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Shah P, Agbor-Enoh S, Lee S, Andargie TE, Sinha SS, Kong H, Henry L, Park W, McNair E, Tchoukina I, Shah KB, Najjar SS, Hsu S, Rodrigo ME, Jang MK, Marboe C, Berry GJ, Valantine HA. Racial Differences in Donor-Derived Cell-Free DNA and Mitochondrial DNA After Heart Transplantation, on Behalf of the GRAfT Investigators. Circ Heart Fail 2024; 17:e011160. [PMID: 38375637 PMCID: PMC11021168 DOI: 10.1161/circheartfailure.123.011160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/07/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND Black heart transplant patients are at higher risk of acute rejection (AR) and death than White patients. We hypothesized that this risk may be associated with higher levels of donor-derived cell-free DNA (dd-cfDNA) and cell-free mitochondrial DNA. METHODS The Genomic Research Alliance for Transplantation is a multicenter, prospective, longitudinal cohort study. Sequencing was used to quantitate dd-cfDNA and polymerase chain reaction to quantitate cell-free mitochondrial DNA in plasma. AR was defined as ≥2R cellular rejection or ≥1 antibody-mediated rejection. The primary composite outcome was AR, graft dysfunction (left ventricular ejection fraction <50% and decrease by ≥10%), or death. RESULTS We included 148 patients (65 Black patients and 83 White patients), median age was 56 years and 30% female sex. The incidence of AR was higher in Black patients compared with White patients (43% versus 19%; P=0.002). Antibody-mediated rejection occurred predominantly in Black patients with a prevalence of 20% versus 2% (P<0.001). After transplant, Black patients had higher levels of dd-cfDNA, 0.09% (interquartile range, 0.001-0.30) compared with White patients, 0.05% (interquartile range, 0.001-0.23; P=0.003). Beyond 6 months, Black patients showed a persistent rise in dd-cfDNA with higher levels compared with White patients. Cell-free mitochondrial DNA was higher in Black patients (185 788 copies/mL; interquartile range, 101 252-422 133) compared with White patients (133 841 copies/mL; interquartile range, 75 346-337 990; P<0.001). The primary composite outcome occurred in 43% and 55% of Black patients at 1 and 2 years, compared with 23% and 27% in White patients, P<0.001. In a multivariable model, Black patient race (hazard ratio, 2.61 [95% CI, 1.35-5.04]; P=0.004) and %dd-cfDNA (hazard ratio, 1.15 [95% CI, 1.03-1.28]; P=0.010) were associated with the primary composite outcome. CONCLUSIONS Elevated dd-cfDNA and cell-free mitochondrial DNA after heart transplant may mechanistically be implicated in the higher incidence of AR and worse clinical outcomes in Black transplant recipients. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02423070.
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Affiliation(s)
- Palak Shah
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church VA
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
| | - Sean Agbor-Enoh
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore MD
- Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda MD
| | - Seiyon Lee
- Volgenau School of Engineering, George Mason University, Fairfax VA
| | - Temesgen E. Andargie
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda MD
| | - Shashank S. Sinha
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church VA
| | - Hyesik Kong
- Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda MD
| | - Lawrence Henry
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church VA
| | - Woojin Park
- Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda MD
| | - Erick McNair
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church VA
| | - Inna Tchoukina
- The Pauley Heart Center, Virginia Commonwealth University, Richmond VA
| | - Keyur B. Shah
- The Pauley Heart Center, Virginia Commonwealth University, Richmond VA
| | - Samer S. Najjar
- Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington Hospital Center, Washington DC
| | - Steven Hsu
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore MD
| | - Maria E. Rodrigo
- Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington Hospital Center, Washington DC
| | - Moon Kyoo Jang
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda MD
| | - Charles Marboe
- Department of Pathology, New York Presbyterian University Hospital of Cornell and Columbia, New York, New York, USA
| | | | - Hannah A. Valantine
- Genomic Research Alliance for Transplantation (GRAfT), 10 Center Drive, 7S261, Bethesda Maryland, 20982
- Stanford University School of Medicine, Palo Alto, CA
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Gillmore JD, Judge DP, Cappelli F, Fontana M, Garcia-Pavia P, Gibbs S, Grogan M, Hanna M, Hoffman J, Masri A, Maurer MS, Nativi-Nicolau J, Obici L, Poulsen SH, Rockhold F, Shah KB, Soman P, Garg J, Chiswell K, Xu H, Cao X, Lystig T, Sinha U, Fox JC. Efficacy and Safety of Acoramidis in Transthyretin Amyloid Cardiomyopathy. N Engl J Med 2024; 390:132-142. [PMID: 38197816 DOI: 10.1056/nejmoa2305434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Transthyretin amyloid cardiomyopathy is characterized by the deposition of misfolded monomeric transthyretin (TTR) in the heart. Acoramidis is a high-affinity TTR stabilizer that acts to inhibit dissociation of tetrameric TTR and leads to more than 90% stabilization across the dosing interval as measured ex vivo. METHODS In this phase 3, double-blind trial, we randomly assigned patients with transthyretin amyloid cardiomyopathy in a 2:1 ratio to receive acoramidis hydrochloride at a dose of 800 mg twice daily or matching placebo for 30 months. Efficacy was assessed in the patients who had an estimated glomerular filtration rate of at least 30 ml per minute per 1.73 m2 of body-surface area. The four-step primary hierarchical analysis included death from any cause, cardiovascular-related hospitalization, the change from baseline in the N-terminal pro-B-type natriuretic peptide (NT-proBNP) level, and the change from baseline in the 6-minute walk distance. We used the Finkelstein-Schoenfeld method to compare all potential pairs of patients within strata to generate a P value. Key secondary outcomes were death from any cause, the 6-minute walk distance, the score on the Kansas City Cardiomyopathy Questionnaire-Overall Summary, and the serum TTR level. RESULTS A total of 632 patients underwent randomization. The primary analysis favored acoramidis over placebo (P<0.001); the corresponding win ratio was 1.8 (95% confidence interval [CI], 1.4 to 2.2), with 63.7% of pairwise comparisons favoring acoramidis and 35.9% favoring placebo. Together, death from any cause and cardiovascular-related hospitalization contributed more than half the wins and losses to the win ratio (58% of all pairwise comparisons); NT-proBNP pairwise comparisons yielded the highest ratio of wins to losses (23.3% vs. 7.0%). The overall incidence of adverse events was similar in the acoramidis group and the placebo group (98.1% and 97.6%, respectively); serious adverse events were reported in 54.6% and 64.9% of the patients. CONCLUSIONS In patients with transthyretin amyloid cardiomyopathy, the receipt of acoramidis resulted in a significantly better four-step primary hierarchical outcome containing components of mortality, morbidity, and function than placebo. Adverse events were similar in the two groups. (Funded by BridgeBio Pharma; ATTRibute-CM ClinicalTrials.gov number, NCT03860935.).
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Affiliation(s)
- Julian D Gillmore
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Daniel P Judge
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Francesco Cappelli
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Marianna Fontana
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Pablo Garcia-Pavia
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Simon Gibbs
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Martha Grogan
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Mazen Hanna
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - James Hoffman
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Ahmad Masri
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Mathew S Maurer
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Jose Nativi-Nicolau
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Laura Obici
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Steen Hvitfeldt Poulsen
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Frank Rockhold
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Keyur B Shah
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Prem Soman
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Jyotsna Garg
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Karen Chiswell
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Haolin Xu
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Xiaofan Cao
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Ted Lystig
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Uma Sinha
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
| | - Jonathan C Fox
- From the National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London (J.D.G., M.F.); the Medical University of South Carolina, Charleston, SC (D.P.J.); Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence (F.C.), and the Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia (L.O.) - both in Italy; the Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigacíon Biomédica en Red Enfermedades Cardiovaculares, and Centro Nacional de Investigaciones Cardiovasculares (P.G.-P.) - both in Madrid; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam (P.G.-P.); the Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash University Eastern Health Clinical School, Box Hill, VIC, Australia (S.G.); the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (M.G.); the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland (M.H.); the Sylvester Comprehensive Cancer Center, University of Miami, Miami (J.H.), and the Amyloidosis Program, Department of Transplant, Mayo Clinic, Jacksonville (J.N.-N.) - both in Florida; the Cardiac Amyloidosis Program, Knight Cardiovascular Institute, Oregon Health and Science University, Portland (A.M.); the Cardiac Amyloidosis Program, Division of Cardiology, Columbia College of Physicians and Surgeons, New York (M.S.M.); the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark (S.H.P.); Duke Clinical Research Institute (F.R., J.G., K.C., H.X.) and Duke University Medical Center (F.R.) - both in Durham, NC; the Pauley Heart Center, Virginia Commonwealth University, Richmond (K.B.S.); the Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh (P.S.); and Eidos Therapeutics affiliate of BridgeBio Pharma, San Francisco (X.C., T.L., U.S., J.C.F.)
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Cascino TM, Cogswell R, Shah P, Cowger JA, Molina EJ, Shah KB, Grinstein J, Wood KL, Gosev I, Kanwar MK. Equitable Access to Advanced Heart Failure Therapies in the United States: A Call to Action. J Card Fail 2024; 30:78-84. [PMID: 37884168 DOI: 10.1016/j.cardfail.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Thomas M Cascino
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI
| | - Rebecca Cogswell
- Division of Cardiology, University of Minnesota, Minneapolis, MN
| | - Palak Shah
- Cardiovascular Medicine, Inova Heart and Vascular Institute, Falls Church, VA
| | | | | | - Keyur B Shah
- The Pauley Heart Center, Virginia Commonwealth University, Richmond, VA
| | | | - Katherine L Wood
- Division of Cardiothoracic Surgery, University of Rochester, Rochester, NY
| | - Igor Gosev
- Division of Cardiothoracic Surgery, University of Rochester, Rochester, NY
| | - Manreet K Kanwar
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI; Cardiovascular Institute at Allegheny Health Network, Pittsburgh, PA.
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Lerman JB, Green CL, Molina MR, Maharaj V, Ortega-Legaspi JM, Sen S, Flattery M, Maziarz EK, Shah KB, Martin CM, Alexy T, Shah P, Morris AA, DeVore AD, Cole RT. Multicenter study of universal prophylaxis versus pre-emptive therapy for patients at intermediate risk (R+) for CMV following heart transplantation. Clin Transplant 2023; 37:e15065. [PMID: 37392192 PMCID: PMC10592402 DOI: 10.1111/ctr.15065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION Heart transplant (HT) recipients with prior exposure to cytomegalovirus (CMV R+) are considered intermediate risk for CMV-related complications. Consensus guidelines allow for either universal prophylaxis (UP) or preemptive therapy (PET) (serial CMV testing) approaches to CMV prevention in such patients. Whether an optimal approach to mitigate CMV related risks exists in this setting remains uncertain. We therefore assessed the utility of PET as compared to UP in CMV R+ HT recipients. METHODS Retrospective analysis of all CMV R+ HT recipients from 6 U.S. centers between 2010 and 2018 was performed. The primary outcome was the development of CMV DNAemia or end-organ disease resulting in the initiation/escalation of anti-CMV therapy. The secondary outcome was CMV-related hospitalization. Additional outcomes included incidence of acute cellular rejection (ACR) ≥ grade 2R, death, cardiac allograft vasculopathy (CAV), and leukopenia. RESULTS Of 563 CMV R+ HT recipients, 344 (61.1%) received UP. PET was associated with increased risk for the primary (adjusted HR 3.95, 95% CI: 2.65-5.88, p < .001) and secondary (adjusted HR 3.19, 95% CI: 1.47-6.94, p = .004) outcomes, and with increased ACR ≥ grade 2R (PET 59.4% vs. UP 34.4%, p < .001). Incidence of detectable CAV was similar at 1 year (PET 8.2% vs. UP 9.5%, p = .698). UP was associated with increased incidence of leukopenia within 6 months post-HT (PET 34.7% vs. UP 43.6%, p = .036). CONCLUSION The use of a PET CMV prophylaxis strategy in intermediate risk HT recipients associated with increased risk of CMV infection and CMV-related hospitalization, and may associate with worse post-HT graft outcomes.
