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Yuzefpolskaya M, Bohn B, Nasiri M, Zuver AM, Onat DD, Royzman EA, Nwokocha J, Mabasa M, Pinsino A, Brunjes D, Gaudig A, Clemons A, Trinh P, Stump S, Giddins MJ, Topkara VK, Garan AR, Takeda K, Takayama H, Naka Y, Farr MA, Nandakumar R, Uhlemann AC, Colombo PC, Demmer RT. Gut microbiota, endotoxemia, inflammation, and oxidative stress in patients with heart failure, left ventricular assist device, and transplant. J Heart Lung Transplant 2020; 39:880-890. [PMID: 32139154 DOI: 10.1016/j.healun.2020.02.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/13/2020] [Accepted: 02/06/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Gut microbial imbalance may contribute to endotoxemia, inflammation, and oxidative stress in heart failure (HF). Changes occurring in the intestinal microbiota and inflammatory/oxidative milieu during HF progression and following left ventricular assist device (LVAD) or heart transplantation (HT) are unknown. We aimed to investigate variation in gut microbiota and circulating biomarkers of endotoxemia, inflammation, and oxidative stress in patients with HF (New York Heart Association, Class I-IV), LVAD, and HT. METHODS We enrolled 452 patients. Biomarkers of endotoxemia (lipopolysaccharide and soluble [sCD14]), inflammation (C-reactive protein, interleukin-6, tumor necrosis factor-α, and endothelin-1 adiponectin), and oxidative stress (isoprostane) were measured in 644 blood samples. A total of 304 stool samples were analyzed using 16S rRNA sequencing. RESULTS Gut microbial community measures of alpha diversity were progressively lower across worsening HF class and were similarly reduced in patients with LVAD and HT (p < 0.05). Inflammation and oxidative stress were elevated in patients with Class IV HF vs all other groups (all p < 0.05). Lipopolysaccharide was elevated in patients with Class IV HF (vs Class I-III) as well as in patients with LVAD and HT (p < 0.05). sCD14 was elevated in patients with Class IV HF and LVAD (vs Class I-III, p < 0.05) but not in patients with HT. CONCLUSIONS Reduced gut microbial diversity and increased endotoxemia, inflammation, and oxidative stress are present in patients with Class IV HF. Inflammation and oxidative stress are lower among patients with LVAD and HT relative to patients with Class IV HF, whereas reduced gut diversity and endotoxemia persist in LVAD and HT.
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Affiliation(s)
- Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Bruno Bohn
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Mojdeh Nasiri
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Amelia M Zuver
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Drew D Onat
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Eugene A Royzman
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Joseph Nwokocha
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Melissa Mabasa
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Alberto Pinsino
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Danielle Brunjes
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Antonia Gaudig
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Autumn Clemons
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Pauline Trinh
- Department of Environmental and Occupational Health Sciences, University of Washington, School of Public Health, Seattle, Washington
| | - Stephania Stump
- Department of Medicine, Division of Infectious Diseases and Microbiome and Pathogen Genomics Core, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Marla J Giddins
- Department of Medicine, Division of Infectious Diseases and Microbiome and Pathogen Genomics Core, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - A Reshad Garan
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Maryjane A Farr
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Renu Nandakumar
- Biomarkers Core Laboratory, Irving Institute for Clinical and Translational Research, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Anne-Catrin Uhlemann
- Department of Medicine, Division of Infectious Diseases and Microbiome and Pathogen Genomics Core, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Division of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York.
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Pinsino A, Mondellini GM, Royzman EA, Hoffman KL, D'Angelo D, Mabasa M, Gaudig A, Zuver AM, Masoumi A, Garan AR, Mohan S, Husain SA, Toma K, Faillace RT, Giles JT, Takeda K, Takayama H, Naka Y, Topkara VK, Demmer RT, Radhakrishnan J, Colombo PC, Yuzefpolskaya M. Cystatin C- Versus Creatinine-Based Assessment of Renal Function and Prediction of Early Outcomes Among Patients With a Left Ventricular Assist Device. Circ Heart Fail 2020; 13:e006326. [PMID: 31959016 DOI: 10.1161/circheartfailure.119.006326] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Estimated glomerular filtration rate (eGFR) based on serum creatinine (sCr) improves early after left ventricular assist device (LVAD) implantation but subsequently declines. Although sCr is a commonly accepted clinical standard, cystatin C (CysC) has shown superiority in assessment of renal function in disease states characterized by muscle wasting. Among patients with an LVAD, we aimed to (1) longitudinally compare CysC-eGFR and sCr-eGFR, (2) assess their predictive value for early postoperative outcomes, and (3) investigate mechanisms which might explain potential discrepancies. METHODS A prospective cohort (n=116) with CysC and sCr concurrently measured at serial time points, and a retrospective cohort (n=91) with chest computed tomography performed within 40 days post-LVAD were studied. In the prospective cohort, the primary end point was a composite of in-hospital mortality, renal replacement therapy, or severe right ventricular failure. In the retrospective cohort, muscle mass was estimated using pectoralis muscle area indexed to body surface area (pectoralis muscle index). RESULTS In the prospective cohort, sCr-eGFR significantly improved early post-LVAD and subsequently declined, whereas CysC-eGFR remained stable. CysC-eGFR but not sCr-eGFR predicted the primary end point: odds ratio per 5 mL/(min·1.73 m2) decrease 1.16 (1.02-1.31) versus 0.99 (0.94-1.05). In retrospective cohort, for every 5 days post-LVAD, a 6% decrease in pectoralis muscle index was observed (95% CI, 2%-9%, P=0.003). After adjusting for time on LVAD, for every 1 cm2/m2 decrease in pectoralis muscle index, there was a 4% decrease in 30-day post-LVAD sCr (95% CI, 1%-6%, P=0.004). CONCLUSIONS Initial improvement in sCr-eGFR is likely due to muscle wasting following LVAD surgery. CysC may improve assessment of renal function and prediction of early postoperative outcomes in patients with an LVAD.
