1
|
Rowin EJ, Wadid M, Maron MS, White M, Hook BG, Harnish P, Silver JS, Reynolds MR, Maron BJ. Assessing the impact of atrial fibrillation on symptoms and quality of life in hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 2024; 35:654-663. [PMID: 38288888 DOI: 10.1111/jce.16192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION In hypertrophic cardiomyopathy (HCM), atrial fibrillation (AF) has historically been regarded to have a deleterious impact on clinical course, strongly associated with progressive heart failure (HF) symptoms. However, there is a paucity of information regarding the impact of AF on HCM employing validated quality of life (QoL) surveys. Therefore, we evaluated the impact of AF on QoL utilizing patient reported outcome measures (PROMs). METHODS 218 consecutive HCM patients with or without AF at the Lahey HCM center in 2022 completed PROMs at their most recent visit evaluating HF (Kansas City Cardiomyopathy Questionnaire [KCCQ]) and AF symptoms (AF Effect on QoL [AFEQT]). RESULTS Among the 218 patients, 50 (23%) had a history of AF and comprise the primary study cohort. AF was diagnosed at 55 ± 10 years of age, median of 5.5 years before PROM, with 66% of patients treated with a rhythm control strategy with antiarrhythmic drug and/or AF ablation. AFEQT indicated that 52% of patients experienced no or minimal AF-related disability, mild to moderate in 22%, and severe in 26%. There was no substantial difference in HCM phenotype in patients with no or minimal AF disability compared to those with severe disability. HF symptoms for most HCM patients with prior AF history was consistent with no or minimal (59%) or only mild (27%) disability as measured by KCCQ overall summary scores. In addition, with multivariate analysis, AF history was associated with less HF symptoms and improved QoL (OR 0.4, p = 0.02). CONCLUSION In contrast to prior perceptions, HCM patients with prior AF history were less likely to incur HF symptoms impairing QoL compared to HCM patients without AF. After treatment, prior history of AF did not substantially impact current QoL. These data provide a realistic appraisal for the impact that AF has on HCM patients and also offers a measure of reassurance for this patient subgroup.
Collapse
Affiliation(s)
- Ethan J Rowin
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Mark Wadid
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Maggie White
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Bruce G Hook
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Paul Harnish
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Jonathan S Silver
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Matthew R Reynolds
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| |
Collapse
|
2
|
Reynolds MR, Passman R, Swindle J, Mohammadi I, Wright B, Boyle K, Turakhia MP, Mittal S. Comparative effectiveness and healthcare utilization for ambulatory cardiac monitoring strategies in Medicare beneficiaries. Am Heart J 2024; 269:25-34. [PMID: 38072334 DOI: 10.1016/j.ahj.2023.12.002] [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] [Received: 07/21/2023] [Revised: 11/19/2023] [Accepted: 12/04/2023] [Indexed: 01/02/2024]
Abstract
BACKGROUND Objective data comparing the diagnostic performance of different ambulatory cardiac monitors (ACMs) are lacking. OBJECTIVES To assess variation in monitoring strategy, clinical outcomes and healthcare utilization in patients undergoing ambulatory monitoring without a pre-existing arrhythmia diagnosis. METHODS Using the full sample (100%) of Medicare claims data, we performed a retrospective cohort study of diagnostic-naïve patients who received first-time ACM in 2017 to 2018 and evaluated arrhythmia encounter diagnosis at 3-months, repeat ACM testing at 6 months, all-cause 90-day emergency department (ED) and inpatient utilization, and cost of different strategies: Holter; long-term continuous monitor (LTCM); non-continuous, event-based external ambulatory event monitor (AEM); and mobile cardiac telemetry (MCT). We secondarily performed a device-specific analysis by manufacturer, identified from unique claim modifier codes. RESULTS ACMs were used in 287,789 patients (AEM = 10.3%; Holter = 53.8%; LTCM = 13.3%; MCT = 22.5%). Device-specific analysis showed that compared to Holter, AEM, MCT, or other LTCM manufacturers, a specific LTCM (ZioⓇ XT 14-day patch, iRhythm Technologies, San Francisco, CA) had the highest adjusted odds of diagnosis and lowest adjusted odds of ACM retesting. Findings were consistent for specific arrhythmia diagnoses of ventricular tachycardia, atrioventricular block, and paroxysmal atrial fibrillation. As a category, LTCM was associated with the lowest 1-year incremental health care expenditures (mean Δ$10,159), followed by Holter ($10,755), AEM ($11,462), and MCT ($12,532). CONCLUSIONS There was large variation in diagnostic monitoring strategy. A specific LTCM was associated with the highest adjusted odds of a new arrhythmia diagnosis and lowest adjusted odds of repeat ACM testing. LTCM as a category had the lowest incremental acute care utilization. Different monitoring strategies may produce different results with respect to diagnosis and care.
Collapse
Affiliation(s)
| | - Rod Passman
- Northwestern University School of Medicine, Chicago, IL
| | | | | | | | | | | | | |
Collapse
|
3
|
Maher TR, Raza AS, Tapias C, Garcia F, Reynolds MR, Chaudry GM, Saenz LC, Valderrábano M, d'Avila A. Ventricular septal defect as a complication of bipolar radiofrequency ablation for ventricular tachycardia. Heart Rhythm 2024:S1547-5271(24)00106-1. [PMID: 38309450 DOI: 10.1016/j.hrthm.2024.01.052] [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] [Received: 12/19/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Affiliation(s)
- Timothy R Maher
- Harvard Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Adnan S Raza
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Carlos Tapias
- Internacional Arrhythmia Center at Cardioinfantil Foundation, Bogota, Colombia
| | - Fermin Garcia
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew R Reynolds
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - G Muqtada Chaudry
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Luis C Saenz
- Internacional Arrhythmia Center at Cardioinfantil Foundation, Bogota, Colombia
| | - Miguel Valderrábano
- Houston Methodist DeBakey Heart and Vascular Center and Research Institute, Houston, Texas
| | - Andre d'Avila
- Harvard Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
4
|
Weinfurter JT, Bennett SN, Reynolds MR. A SMART method for isolating monoclonal antibodies from individual rhesus macaque memory B cells. J Immunol Methods 2024; 525:113602. [PMID: 38103783 PMCID: PMC10842827 DOI: 10.1016/j.jim.2023.113602] [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: 06/09/2023] [Revised: 11/07/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Abstract
Characterizing antigen-specific B cells is a critical component of vaccine and infectious disease studies in rhesus macaques (RMs). However, it is challenging to capture immunoglobulin variable (IgV) genes from individual RM B cells using 5' multiplex (MTPX) primers in nested PCR reactions. In particular, the diversity within RM IgV gene leader sequences necessitates large 5' MTPX primer sets to amplify IgV genes, decreasing PCR efficiency. To address this problem, we developed a switching mechanism at the 5' ends of the RNA transcript (SMART)-based method for amplifying IgV genes from single RM B cells to capture Ig heavy and light chain pairs. We demonstrate this technique by isolating simian immunodeficiency virus (SIV) envelope-specific antibodies from single-sorted RM memory B cells. This approach has several advantages over existing methods for cloning antibodies from RMs. First, optimized PCR conditions and SMART 5' and 3' rapid amplification of cDNA ends (RACE) reactions generate full-length cDNAs from individual B cells. Second, it appends synthetic primer binding sites to the 5' and 3' ends of cDNA during synthesis, allowing for PCR amplification of low-abundance antibody templates. Third, the nested PCR primer mixes are simplified by employing universal 5' primers, eliminating the need for complex 5' MTPX primer sets. We anticipate this method will enhance the isolation of antibodies from individual RM B cells, supporting the genetic and functional characterization of antigen-specific B cells.
Collapse
Affiliation(s)
- Jason T Weinfurter
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, United States of America
| | - Sarah N Bennett
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, United States of America
| | - Matthew R Reynolds
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, United States of America; Wisconsin National Primate Research Center, University of Wisconsin, Madison, WI, United States of America.
| |
Collapse
|
5
|
Reynolds MR, Stein AB, Sun X, Hytopoulos E, Steinhubl SR, Cohen DJ. Cost-Effectiveness of AF Screening With 2-Week Patch Monitors: The mSToPS Study. Circ Cardiovasc Qual Outcomes 2023; 16:e009751. [PMID: 37905421 PMCID: PMC10659247 DOI: 10.1161/circoutcomes.122.009751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 08/07/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND The mSToPS study (mHealth Screening to Prevent Strokes) reported screening older Americans at risk for atrial fibrillation (AF) and stroke using 2-week patch monitors was associated with increased rates of AF diagnosis and anticoagulant prescription within 1 year and improved clinical outcomes at 3 years relative to matched controls. Cost-effectiveness of this AF screening approach has not been explored. METHODS We conducted a US-based health economic analysis of AF screening using patient-level data from mSToPS. Clinical outcomes, resource use, and costs were obtained through 3 years using claims data. Individual costs, survival, and quality-adjusted life years (QALYs) were projected over a lifetime horizon using regression modeling, US life tables, and external data where needed. Adjustment between groups was performed using propensity score bin bootstrapping. RESULTS Screening participants (mean age, 74 years, 41% female, median CHA2DS2-VASC score 3) wore on average 1.7 two-week monitors at a mean cost of $614/person. Over 3 years, outpatient visits were more frequent for monitored than unmonitored individuals (difference 190 per 100 patient-years [95% CI, 82-298]), but emergency department visits (-8.3 [95% CI, -12.6 to -4.1]) and hospitalizations (-15.2 [CI, -22 to -8.6]) were less frequent. Total adjusted 3-year costs were slightly higher (mean difference, $1551 [95% CI, -$1047 to $4038]) in the monitoring group. In patient-level projections, the monitoring group had slightly greater quality-adjusted survival (8.81 versus 8.71 QALYs, difference, 0.09 [95% CI, -0.05 to 0.24]) and slightly higher lifetime costs, resulting in an incremental cost-effectiveness ratio of $36 100/QALY gained. With bootstrap resampling, the incremental cost-effectiveness ratio for monitoring was <$50 000/QALY in 64% of study replicates, and <$150 000/QALY in 91%. CONCLUSIONS Using lifetime projections derived from the mSToPS study, we found that AF screening using 2-week patch monitors in older Americans was associated with high economic value. Confirmation of these uncertain findings in a randomized trial is warranted. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02506244.
Collapse
Affiliation(s)
- Matthew R. Reynolds
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, MA (M.R.R.)
| | | | - Xiaowu Sun
- CVS Health, Woonsocket, RI (A.B.S., X.S.)
| | | | | | - David J. Cohen
- Cardiovascular Research Foundation, New York, NY (D.J.C.)
- St. Francis Hospital and Heart Center, Roslyn, New York, NY (D.J.C.)
| |
Collapse
|
6
|
Abu-Qaoud MR, Kumar A, Tarun T, Abraham S, Ahmad J, Khadke S, Husami R, Kulbak G, Sahoo S, Januzzi JL, Neilan TG, Baron SJ, Martin D, Nohria A, Reynolds MR, Kosiborod M, Dani SS, Ganatra S. Impact of SGLT2 Inhibitors on AF Recurrence After Catheter Ablation in Patients With Type 2 Diabetes. JACC Clin Electrophysiol 2023; 9:2109-2118. [PMID: 37565953 DOI: 10.1016/j.jacep.2023.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The effects of sodium-glucose cotransporter 2 inhibitors (SGLT2-Is) on recurrent atrial fibrillation (AF) among patients undergoing catheter ablation is not well described. OBJECTIVES This study sought to assess the impact of SGLT2-Is on the recurrence of AF among patients with type 2 diabetes mellitus (DM) after catheter ablation. METHODS Using the TriNetX research network, we identified, by means of Current Procedural Terminology codes, patients ≥18 years of age with type 2 diabetes mellitus (DM) who had undergone AF ablation from April 1, 2014, to November 30, 2021. Patients were stratified based on the baseline SGLT2-I use. Propensity-score matching resulted in 2,225 patients in each cohort. The primary outcome was a composite of cardioversion, new antiarrhythmic drug (AAD) therapy, or re-do AF ablation after a blanking period after the index ablation. Additional outcomes included heart failure exacerbations, ischemic stroke, all-cause hospitalization, and death during 12 months of follow-up. RESULTS SGLT2-I use in patients with type 2 DM undergoing AF ablation was associated with a significantly lower risk of cardioversion, new AAD therapy, and re-do AF ablation (adjusted OR: 0.68; 95% CI: 0.602-0.776; P < 0.0001). At 12 months, patients on SGLT2-Is had a higher probability of event-free survival (HR: 0.85, 95% CI: 0.77-0.95; log-rank test chi-square = 8.7; P = 0.003). All secondary outcomes were lower in the SGLT2I group; however, the ischemic stroke did not differ between groups. CONCLUSIONS Use of SGLT2-Is in patients with type 2 DM is associated with a lower risk of arrhythmia recurrence after AF ablation and thence a reduced need for cardioversion, AAD therapy, or re-do AF ablation.