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Affiliation(s)
- Joseph B. Lerman
- Division of Cardiology, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Cynthia L. Green
- Duke Clinical Research Institute, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Maria R. Molina
- Department of Medicine, Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Valmiki Maharaj
- Division of Cardiology, University of Minnesota, Minneapolis, MN
| | - Juan M. Ortega-Legaspi
- Department of Medicine, Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Sounok Sen
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - Maureen Flattery
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA
| | - Eileen K. Maziarz
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC
| | - Keyur B. Shah
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA
| | - Cindy M. Martin
- Department of Cardiovascular Medicine, Houston Methodist Hospital, Houston, TX
| | - Tamas Alexy
- Division of Cardiology, University of Minnesota, Minneapolis, MN
| | - Palak Shah
- Heart Failure, MCS and Transplant, Inova Heart and Vascular Institute, Falls Church, VA
| | - Alanna A. Morris
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Adam D. DeVore
- Division of Cardiology, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Robert T. Cole
- Samsky Advanced Heart Failure Center, Piedmont Heart Institute, Atlanta, GA
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5
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Saeed D, Feldman D, Banayosy AE, Birks E, Blume E, Cowger J, Hayward C, Jorde U, Kremer J, MacGowan G, Maltais S, Maybaum S, Mehra M, Shah KB, Mohacsi P, Schweiger M, Schroeder SE, Shah P, Slepian M, Tops LF, Alvarez P, Arabia F, Aslam S, Benson-Louis L, Birati E, Buchholz HW, Cedars A, Christensen D, Ciarka A, Coglianese E, Cogswell R, Cook J, Copeland J, Costello JG, Drakos SG, Eghtesady P, Elliot T, Estep JD, Eulert-Grehn JJ, Fabrizio DR, Garbade J, Gelow J, Guglin M, Hernandez-Montfort J, Horstmanshof D, John R, Kanwar M, Khaliel F, Kim G, Kumar S, Lavee J, Leache M, Leprince P, Lim S, Loforte A, Maly J, Najjar S, Netuka I, Pamboukian SV, Patel SR, Pinney S, Pluym CV, Potapov E, Robson D, Rochlani Y, Russell S, Sandau K, Sandoval E, Sayer G, Schettle S, Schibilsky D, Schlöglhofer T, Schmitto J, Siddique A, Silvestry S, Slaughter MS, Sun B, Takayama H, Tedford R, Teuteberg JJ, Ton VK, Uriel N, Vierecke J, Zimpfer D, D'Alessandro D. The 2023 International Society for Heart and Lung Transplantation Guidelines for Mechanical Circulatory Support: A 10- Year Update. J Heart Lung Transplant 2023; 42:e1-e222. [PMID: 37245143 DOI: 10.1016/j.healun.2022.12.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/05/2022] [Indexed: 05/29/2023] Open
Affiliation(s)
- Diyar Saeed
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany..
| | - David Feldman
- University of Cincinnati & Cincinnati Childrens Hosptial, Cincinnati, Ohio, USA.
| | - Aly El Banayosy
- Integris Nazih Zuhdi Transplant Institute, Oklahoma City, OK, USA
| | - Emma Birks
- University of Louisville, Louisville, KY, USA
| | | | - Jennifer Cowger
- Department of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | - Christopher Hayward
- Faculty of Medicine, St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | | | - Jamila Kremer
- Department of Cardiothoracic Surgery, Heidelberg University, Heidelberg, Germany
| | - Guy MacGowan
- Newcastle Upon Tyne Hospitals, and Newcastle University, Newcastle upon Tyne, UK
| | - Simon Maltais
- Department of cardiac Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Keyur B Shah
- Department of Cardiology, Virginia Commonwealth University, Virginia
| | - Paul Mohacsi
- CardioVascular Center Im Park, Seestrasse 247, CH-8038 Zürich
| | | | | | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church VA, USA
| | | | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Paulino Alvarez
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Francisco Arabia
- Advanced Heart Program, Banner University Medical Group, Phoenix, AZ, USA
| | - Saima Aslam
- University of California, San Diego, San Diego, CA, USA
| | | | - Edo Birati
- Cardiovascular Division, Padeh-Poriya Medical Center, Bar Ilan University, Israel
| | | | - Ari Cedars
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Erin Coglianese
- Department of Medicine/Cardiology, Mass General Hospital, Harvard School of Medicine, Boston Massachusetts USA
| | | | - Jennifer Cook
- University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Jack Copeland
- Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona, Tucson, AZ, USA
| | | | - Stavros G Drakos
- University of Utah Health and School of Medicine and Salt Lake VA Medical Center, Salt Lake City, Utah, USA
| | - Pirooz Eghtesady
- Department of Pediatrics, Washington University in St. Louis, USA
| | | | - Jerry D Estep
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | | | - De Rita Fabrizio
- Consultant in Congenital Heart Surgery, Adult and Paediatric Congenital Heart Unit Freeman Hospital, Newcastle Upon Tyne, UK
| | - Jens Garbade
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzg, Germany
| | - Jill Gelow
- Department of Pediatrics, Providence Heart Institute, Portland, Oregon, USA
| | | | | | | | - Ranjit John
- University of Minnesota, Minneapolis, MN, USA
| | | | - Feras Khaliel
- King Faisal Specialist Hospital & Research Center, Riyadh
| | - Gene Kim
- Department of Cardiology, University of Chicago, Illinois, USA
| | - Sachin Kumar
- Division of Cardiovascular Surgery, Advanced Heart Failure Program, University of Texas Medical Center, Houston, Texas, USA
| | - Jacob Lavee
- Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Marzia Leache
- Department of Cardiac Surgery, New Yok University Medical Center, New York, NY, USA
| | - Pascal Leprince
- Department of Thoracic and Cardiovascular Surgery, Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Sern Lim
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Antonio Loforte
- Bologna University, Cardiothorac, Transplant and Vasc Surg Dept, Bologna, Italy
| | - Jiri Maly
- Department of Cardiac Surgery, Institute for Clinical and Experimental Medicine, Prague, Czeck Republic
| | - Samer Najjar
- Department of Medicine, MedStar Washington Hospital Center, Georgetown University, Wahington DC USA
| | - Ivan Netuka
- Dept. of Cardiac Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Snehal R Patel
- Cardiology Division, Montefiore Medical Center, Bronx, NY, USA
| | - Sean Pinney
- Mount Sinai Medical Center, New York, NY, USA
| | - Christina Vander Pluym
- Division of Cardiology, Boston Children's Hospital/Harvard School of Medicine, Boston, Massachusetts, USA
| | | | - Desiree Robson
- Department of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | | | | | | | | | - Gabriel Sayer
- University of Chicago Medical Center, Chicago, IL, USA
| | | | - David Schibilsky
- Department of Surgery, Universitats- Herzzentrum, Freiburg Germany
| | | | - Jan Schmitto
- Dept. of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Aleem Siddique
- Department of Surgery, University of Nebraska Medical Center, Omha, Nebraska, USA
| | - Scott Silvestry
- Department of Cardiac Surgery, Florida Hospital, Orlando, FL, USA
| | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Kentucky, USA
| | - Benjamin Sun
- Cardiac Surgery department, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Hiroo Takayama
- Department of Cardiac Surgery, Columbia University Medical Center, New York, NY, USA
| | - Ryan Tedford
- Department of Medicine/Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Van-Khue Ton
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nir Uriel
- Department of Cardiology, Columbia University, New York, NY, USA
| | - Juliane Vierecke
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - David D'Alessandro
- Massachusetts General Hospital, Boston, Harvard School of Medicine, Boston, MA, USA.
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6
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Noly PE, Moriguchi J, Shah KB, Anyanwu AC, Mahr C, Skipper E, Cossette M, Lamarche Y, Carrier M. A bridge-to-bridge approach to heart transplantation using extracorporeal membrane oxygenation and total artificial heart. J Thorac Cardiovasc Surg 2023; 165:1138-1148.e1. [PMID: 34627602 DOI: 10.1016/j.jtcvs.2021.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/29/2021] [Accepted: 09/07/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study aims to describe the outcomes after heart transplantation using a bridge-to-bridge strategy with a sequence of extracorporeal membrane oxygenation (ECMO) support followed by temporary total artificial heart implantation (TAH-t). METHODS A retrospective, multicenter analysis of 54 patients who underwent TAH-t implantation following an ECMO for cardiogenic shock was performed (ECMO-TAH-t group). A control group of 163 patients who underwent TAH-t implantation as a direct bridge to transplantation (TAH-t group) was used to assess this strategy's impact on outcomes. RESULTS Fifty-four patients, averaging 47 ± 13 year old, underwent implantation of a TAH-t after 5.3 ± 3.4 days of ECMO perfusion for cardiogenic shock. In the ECMO-TAH-t group, 20 patients (20/54%; 37%) died after TAH-t implantation and 57 patients (57/163%; 35%) died in the TAH-t group (Gray test; P = .49). The top 3 causes of death of patients on TAH-t support were multisystem organ failure (40%), sepsis (20%), and neurologic events (20%). Overall, 32 patients (32/54%; 59%) underwent heart transplantation in the ECMO-TAH-t group compared with 106 patients (106/163%, 65%) in the TAH-t group (P = .44). No significant difference in survival was observed at 6 months, 1 year, and 3 years after heart transplant (ECMO-TAH-t group: 94%, 87%, and 80% vs 87%, 83%, and 76% in the TAH-t group, respectively). Deterioration of liver function (bilirubin, aspartate transaminase, and alanine aminotransferase levels on TAH-t) was associated with increased mortality before heart transplant in both groups. CONCLUSIONS Sequential bridging from ECMO to TAH-t followed by heart transplantation is a viable option for a group of highly selected patients.
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Affiliation(s)
- Pierre-Emmanuel Noly
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
| | - Jaime Moriguchi
- Department of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, Calif
| | - Keyur B Shah
- Division of Cardiology, The Pauley Heart Center, Virginia Commonwealth University, Richmond, Va
| | - Anelechi C Anyanwu
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Claudius Mahr
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Wash
| | - Eric Skipper
- Department of Thoracic and Cardiovascular Surgery, Carolinas Medical Center, Charlotte, NC
| | - Mariève Cossette
- Montreal Health Innovations Coordinating Center (MHICC), Montreal, Canada
| | - Yoan Lamarche
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Michel Carrier
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Quebec, Canada
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7
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Shah P, Agbor-Enoh S, Bagchi P, deFilippi CR, Mercado A, Diao G, Morales DJ, Shah KB, Najjar SS, Feller E, Hsu S, Rodrigo ME, Lewsey SC, Jang MK, Marboe C, Berry GJ, Khush KK, Valantine HA. Circulating microRNAs in cellular and antibody-mediated heart transplant rejection. J Heart Lung Transplant 2022; 41:1401-1413. [PMID: 35872109 PMCID: PMC9529890 DOI: 10.1016/j.healun.2022.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Noninvasive monitoring of heart allograft health is important to improve clinical outcomes. MicroRNAs (miRs) are promising biomarkers of cardiovascular disease and limited studies suggest they can be used to noninvasively diagnose acute heart transplant rejection. METHODS The Genomic Research Alliance for Transplantation (GRAfT) is a multicenter prospective cohort study that phenotyped heart transplant patients from 5 mid-Atlantic centers. Patients who had no history of rejection after transplant were compared to patients with acute cellular rejection (ACR) or antibody-mediated rejection (AMR). Small RNA sequencing was performed on plasma samples collected at the time of an endomyocardial biopsy. Differential miR expression was performed with adjustment for clinical covariates. Regression was used to develop miR panels with high diagnostic accuracy for ACR and AMR. These panels were then validated in independent samples from GRAfT and Stanford University. Receiver operating characteristic curves were generated and area under the curve (AUC) statistics calculated. Distinct ACR and AMR clinical scores were developed to translate miR expression data for clinical use. RESULTS The GRAfT cohort had a median age of 52 years, with 35% females and 45% Black patients. Between GRAfT and Stanford, we included 157 heart transplant patients: 108 controls and 49 with rejection (50 ACR and 38 AMR episodes). After differential miR expression and regression analysis, we identified 12 miRs that accurately discriminate ACR and 17 miRs in AMR. Independent validation of the miR panels within GRAfT led to an ACR AUC 0.92 (95% confidence interval [CI]: 0.86-0.98) and AMR AUC 0.82 (95% CI: 0.74-0.90). The externally validated ACR AUC was 0.72 (95% CI: 0.59-0.82). We developed distinct ACR and AMR miR clinical scores (range 0-100), a score ≥ 65, identified ACR with 86% sensitivity, 76% specificity, and 98% negative predictive value, for AMR score performance was 82%, 84% and 97%, respectively. CONCLUSIONS We identified novel miRs that had excellent performance to noninvasively diagnose acute rejection after heart transplantation. Once rigorously validated, the unique clinical ACR and AMR scores usher in an era whereby genomic biomarkers can be used to screen and diagnose the subtype of rejection. These novel biomarkers may potentially alleviate the need for an endomyocardial biopsy while facilitating the initiation of targeted therapy based on the noninvasive diagnosis of ACR or AMR.
