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Batra J, Mourad M, Collado FK, Takeda K, Greenwald A, Ring L, Chen X, Haythe J. Case report of pregnancy complicated by severe pulmonary hypertension from mitral stenosis and placenta accreta spectrum disorder: management of two life-threatening conditions. Eur Heart J Case Rep 2024; 8:ytae055. [PMID: 38425728 PMCID: PMC10903160 DOI: 10.1093/ehjcr/ytae055] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/20/2024] [Accepted: 01/24/2024] [Indexed: 03/02/2024]
Abstract
Background Antenatal cardiovascular disease is a major cause of maternal morbidity and mortality. Severe rheumatic mitral stenosis is especially poorly tolerated during pregnancy. Case Summary We present a young woman with severe pulmonary hypertension secondary to rheumatic mitral stenosis. She presented at 25 weeks 4 days gestation for evaluation of a pregnancy complicated by placenta accreta spectrum disorder. Invasive hemodynamic testing was carried out to delineate her hemodynamics, and a multidisciplinary cardio-obstetrics team collaborated closely with the patient and her partner to create a management plan. Ultimately, the patient was initiated on veno-arterial extracorporeal membrane oxygenation and underwent caesarean section delivery followed by hysterectomy and subsequent valve replacement surgery. Discussion This case describes the treatment options considered to balance the risk of decompensation in the setting of severe pulmonary hypertension with hemorrhage associated with placenta accreta spectrum disorder. It highlights the importance of a multidisciplinary, team-based approach to the management of high-risk cardiac conditions throughout pregnancy.
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Affiliation(s)
- Jaya Batra
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, PH 12 STEM, New York, NY 10032, USA
| | - Mirella Mourad
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, USA
| | - Fady Khoury Collado
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, USA
| | - Koji Takeda
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, USA
| | - Andrew Greenwald
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, USA
| | - Laurence Ring
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, USA
| | - Xuxin Chen
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, USA
| | - Jennifer Haythe
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, PH 12 STEM, New York, NY 10032, USA
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Batra J, Haythe J, Purisch S. A Case of a Cardiac Hamartoma in Pregnancy: Preconception Through Delivery. JACC Case Rep 2023; 28:102128. [PMID: 38204524 PMCID: PMC10774817 DOI: 10.1016/j.jaccas.2023.102128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 01/12/2024]
Abstract
A 32-year-old woman with a large cardiac hamartoma was referred to our institution's cardio-obstetrics group for preconception counseling. Results of hemodynamic testing revealed restrictive physiology. This case highlights the role of multimodality testing in predicting the hemodynamic consequences of pregnancy in the setting of high-risk cardiovascular conditions.
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Affiliation(s)
- Jaya Batra
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Jennifer Haythe
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Stephanie Purisch
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Nguyen SN, Blitzer D, Haythe J, Shimada YJ, Weiner SD, Takayama H. Commentary: What's a girl like you doing with a heart like this? J Thorac Cardiovasc Surg 2021:S0022-5223(21)01736-0. [DOI: 10.1016/j.jtcvs.2021.12.011] [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] [Received: 12/03/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
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DeFilippis EM, Blumer V, Agarwal R, Haythe J, Kittleson M. IN-HOSPITAL OUTCOMES AFTER DELIVERY IN PREGNANT HEART TRANSPLANT RECIPIENTS: INSIGHTS FROM THE NATIONAL INPATIENT SAMPLE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)04742-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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5
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Bell J, Takeda K, Haythe J, Szabolcs M, Griffin J, Geskin L, Fanek T, Gaine M, Axsom K. Behcet's Disease Unmasked after Heart Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1295] [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] Open
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Huang AL, Fried JA, Malick W, Topkara V, DeFilippis EM, Haythe J, Farr M, Yuzefpolskaya M, Colombo PC, Takeda K, Grandin EW, Kirtane AJ, Pinto D, Garan AR. Predictors of Hemodynamic Response to Intra-Aortic Balloon Pump Therapy in Patients With Acute Decompensated Heart Failure and Cardiogenic Shock. J Invasive Cardiol 2021; 33:E275-E280. [PMID: 33723089] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES There is renewed interest in intra-aortic balloon pump (IABP) use in chronic systolic heart failure (HF) patients with acute decompensation and cardiogenic shock (CS). We sought to identify predictors of early IABP response to guide optimal use in this population. METHODS We retrospectively analyzed records of chronic systolic HF patients presenting to our center between 2011-2018 with acute decompensated HF who received IABP for CS. An IABP responder was defined as having both an early cardiac output (CO) increase and mean pulmonary artery pressure (MPAP) decrease above the cohort median values. RESULTS During this period, a total of 218 chronic systolic HF patients received IABP for acute decompensation with CS. The average CO increase was 0.57 ± 0.85 L/min and MPAP reduction was 5.1 ± 7.6 mm Hg. Fifty-six patients (25.7%) were identified as IABP responders, with mean CO increase of 1.21 ± 0.87 L/min and MPAP reduction of 12.1 ± 5.9 mm Hg. Systemic vascular resistance (SVR) >1300 dynes/sec/cm-5 (odds ratio [OR], 5.04; 95% confidence interval [CI], 1.86-13.6; P<.01) and moderate-severe mitral regurgitation (OR, 2.42; 95% CI, 1.25-4.66; P<.01) predicted robust hemodynamic response. CONCLUSIONS A subset of chronic systolic HF patients had robust hemodynamic response to IABP with significant CO augmentation and MPAP reduction. Higher SVR and moderate-severe mitral regurgitation predicted early hemodynamic response to IABP.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - A Reshad Garan
- Advanced Heart Failure and Mechanical Circulatory Support, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Boston, MA 02215 USA.