Collapse
Affiliation(s)
- Moh'd Rasheed Abu-Qaoud
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Ashish Kumar
- Division of Internal Medicine, Cleveland Clinic, Akron, Ohio, USA
| | - Tushar Tarun
- Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences, Arkansas, USA
| | - Sonu Abraham
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Javaria Ahmad
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Sumanth Khadke
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Raya Husami
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Guy Kulbak
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Sibasis Sahoo
- U.N. Mehta Institute of Cardiology and Reserch Center, Ahmedabad, Gujarat, India
| | - James L Januzzi
- Division of Cardiovascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tomas G Neilan
- Division of Cardiovascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Suzanne J Baron
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - David Martin
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Anju Nohria
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew R Reynolds
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, Missouri, USA
| | - Sourbha S Dani
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Sarju Ganatra
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA.
| |
Collapse
|
7
|
Wazni O, Moss J, Kuniss M, Andrade J, Chierchia GB, Mealing S, Mburu W, Sale A, Kaplon R, Ismyrloglou E, Bromilow T, Lane E, Lewis D, Reynolds MR. An economic evaluation of first-line cryoballoon ablation vs antiarrhythmic drug therapy for the treatment of paroxysmal atrial fibrillation from a U.S. Medicare perspective. Heart Rhythm O2 2023; 4:528-537. [PMID: 37744940 PMCID: PMC10513914 DOI: 10.1016/j.hroo.2023.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background Three recent randomized controlled trials have demonstrated that, as an initial rhythm control strategy, first-line cryoballoon ablation (cryoablation) reduces atrial arrhythmia recurrence compared with antiarrhythmic drugs (AADs) in patients with symptomatic paroxysmal atrial fibrillation (PAF). Objective The study sought to evaluate the cost-effectiveness of first-line cryoablation compared with first-line AADs for treating symptomatic PAF from a U.S. Medicare payer perspective. Methods Individual patient-level data from 703 participants with PAF enrolled into the Cryo-FIRST (NCT01803438), STOP AF First (NCT03118518), and EARLY-AF (NCT02825979) trials were used to derive parameters for the cost-effectiveness model. The cost-effectiveness model used a hybrid decision tree and Markov structure. The decision tree had a 1-year time horizon and was used to inform the initial health state allocation in the first cycle of the Markov model. The Markov model used a 40-year time horizon (3-month cycle length). Health benefits were expressed in quality-adjusted life years (QALYs). Costs and benefits were discounted at 3% per year. Results Cryoablation was estimated to yield higher QALYs (+0.17) and higher costs (+$4274) per patient over a 40-year time horizon than AADs. Ultimately, this produced an average incremental cost-effectiveness ratio of $24,637 per QALY gained. Independent of initial treatment, individuals were expected to receive ∼1.2 ablations over a lifetime. There was a 45% relative reduction in time spent in atrial fibrillation health states for those initially treated with cryoablation compared with AADs. Conclusion Initial rhythm control with first-line cryoballoon ablation is highly cost-effective compared with first-line AADs from a U.S. Medicare payer perspective.
Collapse
Affiliation(s)
- Oussama Wazni
- Department of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, Ohio
| | - Joe Moss
- York Health Economics Consortium, York, United Kingdom
| | - Malte Kuniss
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Jason Andrade
- Division of Cardiology and Cardiac Electrophysiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gian Battista Chierchia
- Department of Cardiology at Heart Rhythm Management Center, Universitair Ziekenhuis Brussel and Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | | | | | | | - Tom Bromilow
- York Health Economics Consortium, York, United Kingdom
| | - Emily Lane
- York Health Economics Consortium, York, United Kingdom
| | - Damian Lewis
- York Health Economics Consortium, York, United Kingdom
| | - Matthew R. Reynolds
- Baim Institute for Clinical Research, Boston, Massachusetts
- Lahey Hospital and Medical Center, Burlington, Massachusetts
| |
Collapse
|
8
|
Harwood OE, Matschke LM, Moriarty RV, Balgeman AJ, Weaver AJ, Ellis-Connell AL, Weiler AM, Winchester LC, Fletcher CV, Friedrich TC, Keele BF, O’Connor DH, Lang JD, Reynolds MR, O’Connor SL. CD8+ cells and small viral reservoirs facilitate post-ART control of SIV replication in M3+ Mauritian cynomolgus macaques initiated on ART two weeks post-infection. PLoS Pathog 2023; 19:e1011676. [PMID: 37747933 PMCID: PMC10553806 DOI: 10.1371/journal.ppat.1011676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/05/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023] Open
Abstract
Sustainable HIV remission after antiretroviral therapy (ART) withdrawal, or post-treatment control (PTC), remains a top priority for HIV treatment. We observed surprising PTC in an MHC-haplomatched cohort of MHC-M3+ SIVmac239+ Mauritian cynomolgus macaques (MCMs) initiated on ART at two weeks post-infection (wpi). None of the MCMs possessed MHC haplotypes previously associated with SIV control. For six months after ART withdrawal, we observed undetectable or transient viremia in seven of the eight MCMs, despite detecting replication competent SIV using quantitative viral outgrowth assays. In vivo depletion of CD8α+ cells induced rebound in all animals, indicating the observed PTC was mediated, at least in part, by CD8α+ cells. With intact proviral DNA assays, we found that MCMs had significantly smaller viral reservoirs two wpi than a cohort of identically infected rhesus macaques, a population that rarely develops PTC. We found a similarly small viral reservoir among six additional SIV+ MCMs in which ART was initiated at eight wpi, some of whom exhibited viral rebound. These results suggest that an unusually small viral reservoir is a hallmark among SIV+ MCMs. By evaluating immunological differences between MCMs that did and did not rebound, we identified that PTC was associated with a reduced frequency of CD4+ and CD8+ lymphocyte subsets expressing exhaustion markers. Together, these results suggest a combination of small reservoirs and immune-mediated virus suppression contribute to PTC in MCMs. Further, defining the immunologic mechanisms that engender PTC in this model may identify therapeutic targets for inducing durable HIV remission in humans.
Collapse
Affiliation(s)
- Olivia E. Harwood
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Lea M. Matschke
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Ryan V. Moriarty
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Alexis J. Balgeman
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Abigail J. Weaver
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Amy L. Ellis-Connell
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Andrea M. Weiler
- Wisconsin National Primate Research Center, Madison, Wisconsin, United States of America
| | - Lee C. Winchester
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Courtney V. Fletcher
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Thomas C. Friedrich
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Wisconsin National Primate Research Center, Madison, Wisconsin, United States of America
| | - Brandon F. Keele
- AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, Maryland, United States of America
| | - David H. O’Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Wisconsin National Primate Research Center, Madison, Wisconsin, United States of America
| | - Jessica D. Lang
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Center for Human Genomics and Precision Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Matthew R. Reynolds
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Wisconsin National Primate Research Center, Madison, Wisconsin, United States of America
| | - Shelby L. O’Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Wisconsin National Primate Research Center, Madison, Wisconsin, United States of America
| |
Collapse
|
9
|
Maron BJ, Estes NAM, Rowin EJ, Maron MS, Reynolds MR. Development of the Implantable Cardioverter-Defibrillator: JACC Historical Breakthroughs in Perspective. J Am Coll Cardiol 2023; 82:353-373. [PMID: 37468191 DOI: 10.1016/j.jacc.2023.04.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/22/2023] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 07/21/2023]
Abstract
Implantable cardioverter-defibrillators (ICDs) represent transformational technology, arguably the most significant advance in cardiovascular medicine in 50 years. The vision and determination of pioneers Mirowski and Mower was fundamental to this monumental achievement, working with limited resources and confronted by skepticism/criticism from medical establishment. The inventors were followed >35 years in which a multitude of innovative clinical scientists and engineers introduced technological advances leading to the sophisticated devices in practice today. A pivotal patient experiment with automated termination of ventricular fibrillation (1980) led to U.S. Food and Drug Administration approval. Transvenous lead systems converted ICDs from thoracotomy-based secondary prevention to primary prevention of sudden death devices in countless patients worldwide. ICD acceptance was solidified by prospective randomized controlled trials showing reduced mortality superior to antiarrhythmic drugs. ICDs eventually expanded from coronary disease to inherited arrhythmia conditions (eg, hypertrophic cardiomyopathy). The ICD breakthrough story demonstrates how significant progress is possible in medicine against all odds, given fearless imagination to pursue novel ideas that conflict with accepted wisdom.
Collapse
Affiliation(s)
- Barry J Maron
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
| | - N A Mark Estes
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ethan J Rowin
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Martin S Maron
- Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | | |
Collapse
|
10
|
Cannon CP, Kim JM, Lee JJ, Sutherland J, Bachireddy R, Valentine CM, Hearne S, Trebnick A, Jaffer S, Datta S, Semmel E, Thorpe F, Doros G, Cavender MA, Reynolds MR. Patients and Their Physician's Perspectives About Oral Anticoagulation in Patients With Atrial Fibrillation Not Receiving an Anticoagulant. JAMA Netw Open 2023; 6:e239638. [PMID: 37093601 PMCID: PMC10126870 DOI: 10.1001/jamanetworkopen.2023.9638] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/09/2023] [Indexed: 04/25/2023] Open
Abstract
Importance The underuse of oral anticoagulation in patients with nonvalvular atrial fibrillation (AF) is a major issue that is not well understood. Objective To understand the lack of anticoagulation by assessing the perceptions of patients with AF who are not receiving anticoagulation and their physician's about the risk of stroke and the benefits and risks of anticoagulation. Design, Setting, and Participants This cohort study included patients with nonvalvular AF and a CHA2DS2-VASc score of 2 or more (calculated as congestive heart failure, hypertension, age 75 years and older, diabetes, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, and sex category) who were not receiving anticoagulation and were enrolled from 19 sites within the National Cardiovascular Data Registry (NCDR) Practice Innovation and Clinical Excellence Registry (PINNACLE Registry) between January 18, 2017, and May 7, 2018. Data were collected from January 18, 2017, to September 30, 2019, and analyzed from April 2022 to March 2023. Exposure Each patient enrolled in the study completed a survey, and their treating physician then conducted a clinical review of their care. Main Outcomes and Measures Assessment of willingness for anticoagulation treatment and its appropriateness after central review by a panel of 4 cardiologists. Use of anticoagulation at 1 year follow-up was compared vs similar patients at other centers in the PINNACLE Registry. Results Of the 817 patients enrolled, the median (IQR) age was 76.0 (69.0-83.0) years, 369 (45.2%) were women, and the median (IQR) CHA2DS2-VASc score was 4.0 (3.0-6.0). The top 5 reasons physicians cited for no anticoagulation were low AF burden or successful rhythm control (278 [34.0%]), patient refusal (272 [33.3%]), perceived low risk of stroke (206 [25.2%]), fall risk (175 [21.4%]), and high bleeding risk (167 [20.4%]). After rereview, 221 physicians (27.1%) would reconsider prescribing oral anticoagulation as compared with 311 patients (38.1%), including 67 (24.6%) whose physician cited patient refusal. Of 647 patients (79.2%) adjudicated as appropriate or may be appropriate for anticoagulation, physicians would reconsider anticoagulation for only 177 patients (21.2%), while 527 patients (64.5%) would either agree to starting anticoagulation (311 [38.1%]) or were neutral (216 [27.3%]) to starting anticoagulation. Upon follow-up, 119 patients (14.6%) in the BOAT-AF study were prescribed anticoagulation, as compared with 55 879 of 387 975 similar patients (14.4%) at other centers in the PINNACLE Registry. Conclusions and Relevance The findings of this cohort study suggest that patients with AF who are not receiving anticoagulation are more willing to consider anticoagulation than their physicians. These data emphasize the need to revisit any prior decision against anticoagulation in a shared decision-making manner.