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Affiliation(s)
- Palak Shah
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church, Virginia; Genomic Research Alliance for Transplantation (GRAfT), Bethesda, Maryland.
| | - Sean Agbor-Enoh
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, Maryland; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Pramita Bagchi
- Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | | | - Angela Mercado
- Heart Failure, Mechanical Circulatory Support & Transplant, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Gouqing Diao
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Dave Jp Morales
- Heart Failure & Transplantation, Stanford University, Palo Alto, California
| | - Keyur B Shah
- The Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Samer S Najjar
- Advanced Heart Failure Program, Medstar Heart and Vascular Institute, Washington Hospital Center, Washington, District of Columbia
| | - Erika Feller
- Heart Failure & Transplantation, University of Maryland, Baltimore, Maryland
| | - Steven Hsu
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Maria E Rodrigo
- The Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Sabra C Lewsey
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Moon Kyoo Jang
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, Maryland; Applied Precision Genomics, National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Charles Marboe
- Department of Pathology, New York Presbyterian University Hospital of Cornell and Columbia, New York, New York, New York
| | - Gerald J Berry
- Stanford University School of Medicine, Palo Alto, California
| | - Kiran K Khush
- Stanford University School of Medicine, Palo Alto, California
| | - Hannah A Valantine
- Genomic Research Alliance for Transplantation (GRAfT), Bethesda, Maryland; Stanford University School of Medicine, Palo Alto, California
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8
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Moroni F, Shah KB, Quader MA, Klein K, Smallfield MC, Parris KE, Gertz ZM. Percutaneous approach to left ventricular assist device decommissioning. Catheter Cardiovasc Interv 2022; 100:169-174. [PMID: 35579199 PMCID: PMC9543180 DOI: 10.1002/ccd.30230] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/26/2022] [Accepted: 05/03/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the outcomes of a single-center experience with percutaneous left ventricular assist device (LVAD) decommissioning. BACKGROUND Patients with LVADs may eventually require their removal, either due to recovery of left ventricular function or recurrent complications. Traditionally, withdrawal of LVAD support has been managed with surgical device explantation, which carries significant procedural risks. Transcatheter LVAD decommissioning, with outflow graft occlusion and driveline transection, has recently been described as an alternative to surgical removal. METHODS Here, we report on a retrospective cohort of five consecutive cases treated with transcatheter LVAD decommissioning. RESULTS The procedure was effective in all cases, and no patient experienced procedure-related complications. At midterm follow-up, the three patients who had myocardial function recovery were alive and had not experienced heart failure-related symptoms or complications. CONCLUSION Percutaneous LVAD decommissioning appears to be a safe and effective approach to LVAD treatment discontinuation.
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Affiliation(s)
- Francesco Moroni
- Division of Cardiovascular Medicine, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Keyur B Shah
- Division of Cardiovascular Medicine, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mohammed A Quader
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Katherine Klein
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Melissa C Smallfield
- Division of Cardiovascular Medicine, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kendall E Parris
- Division of Cardiovascular Medicine, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Zachary M Gertz
- Division of Cardiovascular Medicine, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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Shah KB, Rao K, Trankle CR. Response by Shah et al to Letter Regarding Article, "False-Positive 99mTechnetium-Pyrophosphate Scintigraphy in Two Patients With Hypertrophic Cardiomyopathy". Circ Heart Fail 2022; 15:e008697. [PMID: 35378983 DOI: 10.1161/circheartfailure.121.008697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Keyur B Shah
- Pauley Heart Center, Department of Medicine, Virginia Commonwealth University, Richmond
| | - Krishnasree Rao
- Pauley Heart Center, Department of Medicine, Virginia Commonwealth University, Richmond
| | - Cory R Trankle
- Pauley Heart Center, Department of Medicine, Virginia Commonwealth University, Richmond
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10
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Tushak ZJ, Doshi A, Trankle CR, Rao K, Cei L, Shah KB. Phenotypic Spectrum of Transthyretin Cardiac Amyloidosis in a Family: Impact of Mutation Zygosity and Sex. JACC CardioOncol 2021; 3:602-605. [PMID: 34729535 PMCID: PMC8543089 DOI: 10.1016/j.jaccao.2021.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 01/15/2023] Open
Key Words
- ATTR, transthyretin amyloidosis
- CMR, cardiac magnetic resonance imaging
- HCL, heart to contralateral lung (uptake ratio for PYP scan)
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- PYP, technetium-99m pyrophosphate (scan)
- SPECT, single-photon emission computed tomography
- TTE, transthoracic echocardiogram
- TTR, transthyretin
- V122I, valine substitution for isoleucine at position 122
- amyloidosis
- cardiomyopathy
- gender differences
- genetic variability
- hATTR, hereditary transthyretin amyloidosis
- heart failure
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Affiliation(s)
- Zackary J Tushak
- Division of Cardiology, Virginia Commonwealth University Health, Pauley Heart Center, Richmond, Virginia, USA
| | - Amar Doshi
- Division of Cardiology, Virginia Commonwealth University Health, Pauley Heart Center, Richmond, Virginia, USA
| | - Cory R Trankle
- Division of Cardiology, Virginia Commonwealth University Health, Pauley Heart Center, Richmond, Virginia, USA
| | - Kris Rao
- Division of Cardiology, Virginia Commonwealth University Health, Pauley Heart Center, Richmond, Virginia, USA
| | - Laura Cei
- Division of Cardiology, Virginia Commonwealth University Health, Pauley Heart Center, Richmond, Virginia, USA
| | - Keyur B Shah
- Division of Cardiology, Virginia Commonwealth University Health, Pauley Heart Center, Richmond, Virginia, USA
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11
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Gilotra NA, Pamboukian SV, Mountis M, Robinson SW, Kittleson M, Shah KB, Forde-McLean RC, Haas DC, Horstmanshof DA, Jorde UP, Russell SD, Taddei-Peters WC, Jeffries N, Khalatbari S, Spino CA, Richards B, Yosef M, Mann DL, Stewart GC, Aaronson KD, Grady KL. Caregiver Health-Related Quality of Life, Burden, and Patient Outcomes in Ambulatory Advanced Heart Failure: A Report From REVIVAL. J Am Heart Assoc 2021; 10:e019901. [PMID: 34250813 PMCID: PMC8483456 DOI: 10.1161/jaha.120.019901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Heart failure (HF) imposes significant burden on patients and caregivers. Longitudinal data on caregiver health-related quality of life (HRQOL) and burden in ambulatory advanced HF are limited. Methods and Results Ambulatory patients with advanced HF (n=400) and their participating caregivers (n=95) enrolled in REVIVAL (Registry Evaluation of Vital Information for VADs [Ventricular Assist Devices] in Ambulatory Life) were followed up for 24 months, or until patient death, left ventricular assist device implantation, heart transplantation, or loss to follow-up. Caregiver HRQOL (EuroQol Visual Analog Scale) and burden (Oberst Caregiving Burden Scale) did not change significantly from baseline to follow-up. At time of caregiver enrollment, better patient HRQOL by Kansas City Cardiomyopathy Questionnaire was associated with better caregiver HRQOL (P=0.007) and less burden by both time spent (P<0.0001) and difficulty (P=0.0007) of caregiving tasks. On longitudinal analyses adjusted for baseline values, better patient HRQOL (P=0.034) and being a married caregiver (P=0.016) were independently associated with better caregiver HRQOL. Patients with participating caregivers (versus without) were more likely to prefer left ventricular assist device therapy over time (odds ratio, 1.43; 95% CI, 1.03-1.99; P=0.034). Among patients with participating caregivers, those with nonmarried (versus married) caregivers were at higher composite risk of HF hospitalization, death, heart transplantation or left ventricular assist device implantation (hazard ratio, 2.99; 95% CI, 1.29-6.96; P=0.011). Conclusions Patient and caregiver characteristics may impact their HRQOL and other health outcomes over time. Understanding the patient-caregiver relationship may better inform medical decision making and outcomes in ambulatory advanced HF.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Wendy C Taddei-Peters
- Division of Cardiovascular Sciences National Heart, Lung, and Blood Institute Bethesda MD
| | - Neal Jeffries
- Division of Cardiovascular Sciences National Heart, Lung, and Blood Institute Bethesda MD
| | - Shokoufeh Khalatbari
- University of MichiganMichigan Institute for Clinical and Health Research Ann Arbor MI
| | | | - Blair Richards
- University of MichiganMichigan Institute for Clinical and Health Research Ann Arbor MI
| | - Matheos Yosef
- University of MichiganMichigan Institute for Clinical and Health Research Ann Arbor MI
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12
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Sickels A, Shah KB, Ruch B, Cotterell A, Tchoukina I, Quader M, Bhati C, Kumaran V, Bruno D, Stravitz R, Levy M, Kasirajan V, Sharma A. Combined Heart-Liver and Domino Liver Transplantation in Familial Amyloidosis. Am Surg 2021; 88:2267-2273. [PMID: 34060933 DOI: 10.1177/00031348211023427] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Combined heart-liver transplantation (CHLT) is the only curative option for patients with concomitant pathology affecting the heart and liver. In some cases, the native livers of familial amyloidosis (FA) patients may be suitable for domino transplantation into other recipients. METHODS Retrospective analysis (2013 to 2019) of all CHLT at our center was performed. Continuous data were presented as mean with standard deviation and discrete variables as percentages. RESULTS Familial amyloidosis was the indication for CHLT in 5 out of 6 patients. The mean recipient age was 55 ± 5.62 years. Two patients were bridged with total artificial heart. The mean model for end-stage liver disease score at transplant was 17.17 ± 3.7. Two explanted livers were used for transplantation in a domino fashion. The median intensive care and hospital stays were 5.5 and 19 days, respectively. Complications included renal failure (1), groin abscess (1), pulmonary embolism (1), and cardiac rejection (1). Patient and graft survival for both organs was 100% at a median follow-up of 59 (range 20-76) months. DISCUSSION Combined heart-liver transplantation for FA achieves excellent outcomes. The possible use of livers explanted from patients with FA for domino liver transplantation can contribute to the liver donor pool.
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Affiliation(s)
- Angela Sickels
- School of Medicine, 6886Virginia Commonwealth University, Richmond, VA, USA
| | - Keyur B Shah
- Pauley Heart Center and 6887Virginia Commonwealth University, Richmond, VA, USA
| | - Brianna Ruch
- Department of Surgery, Hume-Lee Transplant Center, 6887Virginia Commonwealth University, Richmond, VA, USA
| | - Adrian Cotterell
- Department of Surgery, Hume-Lee Transplant Center, 6887Virginia Commonwealth University, Richmond, VA, USA
| | - Inna Tchoukina
- Pauley Heart Center and 6887Virginia Commonwealth University, Richmond, VA, USA
| | - Mohammed Quader
- Pauley Heart Center and 6887Virginia Commonwealth University, Richmond, VA, USA
| | - Chandra Bhati
- Department of Surgery, Hume-Lee Transplant Center, 6887Virginia Commonwealth University, Richmond, VA, USA
| | - Vinay Kumaran
- Department of Surgery, Hume-Lee Transplant Center, 6887Virginia Commonwealth University, Richmond, VA, USA
| | - David Bruno
- Department of Surgery, Hume-Lee Transplant Center, 6887Virginia Commonwealth University, Richmond, VA, USA
| | - Richard Stravitz
- Department of Surgery, Hume-Lee Transplant Center, 6887Virginia Commonwealth University, Richmond, VA, USA
| | - Marlon Levy
- Department of Surgery, Hume-Lee Transplant Center, 6887Virginia Commonwealth University, Richmond, VA, USA
| | | | - Amit Sharma
- Department of Surgery, Hume-Lee Transplant Center, 6887Virginia Commonwealth University, Richmond, VA, USA
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13
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Keller A, Shah KB, Delgado D, Vallakati A, Akinboboye O, Marti C, Dolinsky J, Gabriel A, Narayana A, Olugemo K. GENOTYPIC AND PHENOTYPIC DIFFERENCES AND SIMILARITIES AMONG PATIENTS WITH TRANSTHYRETIN AMYLOIDOSIS OR OTHER INHERITED CARDIOVASCULAR DISEASES: INSIGHTS FROM A GENETIC TESTING PROGRAM. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02247-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Shah KB, Bumma N, Delgado D, Keller A, Khella S, Gabriel A, Narayana A, Olugemo K. CHARACTERISTICS OF PATIENTS WITH P.V142I MUTATIONS ASSOCIATED WITH HEREDITARY TRANSTHYRETIN AMYLOIDOSIS: INSIGHTS FROM A GENETIC TESTING PROGRAM. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Marawan A, Thomas GK, Canada JM, Billingsley HE, Dixon DL, Van Tassell BW, Kadariya D, Markley R, Rotelli B, Shah KB, Kang L, Celi FS, Abbate A, Carbone S. Edema Index Predicts Cardiorespiratory Fitness in Patients With Heart Failure With Reduced Ejection Fraction and Type 2 Diabetes Mellitus. J Am Heart Assoc 2021; 10:e018631. [PMID: 33825487 PMCID: PMC8174175 DOI: 10.1161/jaha.120.018631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amr Marawan
- Division of Hospital Medicine Department of Internal Medicine, School of Medicine Virginia Commonwealth University Richmond VA.,Division of Cardiology Department of Internal Medicine VCU Pauley Heart CenterVirginia Commonwealth University Richmond VA
| | - Georgia K Thomas
- Division of Hospital Medicine Department of Internal Medicine, School of Medicine Virginia Commonwealth University Richmond VA.,Division of Cardiology Department of Internal Medicine VCU Pauley Heart CenterVirginia Commonwealth University Richmond VA
