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Urey MA, Hibbert B, Jorde U, Eckman P, Simard T, Labinaz M, Nazer B, Wiley M, Gupta B, Sauer A, Shah H, Sorajja P, Pineda AM, Missov E, Mahmud E, Kahwash R, Lilly S, Latib A, Murthy S, Fam N, Garcia S, Chung ES, Klein L, Cheng R, Houston BA, Amoroso NS, Chang L, Gafoor S, Chaudhry SP, Hermiller J, Schwartz JG, Aldaia L, Koulogiannis K, Gray WA, Zahr F. Left atrial to coronary sinus shunting for treatment of heart failure with mildly reduced or preserved ejection fraction: The ALT FLOW Early Feasibility Study 1-year results. Eur J Heart Fail 2024. [PMID: 38606485 DOI: 10.1002/ejhf.3241] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/27/2024] [Accepted: 03/30/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS Patients with heart failure and mildly reduced or preserved ejection fraction have limited therapeutic options. The ALT-FLOW Early Feasibility Study evaluated safety, haemodynamics and outcomes for the APTURE transcatheter shunt system, a novel left atrium to coronary sinus shunt in these patients. METHODS AND RESULTS Safety and shunt implantation success was evaluated for all 116 enrolled patients. An analysis population of implanted patients with a left ventricular ejection fraction (LVEF) >40% (n = 95) was chosen to assess efficacy via paired comparison between baseline and follow-up haemodynamic (3 and 6 months), and echocardiographic, clinical and functional outcomes (6 months and 1 year). Health status and quality of life outcomes were assessed using the Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OSS). The primary safety endpoint, major adverse cardiac, cerebral, and renal events, and reintervention through 30 days, occurred in 3/116 patients (2.6%). All implanted shunts were patent at 1 year. In patients with LVEF >40%, the mean (95% confidence interval) reduction in exercise pulmonary capillary wedge pressure (PCWP) at 20 W was -5.7 (-8.6, -2.9) mmHg at 6 months (p < 0.001). At baseline, 8% had New York Heart Association class I-II status and improved to 68% at 1 year (p < 0.001). KCCQ-OSS at baseline was 39 (35, 43) and improved at 6 months and 1 year by 25 (20-30) and 27 (22-32) points, respectively (both p < 0.0001). No adverse changes in haemodynamic and echocardiographic indices of right heart function were observed at 1 year. Overall, the reduction in PCWP at 20 W and improvement in KCCQ-OSS in multiple subgroups were consistent with those observed for the entire population. CONCLUSIONS In patients with heart failure and LVEF >40%, the APTURE shunt demonstrated an acceptable safety profile with significant sustained improvements in haemodynamic and patient-centred outcomes, underscoring the need for further evaluation of the APTURE shunt in a randomized trial.
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Affiliation(s)
- Marcus A Urey
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Benjamin Hibbert
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- CAPITAL Research, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ulrich Jorde
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Peter Eckman
- Department of Cardiology, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Marino Labinaz
- CAPITAL Research, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Babak Nazer
- Division of Cardiology, University of Washington Medical Center
| | - Mark Wiley
- Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Bhanu Gupta
- Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Andrew Sauer
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Hirak Shah
- Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Paul Sorajja
- Department of Cardiology, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Andres M Pineda
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Emil Missov
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Ehtisham Mahmud
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Rami Kahwash
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Scott Lilly
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Sandhya Murthy
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Neil Fam
- St. Michael's Hospital Unity Health, Toronto, ON, Canada
| | - Santiago Garcia
- The Christ Hospital and The Carl and Edyth Lindner Center for Research and Education, Cincinnati, OH, USA
| | - Eugene S Chung
- Lindner Research Center at The Christ Hospital, Cincinnati, OH, USA
| | - Liviu Klein
- Advanced Heart Failure Comprehensive Care Center, Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Richard Cheng
- Division of Cardiovascular Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Brian A Houston
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Nicholas S Amoroso
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Lee Chang
- Swedish Heart and Vascular, Seattle, WA, USA
| | - Sameer Gafoor
- Swedish Heart and Vascular, Seattle, WA, USA
- Cardiovascular Center Frankfurt, Frankfurt, Germany
| | - Sunit-Preet Chaudhry
- Ascension St. Vincent Heart Center, Indianapolis, Indiana and Ascension St. Vincent Cardiovascular Research Institute, Indianapolis, IN, USA
| | - James Hermiller
- Ascension St. Vincent Heart Center, Indianapolis, Indiana and Ascension St. Vincent Cardiovascular Research Institute, Indianapolis, IN, USA
| | | | - Lillian Aldaia
- Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | - Konstantinos Koulogiannis
- Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | | | - Firas Zahr
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
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Trovato V, Asada A, Fussner L, Curtis C, Kahwash R. Interleukin-5 Antagonist Monoclonal Antibody Therapy Improves Symptoms and Reduces Steroid Dependence in Eosinophilic Myocarditis Patients. JACC Case Rep 2024; 29:102267. [PMID: 38645295 PMCID: PMC11031656 DOI: 10.1016/j.jaccas.2024.102267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 04/23/2024]
Abstract
Eosinophilic myocarditis (EM) is a rare disease associated with significant morbidity and mortality. This case series follows the clinical courses of 3 patients with EM. The use of mepolizumab, an anti-interleukin-5 monoclonal antibody, as an adjunctive treatment was associated with stabilization of cardiac function and improved long-term outcomes.
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Affiliation(s)
- Vincenzo Trovato
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ashlee Asada
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lynn Fussner
- Division of Pulmonary, Critical Care, and Sleep Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Casey Curtis
- Division of Allergy and Immunology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Rami Kahwash
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Stock JC, Carlquist J, Melnyk M, Smith S, Bole I, Patel V, Emani S, Foreman B, Hasan A, Franco V, Lampert BC, Haas GJ, Vallakati A, Ma J, Peng J, Boudoulas KD, Kahwash R. A retrospective analysis of anticoagulant safety among heart transplant recipients undergoing endomyocardial biopsy. Clin Transplant 2024; 38:e15254. [PMID: 38369817 DOI: 10.1111/ctr.15254] [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: 09/01/2023] [Revised: 12/13/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Transvenous endomyocardial biopsy is an invasive procedure which is used to diagnose rejection following an orthotopic heart transplant. Endomyocardial biopsy is widely regarded as low risk with all-cause complication rates below 5% in most safety studies. Following transplant, some patients require therapeutic anticoagulation. It is unknown whether anticoagulation increases endomyocardial biopsy bleeding risk. METHODS Records from 2061 endomyocardial biopsies performed for post-transplant rejection surveillance at our institution between November 2016 and August 2022 were reviewed. Bleeding complications were defined as vascular access-related hematoma or bleeding, procedure-related red blood cell transfusion, and new pericardial effusion. Relative risk and small sample-adjusted 95% confidence interval was calculated to investigate the association between bleeding complications and anticoagulation. RESULTS AND CONCLUSIONS The overall risk of bleeding was 1.2% (25/2061 cases). There was a statistically significant increase in bleeding among patients on intravenous (RR 4.46, CI 1.09-18.32) but not oral anticoagulants (RR .62, CI .15-2.63) compared to patients without anticoagulant exposure. There was a trend toward increased bleeding among patients taking warfarin with INR ≥ 1.8 (RR 3.74, CI .90-15.43). Importantly, no bleeding events occurred in patients taking direct oral anticoagulants such as apixaban. Based on these results, intravenous rather than oral anticoagulation was associated with a significantly higher risk of bleeding complications following endomyocardial biopsy.