Collapse
Affiliation(s)
- Christopher P. Cannon
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Baim Institute for Clinical Research, Boston, Massachusetts
| | - Joseph M. Kim
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jane J. Lee
- Baim Institute for Clinical Research, Boston, Massachusetts
| | | | | | | | | | - April Trebnick
- Baim Institute for Clinical Research, Boston, Massachusetts
| | - Sara Jaffer
- Baim Institute for Clinical Research, Boston, Massachusetts
| | | | | | - Fran Thorpe
- American College of Cardiology, Washington, DC
| | - Gheorghe Doros
- Baim Institute for Clinical Research, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Matthew A. Cavender
- Baim Institute for Clinical Research, Boston, Massachusetts
- University of North Carolina, Chapel Hill
| | - Matthew R. Reynolds
- Baim Institute for Clinical Research, Boston, Massachusetts
- Lahey Hospital and Medical Center, Burlington, Massachusetts
| |
Collapse
|
11
|
Reynolds MR. Addition by Subtraction: Disease Progression and the Value of Atrial Fibrillation Ablation. Circ Arrhythm Electrophysiol 2023; 16:e011918. [PMID: 37009736 PMCID: PMC10473022 DOI: 10.1161/circep.123.011918] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Affiliation(s)
- Matthew R. Reynolds
- Division of Cardiology, Lahey Hospital & Medical Center, Burlington, MA. Baim Institute for Clinical Research, Boston, MA
| |
Collapse
|
12
|
Reynolds MR, Ahmad J. The NCDR AFib Ablation Registry: Better Late Than Never? J Am Coll Cardiol 2023; 81:879-881. [PMID: 36858708 DOI: 10.1016/j.jacc.2022.12.017] [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] [Received: 11/29/2022] [Accepted: 12/22/2022] [Indexed: 03/02/2023]
Affiliation(s)
- Matthew R Reynolds
- Division of Cardiology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA.
| | - Javaria Ahmad
- Division of Cardiology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| |
Collapse
|
13
|
Harwood OE, Matschke LM, Moriarty RV, Balgeman AJ, Weaver AJ, Ellis-Connell AL, Weiler AM, Winchester LC, Fletcher CV, Friedrich TC, Keele BF, O'Connor DH, Lang JD, Reynolds MR, O'Connor SL. CD8+ cells and small viral reservoirs facilitate post-ART control of SIV in Mauritian cynomolgus macaques. bioRxiv 2023:2023.03.01.530655. [PMID: 36909458 PMCID: PMC10002716 DOI: 10.1101/2023.03.01.530655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Sustainable HIV remission after antiretroviral therapy (ART) withdrawal, or post-treatment control (PTC), remains a top priority for HIV treatment. We observed surprising PTC in an MHC-haplomatched cohort of MHC-M3+ SIVmac239+ Mauritian cynomolgus macaques (MCMs) initiated on ART at two weeks post-infection (wpi). For six months after ART withdrawal, we observed undetectable or transient viremia in seven of eight MCMs. In vivo depletion of CD8α+ cells induced rebound in all animals, indicating the PTC was mediated, at least in part, by CD8α+ cells. We found that MCMs had smaller acute viral reservoirs than a cohort of identically infected rhesus macaques, a population that rarely develops PTC. The mechanisms by which unusually small viral reservoirs and CD8α+ cell-mediated virus suppression enable PTC can be investigated using this MHC-haplomatched MCM model. Further, defining the immunologic mechanisms that engender PTC in this model may identify therapeutic targets for inducing durable HIV remission in humans.
Collapse
Affiliation(s)
- Olivia E Harwood
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53711
| | - Lea M Matschke
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI 53711
| | - Ryan V Moriarty
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53711
| | - Alexis J Balgeman
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53711
| | - Abigail J Weaver
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53711
| | - Amy L Ellis-Connell
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53711
| | - Andrea M Weiler
- Wisconsin National Primate Research Center, Madison, WI, 53711
| | - Lee C Winchester
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE 68198
| | | | - Thomas C Friedrich
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI 53711
- Wisconsin National Primate Research Center, Madison, WI, 53711
| | - Brandon F Keele
- AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD 21701
| | - David H O'Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53711
- Wisconsin National Primate Research Center, Madison, WI, 53711
| | - Jessica D Lang
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53711
- Center for Human Genomics and Precision Medicine, University of Wisconsin-Madison, Madison, WI 53711
| | - Matthew R Reynolds
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI 53711
- Wisconsin National Primate Research Center, Madison, WI, 53711
| | - Shelby L O'Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53711
- Wisconsin National Primate Research Center, Madison, WI, 53711
| |
Collapse
|
14
|
Elkind MSV, Witte KK, Kasner SE, Sawyer LM, Grimsey Jones FW, Rinciog C, Tsintzos S, Rosemas SC, Lanctin D, Ziegler PD, Reynolds MR. Cost-effectiveness of an insertable cardiac monitor in a high-risk population in the US. BMC Cardiovasc Disord 2023; 23:45. [PMID: 36698055 PMCID: PMC9875401 DOI: 10.1186/s12872-023-03073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Insertable cardiac monitors (ICMs) are a clinically effective means of detecting atrial fibrillation (AF) in high-risk patients, and guiding the initiation of non-vitamin K oral anticoagulants (NOACs). Their cost-effectiveness from a US clinical payer perspective is not yet known. The objective of this study was to evaluate the cost-effectiveness of ICMs compared to standard of care (SoC) for detecting AF in patients at high risk of stroke (CHADS2 ≥ 2), in the US. METHODS Using patient data from the REVEAL AF trial (n = 393, average CHADS2 score = 2.9), a Markov model estimated the lifetime costs and benefits of detecting AF with an ICM or with SoC (specifically intermittent use of electrocardiograms and 24-h Holter monitors). Ischemic and hemorrhagic strokes, intra- and extra-cranial hemorrhages, and minor bleeds were modelled. Diagnostic and device costs, costs of treating stroke and bleeding events and medical therapy-specifically costs of NOACs were included. Costs and health outcomes, measured as quality-adjusted life years (QALYs), were discounted at 3% per annum, in line with standard practice in the US setting. One-way deterministic and probabilistic sensitivity analyses (PSA) were undertaken. RESULTS Lifetime per-patient cost for ICM was $31,116 versus $25,330 for SoC. ICMs generated a total of 7.75 QALYs versus 7.59 for SoC, with 34 fewer strokes projected per 1000 patients. The model estimates a number needed to treat of 29 per stroke avoided. The incremental cost-effectiveness ratio was $35,528 per QALY gained. ICMs were cost-effective in 75% of PSA simulations, using a $50,000 per QALY threshold, and a 100% probability of being cost-effective at a WTP threshold of $150,000 per QALY. CONCLUSIONS The use of ICMs to identify AF in a high-risk population is likely to be cost-effective in the US healthcare setting.
Collapse
Affiliation(s)
- Mitchell S. V. Elkind
- grid.21729.3f0000000419368729Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA
| | - Klaus K. Witte
- grid.9909.90000 0004 1936 8403Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK ,grid.412301.50000 0000 8653 1507University Clinic, RWTH, Aachen, Germany
| | - Scott E. Kasner
- grid.25879.310000 0004 1936 8972Department of Neurology, University of Pennsylvania, Philadelphia, PA USA
| | | | | | | | | | | | - David Lanctin
- grid.419673.e0000 0000 9545 2456Medtronic, Mounds View, MN USA
| | - Paul D. Ziegler
- grid.419673.e0000 0000 9545 2456Medtronic, Mounds View, MN USA
| | - Matthew R. Reynolds
- grid.488688.20000 0004 0422 1863Baim Institute for Clinical Research, Boston, MA USA ,grid.415731.50000 0001 0725 1353Lahey Hospital and Medical Center, Burlington, MA USA
| |
Collapse
|
15
|
Reynolds MR, Bunch TJ, Steinberg BA, Ronk CJ, Kim H, Wieloch M, Lip GYH. Novel methodology for the evaluation of symptoms reported by patients with newly diagnosed atrial fibrillation: Application of natural language processing to electronic medical records data. J Cardiovasc Electrophysiol 2022; 34:790-799. [PMID: 36542764 DOI: 10.1111/jce.15784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Understanding symptom patterns in atrial fibrillation (AF) can help in disease management. We report on the application of natural language processing (NLP) to electronic medical records (EMRs) to capture symptom reports in patients with newly diagnosed (incident) AF. METHODS AND RESULTS This observational retrospective study included adult patients with an index diagnosis of incident AF during January 1, 2016 through June 30, 2018, in the Optum datasets. The baseline and follow-up periods were 1 year before/after the index date, respectively. The primary objective was identification of the following predefined symptom reports: dyspnea or shortness of breath; syncope, presyncope, lightheadedness, or dizziness; chest pain; fatigue; and palpitations. In an exploratory analysis, the incidence rates of symptom reports and cardiovascular hospitalization were assessed in propensity-matched patient cohorts with incident AF receiving first-line dronedarone or sotalol. Among 30 447 patients with an index AF diagnosis, the NLP algorithm identified at least 1 predefined symptom in 9734 (31.9%) patients. The incidence rate of symptom reports was highest at 0-3 months post-diagnosis and lower at >3-6 and >6-12 months (pre-defined timepoints). Across all time periods, the most common symptoms were dyspnea or shortness of breath, followed by syncope, presyncope, lightheadedness, or dizziness. Similar temporal patterns of symptom reports were observed among patients with prescriptions for dronedarone or sotalol as first-line treatment. CONCLUSION This study illustrates that NLP can be applied to EMR data to characterize symptom reports in patients with incident AF, and the potential for these methods to inform comparative effectiveness.
Collapse
Affiliation(s)
- Matthew R Reynolds
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.,Economics and Quality of Life Research, Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | | | | | | | - Hankyul Kim
- Real-World Evidence Team, Evidera, Boston, Massachusetts, USA
| | - Mattias Wieloch
- General Medicines Global Medical, Sanofi, Paris, France.,Department of Clinical Sciences Malmö, Center for Thrombosis and Haemostasis, Lund University, Malmö, Sweden
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
16
|
Meyer EM, Reynolds MR. Multidimensional Scaling of Cognitive Ability and Academic Achievement Scores. J Intell 2022; 10:jintelligence10040117. [PMID: 36547504 PMCID: PMC9785841 DOI: 10.3390/jintelligence10040117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
Multidimensional scaling (MDS) was used as an alternate multivariate procedure for investigating intelligence and academic achievement test score correlations. Correlation coefficients among Wechsler Intelligence Scale for Children, Fifth Edition (WISC-5) and Wechsler Individual Achievement Test, Third Edition (WIAT-III) validity sample scores and among Kaufman Assessment Battery for Children, Second Edition (KABC-II) and Kaufman Test of Educational Achievement, Second Edition (KTEA-2) co-norming sample scores were analyzed using multidimensional scaling (MDS). Three-dimensional MDS configurations were the best fit for interpretation in both datasets. Subtests were more clearly organized by CHC ability and academic domain instead of complexity. Auditory-linguistic, figural-visual, reading-writing, and quantitative-numeric regions were visible in all models. Results were mostly similar across different grade levels. Additional analysis with WISC-V and WIAT-III tests showed that content (verbal, numeric, figural) and response process facets (verbal, manual, paper-pencil) were also useful in explaining test locations. Two implications from this study are that caution may be needed when interpreting fluency scores across academic areas, and MDS provides more empirically based validity evidence regarding content and response mode processes.