| | - Justin M Canada
- Division of Cardiology Department of Internal Medicine VCU Pauley Heart CenterVirginia Commonwealth University Richmond VA
| | - Hayley E Billingsley
- Division of Cardiology Department of Internal Medicine VCU Pauley Heart CenterVirginia Commonwealth University Richmond VA.,Department of Kinesiology and Health Sciences College of Humanities and Sciences Virginia Commonwealth University Richmond VA
| | - Dave L Dixon
- Department of Pharmacotherapy and Outcomes Science School of Pharmacy Virginia Commonwealth University Richmond VA
| | - Benjamin W Van Tassell
- Department of Pharmacotherapy and Outcomes Science School of Pharmacy Virginia Commonwealth University Richmond VA
| | - Dinesh Kadariya
- Division of Cardiology Department of Internal Medicine VCU Pauley Heart CenterVirginia Commonwealth University Richmond VA
| | - Roshanak Markley
- Division of Cardiology Department of Internal Medicine VCU Pauley Heart CenterVirginia Commonwealth University Richmond VA
| | - Brando Rotelli
- Division of Cardiology Department of Internal Medicine VCU Pauley Heart CenterVirginia Commonwealth University Richmond VA
| | - Keyur B Shah
- Division of Cardiology Department of Internal Medicine VCU Pauley Heart CenterVirginia Commonwealth University Richmond VA
| | - Le Kang
- Department of Biostatistics Virginia Commonwealth University Richmond VA
| | - Francesco S Celi
- Division of Endocrinology Diabetes and Metabolism Department of Internal Medicine Virginia Commonwealth University Richmond VA
| | - Antonio Abbate
- Division of Cardiology Department of Internal Medicine VCU Pauley Heart CenterVirginia Commonwealth University Richmond VA
| | - Salvatore Carbone
- Division of Cardiology Department of Internal Medicine VCU Pauley Heart CenterVirginia Commonwealth University Richmond VA.,Department of Kinesiology and Health Sciences College of Humanities and Sciences Virginia Commonwealth University Richmond VA
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16
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Schafer EB, Tushak Z, Trankle CR, Rao K, Cartagena LC, Shah KB. False-Positive 99mTechnetium-Pyrophosphate Scintigraphy in Two Patients With Hypertrophic Cardiomyopathy. Circ Heart Fail 2021; 14:e007558. [PMID: 33663232 DOI: 10.1161/circheartfailure.120.007558] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eric B Schafer
- Division of Internal Medicine (E.B.S.), Virginia Commonwealth University Health System, Richmond, VA
| | - Zackary Tushak
- Division of Cardiology within Pauley Heart Center (Z.T., C.R.T., K.R., K.B.S.), Virginia Commonwealth University Health System, Richmond, VA
| | - Cory R Trankle
- Division of Cardiology within Pauley Heart Center (Z.T., C.R.T., K.R., K.B.S.), Virginia Commonwealth University Health System, Richmond, VA
| | - Krishnasree Rao
- Division of Cardiology within Pauley Heart Center (Z.T., C.R.T., K.R., K.B.S.), Virginia Commonwealth University Health System, Richmond, VA
| | | | - Keyur B Shah
- Division of Cardiology within Pauley Heart Center (Z.T., C.R.T., K.R., K.B.S.), Virginia Commonwealth University Health System, Richmond, VA
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17
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Gertz ZM, Trankle CR, Grizzard JD, Quader MA, Medalion B, Parris KE, Shah KB. An interventional approach to left ventricular assist device outflow graft obstruction. Catheter Cardiovasc Interv 2021; 98:969-974. [PMID: 33586847 DOI: 10.1002/ccd.29556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 12/21/2020] [Revised: 01/21/2021] [Accepted: 02/02/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND LVADs provide life-sustaining treatment for patients with heart failure, but their complexity allows for complications. One complication, LVAD outflow graft obstruction, may be misdiagnosed as intraluminal thrombus, when more often it is extraluminal compression from biodebris accumulation. It can often be treated endovascularly with stenting. This case series describes diagnostic and procedural techniques for the treatment of left ventricular assist device (LVAD) outflow graft obstruction. METHODS We present four patients with LVADs who developed LVAD outflow graft obstruction within the bend relief-covered segment. All were initially diagnosed with computed tomographic angiography (CTA). All underwent invasive evaluation with intravascular ultrasound (IVUS), then were treated with stenting. After misdiagnosing a twist, we developed the technique of balloon "graftoplasty" to ensure suitability for stent delivery in subsequent cases. RESULTS All patients presented with low-flow alarms and symptoms of low output, and were diagnosed with outflow graft obstruction by CTA. In all four, IVUS confirmed an extraluminal etiology. Patient 1 was treated with stenting and had a good outcome. Patient 2's obstruction was from twisting, rather than biodebris accumulation, and had sub-optimal stent expansion and ultimately required surgery. Balloon "graftoplasty" was used in subsequent cases to ensure subsequent stent expansion. Patients 3 and 4 were successfully stented. All improved after treatment. CONCLUSIONS In patients with LVAD outflow graft obstruction, IVUS can distinguish intraluminal thrombus from extraluminal compression. Balloon "graftoplasty" can ensure that the outflow graft will respond to stenting. Many cases of LVAD outflow graft obstruction should be amenable to endovascular treatment.
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Affiliation(s)
- Zachary M Gertz
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Cory R Trankle
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John D Grizzard
- Department of Radiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mohammed A Quader
- Division of Cardiothoracic Surgery, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Benjamin Medalion
- Division of Cardiothoracic Surgery, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kendall E Parris
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Keyur B Shah
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
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18
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Lala A, Shah KB, Lanfear DE, Thibodeau JT, Palardy M, Ambardekar AV, McNamara DM, Taddei-Peters WC, Baldwin JT, Jeffries N, Khalatbari S, Spino C, Richards B, Mann DL, Stewart GC, Aaronson KD, Mancini DM. Predictive Value of Cardiopulmonary Exercise Testing Parameters in Ambulatory Advanced Heart Failure. JACC Heart Fail 2021; 9:226-236. [PMID: 33549559 DOI: 10.1016/j.jchf.2020.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study sought to determine cardiopulmonary exercise (CPX) predictors of the combined outcome of durable mechanical circulatory support (MCS), transplantation, or death at 1 year among patients with ambulatory advanced heart failure (HF). BACKGROUND Optimal CPX predictors of outcomes in contemporary ambulatory advanced HF patients are unclear. METHODS REVIVAL (Registry Evaluation of Vital Information for ventricular assist devices [VADs] in Ambulatory Life) enrolled 400 systolic HF patients, INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles 4-7. CPX was performed by 273 subjects 2 ± 1 months after study enrollment. Discriminative power of maximal (peak oxygen consumption [peak VO2]; VO2 pulse, circulatory power [CP]; peak systolic blood pressure • peak VO2], peak end-tidal pressure CO2 [PEtCO2], and peak Borg scale score) and submaximal CPX parameters (ventilatory efficiency [VE/VCO2 slope]; VO2 at anaerobic threshold [VO2AT]; and oxygen uptake efficiency slope [OUES]) to predict the composite outcome were assessed by univariate and multivariate Cox regression and Harrell's concordance statistic. RESULTS At 1 year, there were 39 events (6 transplants, 15 deaths, 18 MCS implantations). Peak VO2, VO2AT, OUES, peak PEtCO2, and CP were higher in the no-event group (all p < 0.001), whereas VE/VCO2 slope was lower (p < 0.0001); respiratory exchange ratio was not different. CP (hazard ratio [HR]: 0.89; p = 0.001), VE/VCO2 slope (HR: 1.05; p = 0.001), and peak Borg scale score (HR: 1.20; p = 0.005) were significant predictors on multivariate analysis (model C-statistic: 0.80). CONCLUSIONS Among patients with ambulatory advanced HF, the strongest maximal and submaximal CPX predictor of MCS implantation, transplantation, or death at 1 year were CP and VE/VCO2, respectively. The patient-reported measure of exercise effort (Borg scale score) contributed substantially to the prediction of outcomes, a surprising and novel finding that warrants further investigation. (Registry Evaluation of Vital Information for VADs in Ambulatory Life [REVIVAL]; NCT01369407).
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Affiliation(s)
- Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Keyur B Shah
- Department of Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - David E Lanfear
- Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jennifer T Thibodeau
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Maryse Palardy
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Dennis M McNamara
- Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Wendy C Taddei-Peters
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | - Neal Jeffries
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Shokoufeh Khalatbari
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Cathie Spino
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Blair Richards
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Douglas L Mann
- Cardiovascular Division, Washington University School of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Garrick C Stewart
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Keith D Aaronson
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Donna M Mancini
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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19
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Givertz MM, DeFilippis EM, Colvin M, Darling CE, Elliott T, Hamad E, Hiestand BC, Martindale JL, Pinney SP, Shah KB, Vierecke J, Bonnell M. HFSA/SAEM/ISHLT clinical expert consensus document on the emergency management of patients with ventricular assist devices. J Heart Lung Transplant 2020; 38:677-698. [PMID: 31272557 DOI: 10.1016/j.healun.2019.05.004] [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: 04/15/2019] [Accepted: 05/01/2019] [Indexed: 01/21/2023] Open
Abstract
Mechanical circulatory support is now widely accepted as a viable long-term treatment option for patients with end-stage heart failure (HF). As the range of indications for the implantation of ventricular assist devices grows, so does the number of patients living in the community with durable support. Because of their underlying disease and comorbidities, in addition to the presence of mechanical support, these patients are at a high risk for medical urgencies and emergencies (Table 1). Thus, it is the responsibility of clinicians to understand the basics of their emergency care. This consensus document represents a collaborative effort by the Heart Failure Society of America, the Society for Academic Emergency Medicine, and the International Society for Heart and Lung Transplantation (ISHLT) to educate practicing clinicians about the emergency management of patients with ventricular assist devices. The target audience includes HF specialists and emergency medicine physicians, as well as general cardiologists and community-based providers.
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Affiliation(s)
- Michael M Givertz
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Ersilia M DeFilippis
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Monica Colvin
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Chad E Darling
- UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Tonya Elliott
- MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Eman Hamad
- Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Brian C Hiestand
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | | | | | - Keyur B Shah
- VCU Pauley Heart Center, Richmond, Virginia, USA
| | - Juliane Vierecke
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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20
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Carbone S, Billingsley HE, Canada JM, Bressi E, Rotelli B, Kadariya D, Dixon DL, Markley R, Trankle CR, Cooke R, Rao K, B. Shah K, Medina de Chazal H, Chiabrando JG, Vecchié A, Dell M, L. Mihalick V, Bogaev R, Hart L, Van Tassell BW, Arena R, Celi FS, Abbate A. The effects of canagliflozin compared to sitagliptin on cardiorespiratory fitness in type 2 diabetes mellitus and heart failure with reduced ejection fraction: The CANA-HF study. Diabetes Metab Res Rev 2020; 36:e3335. [PMID: 32415802 PMCID: PMC7685099 DOI: 10.1002/dmrr.3335] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/27/2020] [Accepted: 05/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Canagliflozin reduces hospitalizations for heart failure (HF) in type 2 diabetes mellitus (T2DM). Its effect on cardiorespiratory fitness and cardiac function in patients with established HF with reduced ejection fraction (HFrEF) is unknown. METHODS We conducted a double-blind randomized controlled trial of canagliflozin 100 mg or sitagliptin 100 mg daily for 12 weeks in 88 patients, and measured peak oxygen consumption (VO2 ) and minute ventilation/carbon dioxide production (VE/VCO2 ) slope (co-primary endpoints for repeated measure ANOVA time_x_group interaction), lean peak VO2 , ventilatory anaerobic threshold (VAT), cardiac function and quality of life (ie, Minnesota Living with Heart Failure Questionnaire [MLHFQ]), at baseline and 12-week follow-up. RESULTS The study was terminated early due to the new guidelines recommending canagliflozin over sitagliptin in HF: 17 patients were assigned to canagliflozin and 19 to sitagliptin, total of 36 patients. There were no significant changes in peak VO2 and VE/VCO2 slope between the two groups (P = .083 and P = .98, respectively). Canagliflozin improved lean peak VO2 (+2.4 mL kgLM-1 min-1 , P = .036), VAT (+1.5 mL kg-1 min-1 , P = .012) and VO2 matched for respiratory exchange ratio (+2.4 mL Kg-1 min-1 , P = .002) compared to sitagliptin. Canagliflozin also reduced MLHFQ score (-12.1, P = .018). CONCLUSIONS In this small and short-term study of patients with T2DM and HFrEF, interrupted early after only 36 patients, canagliflozin did not improve the primary endpoints of peak VO2 or VE/VCO2 slope compared to sitagliptin, while showing favourable trends observed on several additional surrogate endpoints such as lean peak VO2 , VAT and quality of life.