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Magun E, DeFilippis EM, Noble S, LaSala A, Waksmonski C, D'Alton ME, Haythe J. Cardiovascular Care for Pregnant Women With Cardiovascular Disease. J Am Coll Cardiol 2021; 76:2102-2113. [PMID: 33121718 DOI: 10.1016/j.jacc.2020.08.071] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Cardio-obstetrics refers to a team-based approach to maternal care that includes multidisciplinary collaboration among maternal fetal medicine, cardiology, and others. OBJECTIVES This study sought to describe clinical characteristics, maternal and fetal outcomes, and cardiovascular readmissions in a cohort of pregnant women with underlying cardiovascular disease (CVD) followed by a cardio-obstetrics team. METHODS We identified patients evaluated by our cardio-obstetrics team from January 1, 2010, through December 31, 2019, at a quaternary care hospital in New York City. Information was collected regarding demographics, comorbidities, underlying CVD, medications, maternal and fetal outcomes, and cardiovascular readmissions. Each patient was assigned a Cardiac Disease in Pregnancy (CARPREG) II score based on her clinical characteristics and underlying CVD. RESULTS During the study period, 306 pregnant women (median age 29 years, 52.9% Hispanic or Latino) with CVD were seen. Most women (74.2%) were insured through Medicaid. The most common forms of CVD included arrhythmia (n = 88, 28.8%), congenital heart disease (n = 72, 23.5%), and cardiomyopathy (n = 72, 23.5%). The median CARPREG II score was 3; 130 patients (42.5%) had a CARPREG II score ≥4. Gestational diabetes occurred in 11.4%, gestational hypertension in 9.5%, and preeclampsia in 12.1% of women. Intensive care unit admission was required for 27 patients (8.8%) during delivery. Median gestational age for delivery was 38 weeks (interquartile range: 37 to 39). Live birth occurred in 98% of pregnancies. One maternal death occurred within a year of delivery in a woman with Eisenmenger syndrome. Following delivery, 30-day readmission rate was 2% and the rate of readmission from 30 to 90 days postpartum was 4.6%. Median follow-up was 2.6 years. CONCLUSIONS In a population of primarily Medicaid-insured pregnant women managed by a cardio-obstetrics team, maternal outcomes were encouraging and readmission rates following delivery were low. Prospective studies are needed to evaluate the impact of cardio-obstetric models of care on maternal outcomes.
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Affiliation(s)
- Ella Magun
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Ersilia M DeFilippis
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Sarah Noble
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Anita LaSala
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Carol Waksmonski
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Jennifer Haythe
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
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Griffin JM, Chiu L, Axsom KM, Bijou R, Clerkin KJ, Colombo P, Cuomo MO, De Los Santos J, Fried JA, Goldsmith J, Habal M, Haythe J, Helmke S, Horn EM, Latif F, Hi Lee S, Lin EF, Naka Y, Raikhelkar J, Restaino S, Sayer GT, Takayama H, Takeda K, Teruya S, Topkara V, Tsai EJ, Uriel N, Yuzefpolskaya M, Farr MA, Maurer MS. United network for organ sharing outcomes after heart transplantation for al compared to ATTR cardiac amyloidosis. Clin Transplant 2020; 34:e14028. [PMID: 32623785 DOI: 10.1111/ctr.14028] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/20/2020] [Accepted: 06/25/2020] [Indexed: 12/17/2022]
Abstract
Light-chain (AL) cardiac amyloidosis (CA) has a worse prognosis than transthyretin (ATTR) CA. In this single-center study, we compared post-heart transplant (OHT, orthotopic heart transplantation) survival for AL and ATTR amyloidosis, hypothesizing that these differences would persist post-OHT. Thirty-nine patients with CA (AL, n = 18; ATTR, n = 21) and 1023 non-amyloidosis subjects undergoing OHT were included. Cox proportional hazards modeling was used to evaluate the impact of amyloid subtype and era (early era: from 2001 to 2007; late era: from 2008 to 2018) on survival post-OHT. Survival for non-amyloid patients was greater than ATTR (P = .034) and AL (P < .001) patients in the early era. One, 3-, and 5-year survival rates were higher for ATTR patients than AL patients in the early era (100% vs 75%, 67% vs 50%, and 67% vs 33%, respectively, for ATTR and AL patients). Survival in the non-amyloid cohort was 87% at 1 year, 81% at 3 years, and 76% at 5 years post-OHT. In the late era, AL and ATTR patients had unadjusted 1-year, 3-year, and 5-year survival rates of 100%, which was comparable to non-amyloid patients (90% vs 84% vs 81%). Overall, these findings demonstrate that in the current era, differences in post-OHT survival for AL compared to ATTR are diminishing; OHT outcomes for selected patients with CA do not differ from non-amyloidosis patients.
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Affiliation(s)
- Jan M Griffin
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Leonard Chiu
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Kelly M Axsom
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Rachel Bijou
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Kevin J Clerkin
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Paolo Colombo
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Margaret O Cuomo
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Jeffeny De Los Santos
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Justin A Fried
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | | | - Marlena Habal
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Jennifer Haythe
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Stephen Helmke
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Evelyn M Horn
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA.,Division of Cardiology, Department of Medicine, Weill-Cornell Medical School, New York, NY, USA
| | - Farhana Latif
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Sun Hi Lee
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Edward F Lin
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Jayant Raikhelkar
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Susan Restaino
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Gabriel T Sayer
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Sergio Teruya
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Veli Topkara
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Emily J Tsai
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Nir Uriel
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Melana Yuzefpolskaya
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Maryjane A Farr
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
| | - Mathew S Maurer
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia College of Physicians & Surgeons, New York, NY, USA
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Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, Brown TS, Der Nigoghossian C, Zidar DA, Haythe J, Brodie D, Beckman JA, Kirtane AJ, Stone GW, Krumholz HM, Parikh SA. Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic. J Am Coll Cardiol 2020; 75:2352-2371. [PMID: 32201335 PMCID: PMC7198856 DOI: 10.1016/j.jacc.2020.03.031] [Citation(s) in RCA: 1288] [Impact Index Per Article: 322.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023]
Abstract
The coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 that has significant implications for the cardiovascular care of patients. First, those with COVID-19 and pre-existing cardiovascular disease have an increased risk of severe disease and death. Second, infection has been associated with multiple direct and indirect cardiovascular complications including acute myocardial injury, myocarditis, arrhythmias, and venous thromboembolism. Third, therapies under investigation for COVID-19 may have cardiovascular side effects. Fourth, the response to COVID-19 can compromise the rapid triage of non-COVID-19 patients with cardiovascular conditions. Finally, the provision of cardiovascular care may place health care workers in a position of vulnerability as they become hosts or vectors of virus transmission. We hereby review the peer-reviewed and pre-print reports pertaining to cardiovascular considerations related to COVID-19 and highlight gaps in knowledge that require further study pertinent to patients, health care workers, and health systems.