Collapse
Affiliation(s)
- Em M. Meyer
- Department of Counseling, School Psychology and Family Science, College of Education, University of Nebraska, Kearney, NE 68849, USA
- Correspondence:
| | - Matthew R. Reynolds
- Department of Educational Psychology, School of Education and Human Sciences, University of Kansas, Lawrence, KS 66045, USA
| |
Collapse
|
17
|
Meléndez DM, Marti S, Schwinghamer TD, Haley DB, Yang X, Reynolds MR, Schwartzkopf-Genswein KS. PSXIII-2 Effect of Rest, Post-Rest Transport Duration, and Conditioning on Performance and Physiological Welfare Indicators of Beef Calves. J Anim Sci 2022. [DOI: 10.1093/jas/skac247.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The aim of this study was to assess the effects of conditioning, rest, and post-rest transport duration on welfare indicators of 6-7 mo old beef calves. A total of 328 weaned calves (237 ± 29.7 kg BW) were randomly assigned to a 2 × 2 × 2 factorial design: conditioning, conditioned (C) or non-conditioned (N); rest, 0 (R0) or 8 (R8) h, and post-rest transport, 4 (T4) or 15 (T15) h. Calves were sampled prior to and after 20h of transport, prior to and after the additional 4 or 15-h transport, and at 1, 2, 3, 5, 14, and 28 d after transport ended. Data were analyzed using the GLIMMIX procedure of SAS. Fixed effects were conditioning, transport and time nested within rest period, while random effects were animal and pen. For R0-T4 calves, the mean L-lactate concentrations were greater than R8-T4 calves on d 1 and 2 (p-values = 0.02) while, for R0 calves, mean ADG was greater than R8 calves 14 to 28 d after transport (p-values < 0.01). For R8-T4 calves 1 week after transport, mean ADG was greater and mean WBC counts were less than R8-T15 calves on d 5 (p-values < 0.01). For N calves, overall mean haptoglobin, creatine kinase, serum amyloid-A, and non-esterified fatty acids were greater than C calves (p-values ≤ 0.05). Overall, few and inconsistent differences were observed for rest, where rest improved L-lactate but affected ADG. Few differences were observed for transport, where shorter transport durations after the rest improved ADG and WBC counts. In general, N calves had greater physiological indicators of reduced welfare than C calves. Based on these findings, the best way to improve calf welfare during and after transport is to condition them prior to transport.
Collapse
Affiliation(s)
- Daniela M Meléndez
- Lethbridge Research and Development Centre, Agriculture and Agri-Food Canada
| | | | - Timothy D Schwinghamer
- Agriculture and Agri-Food Canada, Lethbridge Research and Development Centre, Lethbridge
| | | | - Xiaohui Yang
- Agriculture and Agri-Food Canada, Lethbridge Research and Development Centre, Lethbridge
| | | | | |
Collapse
|
18
|
Reynolds MR, Stanford K, Meléndez DM, Schwartzkopf-Genswein KS, McAllister TA, Blakley BR, McKinnon JJ, Ribeiro GO. 152 Effect of Continuous or Intermittent Feeding of Ergot Contaminated Grain in a Mash or Pelleted Form on the Performance of Backgrounding Beef Steers. J Anim Sci 2022. [DOI: 10.1093/jas/skac247.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The objective of this study was to evaluate the effect of feeding pelleted or mash ergot contaminated grain continuously or intermittently on performance and blood parameters of backgrounding steers. Sixty black angus steers (300 ± 29.4 kg) were used in a complete randomized backgrounding (60% barley silage:40% concentrate DM basis) 84 d study. Steers were randomly assigned to 4 different treatments and housed individually. Treatments included: 1) control ration (CON; no added ergot), 2) continuous ergot mash (CEM; fed continuously at 2 ppm), 3) intermittent ergot mash (IEM; fed at 2 ppm on the first wk of each 21 d period and control diet for the remaining 2 wk), and 4) intermittent ergot pellet (IEP; fed at 2 ppm during the first wk of each 21 d period and control diet for the other 2 wk). Calves were weighed every 21 days and blood samples were collected on d 0, 42, and 84. No treatment effects (P>0.05) were observed for complete blood count. Steer DMI was reduced for all ergot diets compared to the CON diet (P< 0.01, 7.45 vs. 8.05 kg/d). Steer ADG was reduced for all ergot diets compared to the CON diet (P< 0.01). CEM fed steers had lower ADG (P< 0.01, 0.980 vs. 0.735 kg) and shrunk final weight (P< 0.01, 366 vs. 350 kg) than CON calves, but CEM and IEM were no different. CEM fed steers had lower Gain:Feed (P< 0.07, 0.130 vs. 0.142) than CON calves. Pelleting ergot contaminated grain did not reduce the impact of ergot alkaloids on any of the measured parameters. Results suggest that continuously or intermittently feeding an ergot contaminated TMR (2 ppm) can significantly reduce the growth performance of backgrounded feedlot steers but no effects were observed for blood parameters. Pelleting was not an effective method of reducing ergot toxicity.
Collapse
Affiliation(s)
| | | | - Daniela M Meléndez
- Lethbridge Research and Development Centre, Agriculture and Agri-Food Canada
| | | | | | | | | | - Gabriel O Ribeiro
- Department of Animal and Poultry Science, College of Agriculture and Bioresources, University of Saskatchewan
| |
Collapse
|
19
|
Schmidt JK, Reynolds MR, Golos TG, Slukvin II. CRISPR/Cas9 genome editing to create nonhuman primate models for studying stem cell therapies for HIV infection. Retrovirology 2022; 19:17. [PMID: 35948929 PMCID: PMC9363854 DOI: 10.1186/s12977-022-00604-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/28/2022] [Indexed: 12/13/2022] Open
Abstract
Nonhuman primates (NHPs) are well-established basic and translational research models for human immunodeficiency virus (HIV) infections and pathophysiology, hematopoietic stem cell (HSC) transplantation, and assisted reproductive technologies. Recent advances in CRISPR/Cas9 gene editing technologies present opportunities to refine NHP HIV models for investigating genetic factors that affect HIV replication and designing cellular therapies that exploit genetic barriers to HIV infections, including engineering mutations into CCR5 and conferring resistance to HIV/simian immunodeficiency virus (SIV) infections. In this report, we provide an overview of recent advances and challenges in gene editing NHP embryos and discuss the value of genetically engineered animal models for developing novel stem cell-based therapies for curing HIV.
Collapse
Affiliation(s)
- Jenna Kropp Schmidt
- grid.14003.360000 0001 2167 3675Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI USA
| | - Matthew R. Reynolds
- grid.14003.360000 0001 2167 3675Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI USA
| | - Thaddeus G. Golos
- grid.14003.360000 0001 2167 3675Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI USA
| | - Igor I. Slukvin
- grid.14003.360000 0001 2167 3675Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI USA ,grid.14003.360000 0001 2167 3675Department of Pathology and Laboratory Medicine, Wisconsin National Primate Research Center, University of Wisconsin-Madison, 1220 Capitol Court, Madison, WI 53715 USA ,grid.14003.360000 0001 2167 3675Department of Cell and Regenerative Biology, University of Wisconsin-Madison, Madison, WI USA
| |
Collapse
|
20
|
Hoppe BL, Reynolds MR, Srivatsa UN, HSU MICHAEL, Wilk A, Crosson L, Langan MNS. ARTIFICIAL INTELLIGENCE ANALYSIS OF AMBULATORY ECG MONITORING IN SYNCOPE INDICATED PATIENTS. Cardiovascular Digital Health Journal 2022. [DOI: 10.1016/j.cvdhj.2022.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
21
|
Reynolds MR, Izzo JR, Schultz RC. Beyond Simple Mean Differences: Analysis of Sex Similarities and Differences in Academic Achievement With the Kaufman Tests of Educational Achievement, Third Edition. Journal of Psychoeducational Assessment 2022. [DOI: 10.1177/07342829221111225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Simple mean differences summarized in meta-analyses do not always adequately describe sex similarities and differences. We investigated sex similarities and differences in academic achievement test scores during childhood and adolescence multiple ways based on composite and subtest scores from the Kaufman Test of Educational Achievement (Third edition) norming sample. Sex differences in means were investigated across achievement domains and ability levels. Test score variance and percentages of scores at different parts of score distributions were also compared across sex. The largest and most consistent sex differences were female advantages in writing tests: Larger advantages were found in more complex writing tasks. Females also showed consistent advantages in silent reading fluency. Males demonstrated advantages in math problem solving that emerged at the average ability level. Females were more likely to be high achievers in reading fluency and written expression, whereas males were more likely to be low achievers in reading fluency and aspects of writing, and very low achievers in word recognition, word recognition fluency, and reading vocabulary. Males were more likely to be high achievers in math problem solving. Analysis that goes beyond simple mean differences reveals important sex differences regarding academic achievement, and theories should account for overall patterns of academic achievement similarities and differences.
Collapse
Affiliation(s)
| | - James R. Izzo
- Educational Psychology, University of Kansas, Lawrence, KS, USA
| | | |
Collapse
|
22
|
|
23
|
Ziegler P, yaghi S, Gunnarsson C, Ryan M, Rosemas S, Reynolds MR. CE-539-02 UTILIZATION OF ORAL ANTICOAGULATION AFTER BLEEDING EVENTS IN STROKE PATIENTS WITH ATRIAL FIBRILLATION. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.645] [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: 11/29/2022]
|
24
|
D'Souza SS, Kumar A, Weinfurter J, Park MA, Maufort J, Tao L, Kang H, Dettle ST, Golos T, Thomson JA, Reynolds MR, Slukvin I. Generation of SIV-resistant T cells and macrophages from nonhuman primate induced pluripotent stem cells with edited CCR5 locus. Stem Cell Reports 2022; 17:953-963. [PMID: 35364011 PMCID: PMC9023799 DOI: 10.1016/j.stemcr.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022] Open
Abstract
Adoptive therapies with genetically modified somatic T cells rendered HIV resistance have shown promise for AIDS therapy. A renewable source of HIV-resistant human T cells from induced pluripotent stem cells (iPSCs) would further facilitate and broaden the applicability of these therapies. Here, we report successful targeting of the CCR5 locus in iPSCs generated from T cells (T-iPSCs) or fibroblasts (fib-iPSCs) from Mauritian cynomolgus macaques (MCM), using CRISPR-Cas9 technology. We found that CCR5 editing does not affect hematopoietic and T cell differentiation potentials of fib-iPSCs. However, T-iPSCs with edited CCR5 lost their capacity to differentiate into CD4+CD8+ T cells while maintaining myeloid differentiation potential. T cells and macrophages produced from CCR5-edited MCM iPSCs did not support replication of the CCR5-tropic simian immunodeficiency viruses SIVmac239 (T cell tropic) and SIVmac316 (macrophage-tropic). Overall, these studies provide a platform for further exploration of AIDS therapies based on gene-edited iPSCs in a nonhuman primate model.