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Affiliation(s)
- James Christian Stock
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jason Carlquist
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Megan Melnyk
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Sakima Smith
- The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA
| | - Indra Bole
- The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA
| | - Vaiibhav Patel
- The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA
| | - Sitaramesh Emani
- The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA
| | - Beth Foreman
- The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA
| | - Ayesha Hasan
- The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA
| | - Veronica Franco
- The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA
| | | | - Garrie Joseph Haas
- The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA
| | - Ajay Vallakati
- The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA
| | - Jianing Ma
- The Ohio State University College of Medicine, Center for Biostatistics, Columbus, Ohio, USA
| | - Jing Peng
- The Ohio State University College of Medicine, Center for Biostatistics, Columbus, Ohio, USA
| | | | - Rami Kahwash
- The Ohio State University Division of Cardiovascular Medicine, Columbus, Ohio, USA
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Zile MR, Kahwash R, Sarkar S, Koehler J, Zielinski T, Mehra MR, Fonarow GC, Gulati S, Butler J. A Novel Heart Failure Diagnostic Risk Score Using a Minimally Invasive Subcutaneous Insertable Cardiac Monitor. JACC Heart Fail 2024; 12:182-196. [PMID: 37943225 DOI: 10.1016/j.jchf.2023.09.014] [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] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND The authors tested the hypothesis that physiological information from sensors within a minimally invasive, subcutaneous, insertable cardiac monitor (ICM) could be used to develop an ambulatory heart failure risk score (HFRS) to accurately identify heart failure (HF) patients, across the ejection fraction spectrum, at high risk of an impending worsening heart failure event (HFE). OBJECTIVES The purpose of this study was to examine performance of ICM-based, multiparameter, dynamic HFRS to predict HFEs in patients with NYHA functional class II/III HF. METHODS In 2 observational cohorts, HF patients were implanted with an ICM; subcutaneous impedance, respiratory rate, heart rate and variability, atrial fibrillation burden, ventricular rate during atrial fibrillation, and activity duration were combined into an HFRS to identify the probability of HFE within 30 days. Patients and providers were blinded to the data. HFRS sensitivity and unexplained detection rate were defined in 2 independent patient population data sets. HFEs were defined as hospitalization, observation unit, or emergency department visit with a primary diagnosis of HF, and intravenous diuretic treatment. RESULTS First data set (development): 42 patients had 19 HFE; second data set (validation): 94 patients had 19 HFE (mean age 66 ± 11 years, 63% men, 50% with LVEF ≥40%, 80% NYHA functional class III). Using a high-risk threshold = 7.5%, development and validation data sets: sensitivity was 73.7% and 68.4%; unexplained detection rate of 1.4 and 1.5 per patient-year; median 47 and 64 days early warning before HFE. CONCLUSIONS ICM-HFRS provides a multiparameter, integrated diagnostic method with the ability to identify when HF patients are at increased risk of heart failure events. (Reveal LINQ Evaluation of Fluid [REEF]; NCT02275923, Reveal LINQ Heart Failure [LINQ HF]; NCT02758301, Algorithm Using LINQ Sensors for Evaluation and Treatment of Heart Failure [ALLEVIATE-HF]; NCT04452149).
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Affiliation(s)
- Michael R Zile
- Medical University of South Carolina and the Ralph H. Johnson Department of Veterans Affairs Health Care System, Charleston, South Carolina, USA.
| | | | | | | | | | - Mandeep R Mehra
- Center for Advanced Heart Disease, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Gregg C Fonarow
- University of California, Division of Cardiology, Los Angeles, California, USA
| | - Sanjeev Gulati
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Javed Butler
- Baylor Scott and White Research Institute Dallas Texas, University of Mississippi, Jackson, Mississippi, USA
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Wallner AL, Savona S, Kahwash R. Cardiac Contractility Modulation: Implications in Heart Failure, a Current Review. Heart Fail Clin 2024; 20:51-60. [PMID: 37953021 DOI: 10.1016/j.hfc.2023.05.006] [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] [Indexed: 11/14/2023]
Abstract
Cardiac contractility modulation (CCM) is a novel therapeutic approach for heart failure patients, which utilizes nonexcitatory electrical myocardial stimulation in the absolute refractory period of the cardiac cycle. This stimulation has been shown to increase contractility, leading to improved heart failure symptoms, functional status, and quality of life. CCM is FDA approved for heart failure patients with an LVEF between 25% and 45% who remained symptomatic despite optimal medical therapy and not candidate of cardiac resynchronization therapy. CCM offers expanded treatment options for heart failure patients who have continued symptoms while on optimal medical therapy.
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Affiliation(s)
- Alexander L Wallner
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Salvatore Savona
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rami Kahwash
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Campbell CM, Baiyee CAMT, Almaani S, Bumma N, Sharma N, LoRusso S, Redder E, Bittengle J, Pfund K, Friemer M, Tong M, Kahwash R, Efebera Y, Parikh S, Vallakati A. Targeted Therapeutics for Transthyretin Amyloid Cardiomyopathy. Am J Ther 2023; 30:e447-e453. [PMID: 37713689 DOI: 10.1097/mjt.0000000000001296] [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] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Deposition of wild-type or mutant transthyretin (TTR) amyloid fibrils in the myocardium causes TTR amyloid cardiomyopathy (ATTR-CM). Targeted therapeutics for ATTR-CM include TTR stabilizers (tafamidis and diflunisal) and oligonucleotide drugs (revusiran, patisiran, and inotersen). TTR stabilizers prevent dissociation of transthyretin tetramers. Transthyretin monomers can misfold and form amyloid fibrils. TTR stabilizers thereby limit amyloid fibrils development and deposition. Oligonucleotide drugs inhibit hepatic synthesis of transthyretin, which decreases transthyretin protein levels and thus the amyloid fibril substrate. AREAS OF UNCERTAINTY To study the safety and efficacy of targeted therapeutics in patients with ATTR-CM, we performed a pooled analysis. A random-effects model with the Mantel-Haenszel method was used to pool the data. DATA SOURCES A literature search was performed using PubMed, Cochrane CENTRAL, and Embase databases using the search terms "cardiac amyloidosis" AND "tafamidis" OR "patisiran" OR "inotersen" OR "revusiran" OR "diflunisal." THERAPEUTIC ADVANCES We identified 6 studies that compared targeted therapeutics with placebo. One study was stopped prematurely because of increased mortality in the targeted therapeutics arm. Pooled analysis included 1238 patients, of which 738 patients received targeted therapeutics and 500 patients received placebo. When compared with placebo, targeted therapeutics significantly reduced all-cause mortality [OR 0.39, 95% confidence interval (CI): 0.16-0.97, P = 0.04]. Only 2 studies reported the effect on cardiovascular-related hospitalizations. There was a trend toward an improvement in global longitudinal strain (mean difference -0.69, 95% CI: -1.44 to 0.05, P = 0.07). When compared with placebo, there was no increase in serious adverse events with targeted therapeutics (OR 1.06, 95% CI: 0.78-1.44, P = 0.72). CONCLUSION Evidence from the pooled analysis revealed targeted therapeutics improve survival and are well-tolerated. These findings suggest a potential role for targeted therapeutics in the treatment of patients with ATTR-CM.