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Affiliation(s)
- Elissa Driggin
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Mahesh V Madhavan
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Behnood Bikdeli
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
| | - Taylor Chuich
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Justin Laracy
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Tyler S Brown
- Massachusetts General Hospital, Boston, Massachusetts
| | | | - David A Zidar
- Case Western Reserve School of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
| | - Jennifer Haythe
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Daniel Brodie
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | | | - Ajay J Kirtane
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Icahn School of Medicine at Mount Sinai, New York, New York
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut
| | - Sahil A Parikh
- New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York.
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Abstract
Background:
Pregnancy after heart transplantation (HT) is a concern for many female recipients. The International Society for Heart and Lung Transplantation has guidelines regarding reproductive health, but limited data exist regarding providers’ attitudes and practices surrounding pregnancy post-HT.
Methods:
We conducted an independent, confidential, voluntary, web-based survey sent electronically to 1643 United States heart transplant providers between June and August 2019.
Results:
There were 122 responses, the majority from cardiologists (n=85, 70%) and nurse or transplant coordinators (n=22, 18%). Thirty-one percent (n=37) of respondents indicated that pregnancy should be avoided in all HT recipients, and only 43% (n=52) reported that their center had a formal policy regarding pregnancy following HT. The most commonly reported contraindications included nonadherence (n=109, 89%), reduced left ventricular ejection fraction (n=104, 85%), coronary allograft vasculopathy (n=86, 70%), prior rejection (n=76, 62%), presence of donor-specific antibodies (n=69, 57%), and prior peripartum cardiomyopathy pretransplant (n=57, 47%). Respondent sex, specialty, transplant volume, or prior experience with pregnancy after HT were not associated with recommendations to avoid posttransplant pregnancy.
Conclusions:
Transplant providers’ attitudes regarding posttransplant pregnancy vary widely. Despite International Society for Heart and Lung Transplantation guidelines, a significant proportion indicates that pregnancy is contraindicated in all recipients and the majority of programs have no center-specific policy to manage such pregnancies. While the low response rate limits the generalizability of the findings, they do suggest that education on the feasibility of pregnancy post-HT is indicated as many recipients are of, or survive to, childbearing age.
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Affiliation(s)
- Ersilia M. DeFilippis
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York (E.M.D., J.H., M.F.)
| | - Jennifer Haythe
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York (E.M.D., J.H., M.F.)
| | - Maryjane A. Farr
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York (E.M.D., J.H., M.F.)
| | - Jon Kobashigawa
- Division of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (J.K., M.M.K.)
| | - Michelle M. Kittleson
- Division of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (J.K., M.M.K.)
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Truby L, Farr M, Defillipis E, Takeda K, Takayama H, Colombo P, Yuzefpolskaya M, Haythe J, Axsom K, Naka Y, Uriel N, Topkara V. Utilization of Mechanical Circulatory Support Devices and Impact on Outcomes in the New Heart Allocation System: An Analysis of the UNOS Registry. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.739] [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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12
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Jennings D, Truby L, Fried J, Clerkin K, Griffin J, Raikhelkar J, Axsom K, Lin E, Haythe J, Yuzefpolskaya M, Colombo P, Sayer G, Farr M, Takayama H, Takeda K, Naka Y, Uriel N, Topkara V. Impact of Heart Failure Drug Therapy on GI Bleeding Rates in LVAD Recipients: An INTERMACS Analysis. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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13
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Batra J, Truby L, Garan R, Haythe J, Lin E, Axsom K, Yuzefpolskaya M, Colombo P, Sayer G, Takayama H, Takeda K, Naka Y, Farr M, Uriel N, Topkara V. C-reactive Protein Levels Predict Right Ventricular Failure and Mortality in Patients Undergoing Continuous-Flow Left Ventricular Assist Device Assist Device Implantation: An INTERMACS Analysis. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.231] [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: 11/24/2022] Open
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14
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Malick W, Fried JA, Masoumi A, Nair A, Zuver A, Huang A, Haythe J, Farr M, Rabbani L, Karmpaliotis D, Kirtane AJ, Topkara VK, Takeda K, Garan AR. Comparison of the Hemodynamic Response to Intra-Aortic Balloon Counterpulsation in Patients With Cardiogenic Shock Resulting from Acute Myocardial Infarction Versus Acute Decompensated Heart Failure. Am J Cardiol 2019; 124:1947-1953. [PMID: 31648782 DOI: 10.1016/j.amjcard.2019.09.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
The intra-aortic balloon pump (IABP) neither benefits nor harms patients with acute myocardial infarction (AMI) with cardiogenic shock (CS) but may stabilize those with chronic heart failure who decompensate into CS. We sought to compare its hemodynamic effects in these 2 populations. We performed a retrospective analysis of the hemodynamic effects of IABP for AMI or acute decompensated heart failure (ADHF) patients with hemodynamic evidence of CS. The primary outcome was cardiac output (CO) change following insertion. In total, 205 patients were treated for CS resulting from AMI (73; 35.6%) or ADHF (132; 64.4%). At baseline, both cohorts had significant hemodynamic compromise with mean arterial pressure 75.6 ± 12.3 mm Hg, CO 3.02 ± 0.84 L/min, and cardiac power index 0.26 ± 0.06 W/m2; these parameters were nearly identical between groups though ADHF-CS patients had a higher pre-IABP mean pulmonary artery (PA) pressure than AMI-CS patients. After IABP insertion, ADHF-CS patients had moderate CO augmentation whereas AMI-CS experienced almost no improvement (0.58 ± 0.79 L/min vs 0.12 ± 1.00 L/min; p = 0.0009). Intracardiac filling pressures were reduced by similar amounts in both cohorts. Systemic vascular resistance was reduced in patients with ADHF-CS but not in those with AMI-CS. In conclusion, following IABP insertion, ADHF-CS patients experience roughly a 5-fold greater CO augmentation compared with AMI-CS patients. Pre-IABP PA pressure differences and differential systemic vascular resistance reduction may explain these results and shed light on recent evidence supporting IABP use in ADHF-CS and curbing it in AMI-CS.