Collapse
Affiliation(s)
- Saritha S D'Souza
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI 53715, USA
| | - Akhilesh Kumar
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI 53715, USA
| | - Jason Weinfurter
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA
| | - Mi Ae Park
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI 53715, USA
| | | | - Lihong Tao
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI 53715, USA
| | - HyunJun Kang
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI 53715, USA
| | - Samuel T Dettle
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI 53715, USA
| | - Thaddeus Golos
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI 53715, USA; Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53706 USA; Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI 53705 USA
| | - James A Thomson
- Morgridge Institute for Research, Madison, USA; Department of Molecular, Cellular, and Developmental Biology, University of California, Santa Barbara, CA 93106, USA
| | - Matthew R Reynolds
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI 53715, USA; Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA
| | - Igor Slukvin
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI 53715, USA; Department of Cell and Regenerative Biology, University of Wisconsin-Madison, Madison, WI 53706, USA; Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI 53792, USA.
| |
Collapse
|
25
|
Reynolds MR, Niileksela CR, Gignac GE, Sevillano CN. Working memory capacity development through childhood: A longitudinal analysis. Dev Psychol 2022; 58:1254-1263. [PMID: 35389686 DOI: 10.1037/dev0001360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Working memory is an often studied and important psychological construct. The growth of working memory capacity (WMC) in childhood is described as linear. Average adult WMC is estimated as either four or five "chunks." Using latent curve models of data from a measure of digit span backward that was administered longitudinally to a large sample representative of the native-English-speaking U.S. kindergarten population in 2011, we found that WMC growth in childhood is curvilinear. It shows an increasing yet decelerating pattern. Scoring rules (e.g., requiring 50% or 75% of trials correct) influence age-based estimates, but WMCs have likely been underestimated in children, and the average adult WMC of five is more plausible than four, as measured by digit span backward. Developmental WMC estimates, such as those reported in this research, may help others develop prescriptive learning interventions for children and understand its growth and decline across the life span. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
|
26
|
Africk BN, Heiferman DM, Wozniak AW, Behzadi F, Ballard MS, Chazaro JM, Zsigray BM, Shanker RM, Reynolds MR, Anderson DE, Serrone JC. Angioarchitectural features amongst patients with unruptured brain arteriovenous malformations presenting with headache: findings from a single center retrospective review of 76 patients. J Headache Pain 2021; 22:122. [PMID: 34627140 PMCID: PMC8501699 DOI: 10.1186/s10194-021-01331-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/21/2021] [Indexed: 12/30/2022] Open
Abstract
Background Brain arteriovenous malformations (AVMs) consist of abnormal connections between arteries and veins via an interposing nidus. While hemorrhage is the most common presentation, unruptured AVMs can present with headaches, seizures, neurological deficits, or be found incidentally. It remains unclear as to what AVM characteristics contribute to pain generation amongst unruptured AVM patients with headaches. Methods To assess this relationship, the current study evaluates angiographic and clinical features amongst patients with unruptured brain AVMs presenting with headache. Loyola University Medical Center medical records were queried for diagnostic codes corresponding to AVMs. In patients with unruptured AVMs, we analyzed the correlation between the presenting symptom of headache and various demographic and angiographic features. Results Of the 144 AVMs treated at our institution between 1980 and 2017, 76 were unruptured and had sufficient clinical data available. Twenty-three presented with headaches, while 53 patients had other presenting symptoms. Patients presenting with headache were less likely to have venous stenosis compared to those with a non-headache presentation (13 % vs. 36 %, p = 0.044). Conclusions Our study suggests that the absence of venous stenosis may contribute to headache symptomatology. This serves as a basis for further study of correlations between AVM angioarchitecture and symptomatology to direct headache management in AVM patients.
Collapse
Affiliation(s)
- Benjamin N Africk
- Department of Pediatric Neurology, Lucile Packard Children's Hospital at Stanford, 725 Welch Road, CA, 94304, Palo Alto, USA
| | | | - Amy W Wozniak
- Clinical Research Office, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Avenue, IL, 60153, Maywood, USA
| | - Faraz Behzadi
- Loyola Stritch School of Medicine, 2160 S. First Avenue, IL, 60153, Maywood, USA
| | - Matthew S Ballard
- Loyola Stritch School of Medicine, 2160 S. First Avenue, IL, 60153, Maywood, USA
| | - Joshua M Chazaro
- Loyola Stritch School of Medicine, 2160 S. First Avenue, IL, 60153, Maywood, USA
| | - Brandon M Zsigray
- Department of Neurological Surgery, Loyola University Medical Center, 2160 S. First Avenue, IL, 60153, Maywood, USA
| | - Rachyl M Shanker
- Department of Neurological Surgery, Loyola University Medical Center, 2160 S. First Avenue, IL, 60153, Maywood, USA
| | - Matthew R Reynolds
- Department of Neurological Surgery, Loyola University Medical Center, 2160 S. First Avenue, IL, 60153, Maywood, USA
| | - Douglas E Anderson
- Department of Neurological Surgery, Loyola University Medical Center, 2160 S. First Avenue, IL, 60153, Maywood, USA.,Edward Hines Jr Veteran Administration Hospital, 5000 5th Avenue, IL, 60141, Hines, USA
| | - Joseph C Serrone
- Department of Neurological Surgery, Loyola University Medical Center, 2160 S. First Avenue, IL, 60153, Maywood, USA. .,Edward Hines Jr Veteran Administration Hospital, 5000 5th Avenue, IL, 60141, Hines, USA. .,Loyola University Medical Center, 2160 S 1st Avenue, IL, 60153, Maywood, USA.
| |
Collapse
|
27
|
Hsu JC, Reynolds MR, Song Y, Doros G, Lubitz SA, Gehi AK, Turakhia MP, Maddox TM. Outpatient Prescription Practices in Patients with Atrial Fibrillation (From the NCDR PINNACLE Registry). Am J Cardiol 2021; 155:32-39. [PMID: 34284863 DOI: 10.1016/j.amjcard.2021.06.011] [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] [Received: 02/07/2021] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 12/01/2022]
Abstract
This study sought to evaluate inappropriate prescribing practices in an atrial fibrillation (AF) population, as outlined by the 2016 ACC/AHA Clinical Performance and Quality Measures for Adults with Atrial Fibrillation or Atrial Flutter document. The 2016 AF quality measures document specified medications to avoid in certain AF populations, including aspirin and anticoagulant combination therapy in patients without cardiovascular disease, and non-dihydropyridine calcium channel blockers in patients with reduced ejection fraction. Using data from the NCDR PINNACLE registry, a national outpatient cardiology practice registry, we assessed rates of inappropriate prescription of two types of medications among AF outpatients from 5/1/2008-5/1/2016. Overall rates of inappropriate prescription and variation by practice were calculated. Patient and practice factors associated with inappropriate prescription were assessed in adjusted analyses. A total of 107,759 of 658,250 (16.4%) patients without cardiovascular disease were inappropriately prescribed an antiplatelet and anticoagulant together, and 5,731 of 150,079 (3.8%) patients with reduced ejection fraction were inappropriately prescribed a non-dihydropyridine calcium channel blocker. Overall, 14.8% of AF patients were prescribed medications that were not recommended. Both patient and practice factors were associated with inappropriate prescribing, and the adjusted practice-level median odds ratio for inappropriate prescription was 1.70 (95% CI: 1.61-1.82), indicating a 70% likelihood that 2 random practices would treat identical AF patients differently. In a large registry of AF patients treated in cardiology practices, overall rates of inappropriate prescription practices, as defined by the 2016 AF quality measures, were relatively low, but significant practice variation was present.
Collapse
Affiliation(s)
- Jonathan C Hsu
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, San Diego, California.
| | | | - Yang Song
- Baim Institute for Clinical Research, Boston, Massachusetts
| | - Gheorghe Doros
- Baim Institute for Clinical Research, Boston, Massachusetts
| | - Steven A Lubitz
- Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Anil K Gehi
- University of North Carolina, Chapel Hill, North Carolina
| | - Mintu P Turakhia
- VA Palo Alto Health Care Syste, Palo Alto, CA; Center for Digital Health; Stanford University School of Medicine, Stanford, California
| | - Thomas M Maddox
- Healthcare Innovation Lab, BJC HealthCare/Washington University School of Medicine; Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
28
|
Newman CM, Ramuta MD, McLaughlin MT, Wiseman RW, Karl JA, Dudley DM, Stauss MR, Maddox RJ, Weiler AM, Bliss MI, Fauser KN, Haddock LA, Shortreed CG, Haj AK, Accola MA, Heffron AS, Bussan HE, Reynolds MR, Harwood OE, Moriarty RV, Stewart LM, Crooks CM, Prall TM, Neumann EK, Somsen ED, Burmeister CB, Hall KL, Rehrauer WM, Friedrich TC, O'Connor SL, O'Connor DH. Initial Evaluation of a Mobile SARS-CoV-2 RT-LAMP Testing Strategy. J Biomol Tech 2021; 32:137-147. [PMID: 35035293 PMCID: PMC8730517 DOI: 10.7171/jbt.21-32-03-009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) control in the United States remains hampered, in part, by testing limitations. We evaluated a simple, outdoor, mobile, colorimetric reverse-transcription loop-mediated isothermal amplification (RT-LAMP) assay workflow where self-collected saliva is tested for SARS-CoV-2 RNA. From July 16, 2020, to November 19, 2020, surveillance samples (n = 4704) were collected from volunteers and tested for SARS-CoV-2 at 5 sites. Twenty-one samples tested positive for SARS-CoV-2 by RT-LAMP; 12 were confirmed positive by subsequent quantitative reverse-transcription polymerase chain reaction (qRT-PCR) testing, whereas 8 tested negative for SARS-CoV-2 RNA, and 1 could not be confirmed because the donor did not consent to further molecular testing. We estimated the false-negative rate of the RT-LAMP assay only from July 16, 2020, to September 17, 2020 by pooling residual heat-inactivated saliva that was unambiguously negative by RT-LAMP into groups of 6 or fewer and testing for SARS-CoV-2 RNA by qRT-PCR. We observed a 98.8% concordance between the RT-LAMP and qRT-PCR assays, with only 5 of 421 RT-LAMP-negative pools (2493 total samples) testing positive in the more-sensitive qRT-PCR assay. Overall, we demonstrate a rapid testing method that can be implemented outside the traditional laboratory setting by individuals with basic molecular biology skills and that can effectively identify asymptomatic individuals who would not typically meet the criteria for symptom-based testing modalities.
Collapse
Affiliation(s)
- Christina M Newman
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Mitchell D Ramuta
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Matthew T McLaughlin
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Roger W Wiseman
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Julie A Karl
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Dawn M Dudley
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Robert J Maddox
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Andrea M Weiler
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Mason I Bliss
- Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Luis A Haddock
- Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Cecilia G Shortreed
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Amelia K Haj
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Molly A Accola
- University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Anna S Heffron
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Hailey E Bussan
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Matthew R Reynolds
- Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Olivia E Harwood
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Ryan V Moriarty
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Laurel M Stewart
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Chelsea M Crooks
- Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Trent M Prall
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Emma K Neumann
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Elizabeth D Somsen
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Corrie B Burmeister
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristi L Hall
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - William M Rehrauer
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Thomas C Friedrich
- Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Shelby L O'Connor
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - David H O'Connor
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, Madison, WI, USA
| |
Collapse
|
29
|
Hwang HJ, Silver JS, Reynolds MR, Chaudhry MG, Hook BG. B-PO03-104 CHARACTERISTICS OF SLOW CONDUCTION ZONE IN PERIMITRAL FLUTTER: A PROMISING ABLATION TARGET. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.578] [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: 10/20/2022]
|
30
|
Reynolds MR, Gunnarsson CL, Ryan MP, Rosemas S, Ziegler PD, Neisen K, Yaghi S. B-PO01-028 UTILIZATION OF CARDIAC MONITORING FOR ATRIAL FIBRILLATION IN CRYPTOGENIC STROKE PATIENTS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.174] [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: 10/20/2022]
|
31
|
Barker CM, Reynolds MR, Reardon MJ, Van Houten JL, Murphy SM, Mollenkopf SA, Feldman TE. Relation of Institutional Mitral Valve Surgical Volume to Surgical and Transcatheter Outcomes in Medicare Patients. Am J Cardiol 2021; 147:94-100. [PMID: 33662328 DOI: 10.1016/j.amjcard.2021.01.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/15/2022]
Abstract
There are limited data to support proposed increases to the minimum institutional mitral valve (MV) surgery volume required to begin a transcatheter mitral valve repair (TMVr) program. The current study examined the association between institutional MV procedure volumes and outcomes. All 2017 Medicare fee-for-service patients who received a TMVr or MV surgery procedure were included and analyzed separately. The exposure was institutional MV surgery volume: low (1 to 24), medium (25 to 39) or high (40+). Outcomes were in-hospital mortality and 1-year postdischarge mortality and cardiovascular rehospitalization. For MV surgery patients, in-hospital mortality rates were 6.4% at low-volume, 8.7% at medium-volume and 9.8% at high-volume facilities. Rates were significantly higher for low-volume [OR = 1.50, 95% CI (1.23 to 1.84)] and medium-volume [OR = 1.33, 95% CI (1.06 to 1.67)] compared with high-volume facilities. There was no statistically significant relationship between institutional MV surgery volume and in-hospital mortality for TMVr patients, either at low-volume [OR = 1.52, 95% CI (0.56, 4.13)] or medium-volume [OR = 1.58, 95% CI (0.82, 3.02)] facilities, compared with high-volume facilities. Across all volume categories, in-hospital mortality rates for TMVr patients were relatively low (2.3% on average). For both cohorts, the rates of 1-year mortality and cardiovascular rehospitalizations were not significantly higher at low- or medium-volume MV surgery facilities, as compared with high-volume. In conclusion, among Medicare patients, there was a relation between institutional MV surgery volume and in-hospital mortality for MV surgery patients, but not for TMVr patients.