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Affiliation(s)
- Courtney M Campbell
- Division of Cardiovascular Medicine, the Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Salem Almaani
- Division of Nephrology, the Ohio State University Wexner Medical Center, Columbus, OH
| | - Naresh Bumma
- Division of Oncology, the Ohio State University Wexner Medical Center, Columbus, OH
| | - Nidhi Sharma
- Division of Oncology, the Ohio State University Wexner Medical Center, Columbus, OH
| | - Samantha LoRusso
- Division of Neurology, the Ohio State University Wexner Medical Center, Columbus, OH; and
| | - Elyse Redder
- Department of Oncology Rehabilitation, the Ohio State University Wexner Medical Center, Columbus, OH
| | - Jordan Bittengle
- Division of Oncology, the Ohio State University Wexner Medical Center, Columbus, OH
| | - Katherine Pfund
- Division of Oncology, the Ohio State University Wexner Medical Center, Columbus, OH
| | - Miriam Friemer
- Division of Neurology, the Ohio State University Wexner Medical Center, Columbus, OH; and
| | - Matthew Tong
- Division of Cardiovascular Medicine, the Ohio State University Wexner Medical Center, Columbus, OH
| | - Rami Kahwash
- Division of Cardiovascular Medicine, the Ohio State University Wexner Medical Center, Columbus, OH
| | - Yvonne Efebera
- Division of Oncology, the Ohio State University Wexner Medical Center, Columbus, OH
| | - Samir Parikh
- Division of Nephrology, the Ohio State University Wexner Medical Center, Columbus, OH
| | - Ajay Vallakati
- Division of Cardiovascular Medicine, the Ohio State University Wexner Medical Center, Columbus, OH
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Modi S, Kahwash R, Kissling K. Case Report: tacrolimus toxicity in the setting of concurrent Paxlovid use in a heart-transplant recipient. Eur Heart J Case Rep 2023; 7:ytad193. [PMID: 37252201 PMCID: PMC10220502 DOI: 10.1093/ehjcr/ytad193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/07/2022] [Accepted: 04/13/2023] [Indexed: 05/31/2023]
Abstract
Background Tacrolimus toxicity in patient's status post-orthotropic heart transplantation is not commonly reported. Given its narrow therapeutic window and drug-drug interactions, it must be closely monitored by providers who are experienced in transplant management. There are no case series of patients with tacrolimus toxicity in the setting of treatment for Sars-2-CoV-19 (COVID 19) for heart-transplant recipients. We present a case of tacrolimus toxicity in the setting of concurrent ritonavir-nirmatrelvir (Paxlovid) use. Case summary The patient was a 74-year-old male with a prior significant history of heart transplantation and on maintenance immunosuppression with tacrolimus. He contracted COVID-19 and was prescribed antiviral therapy with Paxlovid by an outside provider prior to admission. The patient complained of severe headaches, dehydration, and tremors. After eliminating acute intracranial processes with imaging, laboratory investigation revealed a severely elevated tacrolimus level with acute renal injury. The patient was taken off tacrolimus and treated conservatively with intravenous hydration. The symptoms improved, particularly the headaches. He was discharged with instructions to resume his home dosing of tacrolimus and return to clinic in 1 week with a repeat trough level. The subsequent trough level was no longer supra-therapeutic. Discussion Tacrolimus has a potent drug-drug interaction with Paxlovid (ritonavir-nirmatrelvir) and can be supra-therapeutic. Toxicity is associated with multiple adverse effects, including but not limited to, acute renal injury, neurotoxicity, and infections due to over-immunosuppression. As Paxlovid is effective in treating Sars-2-CoV-19 in heart-transplant recipients, knowledge and understanding of drug-drug interactions is crucial in preventing and mitigating toxicity.
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Affiliation(s)
| | - Rami Kahwash
- Cardiovascular Medicine, The Ross Heart Hospital at The Ohio State University Wexner Medical Center, 473 W. 12th Avenue, Columbus, OH 43210, USA
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Hibbert B, Zahr F, Simard T, Labinaz M, Nazer B, Sorajja P, Eckman P, Pineda AM, Missov E, Mahmud E, Schwartz J, Gupta B, Wiley M, Sauer A, Jorde U, Latib A, Kahwash R, Lilly S, Chang L, Gafoor S, Chaudhry SP, Hermiller J, Aldaia L, Koulogiannis K, Gray WA. Left Atrial to Coronary Sinus Shunting for Treatment of Symptomatic Heart Failure. JACC Cardiovasc Interv 2023:S1936-8798(23)00571-X. [PMID: 36989271 DOI: 10.1016/j.jcin.2023.03.012] [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: 03/06/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Heart failure (HF) is associated with both mortality and a significant decline in health status. Inter-atrial shunting is increasingly being investigated as a novel therapeutic option. OBJECTIVES The ALT FLOW Early Feasibility Study was designed to evaluate the safety of the Edwards left atrial to coronary sinus APTURETM Transcatheter Shunt System in patients with symptomatic HF. METHODS 18 centers enrolled patients with symptomatic HF with a pulmonary capillary wedge pressure (PCWP) >15mmHg at rest or 25mmHg during exercise. RESULTS Between May 2018 and September 2022, 87 patients underwent attempted APTURETM shunt implantation. Mean age was 71 years, and 53% were male. At baseline mean LVEF was 59% with 90% of the patients being NYHA III. Device success was achieved in 78 (90%) of patients with no device occlusions or associated adverse events identified after implantation. The primary safety outcome occurred in only 2 (2.3%) patients at 30 days. At 6 months health status improved: 68% of participants achieved NYHA I-II status, with a 23-point improvement (p<0.0001, 95% CI [17, 29]) in the Kansas City Cardiomyopathy Questionnaire overall summary score. Also at 6 months, 20-watt exercise pulmonary capillary wedge pressure was -7mmHg lower (p<0.0001, 95% CI [-11, -4]) without change in right atrial pressure or other right heart function indices. CONCLUSIONS In this single-arm experience, the APTURETM Transcatheter Shunt System in patients with symptomatic HF was observed to be safe and resulted in reduction in PCWP and clinically meaningful improvements in HF symptoms and quality of life indices.
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Affiliation(s)
- Benjamin Hibbert
- CAPITAL Research, Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Firas Zahr
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Marino Labinaz
- CAPITAL Research, Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada
| | - Babak Nazer
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Paul Sorajja
- Department of Cardiology, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Peter Eckman
- Department of Cardiology, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Andres M Pineda
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
| | - Emil Missov
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
| | - Ehtisham Mahmud
- Division of Cardiovascular Medicine, University of California San Diego, San Diego, California
| | - Jonathan Schwartz
- Sanger Heart & Vascular Institute, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Bhanu Gupta
- Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Mark Wiley
- Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Andrew Sauer
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Ulrich Jorde
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, New York
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, The Bronx, New York
| | - Rami Kahwash
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - Scott Lilly
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - Lee Chang
- Swedish Heart and Vascular, Seattle, Washington
| | - Sameer Gafoor
- Swedish Heart and Vascular, Seattle, Washington; Cardiovascular Center Frankfurt, Frankfurt, Germany
| | - Sunit-Preet Chaudhry
- Department of Cardiology, Ascension St Vincent Heart Center of Indiana, Indianapolis, Indiana
| | - James Hermiller
- Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - Lillian Aldaia
- Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - Konstantinos Koulogiannis
- Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
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Miller A, Whitson BA, Kahwash R. A CHALLENGING DIAGNOSIS OF ISOLATED CARDIAC SARCOIDOSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03416-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Zile MR, Kahwash R, Sarkar S, Koehler J, Butler J. Temporal Characteristics of Device-Based Individual and Integrated Risk Metrics in Patients With Chronic Heart Failure. JACC Heart Fail 2022; 11:143-156. [PMID: 36752485 DOI: 10.1016/j.jchf.2022.10.014] [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] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Temporal characteristics of a multimetric risk score and its individual parameters before, during, and after a heart failure (HF) event have not been defined. OBJECTIVES A large real-world patient cohort with implantable cardioverter-defibrillators and cardiac resynchronization therapy (CRT) defibrillators was used to define these temporal characteristics. METHODS Deidentified health records were linked to manufacturer's device database in 17,886 patients. Multimetric risk score combined daily measures of impedance, heart rate, activity, heart rate variability, and atrial fibrillation (AF) burden, AF ventricular rate, CRT pacing, and ventricular tachycardia episodes and shocks. HF event was defined as an inpatient, emergency department, or observation unit stay with primary diagnosis of HF and intravenous diuretic agents administration. Changes in risk parameters during 60 days before, during, and after an HF event were compared in patients with no HF readmissions vs patients with HF readmission. RESULTS A total of 1,174 patients had HF events with no HF readmission, and 282 patients had HF events with HF readmission. Diagnostic risk score was higher on all 60 days before and after a HF event in patients with HF readmission compared with patients with no readmission (P < 0.001). Change in risk score from admission to discharge was similar in patients with and without HF readmission, but the risk score fell more significantly 7 after discharge and 30 days after admission in patients without HF readmission (P < 0.001). CONCLUSIONS Temporal characteristics of risk metrics were significantly different in patients with no HF readmissions vs patients with HF readmission; patients without HF recurrence had larger recovery of risk metrics values toward normal.