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Huang AL, Fried JA, Malick W, Topkara V, Griffin J, Clerkin K, DeFilippis EM, Farr M, Haythe J, Yuzefpolskaya M, Colombo PC, Takeda K, Garan AR. Predictors of Hemodynamic Response to Intra-Aortic Balloon Pump Therapy in Patients with Acute Decompensated Heart Failure and Cardiogenic Shock. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.501] [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: 11/25/2022]
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16
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Meng ML, Landau R, Haythe J, Takayama H, Spellman J. Mechanical Aortic Valve Thrombus in Pregnancy: A Case Report. A A Pract 2019; 13:44-47. [PMID: 30807301 DOI: 10.1213/xaa.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cardiac disease is one of the leading causes of maternal mortality in developed countries. The presence of a mechanical valve is a predictor of cardiac complications in obstetric patients, likely due to the challenges associated with pregnancy hypercoagulability and the imperative of meticulous management of anticoagulation throughout pregnancy, delivery, and the postpartum and to prevent the devastating event of a mechanical valve thrombosis. We report on the management of a pregnant woman with a mechanical aortic valve found to have a thrombus at 37 weeks gestation. It was decided to perform cesarean delivery to allow for a reoperative mechanical aortic valve replacement 24 hours thereafter.
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Affiliation(s)
| | | | | | - Hiroo Takayama
- Surgery, Columbia University Medical Center, New York, New York
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Batra J, Jennings D, Garan A, Truby L, Latif F, Restaino S, Haythe J, Yuzefpolskaya M, Takeda K, Takayama H, Naka Y, Colombo P, Farr M, Topkara V. Outcomes after Early Initiation of mTOR-Inhibitors in Adult Cardiac Transplant Recipients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.695] [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: 10/27/2022] Open
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Colombo P, Yuzefpolskaya M, Nasiri M, Pinsino A, Onat D, Nwokocha J, Clemons A, Castagna F, Kleet A, Axsom K, Lin E, Haythe J, Gayat E, Mabaaza A, Demmer R. sCD146 - a Novel Marker of Systemic Venous Congestion - Positively Correlates With Plasma Endothelin-1 - Marker of Vasoconstriction and Inflammation - in Heart Failure. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.579] [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: 10/17/2022] Open
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Sridharan L, Givens R, Garan A, Yuzefpolskaya M, Takeda K, Takayama H, Latif F, Haythe J, Restaino S, Maurer M, Mancini D, Farr M, Naka Y, Colombo P, Topkara V. Mechanical Circulatory Support Devices (MSCD) Therapy in the Era of the Affordable Care Act (ACA): National Trends in Hospitalization Costs and In-Hospital Mortality. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sridharan L, Givens R, Takeda K, Garan A, Yuzefpolskaya M, Latif F, Restaino S, Haythe J, Ginns J, Mancini D, Naka Y, Colombo P, Maurer M, Takayama H, Topkara V. The New Heart Allocation System: Implications on Patients with Restrictive Cardiomyopathy in the UNOS Registry. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.333] [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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21
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Truby L, Givens R, Garan A, Yuzefpolskaya M, Flannery M, Takayama H, Takeda K, Haythe J, Latif F, Restaino S, Maurer M, Mancini D, Naka Y, Farr M, Colombo P, Topkara V. Bridging to Transplantation with Contemporary Continuous-Flow Left Ventricular Assist Devices: A Decade Experience. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.276] [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: 10/19/2022] Open
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22
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Truby L, Garan A, Givens R, Takayama H, Takeda K, Haythe J, Yuzefpolskaya M, Latif F, Restaino S, Zorn E, Mancini D, Naka Y, Colombo P, Farr M, Topkara V. Red Cell Distribution Width Predicts 1-Year Mortality Following Heart Transplantation. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.619] [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: 10/19/2022] Open
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23
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Mehta MV, Manson DK, Horn EM, Haythe J. An atypical presentation of adult-onset Still's disease complicated by pulmonary hypertension and macrophage activation syndrome treated with immunosuppression: a case-based review of the literature. Pulm Circ 2016; 6:136-42. [PMID: 27162622 PMCID: PMC4860549 DOI: 10.1086/685112] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a known complication of rheumatologic diseases, but it is only rarely associated with adult-onset Still's disease (AOSD). We describe the case of a 30-year-old woman who presented in a pulmonary hypertension crisis and was found to have underlying AOSD with PAH and nonspecific interstitial pneumonia (NSIP) with a course complicated by macrophage activation syndrome (MAS). She dramatically improved with steroids, cyclosporine A, and anakinra, with total resolution of the MAS and significant improvement of her pulmonary arterial pressures. While there are only select case reports of AOSD associated with PAH, this is the first reported case of (1) AOSD complicated by both PAH and MAS and (2) AOSD complicated by biopsy-proven NSIP. Clinically, this case highlights the efficacy of immunosuppressive agents in the treatment of PAH and MAS from underlying AOSD and supports their use in this setting.