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Affiliation(s)
- Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & SciencesVirginia Commonwealth UniversityRichmondVirginiaUSA
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Hayley E. Billingsley
- Department of Kinesiology & Health Sciences, College of Humanities & SciencesVirginia Commonwealth UniversityRichmondVirginiaUSA
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Justin M. Canada
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Edoardo Bressi
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Brando Rotelli
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Dinesh Kadariya
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Dave L. Dixon
- Department of Pharmacotherapy and & Outcomes Science, School of PharmacyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Roshanak Markley
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Cory R. Trankle
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Richard Cooke
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Krishnasree Rao
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Keyur B. Shah
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Horacio Medina de Chazal
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Juan Guido Chiabrando
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Alessandra Vecchié
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Megan Dell
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Virginia L. Mihalick
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Roberta Bogaev
- Advanced Heart Failure CenterBon Secours Heart & Vascular InstituteRichmondVirginiaUSA
| | - Linda Hart
- Advanced Heart Failure CenterBon Secours Heart & Vascular InstituteRichmondVirginiaUSA
| | - Benjamin W. Van Tassell
- Department of Pharmacotherapy and & Outcomes Science, School of PharmacyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health SciencesUniversity of Illinois at ChicagoChicagoIllinoisUSA
- TotalCardiology Research NetworkCalgaryAlbertaCanada
| | - Francesco S. Celi
- Division of Endocrinology Diabetes and Metabolism, Department of Internal MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Antonio Abbate
- Division of Cardiology, Department of Internal Medicine, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
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Rudisill KG, Smallfield MC, Shah KB, Quader MA, Bhardwaj HL, Gertz ZM. Transcatheter Heart Valve Thrombosis in a Patient With a Left Ventricular Assist Device. Circ Heart Fail 2020; 13:e007112. [PMID: 32842759 DOI: 10.1161/circheartfailure.120.007112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kristyn G Rudisill
- Division of Cardiology (K.G.R., M.C.S., K.B.S., H.L.B., Z.M.G.), Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Melissa C Smallfield
- Division of Cardiology (K.G.R., M.C.S., K.B.S., H.L.B., Z.M.G.), Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Keyur B Shah
- Division of Cardiology (K.G.R., M.C.S., K.B.S., H.L.B., Z.M.G.), Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Mohammed A Quader
- Division of Cardiothoracic Surgery (M.A.Q.), Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Hem L Bhardwaj
- Division of Cardiology (K.G.R., M.C.S., K.B.S., H.L.B., Z.M.G.), Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Zachary M Gertz
- Division of Cardiology (K.G.R., M.C.S., K.B.S., H.L.B., Z.M.G.), Pauley Heart Center, Virginia Commonwealth University, Richmond
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22
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Darling CE, Martindale JL, Hiestand BC, Bonnell M, Colvin M, DeFilippis EM, Elliott T, Hamad E, Pinney SP, Shah KB, Vierecke J, Givertz MM. An Emergency Medicine-focused Summary of the HFSA/SAEM/ISHLT Clinical Consensus Document on the Emergency Management of Patients With Ventricular Assist Devices. Acad Emerg Med 2020; 27:618-629. [PMID: 32176420 DOI: 10.1111/acem.13964] [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] [Received: 11/14/2019] [Revised: 02/24/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
Mechanical circulatory support is increasingly used as a long-term treatment option for patients with end-stage heart failure. Patients with implanted ventricular assist devices are at high risk for a range of diverse medical urgencies and emergencies. Given the increasing prevalence of mechanical circulatory support devices, this expert clinical consensus document seeks to help inform emergency medicine and prehospital providers regarding the approach to acute medical and surgical conditions encountered in these complex patients.
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Affiliation(s)
- Chad E. Darling
- UMass Memorial Medical Center UMass Medical School Worcester MA
| | | | | | | | | | | | | | - Eman Hamad
- Temple University Hospital Philadelphia PA
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Whitaker-Lea WA, Toms B, Toms JB, Shah KB, Quader M, Tang D, Kasirajan V, Rivet DJ, Reavey-Cantwell JF. Neurologic Complications in Patients with Left Ventricular Assist Devices: Single Institution Retrospective Review. World Neurosurg 2020; 139:e635-e642. [DOI: 10.1016/j.wneu.2020.04.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 01/11/2023]
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Chau VQ, Flattery M, Nicholson KS, Mcdougan F, Gupta G, Uber P, Priday AG, Desai K, Kimball PM, Shah KB. Elevated AT1R Antibody and Morbidity in Patients Bridged to Heart Transplant Using Continuous Flow Left Ventricular Assist Devices. J Card Fail 2020; 26:959-967. [PMID: 32592894 DOI: 10.1016/j.cardfail.2020.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/13/2020] [Accepted: 06/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND We studied longitudinal levels of angiotensin-II type 1 receptor antibody (AT1R-Ab) and their effects on adverse events (death, treated rejection and cardiac allograft vasculopathy) in patients who were bridged to heart transplant using a continuous flow left ventricular assist device (LVAD). METHODS AND RESULTS Sera of 77 patients bridged to heart transplant (from 2009 to 2017) were tested for AT1R-Ab and CRP before and after LVAD. Elevated AT1R-Ab was defined as >10.0 U/mL. The median follow-up after transplant was 3.6 years (interquartile range, 2.2-5.6 years). After LVAD, AT1R-Ab levels increased from baseline and remained elevated until transplant. Freedom from adverse events at 5 years was lower in those with elevated AT1R-Ab levels at time of transplant. In an adjusted, multivariable Cox analysis, an AT1R-Ab level of >10 U/mL was associated with developing the primary end point (adjusted hazard ratio 3.4, 95% confidence interval 1.2-9.2, P = .017). Although C-reactive protein levels were high before and after LVAD placement, C-reactive protein did not correlate with AT1R-Ab. CONCLUSIONS In LVAD patients bridged to heart transplant, an increased AT1R-Ab level at time of transplant was associated with poor outcomes after heart transplant. Post-LVAD AT1R-Ab elevations were not correlated with serum markers of systemic inflammation. Larger studies are needed to examine the pathologic role of AT1R-Ab in heart transplant.
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Affiliation(s)
- Vinh Q Chau
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maureen Flattery
- Division of Cardiology, Department of Internal Medicine and Pauley Heart Center, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Kate S Nicholson
- Division of Cardiology, Department of Internal Medicine and Pauley Heart Center, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Felecia Mcdougan
- Department of Transplant Surgery and HLA Laboratory, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Gaurav Gupta
- Division of Nephrology, Department of Internal Medicine and Pauley Heart Center, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Patricia Uber
- Division of Cardiology, Department of Internal Medicine and Pauley Heart Center, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Anna G Priday
- Johnson Center for Critical Care Research, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Kevin Desai
- Department of Transplant Surgery and HLA Laboratory, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Pamela M Kimball
- Department of Transplant Surgery and HLA Laboratory, Virginia Commonwealth University Health Systems, Richmond, Virginia
| | - Keyur B Shah
- Division of Cardiology, Department of Internal Medicine and Pauley Heart Center, Virginia Commonwealth University Health Systems, Richmond, Virginia.
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Affiliation(s)
- Keyur B Shah
- The Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
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Shah KB, Bumma N, Gabriel A, Stevenson M, Cannon C, Khella S. GENETIC TESTING FOR HEREDITARY ATTR AMYLOIDOSIS: INSIGHTS FROM THE HATTR COMPASS PROGRAM. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31371-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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van Wezenbeek J, Canada JM, Ravindra K, Carbone S, Kadariya D, Trankle CR, Wohlford G, Buckley L, Del Buono MG, Billingsley H, Viscusi M, Tchoukina I, Shah KB, Arena R, Van Tassell B, Abbate A. Determinants of Cardiorespiratory Fitness in Patients with Heart Failure Across a Wide Range of Ejection Fractions. Am J Cardiol 2020; 125:76-81. [PMID: 31703805 DOI: 10.1016/j.amjcard.2019.09.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 08/05/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 12/23/2022]
Abstract
Impaired cardiorespiratory fitness (CRF) in heart failure (HF) is influenced by a complex array of cardiac and extracardiac factors. The study aimed to identify clinical determinants of CRF measured as peak oxygen consumption (peak VO2) in HF patients, and to determine a peak VO2 prediction model using regression equations. Retrospective analysis of 200 HF patients who completed treadmill cardiopulmonary exercise testing and underwent Doppler echocardiography and/or biomarker analysis on the same day was performed. After univariate linear regression analysis, a multivariate peak VO2 prediction model was developed using significant variables in a stepwise linear regression analysis. In subjects with repeated testing, Pearson's correlation was used to assess correlations between measured and predicted change in peak VO2 (Δpeak VO2) over time. Mean age was 57 years, with 55% being male. Stepwise linear regression was used to generate a weighted model for peak VO2: 30.895 + (-0.112•age[years]) + (0.296•hemoglobin [g/dl]) + (-0.101•E/e'[unit change]) + (-0.202• body mass index [kg/m2]) + (-0.593• N-terminal pro-brain natriuretic peptide [logN pg/ml])) + (-1.349•CRP [log mg/L]). Predicted peak VO2 correlated strongly with measured peak VO2 in HF with reduced ejection fraction and HF with preserved ejection fraction patients (r = +0.63, p <0.001; r = +0.64, p <0.001, respectively). Predicted Δpeak VO2 correlated with measured Δpeak VO2 (r = +0.23, p <0.001). In conclusion, in patients with HF across a wide range of left ventricular ejection fraction, age, systemic inflammation, oxygen carrying capacity, obesity, and elevated filling pressures are the strongest predictors of impaired CRF. The proposed CRF model allows prediction of peak VO2 in HF patients and may be used to estimate peak VO2 changes over time.
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Affiliation(s)
| | - Justin M Canada
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Krishna Ravindra
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Salvatore Carbone
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Dinesh Kadariya
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Cory R Trankle
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - George Wohlford
- Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Leo Buckley
- School of Pharmacy, Brigham and Women's Hospital, Boston, Massachusett
| | | | - Hayley Billingsley
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Michele Viscusi
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Inna Tchoukina
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Keyur B Shah
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Illinois
| | - Benjamin Van Tassell
- Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
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Tchoukina I, Shah KB, Thibodeau JT, Estep JD, Lala A, Lanfear DE, Gilotra NA, Pamboukian SV, Horstmanshof DA, Mcnamara DM, Haas DC, Jorde UP, Mclean RC, Cascino TM, Khalatbari S, Richards B, Yosef M, Spino C, Baldwin JT, Mann DL, Aaronson KD, Stewart GC. Impact of Socioeconomic Factors on Patient Desire for Early LVAD Therapy Prior to Inotrope Dependence. J Card Fail 2019; 26:316-323. [PMID: 31809791 DOI: 10.1016/j.cardfail.2019.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/11/2019] [Accepted: 11/26/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Worsening heart failure (HF) and health-related quality of life (HRQOL) have been shown to impact the decision to proceed with left ventricular assist device (LVAD) implantation, but little is known about how socioeconomic factors influence expressed patient preference for LVAD. METHODS AND RESULTS Ambulatory patients with advanced systolic HF (n=353) reviewed written information about LVAD therapy and completed a brief survey to indicate whether they would want an LVAD to treat their current level of HF. Ordinal logistic regression analyses identified clinical and demographic predictors of LVAD preference. Higher New York Heart Association (NYHA) class, worse HRQOL measured by Kansas City Cardiomyopathy Questionnaire, lower education level, and lower income were significant univariable predictors of patients wanting an LVAD. In the multivariable model, higher NYHA class (OR [odds ratio]: 1.43, CI [confidence interval]: 1.08-1.90, P = .013) and lower income level (OR: 2.10, CI: 1.18 - 3.76, P = .012 for <$40,000 vs >$80,000) remained significantly associated with wanting an LVAD. CONCLUSION Among ambulatory patients with advanced systolic HF, treatment preference for LVAD was influenced by level of income independent of HF severity. Understanding the impact of socioeconomic factors on willingness to consider LVAD therapy may help tailor counseling towards individual needs.
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Affiliation(s)
| | - Keyur B Shah
- Virginia Commonwealth University, Richmond, Virginia
| | | | | | - Anuradha Lala
- Mount Sinai Icahn School of Medicine, New York, New York
| | | | - Nisha A Gilotra
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Van Tassell B, Trankle CR, Kadariya D, Canada JM, Carbone S, Buckley LF, Wohlford GF, Dixon DL, Christopher S, Vo C, Mankad P, Dell M, Shah KB, Kontos MC, Abbate A. 5947Predictive role of C-reactive protein levels in patients with ST-segment elevation acute myocardial infarction for heart failure related events. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
ST-segment elevation myocardial infarction (STEMI) is associated with an intense acute inflammatory response and an increased risk of death and heart failure (HF). C-reactive protein (CRP) is the inflammatory biomarker most commonly used for risk stratification in patients with cardiovascular diseases. CRP levels are known to rise and fall during STEMI in response to myocardial injury. In this study, we analyzed whether admission CRP or delayed CRP (measured at 72 hours after admission) held a greater predictive value for adverse HF events in patients with STEMI.
Methods
We analyzed data from the VCUART3 clinical trial enrolling 99 patients with STEMI within 12 hours of presentation at 3 sites in the United States of America treated with anakinra or placebo. CRP levels were measured with a high-sensitivity assay at time of admission and again at 72 hours later. A dedicated committee composed of individuals not involved in the conduct of the trial adjudicated HF events including a composite endpoint of death from any reason or incidence of HF defined as new-onset HF requiring hospital admission or a new prescription for a loop diuretic (D+HF) and a composite endpoint of death and HF hospitalization (D+HHF) at 1 year. We used a time-dependent Cox-regression analysis to determine the association of CRP at admission or at 72 hours with the outcomes of interest in univariate and multivariate analysis. Data are presented as median and interquartile range. (ClinicalTrials NCT01950299)
Results
CRP levels from admission and 72 hours were available in 90 and 87 subjects respectively and they increased from 4.6 [2.8–8.5] mg/L to 11.6 [4.6–24.5] mg/L (P<0.001). Both admission CRP (CRP0) and CRP at 72 hours (CRP72) were associated with the risk of D+HF (P=0.011 and <0.001, respectively) and of D+HHF (P=0.010 and P<0.001, respectively); however at multivariate analysis, only CRP72 remained significantly associated with the risk of D+HF (P=0.001) and D+HHF (P=0.004) while CRP0 was not. CRP72 significantly correlated with NTproBNP levels at 72 hours (NTproBNP72, Spearman rho R=+0.37, P=0.001). NTproBNP72 predicted D+HF (P=0.030) but not independently of CRP72 (P=0.096 for NTproBNP72 and P=0.007 for CRP72 at multivariate analysis including the 2 variables). NTproBNP72 did not predict D-HHF.