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Affiliation(s)
- Michael R Zile
- Medical University of South Carolina and the Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, USA.
| | | | | | | | - Javed Butler
- University of Mississippi, Jackson, Mississippi, USA
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11
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Bumma N, Kahwash R, Parikh SV, Isfort M, Freimer M, Vallakati A, Redder E, Campbell CM, Sharma N, Efebera Y, Stino A. Multidisciplinary amyloidosis care in the era of personalized medicine. Front Neurol 2022; 13:935936. [PMID: 36341129 PMCID: PMC9630033 DOI: 10.3389/fneur.2022.935936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/22/2022] [Indexed: 11/28/2022] Open
Abstract
Amyloidosis refers to a group of conditions where abnormal protein-or amyloid-deposits in tissues or organs, often leading to organ malfunction. Amyloidosis affects nearly any organ system, but especially the heart, kidneys, liver, peripheral nervous system, and gastrointestinal tract. Neuromuscular deficits comprise some of its ubiquitous manifestations. Amyloidosis can be quite challenging to diagnose given its clinical heterogeneity and multi-system nature. Early diagnosis with accurate genetic and serologic subtyping is key for effective management and prevention of organ decline. In this review, we highlight the value of a multidisciplinary comprehensive amyloidosis clinic. While such a model exists at numerous clinical and research centers across the globe, the lack of more widespread adoption of such a model remains a major hindrance to the timely diagnosis of amyloidosis. Such a multidisciplinary care model allows for the timely and effective diagnosis of amyloidosis, be it acquired amyloid light amyloidosis (AL), hereditary transthyretin amyloidosis (hATTR), or wild type amyloidosis (TTR-wt), especially in the current era of personalized genomic medicine. A multidisciplinary clinic optimizes the delivery of singular or combinatorial drug therapies, depending on amyloid type, fibril deposition location, and disease progression. Such an arrangement also helps advance research in the field. We present our experience at The Ohio State University, as one example out of many, to highlight the centrality of a multi-disciplinary clinic in amyloidosis care.
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Affiliation(s)
- Naresh Bumma
- Division of Hematology-Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Rami Kahwash
- Division of Cardiology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Samir V. Parikh
- Division of Nephrology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Michael Isfort
- Division of Neuromuscular Medicine, Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Miriam Freimer
- Division of Neuromuscular Medicine, Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Ajay Vallakati
- Division of Cardiology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Elyse Redder
- Oncology Rehabilitation, The Ohio State University James Cancer Center, Columbus, OH, United States
| | - Courtney M. Campbell
- Division of Cardiology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Cardiovascular Division, Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, MO, United States
| | - Nidhi Sharma
- Division of Hematology-Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Yvonne Efebera
- Ohio Health, Department of Hematology/Oncology and Blood and Marrow Transplant, Columbus, OH, United States
| | - Amro Stino
- Division of Neuromuscular Medicine, Department of Neurology, The University of Michigan Medical School, Ann Arbor, MI, United States
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12
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Ramsell S, Arias Bermudez C, Takem Baiyee CAM, Rodgers B, Parikh S, Almaani S, Sharma N, LoRusso S, Freimer M, Redder E, Bumma N, Vallkati A, Efebera Y, Kahwash R, Campbell CM. Beta-Adrenergic Antagonist Tolerance in Amyloid Cardiomyopathy. Front Cardiovasc Med 2022; 9:907597. [PMID: 35898273 PMCID: PMC9309481 DOI: 10.3389/fcvm.2022.907597] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/17/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Beta-adrenergic antagonists or blockers (BB) are a cornerstone of cardiac therapy for multiple indications. However, BB are considered relatively contraindicated in amyloid cardiomyopathy due to poor tolerance. This intolerance is hypothesized to be due to concomitant neuropathy and significant restrictive cardiomyopathy. This study analyzes the incidence and characteristics of BB tolerance in patients with amyloid cardiomyopathy. Methods Through a single-center retrospective chart review, patients with amyloid cardiomyopathy, confirmed by endomyocardial biopsy or technetium-99 pyrophosphate scan, were identified and clinical data was collected. Statistical methods included Chi-square test and two sample t-tests. Results Of 135 cardiac amyloidosis patients, 27 patients (20.0%) had no BB use, 56 patients (41.5%) were current BB users, and 52 patients (38.5%) were prior BB users. The most frequent indications for BB use were heart failure, hypertension, coronary artery disease, and arrhythmia. The most common reason for stopping BB therapy was hypotension (62.8%) followed by fatigue, bradycardia, and orthostasis. Neurologic symptoms at the initial BB prescription or most recent evaluation were not significantly different between current and prior BB users. Their cardiovascular profiles were similar by ejection fraction, wall thickness, troponin I, and brain natriuretic peptide. There was no association for BB discontinuation based on amyloid subtype, sex, or race. Conclusion The majority of patients with amyloid cardiomyopathy were prescribed BB, and over half of these patients still tolerated BB therapy. Current and prior BB users had similar profiles from a cardiovascular and neurologic perspective, with no association identified to predict BB discontinuation.
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Affiliation(s)
- Stuart Ramsell
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | | | | | - Brandon Rodgers
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Samir Parikh
- Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Salem Almaani
- Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Nidhi Sharma
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Samantha LoRusso
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Miriam Freimer
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Elyse Redder
- Department of Oncology Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Naresh Bumma
- Division of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Ajay Vallkati
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Yvonne Efebera
- Division of Hematology/Oncology, OhioHealth, Columbus, OH, United States
| | - Rami Kahwash
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Courtney M. Campbell
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, MO, United States
- *Correspondence: Courtney M. Campbell
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13
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Rajpal S, Kahwash R, Tong MS, Paschke K, Satoskar AA, Foreman B, Allen LA, Bhave NM, Gluckman TJ, Fuster V. Fulminant Myocarditis Following SARS-CoV-2 Infection. JACC Case Rep 2022; 4:567-575. [PMID: 35373150 PMCID: PMC8961314 DOI: 10.1016/j.jaccas.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 12/03/2022]
Abstract
A 60-year-old woman with a past medical history of asthma presented with fulminant myocarditis 9 days after testing positive for SARS-CoV-2 and 16 days after developing symptoms consistent with COVID-19. Her hospital course was complicated by the need for veno-arterial extracorporeal membrane oxygenation, ventricular arrhythmias, and pseudomonas bacteremia. She ultimately recovered and was discharged to home with normal left ventricular systolic function. Thereafter, she developed symptomatic ventricular tachycardia, for which she received an implantable cardioverter-defibrillator and antiarrhythmic drug therapy.
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14
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Shah SJ, Borlaug BA, Chung ES, Cutlip DE, Debonnaire P, Fail PS, Gao Q, Hasenfuß G, Kahwash R, Kaye DM, Litwin SE, Lurz P, Massaro JM, Mohan RC, Ricciardi MJ, Solomon SD, Sverdlov AL, Swarup V, van Veldhuisen DJ, Winkler S, Leon MB. Atrial shunt device for heart failure with preserved and mildly reduced ejection fraction (REDUCE LAP-HF II): a randomised, multicentre, blinded, sham-controlled trial. Lancet 2022; 399:1130-1140. [PMID: 35120593 DOI: 10.1016/s0140-6736(22)00016-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 46.5] [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: 12/15/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Placement of an interatrial shunt device reduces pulmonary capillary wedge pressure during exercise in patients with heart failure and preserved or mildly reduced ejection fraction. We aimed to investigate whether an interatrial shunt can reduce heart failure events or improve health status in these patients. METHODS In this randomised, international, blinded, sham-controlled trial performed at 89 health-care centres, we included patients (aged ≥40 years) with symptomatic heart failure, an ejection fraction of at least 40%, and pulmonary capillary wedge pressure during exercise of at least 25 mm Hg while exceeding right atrial pressure by at least 5 mm Hg. Patients were randomly assigned (1:1) to receive either a shunt device or sham procedure. Patients and outcome assessors were masked to randomisation. The primary endpoint was a hierarchical composite of cardiovascular death or non-fatal ischemic stroke at 12 months, rate of total heart failure events up to 24 months, and change in Kansas City Cardiomyopathy Questionnaire overall summary score at 12 months. Pre-specified subgroup analyses were conducted for the heart failure event endpoint. Analysis of the primary endpoint, all other efficacy endpoints, and safety endpoints was conducted in the modified intention-to-treat population, defined as all patients randomly allocated to receive treatment, excluding those found to be ineligible after randomisation and therefore not treated. This study is registered with ClinicalTrials.gov, NCT03088033. FINDINGS Between May 25, 2017, and July 24, 2020, 1072 participants were enrolled, of whom 626 were randomly assigned to either the atrial shunt device (n=314) or sham procedure (n=312). There were no differences between groups in the primary composite endpoint (win ratio 1·0 [95% CI 0·8-1·2]; p=0·85) or in the individual components of the primary endpoint. The prespecified subgroups demonstrating a differential effect of atrial shunt device treatment on heart failure events were pulmonary artery systolic pressure at 20W of exercise (pinteraction=0·002 [>70 mm Hg associated with worse outcomes]), right atrial volume index (pinteraction=0·012 [≥29·7 mL/m2, worse outcomes]), and sex (pinteraction=0·02 [men, worse outcomes]). There were no differences in the composite safety endpoint between the two groups (n=116 [38%] for shunt device vs n=97 [31%] for sham procedure; p=0·11). INTERPRETATION Placement of an atrial shunt device did not reduce the total rate of heart failure events or improve health status in the overall population of patients with heart failure and ejection fraction of greater than or equal to 40%. FUNDING Corvia Medical.