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Affiliation(s)
- Alberto Pinsino
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY.,Department of Medicine, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, NY (A.P., R.T.F.)
| | - Giulio M Mondellini
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Eugene A Royzman
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Katherine L Hoffman
- Department of Healthcare Policy & Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY (K.L.H., D.D.)
| | - Debra D'Angelo
- Department of Healthcare Policy & Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY (K.L.H., D.D.)
| | - Melissa Mabasa
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Antonia Gaudig
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Amelia M Zuver
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Amirali Masoumi
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - A Reshad Garan
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine (S.M., S.A.H., K.T., J.R.), Columbia University Irving Medical Center, New York, NY.,Department of Epidemiology, Mailman School of Public Health (S.M.), Columbia University Irving Medical Center, New York, NY
| | - Syed A Husain
- Division of Nephrology, Department of Medicine (S.M., S.A.H., K.T., J.R.), Columbia University Irving Medical Center, New York, NY
| | - Katherine Toma
- Division of Nephrology, Department of Medicine (S.M., S.A.H., K.T., J.R.), Columbia University Irving Medical Center, New York, NY
| | - Robert T Faillace
- Department of Medicine, NYC Health + Hospitals/Jacobi, Albert Einstein College of Medicine, Bronx, NY (A.P., R.T.F.)
| | - Jon T Giles
- Division of Rheumatology, Department of Medicine (J.T.G.), Columbia University Irving Medical Center, New York, NY
| | - Koji Takeda
- Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University Irving Medical Center, New York, NY
| | - Hiroo Takayama
- Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University Irving Medical Center, New York, NY
| | - Yoshifumi Naka
- Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University Irving Medical Center, New York, NY
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (R.T.D.)
| | - Jai Radhakrishnan
- Division of Nephrology, Department of Medicine (S.M., S.A.H., K.T., J.R.), Columbia University Irving Medical Center, New York, NY
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine (A.P., G.M.M., E.A.R., M.M., A.G., A.M.Z., A.M., A.R.G., V.K.T., P.C.C., M.Y.), Columbia University Irving Medical Center, New York, NY
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Pinsino A, Castagna F, Zuver AM, Royzman EA, Nasiri M, Stöhr EJ, Cagliostro B, McDonnell B, Cockcroft JR, Garan AR, Topkara VK, Schulze PC, Takeda K, Takayama H, Naka Y, Demmer RT, Willey JZ, Yuzefpolskaya M, Colombo PC. Prognostic implications of serial outpatient blood pressure measurements in patients with an axial continuous-flow left ventricular assist device. J Heart Lung Transplant 2018; 38:396-405. [PMID: 30559034 DOI: 10.1016/j.healun.2018.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/06/2018] [Accepted: 11/09/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Elevated blood pressure (BP) has been linked to adverse events during left ventricular assist device support. In this study we investigated the association between outpatient BP and stroke or suspected pump thrombosis among HeartMate II (HMII) recipients. METHODS We retrospectively studied 220 HMII patients. Serial outpatient BP measurements were averaged. Patients were categorized by: (1) mean arterial pressure (MAP), high (>90 mm Hg) vs intermediate (80 mm Hg ≤ MAP ≤ 90 mm Hg) vs low (<80 mm Hg); (2) systolic BP (SBP), high (≥101 mm Hg, median) vs low; and (3) pulse pressure (PP), high (≥22 mm Hg, median) vs low. To assess visit-to-visit BP variability, patients were divided in quartiles of standard deviation of MAP and SBP. The primary end-point was the composite of stroke or suspected pump thrombosis. RESULTS The risk for the primary end-point was increased in the high MAP group (adjusted hazard ratio [HR] 2.75, 95% confidence interval [CI] 1.49 to 5.05, vs intermediate MAP; and 6.73, 1.9 to 23.9, vs low MAP). MAP had higher predictive value for the primary end-point compared with SBP (p = 0.05). Patients with high SBP had a higher rate of stroke (HR 2.8, 95% CI 1.09 to 7.17, vs low SBP). The combination of high SBP and low PP was associated with the highest risk for stroke. The lowest quartile of visit-to-visit MAP variability was associated with the highest risk for the primary end-point. CONCLUSIONS Elevated outpatient BP is associated with increased risk for stroke or suspected pump thrombosis in HMII recipients. Reduced PP and low visit-to-visit BP variability may confer additional risk.
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Affiliation(s)
- Alberto Pinsino
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Francesco Castagna
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA; Department of Medicine, Yale New Haven Bridgeport Hospital, Bridgeport, Connecticut, USA
| | - Amelia M Zuver
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Eugene A Royzman
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Mojdeh Nasiri
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Eric J Stöhr
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA; Cardiff Metropolitan University, Cardiff, UK
| | - Barbara Cagliostro
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | | | - John R Cockcroft
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - A Reshad Garan
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Veli K Topkara
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - P Christian Schulze
- Department of Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Friedrich Schiller University Jena, University Hospital Jena, Jena, Germany
| | - Koji Takeda
- Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York, USA
| | - Hiroo Takayama
- Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York, USA
| | - Yoshifumi Naka
- Department of Surgery, Division of Cardiac Surgery, Columbia University, New York, New York, USA
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Joshua Z Willey
- Department of Neurology, Columbia University, New York, New York, USA
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York, USA.
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