Conclusions
Among contemporary patients with STEMI, the levels of CRP at 72 hours after admission was superior to admission CRP levels for predicting the incidence of HF events, and independent of NTproBNP levels. Our results indicate the importance of the inflammatory response during STEMI, supporting the concept of inhibiting the inflammatory response as a therapeutic strategy.
Acknowledgement/Funding
Funded by NHLBI 1R34HL121402; Drug supply from Swedish Orphan Biovitrum
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Affiliation(s)
- B Van Tassell
- Virginia Commonwealth University, Richmond, United States of America
| | - C R Trankle
- Virginia Commonwealth University, Richmond, United States of America
| | - D Kadariya
- Virginia Commonwealth University, Richmond, United States of America
| | - J M Canada
- Virginia Commonwealth University, Richmond, United States of America
| | - S Carbone
- Virginia Commonwealth University, Richmond, United States of America
| | - L F Buckley
- Brigham and Womens Hospital, Boston, United States of America
| | - G F Wohlford
- Virginia Commonwealth University, Richmond, United States of America
| | - D L Dixon
- Virginia Commonwealth University, Richmond, United States of America
| | - S Christopher
- Virginia Commonwealth University, Richmond, United States of America
| | - C Vo
- Virginia Commonwealth University, Richmond, United States of America
| | - P Mankad
- Virginia Commonwealth University, Richmond, United States of America
| | - M Dell
- Virginia Commonwealth University, Richmond, United States of America
| | - K B Shah
- Virginia Commonwealth University, Richmond, United States of America
| | - M C Kontos
- Virginia Commonwealth University, Richmond, United States of America
| | - A Abbate
- Virginia Commonwealth University, Richmond, United States of America
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Rudisill KG, Smallfield MC, Shah KB, Gertz ZM, Bhardwaj HL, Keller AJ, Quader MA. Transcatheter Aortic Valve Replacement Related Thrombosis in a Patient with a Left Ventricular Assist Device. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Givertz MM, DeFilippis EM, Colvin M, Darling CE, Elliott T, Hamad E, Hiestand BC, Martindale JL, Pinney SP, Shah KB, Vierecke J, Bonnell M. HFSA/SAEM/ISHLT Clinical Expert Consensus Document on the Emergency Management of Patients with Ventricular Assist Devices. J Card Fail 2019; 25:494-515. [DOI: 10.1016/j.cardfail.2019.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/17/2022]
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Trankle CR, Grizzard JD, Shah KB, Rezai Gharai L, Dana F, Kang MS, Andreae AE, Desai K, Quader MA, Gertz ZM. Left Ventricular Assist Device Outflow Graft Compression: Incidence, Clinical Associations and Potential Etiologies. J Card Fail 2019; 25:545-552. [PMID: 31085224 DOI: 10.1016/j.cardfail.2019.05.004] [Citation(s) in RCA: 15] [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: 01/01/2019] [Revised: 03/13/2019] [Accepted: 05/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) have revolutionized the treatment of advanced heart failure, but proliferation of device therapy has unmasked potential complications. Reports have emerged of outflow graft narrowing due to extrinsic compression. METHODS AND RESULTS The records of patients with LVADs that had been implanted at our institution were reviewed. Those who had postimplantation computed tomography angiographies sufficient to analyze the outflow graft lumen were identified, and the studies were analyzed to characterize the outflow graft lumen. We identified 241 patients; 110 (46%) had suitable computed tomography angiographies. Of those, 15 (14%) had evidence of outflow graft lumen narrowing, all in HeartMate devices and all within the portion covered by the bend relief. Of the 15, 3 underwent invasive examination, all without intraluminal thrombus but, rather, with biodebris between the bend relief and the outflow graft. Patients with HeartWare devices had a wide range of biodebris accumulation surrounding the outflow graft but no cases of lumen narrowing. On multivariable analysis, 1) time from device implant to scan, 2) nonischemic cardiomyopathy and 3) age at implant were significantly associated with higher risk of graft narrowing. CONCLUSION Outflow graft narrowing can be seen in a number of patients with HeartMate LVADs within the portion covered by the bend relief. In the limited number of patients who underwent invasive evaluation, the narrowing was found to arise from extrinsic compression rather than intraluminal thrombus. The clinical significance of this requires further investigation.
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Affiliation(s)
- Cory R Trankle
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John D Grizzard
- Department of Radiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Keyur B Shah
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Leila Rezai Gharai
- Department of Radiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Franklin Dana
- Department of Radiology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Matthew S Kang
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Andrew E Andreae
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kevin Desai
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mohammed A Quader
- Division of Cardiothoracic Surgery, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Zachary M Gertz
- Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.
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Abstract
Mechanical circulatory support (MCS) such as extracorporeal membrane oxygenation, left ventricular assist devices and total artificial hearts have altered the natural history of heart failure, and specialists in the fields of cardiology and cardiothoracic surgery are faced with more complex ethical considerations than ever before. Residency and fellowship training programs, however, do not have formal curricula in medical ethics as it applies to MCS. In response, this article proposes that ethics be integrated into graduate medical education with a focus on the following 6 constructs: patient best interest, respect for autonomy, informed consent, shared decision making, surrogate decision making, and end-of-life care. Curricula should offer learning experiences that help physicians navigate common ethical challenges encountered in practice.
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Affiliation(s)
- Elizabeth A Sonntag
- A pulmonary and critical care fellow at the University of North Carolina (UNC) at Chapel Hill and an alumna of the MacLean Center for Clinical Medical Ethics at the University of Chicago, and serves on the UNC Hospitals Ethics Committee and teaches an elective in medical ethics at the UNC School of Medicine
| | - Keyur B Shah
- Chief of the Section of Heart Failure and the medical director of the Mechanical Circulatory Support Program at the Virginia Commonwealth University Health Pauley Heart Center in Richmond, Virginia
| | - Jason N Katz
- An associate professor of medicine and surgery as well as the director of the Cardiovascular Critical Care, Mechanical Circulatory Support, and Cardiogenic Shock Program at the University of North Carolina at Chapel Hill
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Lim HS, Hsich E, Shah KB. International Society of Heart and Lung Transplantation position statement on the role of right heart catheterization in the management of heart transplant recipients. J Heart Lung Transplant 2018; 38:235-238. [PMID: 30638836 DOI: 10.1016/j.healun.2018.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 01/06/2023] Open
Affiliation(s)
- Hoong Sern Lim
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom.
| | | | - Keyur B Shah
- The Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Balderston JR, Shah KB, Paciulli SC, Gertz ZM. Usefulness of Estimated Plasma Volume at Postdischarge Follow-Up to Predict Recurrent Events in Patients With Heart Failure. Am J Cardiol 2018; 122:1191-1194. [PMID: 30241666 DOI: 10.1016/j.amjcard.2018.06.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 01/12/2023]
Abstract
Hospital readmission for patients admitted with heart failure is a persistent problem. Better identification of patients at high risk of readmission for volume overload could have clinical implications. We evaluated estimated plasma volume (ePV), a marker of congestion, to predict readmission for patients seen early after discharge for heart failure. We identified patients hospitalized with a primary heart failure diagnosis and were then seen in a postdischarge clinic. We assessed clinical factors, ePV (derived from hemoglobin and hematocrit), and B-type natriuretic peptide (BNP). The primary outcome was death or readmission for heart failure within 90 days of discharge. We identified 218 patients, of whom 23% experienced the primary outcome. No clinical variables at time of admission were different between those who did and did not experience the primary outcome, nor were BNP (1,581 vs 1,267 pg/ml, p = 0.33) or ePV (6.00 vs 5.80, p = 0.36). At clinic follow-up, both BNP (1,164 vs 636, p = 0.002) and ePV (6.18 vs 5.58, p = 0.02) were higher in those with subsequent events. Kaplan-Meier survival analysis showed that the lowest tertile of ePV had significantly lower incidence of the primary outcome than the other 2 tertiles (12% vs 29% and 27%, p = 0.02). Estimated plasma volume remained independently predictive of outcomes after controlling for BNP (p <0.05). In conclusion, EPV may be predictive of death or hospital readmission in heart failure patients seen soon after discharge, independent of BNP. Its potential warrants future prospective research evaluating its utility in larger heart failure cohorts.
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Affiliation(s)
- Jessica R Balderston
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA
| | - Keyur B Shah
- Division of Cardiology, Virginia Commonwealth University, Richmond, VA
| | - Sarah C Paciulli
- Division of Cardiology, Virginia Commonwealth University, Richmond, VA
| | - Zachary M Gertz
- Division of Cardiology, Virginia Commonwealth University, Richmond, VA.
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Shah KB, Starling RC, Rogers JG, Horstmanshof DA, Long JW, Kasirajan V, Stehlik J, Chuang J, Farrar DJ, Estep JD. Left ventricular assist devices versus medical management in ambulatory heart failure patients: An analysis of INTERMACS Profiles 4 and 5 to 7 from the ROADMAP study. J Heart Lung Transplant 2018; 37:706-714. [DOI: 10.1016/j.healun.2017.12.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/17/2017] [Accepted: 12/05/2017] [Indexed: 11/25/2022] Open
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Trankle CR, Quader MA, Grizzard JD, Tang DG, Shah KB, Paris K, Shepard CK, Gertz ZM. Internal Versus External Compression of a Left Ventricular Assist Device Outflow Graft. Circ Heart Fail 2018; 11:e004959. [DOI: 10.1161/circheartfailure.118.004959] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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)
| | | | - John D. Grizzard
- Pauley Heart Center and Department of Radiology (J.D.G.), Virginia Commonwealth University, Richmond
| | - Daniel G. Tang
- and Division of Cardiothoracic Surgery (M.A.Q., D.G.T., C.K.S.)
| | - Keyur B. Shah
- Division of Cardiology (C.R.T., K.B.S., K.P., Z.M.G.)
| | - Kendall Paris
- Division of Cardiology (C.R.T., K.B.S., K.P., Z.M.G.)
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Shah KB, Gunda S, Emani S, Kanwar MK, Uriel N, Colombo PC, Uber PA, Sears ML, Chuang J, Farrar DJ, Brophy DF, Smallfield GB. Multicenter Evaluation of Octreotide as Secondary Prophylaxis in Patients With Left Ventricular Assist Devices and Gastrointestinal Bleeding. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.004500. [DOI: 10.1161/circheartfailure.117.004500] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/19/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Keyur B. Shah
- From The Pauley Heart Center (K.B.S., S.G., P.A.U., M.L.S.), Department of Pharmacotherapy and Outcomes Research (D.F.B.), and Division of Gastroenterology (G.B.S.), Virginia Commonwealth University, Richmond; Division of Cardiovascular Medicine, The Ohio State University, Columbus (S.E.); McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA (M.K.K.); Division of Cardiology, University of Chicago, IL (N.U.); Division of Cardiology, Columbia University, New York, NY (P.C.C.)
| | - Sampath Gunda
- From The Pauley Heart Center (K.B.S., S.G., P.A.U., M.L.S.), Department of Pharmacotherapy and Outcomes Research (D.F.B.), and Division of Gastroenterology (G.B.S.), Virginia Commonwealth University, Richmond; Division of Cardiovascular Medicine, The Ohio State University, Columbus (S.E.); McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA (M.K.K.); Division of Cardiology, University of Chicago, IL (N.U.); Division of Cardiology, Columbia University, New York, NY (P.C.C.)
| | - Sitaramesh Emani
- From The Pauley Heart Center (K.B.S., S.G., P.A.U., M.L.S.), Department of Pharmacotherapy and Outcomes Research (D.F.B.), and Division of Gastroenterology (G.B.S.), Virginia Commonwealth University, Richmond; Division of Cardiovascular Medicine, The Ohio State University, Columbus (S.E.); McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA (M.K.K.); Division of Cardiology, University of Chicago, IL (N.U.); Division of Cardiology, Columbia University, New York, NY (P.C.C.)
| | - Manreet K. Kanwar
- From The Pauley Heart Center (K.B.S., S.G., P.A.U., M.L.S.), Department of Pharmacotherapy and Outcomes Research (D.F.B.), and Division of Gastroenterology (G.B.S.), Virginia Commonwealth University, Richmond; Division of Cardiovascular Medicine, The Ohio State University, Columbus (S.E.); McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA (M.K.K.); Division of Cardiology, University of Chicago, IL (N.U.); Division of Cardiology, Columbia University, New York, NY (P.C.C.)
| | - Nir Uriel
- From The Pauley Heart Center (K.B.S., S.G., P.A.U., M.L.S.), Department of Pharmacotherapy and Outcomes Research (D.F.B.), and Division of Gastroenterology (G.B.S.), Virginia Commonwealth University, Richmond; Division of Cardiovascular Medicine, The Ohio State University, Columbus (S.E.); McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA (M.K.K.); Division of Cardiology, University of Chicago, IL (N.U.); Division of Cardiology, Columbia University, New York, NY (P.C.C.)