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Affiliation(s)
- Mili V Mehta
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Daniel K Manson
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Evelyn M Horn
- Division of Cardiology, Weill Cornell Medical Center, New York, New York, USA
| | - Jennifer Haythe
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
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Topkara V, Trinh P, Masoumi A, Garan A, Yuzefpolskaya M, Takeda K, Takayama H, Haythe J, Maurer M, Latif F, Restaino S, Farr M, Mancini D, Naka Y, Colombo P. Risk of Post-Transplant Renal Dysfunction Is Increased in Patients Supported with Continuous-Flow Left Ventricular Assist Devices. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.818] [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] Open
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25
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Topkara V, Wayda B, Rao S, Garan A, Yuzefpolskaya M, Takeda K, Takayama H, Castagna F, Clemons A, Wong K, Trinh P, Restaino S, Latif F, Haythe J, Farr M, Maurer M, Mancini D, Naka Y, Colombo P. Impact of Socioeconomic Status on Bridging with Contemporary Left Ventricular Assist Device (LVAD): Analysis of the UNOS Registry. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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26
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Topkara V, Garan A, Yuzefpolskaya M, Takeda K, Takayama H, Cagliostro B, Effner L, Castagna F, Singh S, Fried J, Haythe J, Maurer M, Farr M, Mancini D, Naka Y, Colombo P. Lactate Dehydrogenase Isoenzyme Monitoring in Patients with Continuous-Flow Left Ventricular Assist Devices (CF-LVADs). J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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27
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Topkara V, Garan A, Yuzefpolskaya M, Takeda K, Takayama H, Fried J, Wong K, Jennings D, Te-Frey R, Haythe J, Maurer M, Farr M, Mancini D, Naka Y, Colombo P. Changes in Lipid Profile Subfractions on Continuous-Flow Left Ventricular Assist Device (CF-LVAD) Therapy. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.966] [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: 11/26/2022] Open
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28
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Damp J, Givertz MM, Semigran M, Alharethi R, Ewald G, Felker GM, Bozkurt B, Boehmer J, Haythe J, Skopicki H, Hanley-Yanez K, Pisarcik J, Halder I, Gorcsan J, Rana S, Arany Z, Fett JD, McNamara DM. Relaxin-2 and Soluble Flt1 Levels in Peripartum Cardiomyopathy: Results of the Multicenter IPAC Study. JACC Heart Fail 2016; 4:380-8. [PMID: 26970832 DOI: 10.1016/j.jchf.2016.01.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/28/2015] [Accepted: 01/08/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study explored the association of vascular hormones with myocardial recovery and clinical outcomes in peripartum cardiomyopathy (PPCM). BACKGROUND PPCM is an uncommon disorder with unknown etiology. Angiogenic imbalance may contribute to its pathophysiology. METHODS In 98 women with newly diagnosed PPCM enrolled in the Investigation in Pregnancy Associated Cardiomyopathy study, serum was obtained at baseline for analysis of relaxin-2, prolactin, soluble fms-like tyrosine kinase 1 (sFlt1), and vascular endothelial growth factor (VEGF). Left ventricular ejection fraction (LVEF) was assessed by echocardiography at baseline and 2, 6, and 12 months. RESULTS Mean age was 30 ± 6 years, with a baseline of LVEF 0.35 ± 0.09. Relaxin-2, prolactin, and sFlt1 were elevated in women presenting early post-partum, but decreased rapidly and were correlated inversely with time from delivery to presentation. In tertile analysis, higher relaxin-2 was associated with smaller left ventricular systolic diameter (p = 0.006) and higher LVEF at 2 months (p = 0.01). This was particularly evident in women presenting soon after delivery (p = 0.02). No relationship was evident for myocardial recovery and prolactin, sFlt1 or VEGF levels. sFlt1 levels were higher in women with higher New York Heart Association functional class (p = 0.01) and adverse clinical events (p = 0.004). CONCLUSIONS In women with newly diagnosed PPCM, higher relaxin-2 levels soon after delivery were associated with myocardial recovery at 2 months. In contrast, higher sFlt1 levels correlated with more severe symptoms and major adverse clinical events. Vascular mediators may contribute to the development of PPCM and influence subsequent myocardial recovery. (Investigation in Pregnancy Associate Cardiomyopathy [IPAC]; NCT01085955).
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Affiliation(s)
- Julie Damp
- Division of Cardiovascular Medicine, Vanderbilt University, Nashville, Tennessee.
| | - Michael M Givertz
- Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marc Semigran
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rami Alharethi
- Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah
| | - Gregory Ewald
- Division of Cardiology, Washington University in St. Louis, St. Louis, Missouri
| | | | - Biykem Bozkurt
- Section of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas
| | - John Boehmer
- Division of Cardiology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Jennifer Haythe
- Division of Cardiology, Columbia University, New York, New York
| | - Hal Skopicki
- Division of Cardiology, Stony Brook Medical Center, Stony Brook, New York
| | - Karen Hanley-Yanez
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jessica Pisarcik
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Indrani Halder
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Gorcsan
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarosh Rana
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | - Zoltan Arany
- Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James D Fett
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dennis M McNamara
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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29
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McNamara DM, Elkayam U, Alharethi R, Damp J, Hsich E, Ewald G, Modi K, Alexis JD, Ramani GV, Semigran MJ, Haythe J, Markham DW, Marek J, Gorcsan J, Wu WC, Lin Y, Halder I, Pisarcik J, Cooper LT, Fett JD. Clinical Outcomes for Peripartum Cardiomyopathy in North America: Results of the IPAC Study (Investigations of Pregnancy-Associated Cardiomyopathy). J Am Coll Cardiol 2015; 66:905-14. [PMID: 26293760 DOI: 10.1016/j.jacc.2015.06.1309] [Citation(s) in RCA: 299] [Impact Index Per Article: 33.2] [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: 03/08/2015] [Revised: 06/14/2015] [Accepted: 06/15/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) remains a major cause of maternal morbidity and mortality. OBJECTIVES This study sought to prospectively evaluate recovery of the left ventricular ejection fraction (LVEF) and clinical outcomes in the multicenter IPAC (Investigations of Pregnancy Associated Cardiomyopathy) study. METHODS We enrolled and followed 100 women with PPCM through 1 year post-partum. The LVEF was assessed by echocardiography at baseline and at 2, 6, and 12 months post-partum. Survival free from major cardiovascular events (death, transplantation, or left ventricular [LV] assist device) was determined. Predictors of outcome, particularly race, parameters of LV dysfunction (LVEF), and remodeling (left ventricular end-diastolic diameter [LVEDD]) at presentation, were assessed by univariate and multivariate analyses. RESULTS The cohort was 30% black, 65% white, 5% other; the mean patient age was 30 ± 6 years; and 88% were receiving beta-blockers and 81% angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. The LVEF at study entry was 0.35 ± 0.10, 0.51 ± 0.11 at 6 months, and 0.53 ± 0.10 at 12 months. By 1 year, 13% had experienced major events or had persistent severe cardiomyopathy with an LVEF <0.35, and 72% achieved an LVEF ≥0.50. An initial LVEF <0.30 (p = 0.001), an LVEDD ≥6.0 cm (p < 0.001), black race (p = 0.001), and presentation after 6 weeks post-partum (p = 0.02) were associated with a lower LVEF at 12 months. No subjects with both a baseline LVEF <0.30 and an LVEDD ≥6.0 cm recovered by 1 year post-partum, whereas 91% with both a baseline LVEF ≥0.30 and an LVEDD <6.0 cm recovered (p < 0.00001). CONCLUSIONS In a prospective cohort with PPCM, most women recovered; however, 13% had major events or persistent severe cardiomyopathy. Black women had more LV dysfunction at presentation and at 6 and 12 months post-partum. Severe LV dysfunction and greater remodeling at study entry were associated with less recovery. (Investigations of Pregnancy Associated Cardiomyopathy [IPAC]; NCT01085955).