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Affiliation(s)
- Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - Eugene S Chung
- The Lindner Research Center at The Christ Hospital, Cincinnati, OH, USA
| | | | | | - Peter S Fail
- Cardiovascular Institute of the South, Houma, LA, USA
| | - Qi Gao
- Baim Clinical Research Institute, Boston, MA, USA
| | - Gerd Hasenfuß
- Heart Center, University Medical Center, Göttingen, Germany
| | | | | | - Sheldon E Litwin
- Medical University of South Carolina and Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Philipp Lurz
- Heart Center Leipzig at University Leipzig, Leipzig, Germany
| | | | | | | | | | - Aaron L Sverdlov
- John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
| | | | - Dirk J van Veldhuisen
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | - Martin B Leon
- Cardiovascular Research Foundation, New York City, NY, USA
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15
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Rajpal S, Kahwash R, Tong MS, Paschke K, Satoskar AA, Foreman B, Allen LA, Bhave NM, Gluckman TJ, Fuster V. Fulminant Myocarditis Following SARS-CoV-2 Infection: JACC Patient Care Pathways. J Am Coll Cardiol 2022; 79:2144-2152. [PMID: 35364210 PMCID: PMC8961313 DOI: 10.1016/j.jacc.2022.03.346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Saurabh Rajpal
- Division of Cardiology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Rami Kahwash
- Division of Cardiology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew S Tong
- Division of Cardiology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kelly Paschke
- Division of Cardiology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Anjali A Satoskar
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Beth Foreman
- Division of Cardiology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicole M Bhave
- Division of Cardiology, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Ty J Gluckman
- Center for Cardiovascular Analytics, Research, and Data Science (CARDS), Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon, USA
| | - Valentin Fuster
- The Zena and Michael Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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16
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Deis T, Wolsk E, Mujkanovic J, Komtebedde J, Burkhoff D, Kaye D, Hasenfuß G, Hayward C, Van der Heyden J, Petrie MC, Shah SJ, Borlaug BA, Kahwash R, Litwin S, Hoendermis E, Hummel S, Gustafsson F. Resting and exercise haemodynamic characteristics of patients with advanced heart failure and preserved ejection fraction. ESC Heart Fail 2021; 9:186-195. [PMID: 34877822 PMCID: PMC8788022 DOI: 10.1002/ehf2.13697] [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: 06/19/2021] [Revised: 09/07/2021] [Accepted: 10/29/2021] [Indexed: 01/03/2023] Open
Abstract
Aims This study aimed to describe haemodynamic features of patients with advanced heart failure with preserved ejection fraction (HFpEF) as defined by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Methods and results We used pooled data from two dedicated HFpEF studies with invasive exercise haemodynamic protocols, the REDUCE LAP‐HF (Reduce Elevated Left Atrial Pressure in Patients with Heart Failure) trial and the REDUCE LAP‐HF I trial, and categorized patients according to advanced heart failure (AdHF) criteria. The well‐characterized HFpEF patients were considered advanced if they had persistent New York Heart Association classification of III–IV and heart failure (HF) hospitalization < 12 months and a 6 min walk test distance < 300 m. Twenty‐four (22%) out of 108 patients met the AdHF criteria. On evaluation, clinical characteristics and resting haemodynamics were not different in the two groups. Patients with AdHF had lower work capacity compared with non‐advanced patients (35 ± 16 vs. 45 ± 18 W, P = 0.021). Workload‐corrected pulmonary capillary wedge pressure normalized to body weight (PCWL) was higher in AdHF patients compared with non‐advanced (112 ± 55 vs. 86 ± 49 mmHg/W/kg, P = 0.04). Further, AdHF patients had a smaller increase in cardiac index during exercise (1.1 ± 0.7 vs. 1.6 ± 0.9 L/min/m2, P = 0.028). Conclusions A significantly higher PCWL and lower cardiac index reserve during exercise were observed in AdHF patients compared with non‐advanced. These differences were not apparent at rest. Therapies targeting the haemodynamic compromise associated with advanced HFpEF are needed.
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Affiliation(s)
- T Deis
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, Copenhagen, 2100, Denmark
| | - E Wolsk
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, Copenhagen, 2100, Denmark.,Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - J Mujkanovic
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, Copenhagen, 2100, Denmark
| | | | - D Burkhoff
- Cardiovascular Research Foundation, New York, NY, USA
| | - D Kaye
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - G Hasenfuß
- Georg-August Universität, Heart Centre, Gottingen, Germany
| | - C Hayward
- Department of Cardiology, St-Jan Hospital, Bruges, Belgium
| | | | - M C Petrie
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - S J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - B A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - R Kahwash
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - S Litwin
- Medical University of South Carolina, Charleston, SC, USA
| | - E Hoendermis
- University Medical Center, Groningen, The Netherlands
| | - S Hummel
- University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, USA.,Ann Arbor Veterans Affairs Health System, Ann Arbor, MI, USA
| | - F Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, Copenhagen, 2100, Denmark
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17
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Zakko J, Ganapathi AM, Whitson BA, Mokadam NA, Henn MC, Lampert B, Kahwash R, Franco V, Haas G, Emani S, Hasan A, Vallakati A. Safety of direct oral anticoagulants in solid organ transplant recipients: A meta-analysis. Clin Transplant 2021; 36:e14513. [PMID: 34655500 DOI: 10.1111/ctr.14513] [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: 09/17/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/20/2022]
Abstract
There is limited evidence comparing direct oral anticoagulants (DOACs) and warfarin in solid organ transplant (SOT) recipients. We performed a pooled analysis to study the safety and efficacy of DOACs in this patient population. We searched PubMed, Embase, and Scopus databases using the search terms "heart transplant" or "lung transplant" or "liver transplant" or "kidney transplant" or "pancreas transplant" and "direct oral anticoagulant" for literature search. Random effects model with Mantel-Haenszel method was used to pool the outcomes. Pooled analysis included 489 patients, of which 259 patients received DOACs and 230 patients received warfarin. When compared to warfarin, the use of DOACs was associated with decreased risk of composite bleed (RR .49, 95% CI .32-.76, p = .002). There were no differences in rates of major bleeding (RR .55, 95% CI .20-1.49, p = .24) or venous thromboembolism (RR .65, 95% CI .25-1.70, p = .38) between the two groups. Evidence from pooled analysis suggests that DOACs are comparable to warfarin in terms of safety in SOT recipients. Further research is warranted to conclusively determine whether DOACs are safe alternatives to warfarin for anticoagulation in SOT recipients.
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Affiliation(s)
- Jason Zakko
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Asvin M Ganapathi
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bryan A Whitson
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nahush A Mokadam
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew C Henn
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brent Lampert
- Department of Internal Medicine, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Rami Kahwash
- Department of Internal Medicine, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Veronica Franco
- Department of Internal Medicine, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Garrie Haas
- Department of Internal Medicine, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sitaramesh Emani
- Department of Internal Medicine, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ayesha Hasan
- Department of Internal Medicine, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ajay Vallakati
- Department of Internal Medicine, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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18
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Gil K, Tong MS, Afzal M, Kahwash R, Bhatti S, Addison D, Varghese J, Simonetti OP, Zareba KM, Rajpal S. The role of cardiovascular magnetic resonance imaging with T1 and T2 mapping in sudden cardiac death survivors. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Sudden cardiac death (SCD) in the adult population is poorly studied, although determining its etiology is crucial for management and prognosis [1]. Cardiovascular magnetic resonance imaging (CMR) is being increasingly utilized in SCD survivors [1,2]. The role of late gadolinium enhancement (LGE) imaging in patients with recent SCD and no significant coronary artery disease (CAD) is well established, but there is no data on the additive role of T1 and T2 mapping [1–3].