Collapse
|
32
|
Reynolds MR, Gong T, Li S, Herzog CA, Charytan DM. Cost-Effectiveness of Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention in Patients With Chronic Kidney Disease and Acute Coronary Syndromes in the US Medicare Program. J Am Heart Assoc 2021; 10:e019391. [PMID: 33787323 PMCID: PMC8174359 DOI: 10.1161/jaha.120.019391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/24/2021] [Indexed: 01/24/2023]
Abstract
Background Coronary revascularization provides important long-term clinical benefits to patients with high-risk presentations of coronary artery disease, including those with chronic kidney disease. The cost-effectiveness of coronary interventions in this setting is not known. Methods and Results We developed a Markov cohort simulation model to assess the cost-effectiveness of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with chronic kidney disease who were hospitalized with acute myocardial infarction or unstable angina. Model inputs were primarily drawn from a sample of 14 300 patients identified using the Medicare 20% sample. Survival, quality-adjusted life-years, costs, and cost-effectiveness were projected over a 20-year time horizon. Multivariable models indicated higher 30-day mortality and end-stage renal disease with both PCI and CABG, and higher stroke with CABG, relative to medical therapy. However, the model projected long-term gains of 0.72 quality-adjusted life-years (0.97 life-years) for PCI compared with medical therapy, and 0.93 quality-adjusted life-years (1.32 life-years) for CABG compared with PCI. Incorporation of long-term costs resulted in incremental cost-effectiveness ratios of $65 326 per quality-adjusted life-year gained for PCI versus medical therapy, and $101 565 for CABG versus PCI. Results were robust to changes in input parameters but strongly influenced by the background costs of the population, and the time horizon. Conclusions For patients with chronic kidney disease and high-risk coronary artery disease presentations, PCI and CABG were both associated with markedly increased costs as well as gains in quality-adjusted life expectancy, with incremental cost-effectiveness ratios indicating intermediate value in health economic terms.
Collapse
Affiliation(s)
- Matthew R. Reynolds
- Lahey Hospital & Medical CenterBurlingtonMA
- Baim Institute for Clinical ResearchBostonMA
| | - Tingting Gong
- Chronic Disease Research GroupHennepin Healthcare Research InstituteMinneapolisMN
| | - Shuling Li
- Chronic Disease Research GroupHennepin Healthcare Research InstituteMinneapolisMN
| | - Charles A. Herzog
- Chronic Disease Research GroupHennepin Healthcare Research InstituteMinneapolisMN
- Department of MedicineHennepin Healthcare and University of MinnesotaMinneapolisMN
| | | |
Collapse
|
33
|
Witte KK, Tsivgoulis G, Reynolds MR, Tsintzos SI, Eggington S, Ismyrloglou E, Lyon J, Huynh M, Egea M, de Brouwer B, Ziegler PD, Franco N, Joglekar R, Rosemas SC, Liu S, Thijs V. Burden of oral anticoagulation in embolic stroke of undetermined source without atrial fibrillation. BMC Cardiovasc Disord 2021; 21:160. [PMID: 33789592 PMCID: PMC8015049 DOI: 10.1186/s12872-021-01967-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/23/2021] [Indexed: 12/11/2022] Open
Abstract
Objective Prevention of recurrent stroke in patients with embolic stroke of undetermined source (ESUS) is challenging. The advent of safer anticoagulation in the form of direct oral anticoagulants (DOACs) has prompted exploration of prophylactic anticoagulation for all ESUS patients, rather than anticoagulating just those with documented atrial fibrillation (AF). However, recent trials have failed to demonstrate a clinical benefit, while observing increased bleeding. We modeled the economic impact of anticoagulating ESUS patients without documented AF across multiple geographies. Methods CRYSTAL-AF trial data were used to assess ischaemic stroke event rates in ESUS patients confirmed AF-free after long-term monitoring. Anticipated bleeding event rates (including both minor and major bleeds) with aspirin, dabigatran 150 mg, and rivaroxaban 20 mg were sourced from published meta-analyses, whilst a 30% ischaemic stroke reduction for both DOACs was assumed. Cost data for clinical events and pharmaceuticals were collected from the local payer perspective. Results Compared with aspirin, dabigatran and rivaroxaban resulted in 17.9 and 29.9 additional bleeding events per 100 patients over a patient’s lifetime, respectively. Despite incorporating into our model the proposed 30% reduction in ischaemic stroke risk, both DOACs were cost-additive over patient lifetime, as the costs of bleeding events and pharmaceuticals outweighed cost savings associated with the reduction in ischaemic strokes. DOACs added £5953–£7018 per patient (UK), €6683–€7368 (Netherlands), €4933–€9378 (Spain), AUD$5353–6539 (Australia) and $26,768–$32,259 (US) of payer cost depending on the agent prescribed. Additionally, in the U.S. patient pharmacy co-payments ranged from $2468–$12,844 depending on agent and patient plan. In all settings, cost-savings could not be demonstrated even when the modelling assumed 100% protection from recurrent ischaemic strokes, due to the very low underlying risk of recurrent ischaemic stroke in this population (1.27 per 100 patient-years). Conclusions Anticoagulation of non-AF patients may cause excess bleeds and add substantial costs for uncertain benefits, suggesting a personalised approach to anticoagulation in ESUS patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-01967-x.
Collapse
Affiliation(s)
- Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LIGHT Building, Clarendon Way, Leeds, LS2 9JT, UK.
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, National & Kapodistrian University of Athens Medical School, Athens, Greece
| | | | | | - Simon Eggington
- Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | | | | | | | | | | | - Paul D Ziegler
- Medtronic Global CRHF Headquarters, Mounds View, MN, USA
| | - Noreli Franco
- Medtronic Global CRHF Headquarters, Mounds View, MN, USA
| | - Rashmi Joglekar
- Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | | | - Shufeng Liu
- Medtronic Global CRHF Headquarters, Mounds View, MN, USA
| | - Vincent Thijs
- Florey Institute of Neuroscience, Melbourne, Australia
| |
Collapse
|
34
|
Newman CM, Ramuta MD, McLaughlin MT, Wiseman RW, Karl JA, Dudley DM, Stauss MR, Maddox RJ, Weiler AM, Bliss MI, Fauser KN, Haddock LA, Shortreed CG, Haj AK, Accola MA, Heffron AS, Bussan HE, Reynolds MR, Harwood OE, Moriarty RV, Stewart LM, Crooks CM, Prall TM, Neumann EK, Somsen ED, Burmeister CB, Hall KL, Rehrauer WM, Friedrich TC, O’Connor SL, O’Connor DH. Initial evaluation of a mobile SARS-CoV-2 RT-LAMP testing strategy. medRxiv 2021:2020.07.28.20164038. [PMID: 33655260 PMCID: PMC7924282 DOI: 10.1101/2020.07.28.20164038] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) control in the United States remains hampered, in part, by testing limitations. We evaluated a simple, outdoor, mobile, colorimetric reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay workflow where self-collected saliva is tested for SARS-CoV-2 RNA. From July 16 to November 19, 2020, 4,704 surveillance samples were collected from volunteers and tested for SARS-CoV-2 at 5 sites. A total of 21 samples tested positive for SARS-CoV-2 by RT-LAMP; 12 were confirmed positive by subsequent quantitative reverse-transcription polymerase chain reaction (qRT-PCR) testing, while 8 were negative for SARS-CoV-2 RNA, and 1 could not be confirmed because the donor did not consent to further molecular testing. We estimated the RT-LAMP assay's false-negative rate from July 16 to September 17, 2020 by pooling residual heat-inactivated saliva that was unambiguously negative by RT-LAMP into groups of 6 or less and testing for SARS-CoV-2 RNA by qRT-PCR. We observed a 98.8% concordance between the RT-LAMP and qRT-PCR assays, with only 5 of 421 RT-LAMP negative pools (2,493 samples) testing positive in the more sensitive qRT-PCR assay. Overall, we demonstrate a rapid testing method that can be implemented outside the traditional laboratory setting by individuals with basic molecular biology skills and can effectively identify asymptomatic individuals who would not typically meet the criteria for symptom-based testing modalities.
Collapse
Affiliation(s)
- Christina M. Newman
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Mitchell D. Ramuta
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Matthew T. McLaughlin
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Roger W. Wiseman
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Julie A. Karl
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Dawn M. Dudley
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | | | | | | | - Mason I. Bliss
- Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Luis A. Haddock
- Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Cecilia G. Shortreed
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Amelia K. Haj
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Molly A. Accola
- University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Anna S. Heffron
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Hailey E. Bussan
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Matthew R. Reynolds
- Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Olivia E. Harwood
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Ryan V. Moriarty
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Laurel M. Stewart
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Chelsea M. Crooks
- Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Trent M. Prall
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Emma K. Neumann
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Elizabeth D. Somsen
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Corrie B. Burmeister
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristi L. Hall
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - William M. Rehrauer
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Thomas C. Friedrich
- Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Shelby L. O’Connor
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - David H. O’Connor
- Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, Madison, WI, USA
| |
Collapse
|
35
|
Sutton BS, Bermingham SL, Diamantopoulos A, Rosemas SC, Tsintzos SI, Xia Y, Reynolds MR. Economic value of insertable cardiac monitors in unexplained syncope in the United States. Open Heart 2021; 8:e001263. [PMID: 33622962 PMCID: PMC7907887 DOI: 10.1136/openhrt-2020-001263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/17/2020] [Accepted: 01/31/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Early use of insertable cardiac monitor (ICM) is recommended for patients with unexplained syncope following initial clinical workup, due to its superior ability to establish symptom-rhythm correlation compared with conventional testing (CONV). However, ICMs incur higher upfront costs, and the impact of additional diagnoses and resulting treatment on downstream costs and outcomes is unclear. We aimed to evaluate the cost-effectiveness of ICM compared with CONV for the diagnosis of arrhythmia in patients with unexplained syncope, from a US payer perspective. METHODS A Markov model was developed to estimate lifetime costs and benefits of arrhythmia diagnosis with ICM versus CONV, considering all related diagnostic and arrhythmia-related treatment costs and consequences. Cohort characteristics and costs were informed by original claims database analyses. Risks of mortality, syncopal recurrence, injury due to syncope and quality of life consequences from syncopal events were identified from the literature. RESULTS ICM was less costly and more effective than CONV. Most of the observed US$4532 cost savings were attributed to reduced downstream diagnostic testing. For every 1000 patients, ICM was projected to yield an additional 253 arrhythmia diagnoses and lead to treatment in an additional 168 patients. The ICM strategy resulted in overall improved outcomes (0.30 quality-adjusted life years gained), due to a reduction in syncope recurrence and injury resulting from arrhythmia treatment. The results were robust to changes in the base case parameters but sensitive to the model time horizon, underlying probability of syncope recurrence and prevalence of arrhythmias. CONCLUSIONS Our model projected that early ICM for the diagnosis of unexplained syncope reduced long-term costs, and led to an improvement in overall clinical outcomes by shortening time to arrhythmia treatment. The cost of ICM was outweighed by savings arising from fewer downstream diagnostic episodes, and the increased cost of treatment was counterbalanced by fewer syncope-related event costs.