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Affiliation(s)
| | - Uri Elkayam
- University of Southern California, Los Angeles, California
| | | | - Julie Damp
- Vanderbilt University, Nashville, Tennessee
| | | | | | - Kalgi Modi
- Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Jeffrey D Alexis
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Marc J Semigran
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Josef Marek
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John Gorcsan
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Wen-Chi Wu
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - Yan Lin
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - Indrani Halder
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jessica Pisarcik
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - James D Fett
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Clerkin KJ, Thomas SS, Haythe J, Schulze PC, Farr M, Takayama H, Jorde UP, Restaino SW, Naka Y, Mancini DM. Mechanical circulatory support as a bridge to cardiac retransplantation: a single center experience. J Heart Lung Transplant 2014; 34:161-6. [PMID: 25455751 DOI: 10.1016/j.healun.2014.09.033] [Citation(s) in RCA: 8] [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] [Received: 05/02/2014] [Revised: 08/04/2014] [Accepted: 09/19/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Cardiac retransplantation is increasing in frequency. Recent data have shown that retransplantation outcomes are now comparable with primary transplantation. The use of mechanical circulatory support (MCS) as a bridge to retransplantation has similar post-retransplant outcomes to those without MCS, but the success of bridging patients to retransplant with MCS has not been well studied. METHODS From January 2000 to February 2014 at Columbia University Medical Center, 84 patients were listed for retransplantation. Of this cohort, 48 patients underwent retransplantation, 15 were bridged with MCS, 24 died, and 6 clinically improved. A retrospective analysis was performed examining waiting list time, survival to retransplantation, and survival after retransplant. The effect of the United Network of Organ Sharing (UNOS) allocation policy change in 2006 on waiting list time and MCS use was also investigated. RESULTS Of 48 patients who underwent retransplantation, 11 were bridged with MCS. Overall 1-year survival to retransplantation was 81.3%. There was no significant difference in waiting list survival (p = 0.71) in those with and without MCS. Death from cardiac arrest or multiorgan failure with infection was more frequent in the medically managed group (p = 0.002). After the UNOS 2006 allocation policy change, waiting list time (599 ± 936 days in Era 1 vs 526 ± 498 days in Era 2, p = 0.65) and waiting list survival (p = 0.22) between eras were comparable, but there was a trend toward greater use of MCS (p = 0.13). Survival after retransplant was acceptable. CONCLUSION The use of MCS as a bridge to cardiac retransplantation is a reasonable strategy.
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Affiliation(s)
| | - Sunu S Thomas
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | | | | | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
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Abstract
Cardiomyopathy during pregnancy is uncommon but potentially catastrophic to maternal health, accounting for up to 11% of maternal deaths. Peripartum cardiomyopathy is diagnosed in women without a history of heart disease 1 month before delivery or within 5 months postpartum. About half of all women will have full myocardial recovery within 6 months of diagnosis, but complications such as severe heart failure or death are not rare. African-American women have higher rates of diagnosis and adverse events. Women with preexisting cardiomyopathy, such as dilated or hypertrophic cardiomyopathy, followed closely during pregnancy often tolerate pregnancy and delivery. Risk factors for adverse outcomes include functional status at baseline, severity of systolic dysfunction or outflow tract gradient, or history of prior cardiac event, such as arrhythmia or stroke. The level of brain natriuretic peptide (BNP) can be used to risk stratify women for adverse events. Pregnant women with cardiomyopathy should be followed closely by a multidisciplinary team comprised of nurses, obstetricians, neonatologists, cardiologists, anesthesiologists, and cardiac surgeons.
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Affiliation(s)
- Jennifer Lewey
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Jennifer Haythe
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY.
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Thomas S, Clerkin K, Haythe J, Schulze P, Farr M, Takayama H, Jorde U, Uriel N, Restaino S, Naka Y, Mancini D. Safety of Mechanical Circulatory Support as a Bridge to Cardiac Retransplantation. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.303] [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: 11/24/2022] Open
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Schulze PC, Jiang J, Yang J, Cheema FH, Schaeffle K, Kato TS, Farr M, Restaino S, Deng M, Maurer M, Horn E, Latif F, Colombo PC, Jorde U, Uriel N, Haythe J, Bijou R, Drusin R, Lee SH, Takayama H, Naka Y, Mancini DM. Preoperative assessment of high-risk candidates to predict survival after heart transplantation. Circ Heart Fail 2013; 6:527-34. [PMID: 23505300 DOI: 10.1161/circheartfailure.112.000092] [Citation(s) in RCA: 24] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Alternate waiting list strategies expand listing criteria for patients awaiting heart transplantation (HTx). We retrospectively analyzed clinical events and outcome of patients listed as high-risk recipients for HTx. METHODS AND RESULTS We analyzed 822 adult patients who underwent HTx of whom 111 patients met high-risk criteria. Clinical data were collected from medical records and outcome factors calculated for 61 characteristics. Significant factors were summarized in a prognostic score. Age >65 years (67%) and amyloidosis (19%) were the most common reasons for alternate listing. High-risk recipients were older (63.2±10.2 versus 51.4±11.8 years; P<0.001), had more renal dysfunction, prior cancer, and smoking. Survival analysis revealed lower post-HTx survival in high-risk recipients (82.2% versus 87.4% at 1-year; 59.8% versus 76.3% at 5-year post-HTx; P=0.0005). Prior cerebral vascular accident, albumin <3.5 mg/dL, re-HTx, renal dysfunction (glomerular filtration rate <40 mL/min), and >2 prior sternotomies were associated with poor survival after HTx. A prognostic risk score (CARRS [CVA, albumin, re-HTx, renal dysfunction, and sternotomies]) derived from these factors stratified survival post-HTx in high-risk (3+ points) versus low-risk (0-2 points) patients (87.9% versus 52.9% at 1-year; 65.9% versus 28.4% at 5-year post-HTx; P<0.001). Low-risk alternate patients had survival comparable with regular patients (87.9% versus 87.0% at 1-year and 65.9% versus 74.5% at 5-year post-HTx; P=0.46). CONCLUSIONS High-risk patients had reduced survival compared with regular patients post-HTx. Among patients previously accepted for alternate donor listing, application of the CARRS score identifies patients with unacceptably high mortality after HTx and those with a survival similar to regularly listed patients.
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Affiliation(s)
- P Christian Schulze
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY 10032, USA.