Purpose
This is a retrospective study to assess the role of CMR including T1 and T2 mapping in SCD survivors.
Methods
Between 01/2016 and 12/2019, we retrospectively analyzed patients who underwent CMR on a Siemens Magnetom Avanto 1.5 T scanner within 4 weeks of SCD. CMR protocol included cine imaging, T1 and T2 mapping, and LGE imaging. Native and post-contrast myocardial T1 values were measured within the septum on the mid short axis (SAX) and extracellular volume fraction was calculated using the standard formula. T2 values were measured in six mid segments on the mid SAX map. Additional measurements were performed if long axis T2 maps were available. Clinical data, electrocardiography (ECG), transthoracic echocardiography (TTE), coronary computed tomography angiography (CCTA), and left heart catheterization (LHC) were reviewed from the electronic health record. An ischemic evaluation was performed in 33 (94%) of patients.
Results
A total of 35 patients who underwent CMR for SCD were included for analysis (mean age 46.9±14.1 years; 20 (57%) male). SCD etiology was established based on clinical data, ECG, TTE, CCTA, and LHC in 9 (26%) patients. CMR provided the most probable SCD etiology in an additional 20 (57%) patients with T1 and T2 mapping abnormalities seen in 18 (51%) patients. Diagnoses determined by CMR included myocarditis (35%), hypertrophic cardiomyopathy (CMP) (20%), left ventricular non-compaction CMP (15%), dilated CMP (10%), takotsubo CMP (5%), and myocardial infarction with non-obstructive CAD (15%) (Table, Figure). Elevated native T1 was seen in 15 (43%) (mean T1 1069±60 ms; site specific normal <1080 ms), elevated ECV in 16 (46%) (30±7%; site specific normal <29%), and elevated native T2 in 22 (63%) patients (65±10 ms; site specific normal <60 ms). LGE was present in 31 (89%) patients. The etiology of SCD remained unknown in 6 (17%) patients despite extensive testing including CMR.
Conclusions
CMR has significant diagnostic and prognostic value in assessing SCD etiology compared to non-CMR based evaluation. Myocarditis is a common underdiagnosed cause of SCD in adult patients well seen in a CMR protocol with T1 and T2 mapping. Myocardial inflammation monitoring in SCD survivors with serial CMRs using T1 and T2 mapping could influence clinical decision making by justifying pharmacotherapy modification and timing of ICD implantation. To conclude, CMR with T1 and T2 mapping provides high diagnostic yield in the investigation of SCD etiology.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Gil
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, Columbus, United States of America
| | - M S Tong
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, Columbus, United States of America
| | - M Afzal
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, Columbus, United States of America
| | - R Kahwash
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, Columbus, United States of America
| | - S Bhatti
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, Columbus, United States of America
| | - D Addison
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, Columbus, United States of America
| | - J Varghese
- The Ohio State University, Biomedical Engineering, Columbus, United States of America
| | - O P Simonetti
- The Ohio State University, Biomedical Engineering, Columbus, United States of America
| | - K M Zareba
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, Columbus, United States of America
| | - S Rajpal
- Ohio State University Wexner Medical Center, Division of Cardiovascular Medicine, Columbus, United States of America
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Hyer C, Campbell C, Kahwash R. Clinical implications of atrial natriuretic peptide amyloidosis. BMJ Case Rep 2021; 14:14/6/e242856. [PMID: 34155027 DOI: 10.1136/bcr-2021-242856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 74-year-old woman with a history of diastolic heart failure and refractory atrial fibrillation (AF) presented with unstable angina for coronary artery bypass grafting. Routine pathological analysis of tissue specimens obtained from the left atrial appendage revealed subendocardial and interstitial fibrosis and patchy amyloid deposits with Congo red staining demonstrating filamentous deposits. Mass spectrometry was consistent with isolated atrial amyloidosis (IAA). IAA in this patient was found incidentally on routine postoperative pathology, but likely contributed to significant morbidity. The established relationship between IAA with AF and diastolic heart failure underscores the relevance. Further delineating the pathogenesis has potentially immense implications for the future management of associated conditions. To bridge the gaps in the understanding, a standardised approach to diagnosis is needed to open the door to a large-scale study and further work toward establishing evidence-based management pathways.
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Affiliation(s)
- Chad Hyer
- Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Rami Kahwash
- Internal Medicine, The Ohio State University, Columbus, Ohio, USA
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Nadkarni A, Paschke K, Foreman B, Satoskar A, Kahwash R. FULMINANT MYOCARDITIS, A RARE CASE ASSOCIATED WITH SARS-COV-2 INFECTION. J Am Coll Cardiol 2021. [PMCID: PMC8091402 DOI: 10.1016/s0735-1097(21)03324-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Shaver K, Humeidan M, Ayuk C, Baiyee M, Rogers B, Parikh S, Almaani S, Bittengle J, Pfund K, LoRusso S, Freimer M, Redder E, Bumma N, Vallakati A, Efebera Y, Kahwash R. OUTCOMES OF PATIENTS WITH CARDIAC AMYLOIDOSIS UNDERGOING ANESTHESIA. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Mashali M, Daoud G, More A, Bermudez CA, Kahwash R, Saad N, Peczkowski K, Huang A, Fazlollahi F, Hare A, Campbell C, Janssen P. IMPACT OF VENTRICULAR TACHYCARDIA ELECTRICAL STORM ON CONTRACTILE PERFORMANCE OF HUMAN MYOCARDIUM. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02129-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kaka Y, Ganapathi A, Emani S, Kahwash R, Hasan A, Franco V, Haas G, Vallakati A, Henn M, Benza R, Mokadam N, Whitson B, Lampert B. The Waiting Game: Waitlist Times and Outcomes for Highly Sensitized Patients in the New Heart Transplant Allocation System. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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24
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Adesanya TMA, Campbell CM, Cheng L, Ogbogu PU, Kahwash R. C1 Esterase Inhibition: Targeting Multiple Systems in COVID-19. J Clin Immunol 2021; 41:729-732. [PMID: 33474624 PMCID: PMC7817248 DOI: 10.1007/s10875-021-00972-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/13/2021] [Indexed: 12/20/2022]
Affiliation(s)
- T M Ayodele Adesanya
- Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Courtney M Campbell
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lijun Cheng
- Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Princess U Ogbogu
- Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Rami Kahwash
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Ozga M, Zhao Q, Benson D, Elder P, Williams N, Bumma N, Rosko A, Chaudhry M, Khan A, Devarakonda S, Kahwash R, Vallakati A, Campbell C, Parikh SV, Almaani S, Prosek J, Bittengle J, Pfund K, LoRusso S, Freimer M, Redder E, Efebera Y, Sharma N. AL amyloidosis: The effect of fluorescent in situ hybridization abnormalities on organ involvement and survival. Cancer Med 2020; 10:965-973. [PMID: 33347707 PMCID: PMC7897960 DOI: 10.1002/cam4.3683] [Citation(s) in RCA: 10] [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: 07/09/2020] [Revised: 10/17/2020] [Accepted: 12/02/2020] [Indexed: 01/01/2023] Open
Abstract
Background Systemic light chain (AL) amyloidosis is a clonal plasma‐cell neoplasm that carries a poor prognosis. Although AL amyloidosis and Multiple Myeloma (MM) can co‐exist and share various cytogenetic chromosomal abnormalities, little is known about Fluorescent in situ hybridization (FISH) and its prognostic relevance in AL amyloidosis. Aim: The study aims to evaluate the most prevalent FISH cytogenetic abnormalities in AL patients as independent prognostic factors, and assess the impact of cytogenetics on the survival of high‐risk cardiac AL patients. Materials & Methods This retrospective study reviewed 113 consecutive AL patients treated at The Ohio State University (OSU). Patients were divided into subgroups based on FISH data obtained within 90 days of diagnosis. Hyperdiploidy was defined as trisomies of at least 2 chromosomal loci. Primary endpoints were progression free survival (PFS) and overall survival (OS). Kaplan Meier curves were used to calculate PFS and OS. The log‐rank test and Cox proportional hazard models were used to test the equality of survival functions and further evaluate the differences between groups. Results FISH abnormalities were detected in 76% of patients. Patients with abnormal FISH trended toward lower overall survival (OS) (p=0.06) and progression free survival (PFS) (p=0.06). The two most prevalent aberrations were translocation t(11;14) (39%) and hyperdiploidy‐overall (38%). Hyperdiploidy‐overall was associated with worsening PFS (p=0.018) and OS (p=0.03), confirmed in multivariable analysis. Patients with del 13q most frequently had cardiac involvement (p=0.006) and was associated with increased bone marrow plasmacytosis (p=0.02). Cardiac AL patients with no FISH abnormalities had much improved OS (p=0.012) and PFS (p=0.018) Conclusions Our findings ultimately reveal the association of hyperdiploidy on survival in AL amyloidosis patients, including the high‐risk cardiac AL population.
