three-dimensional CT (3-DCT) surface reconstructions were generated in 157 patients with various disorders of the musculoskeletal system. Whereas generating the 3-D display of ligaments, tendons, intervertebral discs and nerve roots was difficult and time-consuming, the comprehension of complex abnormalities of bony structures was easier than with two-dimensional CT. 3-DCT was particularly useful in the preoperative planning of hip and spine surgeries while it also simplified the intraoperative orientation. 3-DCT proved to be a useful diagnostic method supplementing axial computed tomography.
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Affiliation(s)
- P Lang
- Department of Orthopedic Surgery, University of California, San Francisco 94143
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