Collapse
Affiliation(s)
| | | | | | | | - Stelios I Tsintzos
- Health Economics and Reimbursement, Medtronic Europe SA, Tolochenaz, Vaud, Switzerland
| | - Ying Xia
- Medtronic Inc, Minneapolis, Minnesota, USA
| | - Matthew R Reynolds
- Cardiovascular Medicine, Baim Institute for Clinical Research, Boston, Massachusetts, USA
| |
Collapse
|
36
|
D'Souza SS, Bennett S, Kumar A, Kelnhofer LE, Weinfurter J, Suknuntha K, Coonen J, Mejia A, Simmons H, Golos T, Hematti P, Capitini CM, Reynolds MR, Slukvin II. Transplantation of T-cell receptor α/β-depleted allogeneic bone marrow in nonhuman primates. Exp Hematol 2021; 93:44-51. [PMID: 33176119 PMCID: PMC7855119 DOI: 10.1016/j.exphem.2020.09.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/24/2020] [Accepted: 09/26/2020] [Indexed: 10/23/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a potentially curative treatment for hematologic cancers and chronic infections such as human immunodeficiency virus (HIV). Its success in these settings is attributed to the ability of engrafting immune cells to eliminate cancer cells or deplete the HIV reservoir (graft-versus-host effect [GvHE]). However, alloHSCT is commonly associated with graft-versus-host diseases (GvHDs) causing significant morbidity and mortality, thereby requiring development of novel allogeneic HSCT protocols and therapies promoting GvHE without GvHD using physiologically relevant preclinical models. Here we evaluated the outcomes of major histocompatibility complex-matched T-cell receptor α/β-depleted alloHSCT in Mauritian cynomolgus macaques (MCMs). Following T-cell receptor α/β depletion, bone marrow cells were transplanted into major histocompatibility complex-identical MCMs conditioned with total body irradiation. GvHD prophylaxis included sirolimus alone in two animals or tacrolimus with cyclophosphamide in another two animals. Posttransplant chimerism was determined by sequencing diagnostic single-nucleotide polymorphisms to quantify the amounts of donor and recipient cells present in blood. Animals treated posttransplant with sirolimus developed nearly complete chimerism with acute GvHD. In the cyclophosphamide and tacrolimus treatment group, animals developed mixed chimerism without GvHD, with long-term engraftment observed in one animal. None of the animals developed cytomegalovirus infection. These studies indicate the feasibility of alloHSCT engraftment without GvHD in an MHC-identical MCM model following complete myeloablative conditioning and anti-GvHD prophylaxis with posttransplant cyclophosphamide and tacrolimus. Further exploration of this model will provide a platform for elucidating the mechanisms of GvHD and GvHE and for testing novel alloHSCT modalities for HIV infection.
Collapse
Affiliation(s)
- Saritha S D'Souza
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI
| | - Sarah Bennett
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI
| | - Akhilesh Kumar
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI
| | - Laurel E Kelnhofer
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI
| | - Jason Weinfurter
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI
| | - Kran Suknuntha
- Department of Pathology and Laboratory Medicine, School of Medicine, University of Wisconsin-Madison, Madison, WI; Chakri Naruebodindra Medical Institute, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Jennifer Coonen
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI
| | - Andres Mejia
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI
| | - Heather Simmons
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI
| | - Thaddeus Golos
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI; Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI; Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Peiman Hematti
- Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Christian M Capitini
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Matthew R Reynolds
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI; Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI
| | - Igor I Slukvin
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI; Department of Pathology and Laboratory Medicine, School of Medicine, University of Wisconsin-Madison, Madison, WI; Department of Cell and Regenerative Biology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Madison, WI.
| |
Collapse
|
37
|
Heiferman DM, Cheng EA, Harkins ME, Reynolds MR, Borrowdale RW, Leonetti JP, Anderson DE. Glomus Vagale Tumor Resection: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 20:E57. [PMID: 33027819 DOI: 10.1093/ons/opaa305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/13/2020] [Indexed: 11/12/2022] Open
Abstract
A 37-yr-old female with prior transient left facial paralysis presented with hearing loss, headaches, and resolved transient right facial paralysis. The neurological examination demonstrated normal facial movement, left hearing loss, and left vocal cord weakness. Magnetic resonance imaging demonstrated a >3 cm left paraganglioma traversing the jugular foramen. After obtaining informed consent from the patient, the tumor was embolized and then resected via a combined left postauricular infratemporal fossa and transcervical approach with cranial nerve monitoring. The ossicles were removed and the vertical segment of the facial nerve was skeletonized. The jugular bulb was identified in the hypotympanum and the petrous carotid artery was exposed. The digastric muscle was reflected inferiorly and the extratemporal facial nerve was identified. The stylomandibular ligament was transected to unlock the exposure to the infratemporal fossa. The external carotid branches were ligated. The vagus nerve and cervical sympathetic chain were infiltrated with tumor, requiring resection. The presigmoid dura and occluded jugular bulb were opened to complete the tumor resection, while preserving the medial wall. Despite anatomic preservation, the glossopharyngeal, accessory, and hypoglossal nerves were postoperatively weak and a facial paralysis recovered after 1 wk. Magnetic resonance imaging at 1 yr demonstrated a clean jugular foramen, although a thin rim of tumor remained around the petrous carotid.
Collapse
Affiliation(s)
- Daniel M Heiferman
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois
| | - Esther A Cheng
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Matthew R Reynolds
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois
| | - Richard W Borrowdale
- Department of Otolaryngology, Loyola University Stritch School of Medicine, Maywood, Illinois
| | - John P Leonetti
- Department of Otolaryngology, Loyola University Stritch School of Medicine, Maywood, Illinois
| | - Douglas E Anderson
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois
| |
Collapse
|
38
|
Sawyer LM, Witte KK, Reynolds MR, Mittal S, Grimsey Jones FW, Rosemas SC, Ziegler PD, Kaplon RE, Yaghi S. Cost-effectiveness of an insertable cardiac monitor to detect atrial fibrillation in patients with cryptogenic stroke. J Comp Eff Res 2020; 10:127-141. [PMID: 33300381 DOI: 10.2217/cer-2020-0224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: We assessed cost-effectiveness of insertable cardiac monitors (ICMs) in a US cryptogenic stroke population. Materials & methods: We modelled lifetime costs and quality-adjusted life years for three monitoring strategies post cryptogenic stroke: ICM starting immediately, ICM starting after Holter monitoring (delayed ICM) and standard of care involving intermittent ECG and Holter monitoring. Patient characteristics and detection efficacy were based on the CRYSTAL-AF trial. AF detection altered the modelled anticoagulation therapy and subsequent stroke and bleed risks. Results & conclusion: Immediate ICM was found to be cost-effective versus standard of care and cost-saving versus delayed ICM. Results were robust to sensitivity analyses. ICMs are a cost-effective diagnostic tool for the prevention of recurrent stroke in a US cryptogenic stroke population.
Collapse
Affiliation(s)
- Laura M Sawyer
- Symmetron Limited, 8 Devonshire Square, London, EC2M 4PL, UK
| | - Klaus K Witte
- Leeds Institute for Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, UK
| | - Matthew R Reynolds
- Baim Institute for Clinical Research, Boston, MA & Lahey Hospital & Medical Center, Burlington, MA 02215-1212, USA
| | - Suneet Mittal
- The Snyder Center for Comprehensive Atrial Fibrillation, the Valley Health System, Ridgewood, NJ 07652, USA
| | | | | | | | | | - Shadi Yaghi
- Department of Neurology, New York Langone Hospital, Brooklyn, NY 11220, USA
| |
Collapse
|
39
|
Reynolds MR, Kramer DB, Yeh RW, Cohen DJ. AF Ablation Outcomes: Real World or Fun House Mirror? J Am Coll Cardiol 2020; 75:1243. [PMID: 32164902 DOI: 10.1016/j.jacc.2019.11.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022]
|
40
|
Weinfurter JT, Graham ME, Ericsen AJ, Matschke LM, Llewellyn-Lacey S, Price DA, Wiseman RW, Reynolds MR. Identifying a Minor Histocompatibility Antigen in Mauritian Cynomolgus Macaques Encoded by APOBEC3C. Front Immunol 2020; 11:586251. [PMID: 33193411 PMCID: PMC7649366 DOI: 10.3389/fimmu.2020.586251] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplants can lead to dramatic reductions in human immunodeficiency virus (HIV) reservoirs. This effect is partially mediated by donor T cells recognizing lymphocyte-expressed minor histocompatibility antigens (mHAgs). The potential to mark malignant and latently infected cells for destruction makes mHAgs attractive targets for cellular immunotherapies. However, testing such HIV reservoir reduction strategies will likely require preclinical studies in non-human primates (NHPs). In this study, we used a combination of alloimmunization, whole exome sequencing, and bioinformatics to identify an mHAg in Mauritian cynomolgus macaques (MCMs). We mapped the minimal optimal epitope to a 10-mer peptide (SW10) in apolipoprotein B mRNA editing enzyme catalytic polypeptide-like 3C (APOBEC3C) and determined the major histocompatibility complex class I restriction element as Mafa-A1∗063, which is expressed in almost 90% of MCMs. APOBEC3C SW10-specific CD8+ T cells recognized immortalized B cells but not fibroblasts from an mHAg-positive MCM. These results provide a framework for identifying mHAgs in a non-transplant setting and suggest that APOBEC3C SW10 could be used as a model antigen to test mHAg-targeted therapies in NHPs.
Collapse
Affiliation(s)
- Jason T. Weinfurter
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Michael E. Graham
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Adam J. Ericsen
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Lea M. Matschke
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Sian Llewellyn-Lacey
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - David A. Price
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
- Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Roger W. Wiseman
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Matthew R. Reynolds
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, United States
| |
Collapse
|
41
|
Heiferman DM, Pecoraro NC, Wozniak AW, Ebersole KC, Jimenez LM, Reynolds MR, Ringer AJ, Serrone JC. Reliability of the Modified TICI Score among Endovascular Neurosurgeons. AJNR Am J Neuroradiol 2020; 41:1441-1446. [PMID: 32719092 DOI: 10.3174/ajnr.a6696] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/18/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The modified TICI score is the benchmark for quantifying reperfusion after mechanical thrombectomy. There has been limited investigation into the reliability of this score. We aim to identify intra-rater and inter-rater reliability of the mTICI score among endovascular neurosurgeons. MATERIALS AND METHODS Four independent endovascular neurosurgeons (raters) reviewed angiograms of 67 patients at 2 time points. κ statistics assessed inter- and intrarater reliability and compared raters'-versus-proceduralists' scores. Reliability was also assessed for occlusion location and by dichotomizing modified TICI scores (0-2a versus 2b-3). RESULTS Interrater reliability was moderate-to-substantial, weighted κ = 0.417-0.703, overall κ = 0.374 (P < .001). The dichotomized modified TICI score had moderate-to-substantial interrater agreement, κ statistics = 0.468-0.715, overall κ = 0.582 (P < .001). Intrarater reliability was moderate-to-almost perfect, weighted κ = 0.594-0.81. The dichotomized modified TICI score had substantial-to-almost perfect reliability, κ = 0.632-0.82. Proceduralists had fair-to-moderate agreement with raters, weighted κ = 0.348-0.574, and the dichotomized modified TICI score had fair-to-moderate agreement, κ = 0.365-0.544. When proceduralists and raters disagreed, proceduralists' scores were higher in 79.6% of cases. M1 followed by ICA occlusions had the highest agreement. CONCLUSIONS The modified TICI score is a practical metric for assessing reperfusion after mechanical thrombectomy, though not without limitations. Agreement improved when scores were dichotomized around the clinically relevant threshold of successful revascularization. Interrater reliability improved with time, suggesting that formal training of interventionalists may improve reporting reliability. Agreement of the modified TICI scale is best with M1 and ICA occlusion and becomes less reliable with more distal or posterior circulation occlusions. These findings should be considered when developing research trials.