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Affiliation(s)
- Michael Ozga
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Qiuhong Zhao
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Don Benson
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Patrick Elder
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Nita Williams
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Naresh Bumma
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Ashley Rosko
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Maria Chaudhry
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Abdullah Khan
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Srinivas Devarakonda
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Rami Kahwash
- Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Ajay Vallakati
- Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Courtney Campbell
- Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Samir V Parikh
- Division of Nephrology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Salem Almaani
- Division of Nephrology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Jason Prosek
- Division of Nephrology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Jordan Bittengle
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Katherine Pfund
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Samantha LoRusso
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Miriam Freimer
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Elyse Redder
- Department of Oncology Rehabilitation, The Ohio State University, Columbus, OH, USA
| | - Yvonne Efebera
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
| | - Nidhi Sharma
- Division of Hematology, Department. of Internal Medicine, The Ohio State University Comprehensive Cancer Center Columbus, OH, USA
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Ozga M, Zhao Q, Benson D, Elder P, Williams N, Bumma N, Rosko A, Chaudhry M, Khan A, Devarakonda S, Kahwash R, Vallakati A, Campbell C, Parikh SV, Almaani S, Prosek J, Bittengle J, Pfund K, LoRusso S, Freimer M, Redder E, Efebera Y, Sharma N. AL Amyloidosis: The Effect of Maintenance Therapy on Autologous Stem Cell Transplantation Outcomes. J Clin Med 2020; 9:E3778. [PMID: 33238501 PMCID: PMC7700492 DOI: 10.3390/jcm9113778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/07/2020] [Revised: 11/10/2020] [Accepted: 11/20/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Autologous stem cell transplantation (ASCT) remains an effective treatment option for many patients with systemic light chain (AL) amyloidosis. While maintenance post ASCT in multiple myeloma is now standard, the decision to utilize maintenance in AL amyloidosis remains largely unexplored. The present study aims to determine the prognostic significance of utilizing maintenance therapy following ASCT and assess the impact of fluorescent in situ hybridization (FISH) abnormalities, bone marrow plasma cell burden (BMPC), and degree of organ involvement on this decision. METHODS AND RESULTS This is a retrospective analysis of fifty AL amyloidosis patients who underwent ASCT at The Ohio State University. Twenty-eight patients received maintenance and twenty-two did not. Kaplan-Meier survival analysis was used to compare the effect of maintenance therapy with no significant difference in PFS (p = 0.66) and OS (p = 0.32) between the two groups. There was no difference in survival based on maintenance when further categorized by FISH, PFS (p = 0.15), and OS (p = 0.65); BMPC ≥ 10%, PFS (p = 0.49), and OS (p = 0.32); or with 2 or more organs involved, PFS (p = 0.34) and OS (p = 0.80). CONCLUSION Maintenance therapy post ASCT did not impact PFS or OS when categorized by FISH abnormalities, increasing BMPC, or ≥2 organs involved in AL amyloidosis patients.
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Affiliation(s)
- Michael Ozga
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Qiuhong Zhao
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Don Benson
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Patrick Elder
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Nita Williams
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Naresh Bumma
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Ashley Rosko
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Maria Chaudhry
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Abdullah Khan
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Srinivas Devarakonda
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Rami Kahwash
- Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (R.K.); (A.V.); (C.C.)
| | - Ajay Vallakati
- Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (R.K.); (A.V.); (C.C.)
| | - Courtney Campbell
- Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (R.K.); (A.V.); (C.C.)
| | - Samir V. Parikh
- Division of Nephrology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (S.V.P.); (S.A.); (J.P.)
| | - Salem Almaani
- Division of Nephrology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (S.V.P.); (S.A.); (J.P.)
| | - Jason Prosek
- Division of Nephrology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA; (S.V.P.); (S.A.); (J.P.)
| | - Jordan Bittengle
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Katherine Pfund
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Samantha LoRusso
- Department of Neurology, The Ohio State University, Columbus, OH 43210, USA; (S.L.); (M.F.)
| | - Miriam Freimer
- Department of Neurology, The Ohio State University, Columbus, OH 43210, USA; (S.L.); (M.F.)
| | - Elyse Redder
- Department of Oncology Rehabilitation, The Ohio State University, Columbus, OH 43210, USA;
| | - Yvonne Efebera
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
| | - Nidhi Sharma
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA; (M.O.); (Q.Z.); (D.B.); (P.E.); (N.W.); (N.B.); (A.R.); (M.C.); (A.K.); (S.D.); (J.B.); (K.P.); (Y.E.)
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Barnes A, Campbell C, Weiss R, Kahwash R. Cardiac Contractility Modulation in Heart Failure: Mechanisms and Clinical Evidence. Curr Treat Options Cardio Med 2020. [DOI: 10.1007/s11936-020-00852-8] [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: 10/23/2022]
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Slivnick JA, Betz J, Kalbfleisch S, Crouser ED, Kahwash R. High-dose intravenous glucocorticoids are effective in the acute management of ventricular arrhythmias in cardiac sarcoidosis: A case series. HeartRhythm Case Rep 2020; 6:706-710. [PMID: 33101937 PMCID: PMC7573385 DOI: 10.1016/j.hrcr.2020.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jeremy A Slivnick
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - Jarrod Betz
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - Steven Kalbfleisch
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - Elliott D Crouser
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - Rami Kahwash
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
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Affiliation(s)
- Courtney M. Campbell
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Rami Kahwash
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
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Campbell CM, Cassol C, Cataland SR, Kahwash R. Atypical haemolytic uraemic syndrome: a case report of a rare cause of reversible cardiomyopathy. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 32352052 DOI: 10.1093/ehjcr/ytaa050] [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] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/10/2019] [Accepted: 02/12/2020] [Indexed: 12/29/2022]
Abstract
Background Atypical haemolytic uraemic syndrome (aHUS) is a life-threatening, genetic disease of complement-mediated thrombotic microangiopathy that typically presents as anaemia, thrombocytopenia, and renal failure. Cardiomyopathy is seen in up to 10% of aHUS cases, but the aetiology is not well-understood. Case summary A 63-year-old man recently was diagnosed with a thrombotic microangiopathy most consistent with aHUS by renal biopsy after presentation with acute renal failure requiring haemodialysis. He was started on therapy with complement inhibitor, eculizumab. Six weeks after diagnosis, he presented with progressive dyspnoea on exertion and chest pain. An echocardiogram demonstrated an acute drop in left ventricular ejection fraction to 20-25% with global hypokinesis. Left heart catheterization showed moderate, non-obstructive coronary artery disease. Cardiac magnetic resonance imaging demonstrated diffuse myocardial oedema. Endomyocardial biopsy revealed an arteriole with obliterative changes and a few possible fragmented red blood cells suggestive of thrombotic microangiopathy. There was no biopsy evidence of immune complex deposition or myocarditis. He was treated for heart failure and was maintained on eculizumab. On repeat echocardiogram 3 months later, the patient had complete recovery of his ejection fraction (60-65%). Discussion In this report, we describe complete recovery of aHUS-associated heart failure with eculizumab therapy and demonstrate for the first time that the aetiology of aHUS-associated heart failure is likely an acute thrombotic microangiopathy involving small intramyocardial arterioles, as demonstrated by cardiac biopsy.