| | - Paolo C. Colombo
- From The Pauley Heart Center (K.B.S., S.G., P.A.U., M.L.S.), Department of Pharmacotherapy and Outcomes Research (D.F.B.), and Division of Gastroenterology (G.B.S.), Virginia Commonwealth University, Richmond; Division of Cardiovascular Medicine, The Ohio State University, Columbus (S.E.); McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA (M.K.K.); Division of Cardiology, University of Chicago, IL (N.U.); Division of Cardiology, Columbia University, New York, NY (P.C.C.)
| | - Patricia A. Uber
- From The Pauley Heart Center (K.B.S., S.G., P.A.U., M.L.S.), Department of Pharmacotherapy and Outcomes Research (D.F.B.), and Division of Gastroenterology (G.B.S.), Virginia Commonwealth University, Richmond; Division of Cardiovascular Medicine, The Ohio State University, Columbus (S.E.); McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA (M.K.K.); Division of Cardiology, University of Chicago, IL (N.U.); Division of Cardiology, Columbia University, New York, NY (P.C.C.)
| | - Melissa L. Sears
- From The Pauley Heart Center (K.B.S., S.G., P.A.U., M.L.S.), Department of Pharmacotherapy and Outcomes Research (D.F.B.), and Division of Gastroenterology (G.B.S.), Virginia Commonwealth University, Richmond; Division of Cardiovascular Medicine, The Ohio State University, Columbus (S.E.); McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA (M.K.K.); Division of Cardiology, University of Chicago, IL (N.U.); Division of Cardiology, Columbia University, New York, NY (P.C.C.)
| | - Joyce Chuang
- From The Pauley Heart Center (K.B.S., S.G., P.A.U., M.L.S.), Department of Pharmacotherapy and Outcomes Research (D.F.B.), and Division of Gastroenterology (G.B.S.), Virginia Commonwealth University, Richmond; Division of Cardiovascular Medicine, The Ohio State University, Columbus (S.E.); McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA (M.K.K.); Division of Cardiology, University of Chicago, IL (N.U.); Division of Cardiology, Columbia University, New York, NY (P.C.C.)
| | - David J. Farrar
- From The Pauley Heart Center (K.B.S., S.G., P.A.U., M.L.S.), Department of Pharmacotherapy and Outcomes Research (D.F.B.), and Division of Gastroenterology (G.B.S.), Virginia Commonwealth University, Richmond; Division of Cardiovascular Medicine, The Ohio State University, Columbus (S.E.); McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA (M.K.K.); Division of Cardiology, University of Chicago, IL (N.U.); Division of Cardiology, Columbia University, New York, NY (P.C.C.)
| | - Donald F. Brophy
- From The Pauley Heart Center (K.B.S., S.G., P.A.U., M.L.S.), Department of Pharmacotherapy and Outcomes Research (D.F.B.), and Division of Gastroenterology (G.B.S.), Virginia Commonwealth University, Richmond; Division of Cardiovascular Medicine, The Ohio State University, Columbus (S.E.); McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA (M.K.K.); Division of Cardiology, University of Chicago, IL (N.U.); Division of Cardiology, Columbia University, New York, NY (P.C.C.)
| | - George B. Smallfield
- From The Pauley Heart Center (K.B.S., S.G., P.A.U., M.L.S.), Department of Pharmacotherapy and Outcomes Research (D.F.B.), and Division of Gastroenterology (G.B.S.), Virginia Commonwealth University, Richmond; Division of Cardiovascular Medicine, The Ohio State University, Columbus (S.E.); McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA (M.K.K.); Division of Cardiology, University of Chicago, IL (N.U.); Division of Cardiology, Columbia University, New York, NY (P.C.C.)
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Abstract
PURPOSE OF REVIEW Transthyretin (TTR)-related cardiac amyloidosis is a progressive infiltrative cardiomyopathy that mimics hypertensive, hypertrophic heart disease and may go undiagnosed. Transthyretin-derived amyloidosis accounts for 18% of all cases of cardiac amyloidosis. Thus, the study's purpose is to provide a comprehensive review of transthyretin cardiac amyloidosis. RECENT FINDINGS Wild-type transthyretin (ATTRwt) protein causes cardiac amyloidosis sporadically, with 25 to 36% of the population older than 80 years of age are at risk to develop a slowly progressive, infiltrative amyloid cardiomyopathy secondary to ATTRwt. In contrast, hereditary amyloidosis (ATTRm) is an autosomal dominant inherited disease associated with more than 100 point mutations in the transthyretin gene and has a tendency to affect the heart and nervous system. Up to 4% of African-Americans carry the Val122Ile mutation in the transthyretin gene, the most prevalent cause of hereditary cardiac amyloidosis in the USA. Identifying transthyretin cardiac amyloidosis requires increased awareness of the prevalence, signs and symptoms, and diagnostic tools available for discrimination of this progressive form of cardiomyopathy associated with left ventricular hypertrophy. While there are no FDA-approved medical treatments, investigation is underway on agents to reduce circulating mutated transthyretin.
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Affiliation(s)
- Anit K Mankad
- Division of Cardiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA.
| | - Keyur B Shah
- The Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
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Lanfear DE, Levy WC, Stehlik J, Estep JD, Rogers JG, Shah KB, Boyle AJ, Chuang J, Farrar DJ, Starling RC. Accuracy of Seattle Heart Failure Model and HeartMate II Risk Score in Non-Inotrope-Dependent Advanced Heart Failure Patients: Insights From the ROADMAP Study (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients). Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003745. [PMID: 28465311 DOI: 10.1161/circheartfailure.116.003745] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 03/29/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Timing of left ventricular assist device (LVAD) implantation in advanced heart failure patients not on inotropes is unclear. Relevant prediction models exist (SHFM [Seattle Heart Failure Model] and HMRS [HeartMate II Risk Score]), but use in this group is not established. METHODS AND RESULTS ROADMAP (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients) is a prospective, multicenter, nonrandomized study of 200 advanced heart failure patients not on inotropes who met indications for LVAD implantation, comparing the effectiveness of HeartMate II support versus optimal medical management. We compared SHFM-predicted versus observed survival (overall survival and LVAD-free survival) in the optimal medical management arm (n=103) and HMRS-predicted versus observed survival in all LVAD patients (n=111) using Cox modeling, receiver-operator characteristic (ROC) curves, and calibration plots. In the optimal medical management cohort, the SHFM was a significant predictor of survival (hazard ratio=2.98; P<0.001; ROC area under the curve=0.71; P<0.001) but not LVAD-free survival (hazard ratio=1.41; P=0.097; ROC area under the curve=0.56; P=0.314). SHFM showed adequate calibration for survival but overestimated LVAD-free survival. In the LVAD cohort, the HMRS had marginal discrimination at 3 (Cox P=0.23; ROC area under the curve=0.71; P=0.026) and 12 months (Cox P=0.036; ROC area under the curve=0.62; P=0.122), but calibration was poor, underestimating survival across time and risk subgroups. CONCLUSIONS In non-inotrope-dependent advanced heart failure patients receiving optimal medical management, the SHFM was predictive of overall survival but underestimated the risk of clinical worsening and LVAD implantation. Among LVAD patients, the HMRS had marginal discrimination and underestimated survival post-LVAD implantation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01452802.
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Affiliation(s)
- David E Lanfear
- From Henry Ford Hospital, Detroit, MI (D.E.L.); University of Washington, Seattle, WA (W.C.L.); University of Utah, Salt Lake City (J.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); Virginia Commonwealth University, Richmond (K.B.S.); Thomas Jefferson University, University Hospital, Philadelphia, PA (A.J.B.); St. Jude Medical, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.).
| | - Wayne C Levy
- From Henry Ford Hospital, Detroit, MI (D.E.L.); University of Washington, Seattle, WA (W.C.L.); University of Utah, Salt Lake City (J.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); Virginia Commonwealth University, Richmond (K.B.S.); Thomas Jefferson University, University Hospital, Philadelphia, PA (A.J.B.); St. Jude Medical, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Josef Stehlik
- From Henry Ford Hospital, Detroit, MI (D.E.L.); University of Washington, Seattle, WA (W.C.L.); University of Utah, Salt Lake City (J.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); Virginia Commonwealth University, Richmond (K.B.S.); Thomas Jefferson University, University Hospital, Philadelphia, PA (A.J.B.); St. Jude Medical, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Jerry D Estep
- From Henry Ford Hospital, Detroit, MI (D.E.L.); University of Washington, Seattle, WA (W.C.L.); University of Utah, Salt Lake City (J.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); Virginia Commonwealth University, Richmond (K.B.S.); Thomas Jefferson University, University Hospital, Philadelphia, PA (A.J.B.); St. Jude Medical, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Joseph G Rogers
- From Henry Ford Hospital, Detroit, MI (D.E.L.); University of Washington, Seattle, WA (W.C.L.); University of Utah, Salt Lake City (J.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); Virginia Commonwealth University, Richmond (K.B.S.); Thomas Jefferson University, University Hospital, Philadelphia, PA (A.J.B.); St. Jude Medical, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Keyur B Shah
- From Henry Ford Hospital, Detroit, MI (D.E.L.); University of Washington, Seattle, WA (W.C.L.); University of Utah, Salt Lake City (J.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); Virginia Commonwealth University, Richmond (K.B.S.); Thomas Jefferson University, University Hospital, Philadelphia, PA (A.J.B.); St. Jude Medical, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Andrew J Boyle
- From Henry Ford Hospital, Detroit, MI (D.E.L.); University of Washington, Seattle, WA (W.C.L.); University of Utah, Salt Lake City (J.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); Virginia Commonwealth University, Richmond (K.B.S.); Thomas Jefferson University, University Hospital, Philadelphia, PA (A.J.B.); St. Jude Medical, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Joyce Chuang
- From Henry Ford Hospital, Detroit, MI (D.E.L.); University of Washington, Seattle, WA (W.C.L.); University of Utah, Salt Lake City (J.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); Virginia Commonwealth University, Richmond (K.B.S.); Thomas Jefferson University, University Hospital, Philadelphia, PA (A.J.B.); St. Jude Medical, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - David J Farrar
- From Henry Ford Hospital, Detroit, MI (D.E.L.); University of Washington, Seattle, WA (W.C.L.); University of Utah, Salt Lake City (J.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); Virginia Commonwealth University, Richmond (K.B.S.); Thomas Jefferson University, University Hospital, Philadelphia, PA (A.J.B.); St. Jude Medical, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Randall C Starling
- From Henry Ford Hospital, Detroit, MI (D.E.L.); University of Washington, Seattle, WA (W.C.L.); University of Utah, Salt Lake City (J.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); Virginia Commonwealth University, Richmond (K.B.S.); Thomas Jefferson University, University Hospital, Philadelphia, PA (A.J.B.); St. Jude Medical, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
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Tita C, Gilbert EM, Van Bakel AB, Grzybowski J, Haas GJ, Jarrah M, Dunlap SH, Gottlieb SS, Klapholz M, Patel PC, Pfister R, Seidler T, Shah KB, Zieliński T, Venuti RP, Cowart D, Foo SY, Vishnevsky A, Mitrovic V. A Phase 2a dose-escalation study of the safety, tolerability, pharmacokinetics and haemodynamic effects of BMS-986231 in hospitalized patients with heart failure with reduced ejection fraction. Eur J Heart Fail 2017; 19:1321-1332. [PMID: 28677877 PMCID: PMC6607490 DOI: 10.1002/ejhf.897] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 12/28/2022] Open
Abstract
Aims This study was designed to evaluate the safety, tolerability and haemodynamic effects of BMS‐986231, a novel second‐generation nitroxyl donor with potential inotropic, lusitropic and vasodilatory effects in patients hospitalized with decompensated heart failure and reduced ejection fraction (HFrEF). Methods and results Forty‐six patients hospitalized with decompensated HFrEF were enrolled into four sequential dose‐escalation cohorts in this double‐blind, randomized, placebo‐controlled Phase 2a study. Patients with baseline pulmonary capillary wedge pressure (PCWP) of ≥20 mmHg and a cardiac index of ≤2.5 L/min/m2 received one 6‐h i.v. infusion of BMS‐986231 (at 3, 5, 7 or 12 µg/kg/min) or placebo. BMS‐986231 produced rapid and sustained reductions in PCWP, as well as consistent reductions in time‐averaged pulmonary arterial systolic pressure, pulmonary arterial diastolic pressure and right atrial pressure. BMS‐986231 increased non‐invasively measured time‐averaged stroke volume index, cardiac index and cardiac power index values, and decreased total peripheral vascular resistance. There was no evidence of increased heart rate, drug‐related arrhythmia or symptomatic hypotension with BMS‐986231. Analyses of adverse events throughout the 30‐day follow‐up did not identify any toxicities specific to BMS‐986231, with the potential exception of infrequent mild‐to‐moderate headaches during infusion. There were no treatment‐related serious adverse events. Conclusions BMS‐986231 demonstrated a favourable safety and haemodynamic profile in patients hospitalized with advanced heart failure. Based on preclinical data and these study's findings, it is possible that the haemodynamic benefits may be mediated by inotropic and/or lusitropic as well as vasodilatory effects. The therapeutic potential of BMS‐986231 should be further assessed in patients with heart failure.