Collapse
Affiliation(s)
- D M Heiferman
- From the Department of Neurological Surgery (D.M.H., N.C.P., M.R.R., J.C.S.), Clinical Research Office (A.W.W.), Loyola University Stritch School of Medicine and Loyola University Medical Center, Maywood, Illinois
| | - N C Pecoraro
- From the Department of Neurological Surgery (D.M.H., N.C.P., M.R.R., J.C.S.), Clinical Research Office (A.W.W.), Loyola University Stritch School of Medicine and Loyola University Medical Center, Maywood, Illinois
| | - A W Wozniak
- From the Department of Neurological Surgery (D.M.H., N.C.P., M.R.R., J.C.S.), Clinical Research Office (A.W.W.), Loyola University Stritch School of Medicine and Loyola University Medical Center, Maywood, Illinois
| | - K C Ebersole
- Department of Neurological Surgery (K.C.E.), University of Kansas Medical Center, Kansas City, Kansas; and Mayfield Brain & Spine (L.M.J., A.J.R.), Cincinnati, Ohio
| | - L M Jimenez
- Department of Neurological Surgery (K.C.E.), University of Kansas Medical Center, Kansas City, Kansas; and Mayfield Brain & Spine (L.M.J., A.J.R.), Cincinnati, Ohio
| | - M R Reynolds
- From the Department of Neurological Surgery (D.M.H., N.C.P., M.R.R., J.C.S.), Clinical Research Office (A.W.W.), Loyola University Stritch School of Medicine and Loyola University Medical Center, Maywood, Illinois
| | - A J Ringer
- Department of Neurological Surgery (K.C.E.), University of Kansas Medical Center, Kansas City, Kansas; and Mayfield Brain & Spine (L.M.J., A.J.R.), Cincinnati, Ohio
| | - J C Serrone
- From the Department of Neurological Surgery (D.M.H., N.C.P., M.R.R., J.C.S.), Clinical Research Office (A.W.W.), Loyola University Stritch School of Medicine and Loyola University Medical Center, Maywood, Illinois
| |
Collapse
|
42
|
|
43
|
Barker CM, Reardon MJ, Reynolds MR, Feldman TE. Association Between Institutional Mitral Valve Procedure Volume and Mitral Valve Repair Outcomes in Medicare Patients. JACC Cardiovasc Interv 2020; 13:1137-1139. [DOI: 10.1016/j.jcin.2020.01.212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/10/2020] [Accepted: 01/14/2020] [Indexed: 10/24/2022]
|
44
|
Heiferman DM, Reynolds MR, Reddy AS, Serrone JC. 'Railroad switch' technique for stent-assisted coil embolization of a wide-neck bifurcation intracranial aneurysm: technical note. Neuroradiol J 2020; 33:324-327. [PMID: 32347159 DOI: 10.1177/1971400920919688] [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] [Indexed: 11/16/2022] Open
Abstract
Preservation of the posterior cerebral arteries during endovascular treatment of wide-neck basilar bifurcation aneurysms remains a technical challenge despite recent device innovations. We present a novel stent deployment technique, the 'railroad switch', to protect both posterior cerebral arteries during treatment of a recurrent basilar bifurcation aneurysm. Following asymmetric basilar-posterior cerebral artery stent deployment, favoring distal placement in a posterior cerebral artery, advancement of a jailed microcatheter will advance the proximal stent into the aneurysm, protecting both posterior cerebral arteries and the native basilar terminus. This novel maneuver offers interventionalists another application of commonly used intracranial stents for endovascular management of complex basilar bifurcation aneurysms.
Collapse
Affiliation(s)
- Daniel M Heiferman
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, USA
| | - Matthew R Reynolds
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, USA.,Department of Radiology, Loyola University Stritch School of Medicine, USA
| | - Arra S Reddy
- Department of Radiology, Edward Hines Jr VA Hospital, USA
| | - Joseph C Serrone
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, USA.,Department of Radiology, Loyola University Stritch School of Medicine, USA.,Department of Neurological Surgery, Edward Hines Jr VA Hospital, USA
| |
Collapse
|
45
|
Resnic FS, Majithia A, Dhruva SS, Ssemaganda H, Robbins S, Marinac-Dabic D, Hewitt K, Ohno-Machado L, Reynolds MR, Matheny ME. Active Surveillance of the Implantable Cardioverter-Defibrillator Registry for Defibrillator Lead Failures. Circ Cardiovasc Qual Outcomes 2020; 13:e006105. [PMID: 32283971 DOI: 10.1161/circoutcomes.119.006105] [Citation(s) in RCA: 4] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several defibrillator leads have been recalled due to early lead failure leading to significant patient harm. Confirming the safety of contemporary defibrillator leads is essential to optimizing treatment for patients receiving implantable cardioverter-defibrillators (ICDs). We therefore sought to assess the comparative long-term safety of the 4 most commonly implanted ICD leads within the National Cardiovascular Data Registry ICD Registry. METHODS AND RESULTS A propensity-matched survival analysis of the ICD Registry was performed evaluating 4 contemporary ICD leads in patients receiving an ICD system for the first time. All patients in the ICD Registry aged ≥18 years who underwent an implant of an ICD between April 1, 2011 and March 31, 2016 were included. Monitoring of safety began with ICD implant and continued up to 5 years. A meaningful difference in ICD failure rate was defined as twice (or more) the lead failure rate observed in the propensity-matched comparator patients. Among the 374 132 patients who received a new ICD implant, no safety alerts were triggered for the primary safety end point of lead failure for any of the high energy leads studied. Estimated rates of freedom from lead failure at 5 years ranged from 97.7% to 98.9% for the 4 high-energy leads of interest. CONCLUSIONS Though limited by incomplete long-term outcomes ascertainment, active surveillance of the ICD Registry suggests that there were no meaningful differences in the rate of ICD high-energy lead survival for the 4 most commonly used high-energy ICD leads.
Collapse
Affiliation(s)
- Frederic S Resnic
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.).,Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., M.R.R.).,Tufts School of Medicine, Boston, MA (F.S.R., M.R.R.)
| | - Arjun Majithia
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.).,Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., M.R.R.).,Brigham and Women's Hospital, Boston, MA (A.M.)
| | - Sanket S Dhruva
- UCSF School of Medicine and Section of Cardiology, San Francisco VA Health Care System (S.S.D.)
| | - Henry Ssemaganda
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.)
| | - Susan Robbins
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.)
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health (CDRH), FDA, Silver Spring, MD (D.M.-D.)
| | - Kathleen Hewitt
- National Cardiovascular Data Registry, American College of Cardiology, Washington, DC (K.H.)
| | - Lucila Ohno-Machado
- Department of Biomedical Informatics, University of California San Diego Health, La Jolla (L.O.-M.)
| | - Matthew R Reynolds
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.).,Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., M.R.R.).,Tufts School of Medicine, Boston, MA (F.S.R., M.R.R.)
| | - Michael E Matheny
- Geriatrics Research, Education, and Clinical Care Center, Tennessee Valley Healthcare System VA, Nashville (M.E.M.).,Departments of Biomedical Informatics, Biostatistics and Medicine, Vanderbilt University Medical Center, Nashville, TN (M.E.M.)
| |
Collapse
|
46
|
Field ME, Goldstein L, Yu Lee SH, Kalsekar I, Coplan P, Wong C, Khanna R, Gold MR, Reynolds MR, Winterfield JR. Intracardiac echocardiography use and outcomes after catheter ablation of ventricular tachycardia. J Comp Eff Res 2020; 9:375-385. [PMID: 32134325 DOI: 10.2217/cer-2019-0156] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare outcomes among patients with implantable cardioverter defibrillator/cardiac resynchronization therapy-defibrillator undergoing outpatient ventricular tachycardia (VT) catheter ablation using intracardiac echocardiography (ICE) versus no ICE. Patients & methods: Patients were classified into ICE (n = 1143)/non-ICE (n = 1677) groups based on ICE procedure codes. Patients in each group were propensity matched on study covariates. Survival analyses were used to assess outcomes. To examine residual confounding, falsification outcomes were evaluated. Results: ICE patients had a 24% lower risk of all-cause readmissions, 24% lower risk of cardiovascular-related and 20% lower risk of VT-related readmissions compared with non-ICE patients. Falsification analyses for ICE use association were nonsignificant. Conclusion: Patients with implantable cardioverter defibrillator/cardiac resynchronization therapy-defibrillator undergoing VT ablation with ICE use had significantly lower likelihood of VT-related readmission.
Collapse
Affiliation(s)
- Michael E Field
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Laura Goldstein
- Johnson & Johnson Medical Devices, Franchise Health Economics & Market Access, Irvine, CA, USA
| | | | - Iftekhar Kalsekar
- Medical Device Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA
| | - Paul Coplan
- Medical Device Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA
| | - Charlene Wong
- Medical Device Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA
| | - Rahul Khanna
- Medical Device Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA
| | - Michael R Gold
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Matthew R Reynolds
- Department of Cardiovascular Medicine, Lahey Hospital & Medical Center, Burlington, MA, USA
| | | |
Collapse
|
47
|
|
48
|
Griffiths RI, Amorosi SL, Jacobsen CM, McBee PJ, Menzin J, Reynolds MR. Costs and complications associated with transvenous lead reoperation in cardiac implantable electronic devices. J Cardiovasc Electrophysiol 2020; 31:503-511. [DOI: 10.1111/jce.14337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/28/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Robert I. Griffiths
- Nuffield Department of Primary Care Health SciencesUniversity of Oxford Oxford UK
- Health Economics and Outcomes ResearchBoston Health Economics Inc. Boston Massachusetts
- Health Economics Center of ExcellenceBoston Scientific Corporation Marlborough Massachusetts
| | - Stacey L. Amorosi
- Health Economics Center of ExcellenceBoston Scientific Corporation Marlborough Massachusetts
| | - Caroline M. Jacobsen
- Health Economics Center of ExcellenceBoston Scientific Corporation Marlborough Massachusetts
| | - Patrick J. McBee
- Health Economics and Outcomes ResearchBoston Health Economics Inc. Boston Massachusetts
| | - Joseph Menzin
- Health Economics and Outcomes ResearchBoston Health Economics Inc. Boston Massachusetts
| | - Matthew R. Reynolds
- Economics & Quality of Life ResearchBaim Institute for Clinical Research Boston Massachusetts
- Cardiology DivisionLahey Hospital and Medical Center Burlington Massachusetts
| |
Collapse
|
49
|
Hajovsky D, Reynolds MR, Floyd RG, Turek JJ, Keith TZ. A Multigroup Investigation of Latent Cognitive Abilities and Reading Achievement Relations. School Psychology Review 2019. [DOI: 10.1080/02796015.2014.12087412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
50
|
Keith TZ, Fine J, Taub GE, Reynolds MR, Kranzler JH. Short-Term Estimates of Growth Using Curriculum-Based Measurement of Oral Reading Fluency: Estimating Standard Error of the Slope to Construct Confidence Intervals. School Psychology Review 2019. [DOI: 10.1080/02796015.2006.12088005] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|