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Farr M, Urtusan-Sotil E, Kato T, Schulze P, Gukasyan N, Uriel N, Haythe J, Bijou R, Restaino S, Jorde U, Takayama H, Brown R, Emond J, Naka Y, Mancini D. 217 Risk-Stratification of Heart Transplant (HTX) Candidates with Advanced Liver Dysfunction. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.224] [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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Lang CC, Karlin P, Haythe J, Lim TK, Mancini DM. Peak Cardiac Power Output, Measured Noninvasively, Is a Powerful Predictor of Outcome in Chronic Heart Failure. Circ Heart Fail 2009; 2:33-8. [DOI: 10.1161/circheartfailure.108.798611] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chim C. Lang
- From the Division of Cardiology (C.C.L., P.K., J.H., D.M.M.), Columbia University, New York, NY; and the Division of Medicine and Therapeutics (C.C.L., T.K.L.), Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Paula Karlin
- From the Division of Cardiology (C.C.L., P.K., J.H., D.M.M.), Columbia University, New York, NY; and the Division of Medicine and Therapeutics (C.C.L., T.K.L.), Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Jennifer Haythe
- From the Division of Cardiology (C.C.L., P.K., J.H., D.M.M.), Columbia University, New York, NY; and the Division of Medicine and Therapeutics (C.C.L., T.K.L.), Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Tiong K. Lim
- From the Division of Cardiology (C.C.L., P.K., J.H., D.M.M.), Columbia University, New York, NY; and the Division of Medicine and Therapeutics (C.C.L., T.K.L.), Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Donna M. Mancini
- From the Division of Cardiology (C.C.L., P.K., J.H., D.M.M.), Columbia University, New York, NY; and the Division of Medicine and Therapeutics (C.C.L., T.K.L.), Ninewells Hospital and Medical School, Dundee, United Kingdom
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Almuti K, Haythe J, Dwyer E, Itescu S, Burke E, Green P, Marboe C, Mancini D. The Changing Pattern of Humoral Rejection in Cardiac Transplant Recipients. Transplantation 2007; 84:498-503. [PMID: 17713434 DOI: 10.1097/01.tp.0000278094.41131.9f] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Most humoral rejection (HR) episodes occur early after cardiac transplantation and are associated with hemodynamic compromise and poor prognosis. Late cases of HR (>6 months after transplant) have been reported. We examined the differences in clinical characteristics and outcomes in patients presenting with HR in the early (<6 months) and late transplant periods. METHODS A retrospective chart review was performed of all cases of HR at a single large transplant center from January 1, 1995 to March 1, 2006. RESULTS A total of 37 adult transplants had biopsy-proven HR; 13 patients had early HR and 24 patients had HR a mean of 5 yr after transplantation (range, 7 months to 17 yrs). Treatment for HR included plasmapheresis, cyclophosphamide, and rituximab. The age of the early and late humoral rejecters was similar (58+/-14 vs. 50+/-14 yrs; P=0.12). There was a trend toward more women in the early HR group (54% vs. 33%). Use of left ventricular assist devices was similar (38% vs. 33%). Early rejecters were more likely to have positive cross-matches (46% vs. 8%; P<0.01). Patients with late HR had a coexistent diagnosis of malignancy, or significant recent infection in 50% vs. 8% for early HR, suggesting an activation of a nonhuman leukocyte antigen antibody-mediated immune response to an acute illness. One-year survival after the diagnosis of HR was 78% for the both groups (P=NS). CONCLUSIONS Humoral rejection occurs now more frequently in patients with remote transplants and is commonly associated with the presence of malignancy or infection.
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Affiliation(s)
- Khalid Almuti
- Division of Cardiology, College of Physicians and Surgeons, Columbia University, 622 West 168th Street, New York, NY 10032, USA
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Abstract
BACKGROUND Selection criteria for cardiac transplant candidates with diabetes mellitus (DM) have been liberalized resulting in increased numbers of diabetic patients receiving organs. Calcineurin inhibition results in nephrotoxicity. Whether this nephrotoxicity is accelerated in diabetic heart transplant recipients is unknown. METHODS To investigate this question, we derived the glomerular filtration rate (GFR) at transplant and at multiple time intervals thereafter for adult heart transplants performed from January 1, 2000 to January 1, 2005. GFR was estimated using the Modification of Diet in Renal Disease Study equation (GFRMDRD) and the Cockcroft-Gault (GFRCG) formula. RESULTS In all, 257 patients were nondiabetic and 102 patients were diabetic before and after transplant. The diabetic patients were older (57+/-8 vs. 53+/-13 years; P<0.01) and had greater body mass index (27.5+/-5.1 vs. 25.5+/-4.4 kg/m; P<0.01) than nondiabetic patients. Baseline renal function was significantly reduced in diabetic patients with higher serum creatinine (1.6+/-0.5 vs. 1.4+/-0.5 mg/dL), lower GFRCG (65+/-27 vs. 73+/-35 mL/min), and lower GFRMDRD (54+/-23 vs. 65+/-32 mL/min; all P<0.01) than nondiabetic patients. All patients were treated with cyclosporine or tacrolimus posttransplant. The change in the GFRMDRD in nondiabetic and diabetic patients was constant and comparable at 1, 2, and 3 years posttransplant. In normal subjects, GFRMDRD declined from baseline by 7+/-26, 5+/-23, and 7+/-23 mL/min(2) and in the diabetic patients was 13+/-22, 9+/-26, 10+/-22 ml/min(2) at 1, 2, and 3 years, respectively (P=NS). CONCLUSION This data suggests that nephrotoxicity posttransplant is not accelerated in diabetic recipients.