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Affiliation(s)
- Cristina Tita
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Edward M Gilbert
- Division of Cardiology, Faculty of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Adrian B Van Bakel
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jacek Grzybowski
- Department of Cardiomyopathy, Institute of Cardiology, Warsaw, Poland
| | - Garrie J Haas
- Division of Cardiology and Vascular Medicine, Faculty of Medicine, Ohio State University, Columbus, OH, USA
| | - Mohammad Jarrah
- Department of Cardiology, King Abdullah University Hospital, Irbid, Jordan
| | - Stephanie H Dunlap
- Division of Cardiology, Faculty of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Stephen S Gottlieb
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marc Klapholz
- Division of Cardiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Parag C Patel
- Department of Transplant, Mayo Clinic, Jacksonville, FL, USA
| | - Roman Pfister
- Department III of Internal Medicine, Heart Centre, University Hospital of Cologne, Cologne, Germany
| | - Tim Seidler
- Division of Cardiology and Pulmonology, Medical University of Göttingen, Göttingen, Germany
| | - Keyur B Shah
- Department of Cardiology, Faculty of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Tomasz Zieliński
- Department of Heart Failure and Transplantology, Institute of Cardiology, Warsaw, Poland
| | - Robert P Venuti
- formerly of Cardioxyl Pharmaceuticals, Inc., Chapel Hill, NC, USA
| | - Douglas Cowart
- formerly of Cardioxyl Pharmaceuticals, Inc., Chapel Hill, NC, USA
| | - Shi Yin Foo
- formerly of Cardioxyl Pharmaceuticals, Inc., Chapel Hill, NC, USA
| | - Alexander Vishnevsky
- Intensive Care Unit, Cardiology Department, Pokrovskaya City Hospital, St Petersburg, Russia
| | - Veselin Mitrovic
- Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
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Shah KB, Mankad AK, Castano A, Akinboboye OO, Duncan PB, Fergus IV, Maurer MS. Transthyretin Cardiac Amyloidosis in Black Americans. Circ Heart Fail 2017; 9:e002558. [PMID: 27188913 DOI: 10.1161/circheartfailure.115.002558] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 02/10/2016] [Indexed: 12/20/2022]
Abstract
Transthyretin-related cardiac amyloidosis is a progressive infiltrative cardiomyopathy that mimics hypertensive and hypertrophic heart disease and often goes undiagnosed. In the United States, the hereditary form disproportionately afflicts black Americans, who when compared with whites with wild-type transthyretin amyloidosis, a phenotypically similar condition, present with more advanced disease despite having a noninvasive method for early identification (genetic testing). Although reasons for this are unclear, this begs to consider the inadequate access to care, societal factors, or a biological basis. In an effort to improve awareness and explore unique characteristics, we review the pathophysiology, epidemiology, and therapeutic strategies for transthyretin amyloidosis and highlight diagnostic pitfalls and clinical pearls for identifying patients with amyloid heart disease.
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Affiliation(s)
- Keyur B Shah
- From the Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond (K.B.S., A.K.M., P.B.D.); Division of Cardiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA (A.K.M.); Division of Cardiology, Columbia University Medical Center, New York, NY (A.C., M.S.M.); Queens Heart Institute, Rosedale, NY (O.O.A.); Cardiac Health Management Network, Chester, VA (P.B.D.); and Division of Cardiology, Mount Sinai Medical Center, New York, NY (I.V.F.).
| | - Anit K Mankad
- From the Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond (K.B.S., A.K.M., P.B.D.); Division of Cardiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA (A.K.M.); Division of Cardiology, Columbia University Medical Center, New York, NY (A.C., M.S.M.); Queens Heart Institute, Rosedale, NY (O.O.A.); Cardiac Health Management Network, Chester, VA (P.B.D.); and Division of Cardiology, Mount Sinai Medical Center, New York, NY (I.V.F.)
| | - Adam Castano
- From the Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond (K.B.S., A.K.M., P.B.D.); Division of Cardiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA (A.K.M.); Division of Cardiology, Columbia University Medical Center, New York, NY (A.C., M.S.M.); Queens Heart Institute, Rosedale, NY (O.O.A.); Cardiac Health Management Network, Chester, VA (P.B.D.); and Division of Cardiology, Mount Sinai Medical Center, New York, NY (I.V.F.)
| | - Olakunle O Akinboboye
- From the Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond (K.B.S., A.K.M., P.B.D.); Division of Cardiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA (A.K.M.); Division of Cardiology, Columbia University Medical Center, New York, NY (A.C., M.S.M.); Queens Heart Institute, Rosedale, NY (O.O.A.); Cardiac Health Management Network, Chester, VA (P.B.D.); and Division of Cardiology, Mount Sinai Medical Center, New York, NY (I.V.F.)
| | - Phillip B Duncan
- From the Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond (K.B.S., A.K.M., P.B.D.); Division of Cardiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA (A.K.M.); Division of Cardiology, Columbia University Medical Center, New York, NY (A.C., M.S.M.); Queens Heart Institute, Rosedale, NY (O.O.A.); Cardiac Health Management Network, Chester, VA (P.B.D.); and Division of Cardiology, Mount Sinai Medical Center, New York, NY (I.V.F.)
| | - Icilma V Fergus
- From the Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond (K.B.S., A.K.M., P.B.D.); Division of Cardiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA (A.K.M.); Division of Cardiology, Columbia University Medical Center, New York, NY (A.C., M.S.M.); Queens Heart Institute, Rosedale, NY (O.O.A.); Cardiac Health Management Network, Chester, VA (P.B.D.); and Division of Cardiology, Mount Sinai Medical Center, New York, NY (I.V.F.)
| | - Mathew S Maurer
- From the Pauley Heart Center, Division of Cardiology, Virginia Commonwealth University, Richmond (K.B.S., A.K.M., P.B.D.); Division of Cardiology, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA (A.K.M.); Division of Cardiology, Columbia University Medical Center, New York, NY (A.C., M.S.M.); Queens Heart Institute, Rosedale, NY (O.O.A.); Cardiac Health Management Network, Chester, VA (P.B.D.); and Division of Cardiology, Mount Sinai Medical Center, New York, NY (I.V.F.)
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Houston BA, Shah KB, Mehra MR, Tedford RJ. A new “twist” on right heart failure with left ventricular assist systems. J Heart Lung Transplant 2017; 36:701-707. [DOI: 10.1016/j.healun.2017.03.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/22/2017] [Indexed: 12/31/2022] Open
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Stehlik J, Estep JD, Selzman CH, Rogers JG, Spertus JA, Shah KB, Chuang J, Farrar DJ, Starling RC. Patient-Reported Health-Related Quality of Life Is a Predictor of Outcomes in Ambulatory Heart Failure Patients Treated With Left Ventricular Assist Device Compared With Medical Management. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003910. [DOI: 10.1161/circheartfailure.116.003910] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/08/2017] [Indexed: 11/16/2022]
Abstract
Background—
The prospective observational ROADMAP study (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management) demonstrated that ambulatory advanced heart failure patients selected for left ventricular assist device (LVAD) were more likely to be alive at 1 year on original therapy with ≥75-m improvement in 6-minute walk distance compared with patients assigned to optimal medical management. Whether baseline health-related quality of life (hrQoL) resulted in a heterogeneity of this treatment benefit is unknown.
Methods and Results—
Patient-reported hrQoL was assessed with EuroQol questionnaire and visual analogue scale (VAS). We aimed to identify predictors of event-free survival and survival with acceptable hrQoL (VAS≥60). LVAD patients had significant improvement in 3 of 5 EuroQol dimensions (
P
<0.05), but no significant changes were observed with optimal medical management. Among patients with baseline VAS<55, survival on original treatment was lower for optimal medical management patients compared with those assigned to LVAD (58±7% versus 82±5%;
P
=0.004). No such difference was seen if baseline VAS was ≥55 (70±7% versus 75±9%;
P
=0.79). Survival on original therapy with acceptable quality of life was also more likely with LVAD versus optimal medical management if baseline VAS was <55, whereas outcomes in patients with higher baseline VAS scores were similar regardless of treatment assignment (
P
=0.046 for treatment arm and baseline VAS interaction).
Conclusions—
LVAD therapy resulted in improvement of patient health status in heart failure patients with low self-reported hrQoL, but not in patients with acceptable quality of life at the time of LVAD implantation. Patient-reported hrQoL should be integrated into decision making concerning the use and timing of LVAD therapy in heart failure patients who are symptom limited but remain ambulatory.
Clinical Trial Registration—
URL:
http://www.ClinicalTrials.gov
. Unique identifier: NCT01452802.
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Affiliation(s)
- Josef Stehlik
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Jerry D. Estep
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Craig H. Selzman
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Joseph G. Rogers
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - John A. Spertus
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Keyur B. Shah
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Joyce Chuang
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - David J. Farrar
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
| | - Randall C. Starling
- From the University of Utah, Salt Lake City (J.S., C.H.S.); Houston Methodist Hospital, TX (J.D.E.); Duke University, Durham, NC (J.G.R.); University of Missouri–Kansas City and Saint Luke’s Mid America Heart Institute, Kansas City, MO (J.A.S.); Virginia Commonwealth University, Richmond (K.B.S.); Abbott, Pleasanton, CA (J.C., D.J.F.); and Cleveland Clinic, OH (R.C.S.)
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Hidalgo LF, Shah KB, Cooke RH, Tang DG, Kasirajan V, Cooper HA, Aronow WS. Infections in Patients with a Total Artificial Heart Are Common but Rarely Fatal. ASAIO J 2017; 63:736-739. [PMID: 28319520 DOI: 10.1097/mat.0000000000000562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Patients who received a total artificial heart (TAH) at Virginia Commonwealth University (VCU) between January 1, 2010 and December 31, 2011 were identified from the VCU Mechanical Circulatory Support Clinical Database. Retrospective data extraction from the medical records was performed from the time of TAH implantation until heart transplantation or death. Infections were classified as confirmed or suspected. Twenty-seven men and five women, mean age 49.5 years (range 24-68 years) received a TAH. The mean duration of TAH support was 225 days (range 1-1,334 days). Of the 32 patients, 4 (12.5%) died and 28 (87.5 %) underwent heart transplantation. Causes of death were pneumonia (n = 1), TAH malfunction (n = 1), refractory cardiogenic shock (n = 1), and respiratory failure (n = 1). Seventy documented and 13 suspected infections developed in 25 patients (78%). The most common sources of infection were urinary tract (n = 26), respiratory tract (n = 18), and bloodstream (n = 11). There were five pump infections and two driveline infections. The number of infections per patient ranged from 0 to 10. Sixteen different pathogens were identified; the most common were: Klebsiella pneumoniae (n = 15), coagulase-negative Staphylococci (n = 10), Enterococcus species (n = 9), and Enterobacter species (n = 8). Mortality directly attributable to infection was infrequent.
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Affiliation(s)
- Luis F Hidalgo
- From the *Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York; †Department of Medicine, Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond, Virginia; and ‡Department of Surgery, Division of Cardiothoracic Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Shah KB, Thanavaro KL, Tang DG, Quader MA, Mankad AK, Tchoukina I, Thacker LR, Smallfield MC, Katlaps G, Hess ML, Cooke RH, Kasirajan V. Impact of INTERMACS Profile on Clinical Outcomes for Patients Supported With the Total Artificial Heart. J Card Fail 2016; 22:913-920. [DOI: 10.1016/j.cardfail.2016.04.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 03/23/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
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Quader MA, Green AJ, Shah KB, Cooke R, Kasirajan V. Hospital readmissions after discharge to home with the Total Artificial Heart Freedom driver: Readmission reasons, clinical outcomes, and health care costs. J Heart Lung Transplant 2016; 35:251-2. [DOI: 10.1016/j.healun.2015.10.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 09/03/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022] Open
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Abstract
The total artificial heart (TAH) is a form of mechanical circulatory support in which the patient's native ventricles and valves are explanted and replaced by a pneumatically powered artificial heart. Currently, the TAH is approved for use in end-stage biventricular heart failure as a bridge to heart transplantation. However, with an increasing global burden of cardiovascular disease and congestive heart failure, the number of patients with end-stage heart failure awaiting heart transplantation now far exceeds the number of available hearts. As a result, the use of mechanical circulatory support, including the TAH and left ventricular assist device (LVAD), is growing exponentially. The LVAD is already widely used as destination therapy, and destination therapy for the TAH is under investigation. While most patients requiring mechanical circulatory support are effectively treated with LVADs, there is a subset of patients with concurrent right ventricular failure or major structural barriers to LVAD placement in whom TAH may be more appropriate. The history, indications, surgical implantation, post device management, outcomes, complications, and future direction of the TAH are discussed in this review.
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Affiliation(s)
- Jason A Cook
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Keyur B Shah
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Mohammed A Quader
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Richard H Cooke
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Vigneshwar Kasirajan
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Kris K Rao
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Melissa C Smallfield
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Inna Tchoukina
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Daniel G Tang
- Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, VA, USA
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