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Affiliation(s)
- Khalid Almuti
- Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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Maurer MS, Raina A, Hesdorffer C, Bijou R, Colombo P, Deng M, Drusin R, Haythe J, Horn E, Lee SH, Marboe C, Naka Y, Schulman L, Scully B, Shapiro P, Prager K, Radhakrishnan J, Restaino S, Mancini D. Cardiac Transplantation Using Extended-Donor Criteria Organs for Systemic Amyloidosis Complicated by Heart Failure. Transplantation 2007; 83:539-45. [PMID: 17353770 DOI: 10.1097/01.tp.0000255567.80203.bd] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Systemic amyloidosis complicated by heart failure is associated with high cardiovascular morbidity and mortality. Heart transplantation for patients with systemic amyloidosis is controversial due to recurrence of disease in the transplanted organ or progression of disease in other organs. METHODS All patients with systemic amyloidosis and heart failure referred for heart transplant evaluation from 1997 to 2004 were included in this retrospective cohort analysis. An interdisciplinary protocol for cardiac transplantation using extended-donor criteria organs, followed in 6 months by either high-dose chemotherapy and stem cell transplantation for patients with primary (AL) or by orthotopic liver transplantation for familial (ATTR) amyloidosis, was developed. Survival of the transplanted amyloid cohort was compared to survival of those amyloid patients not transplanted and to patients transplanted for other indications. RESULTS A total of 25 patients with systemic amyloidosis and heart failure were included in the study; 12 patients received heart transplants. Amyloid heart transplant recipients were more likely female (58% vs. 8%, P=0.02) and had lower serum creatinine (1.3+/-0.5 vs. 2.0+/-0.7 mg/dL, P=0.01) than nontransplanted amyloid patients. Survival at 1-year after heart transplant evaluation was higher among transplanted patients (75% vs. 23%) compared to patients not transplanted (P=0.001). Short-term survival posttransplant did not differ between transplanted amyloid patients and contemporaneous standard and extended-donor criteria heart transplant patients (P=0.65). CONCLUSIONS Cardiac transplantation for amyloid patients with extended-donor criteria organs followed by either stem cell or liver transplantation is associated with improved survival compared to patients not transplanted. Short- to intermediate-term survival is similar to patients receiving heart transplantation for other indications. This clinical management strategy provides cardiac amyloid patients a novel therapeutic option.
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Affiliation(s)
- Mathew S Maurer
- Department of Medicine, Divisions of Cardiology, Columbia University Medical Center, New York, NY 10032, USA.
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Lang CC, Karlin P, Haythe J, Tsao L, Mancini DM. Ease of noninvasive measurement of cardiac output coupled with peak VO2 determination at rest and during exercise in patients with heart failure. Am J Cardiol 2007; 99:404-5. [PMID: 17261407 DOI: 10.1016/j.amjcard.2006.08.047] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 08/10/2006] [Accepted: 08/10/2006] [Indexed: 11/27/2022]
Abstract
Peak oxygen consumption (VO2) is a powerful prognostic predictor of survival in patients with heart failure (HF) because it provides an indirect assessment of a patient's ability to increase cardiac output (CO). However, many peripheral factors affect VO2. Inert gas rebreathing using low-concentration soluble and insoluble inert gases can derive CO by the Fick principle. The Innocor rebreathing system uses an oxygen-enriched mixture of an inert soluble gas (0.5% nitrous oxide) and an inert insoluble gas (0.1% sulfur hexafluoride) measured by photoacoustic analyzers over a 5-breath interval. The practicality of this device in measuring CO and VO2 during exercise was assessed in patients with HF. Ninety-two consecutive exercise tests were prospectively performed in 88 patients with HF using the Innocor system. Incremental bicycle exercise was performed with CO measurements at rest, at 50 W, and at peak exercise. The mean age of the 68 men and 20 women was 54 +/- 13 years; 33% had coronary artery disease, and 67% had dilated cardiomyopathy. The mean left ventricular ejection fraction was 24 +/- 9%. Patients were able to rapidly learn the rebreathing technique and easily integrate it into the exercise protocol. Eighty-six percent of the tests had successful measurement of metabolic and cardiac output data. Mean CO at rest was 3.5 +/- 1.1 L/min and increased to 7.2 +/- 2.7 L/min. Mean peak VO2 was 12.6 +/- 4.7 ml/kg/min. A significant linear correlation was observed between peak VO2 and peak CO (r = 0.64, p <0.0001). In conclusion, combined metabolic stress testing with inert gas rebreathing can be easily performed in patients with HF.
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Affiliation(s)
- Chim C Lang
- Division of Cardiology, Columbia University, New York, New York, USA
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Haythe J, Dwyer T, Burke E, Green P, Almuti K, Itescu S, Marboe C, Mancini D. 189. J Heart Lung Transplant 2006. [DOI: 10.1016/j.healun.2005.11.197] [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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Green P, Lund L, Almuti K, Haythe J, Mancini D. 282. J Heart Lung Transplant 2006. [DOI: 10.1016/j.healun.2005.11.293] [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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Vahdat LT, Balmaceda C, Papadopoulos K, Frederick D, Donovan D, Sharpe E, Kaufman E, Savage D, Tiersten A, Nichols G, Haythe J, Troxel A, Antman K, Hesdorffer CS. Phase II trial of sequential high-dose chemotherapy with paclitaxel, melphalan and cyclophosphamide, thiotepa and carboplatin with peripheral blood progenitor support in women with responding metastatic breast cancer. Bone Marrow Transplant 2002; 30:149-55. [PMID: 12189532 DOI: 10.1038/sj.bmt.1703592] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2002] [Accepted: 03/25/2002] [Indexed: 11/09/2022]
Abstract
A single high-dose cycle of chemotherapy can produce response rates in excess of 50%. However, disease-free survival (DFS) is 15-20% at 5 years. The single most important predictor of prolonged DFS is achieving a complete response (CR). Increasing the proportion of patients who achieve a complete response may improve disease-free survival. Women with metastatic breast cancer and at least a partial response (PR) to induction chemotherapy received three separate high-dose cycles of chemotherapy with peripheral blood progenitor support and G-CSF. The first intensification was paclitaxel (825 mg/m(2)), the second melphalan (180 mg/m(2)) and the third consisted of cyclophosphamide 6000 mg/m(2) (1500 mg/m(2)/day x 4), thiotepa 500 mg/m(2) (125 mg/m(2)/day x 4) and carboplatin 800 mg/m(2) (200 mg/m(2)/day x 4) (CTCb). Sixty-one women were enrolled and 60 completed all three cycles. Following the paclitaxel infusion most patients developed a reversible, predominantly sensory polyneuropathy. Of the 30 patients with measurable disease, 12 converted to CR, nine converted to a PR*, and five had a further PR, giving an overall response rate of 87%. The toxic death rate was 5%. No patient progressed on study. Thirty percent are progression-free with a median follow-up of 31 months (range 1-43 months) and overall survival is 61%. Three sequential high-dose cycles of chemotherapy are feasible and resulted in a high response rate. The challenge continues to be maintenance of response and provides the opportunity to evaluate strategies for eliminating minimal residual disease.
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Affiliation(s)
- L T Vahdat
- Weill Cornell Medical College, New York, NY 10021, USA
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