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Affiliation(s)
- Courtney M Campbell
- Division of Cardiovascular Medicine, Department of Internal Medicine, Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Ave, Suite 200, Columbus, OH 43210, USA
| | - Clarissa Cassol
- Department of Pathology, The Ohio State University Wexner Medical Center, 129 Hamilton Hall, 1645 Neil Ave, Columbus, OH 43210, USA
| | - Spero R Cataland
- Division of Hematology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, B302 Starling Loving Hall, 320 West 10th Ave, Columbus, OH 43210, USA
| | - Rami Kahwash
- Division of Cardiovascular Medicine, Department of Internal Medicine, Davis Heart & Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Ave, Suite 200, Columbus, OH 43210, USA
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Savona S, Mann J, Afzal M, Okabe T, Crouser E, Kahwash R, Kalbfleisch S. IMPLICATIONS OF VARIOUS DIAGNOSTIC CRITERIA ON THE DIAGNOSIS OF CARDIAC SARCOIDOSIS: A SINGLE CENTER EXPERIENCE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31494-7] [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: 11/30/2022]
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Ozga MP, Zhao Q, Benson DM, Elder P, Williams N, Bumma N, Rosko A, Chaudhry M, Khan A, Devarakonda S, Kahwash R, Vallakati A, Campbell C, Parikh S, Almaani S, Prosek J, Redder E, Efebera YA, Sharma N. AL Amyloidosis: The Prognostic Impact of Maintenance Therapy Following ASCT. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Savona S, Hess S, Mann J, Afzal M, Okabe T, Crouser E, Kahwash R, Kalbfleisch S. IMPLICATIONS OF PROLONGED RHYTHM MONITORING IN PATIENTS WITH CARDIAC SARCOIDOSIS: A SINGLE CENTER EXPERIENCE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30995-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abraham W, Augostini R, Hasan A, Jackson S, Kahwash R, Mease J, Sitaramesh E. Treatment of Central Sleep Apnea in Heart Failure Patients. Heart Lung 2020. [DOI: 10.1016/j.hrtlng.2020.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Unkovic P, Slivnick J, Kline K, Lampert B, Kahwash R, Franco V, Haas G, Baliga R, Smith SA, Hasan AK. THE MAN WITH NO PULSE: A CASE OF PERMANENT VENTRICULAR FIBRILLATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33027-8] [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: 10/24/2022]
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Huang A, Huang A, Janssen P, Kahwash R, Campbell C. MEMANTINE IS ASSOCIATED WITH DECREASED HOSPITAL ADMISSIONS FOR HEART FAILURE EXACERBATION, BUT NOT ARRHYTHMIA: A SINGLE-CENTER STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31717-4] [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] [Indexed: 10/24/2022]
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Abstract
Cardiac contractility modulation, also referred to as CCM™, by the Optimizer Smart device is an innovative intracardiac device-based therapy that has been recently US FDA-approved for the treatment of patients with chronic heart failure, left ventricular ejection fraction (LVEF) between 25 and 45%, QRS <130 ms who remain symptomatic despite optimal medical therapy. Clinical trials demonstrate that CCM therapy is safe and effective in reducing heart failure hospitalization and improving heart failure symptoms, quality of life and functional performance. This novel device-based therapeutic offers benefits to patients who do not otherwise qualify for cardiac resynchronization therapy. CCM expands the indication beyond the traditional LVEF cutoff of 35% to a newer group including patients who fall in midrange LVEF group, up to 45%.
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Affiliation(s)
- Courtney M Campbell
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 200 Davis Heart & Lung Institute, 473 W 12th Ave, Columbus, OH 43210, USA
| | - Rami Kahwash
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 200 Davis Heart & Lung Institute, 473 W 12th Ave, Columbus, OH 43210, USA
| | - William T Abraham
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 200 Davis Heart & Lung Institute, 473 W 12th Ave, Columbus, OH 43210, USA
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Hanff TC, Kaye DM, Hayward CS, Post MC, Malek F, Hasenfuβ G, Gustafsson F, Burkhoff D, Shah SJ, Litwin SE, Kahwash R, Hummel SL, Borlaug BA, Solomon SD, Lam CSP, Komtebedde J, Silvestry FE. Assessment of Predictors of Left Atrial Volume Response to a Transcatheter InterAtrial Shunt Device (from the REDUCE LAP-HF Trial). Am J Cardiol 2019; 124:1912-1917. [PMID: 31653352 DOI: 10.1016/j.amjcard.2019.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 11/15/2022]
Abstract
In patients with heart failure and preserved or mildly reduced ejection fractions (EF ≥40%), implantation of an interatrial shunt device (IASD) resulted in heterogenous changes of the left atrial (LA) volume. Baseline characteristics that correlate with a favorable decrease in LA volume are unknown. We hypothesized that a larger ratio of left to right atrial volume at baseline would correlate strongly with LA volume decongestion following IASD implantation. Reduce Elevated LA Pressure in Patients With Heart Failure was a multicenter study of the safety and feasibility of IASD implantation. Sixty-four patients with EF ≥40% underwent device implantation along with baseline conventional echocardiograms, speckle tracking echocardiography, and resting and exercise hemodynamics. Higher LA compliance (-4.2%, p = 0.048) and right atrial reservoir strain (-0.8%, p = 0.005) were independently associated with a percent decrease in the systolic LA volume index from baseline to 6-months. In conclusion, greater LA volume reduction following IASD implantation is associated with higher baseline compliance of the left atrium and higher reservoir strain of the right atrium.
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Affiliation(s)
- Thomas C Hanff
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - David M Kaye
- Alfred Hospital and Baker Heart and Diabetes Institute Melbourne, Victoria, Australia
| | | | | | | | - Gerd Hasenfuβ
- Heart Centre, Georg-August University, Gottingen, Germany
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sheldon E Litwin
- Medical University of South Carolina, Charleston, South Carolina
| | - Rami Kahwash
- Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Scott L Hummel
- University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | | | | | | | | | - Frank E Silvestry
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Sinha T, Lyon A, Kahwash R. A case report: pause and consider the late complications of heart transplantation. Eur Heart J Case Rep 2019; 3:ytz107. [PMID: 31660483 PMCID: PMC6764535 DOI: 10.1093/ehjcr/ytz107] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/15/2019] [Accepted: 07/10/2019] [Indexed: 11/14/2022]
Abstract
Background A 75-year-old woman with a past medical history significant for non-ischaemic cardiomyopathy status post orthotopic heart transplant, type II diabetes mellitus, hypertension, chronic kidney disease stage III, chronic anaemia, and chronic diarrhoea presented with nausea, vomiting, and an unexplained fall 23 years after original transplantation. Case summary During her hospital stay, she had multiple episodes of sinus arrest with syncope, preceded by seizure like activity. She was stabilized, and broad work up revealed an occult brain mass that was ultimately resected and consistent with post-transplant lymphoproliferative disease. Discussion Features that make this case study unique include the late onset and location of the malignancy, the absence of Epstein–Barr virus involvement, and asystole that was potentially neurologically mediated and induced by a brain space occupying mass. This case offers insight into potential late parasympathetic reinnervation of transplanted hearts, adds to the growing literature regarding the connection between the brain and the heart, and reviews potential complications in patients with a remote history of heart transplantation.
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Affiliation(s)
- Tejas Sinha
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W. 12th Ave, 3rd Floor, Columbus, OH 43210, USA
| | - Amanda Lyon
- Department of Cardiology, The Ohio State University Wexner Medical Center, 452 W 12th Ave, Columbus, OH 43210, USA
| | - Rami Kahwash
- Department of Cardiology, The Ohio State University Wexner Medical Center, 452 W 12th Ave, Columbus, OH 43210, USA
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Vallakati A, Campbell C, Tong M, Bumma N, Efebera Y, Kahwash R. Targeted Therapeutics for Transthyretin amyloid cardiomyopathy: Time to Move Forward. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Harfi TT, Milks MW, Orsinelli DA, Raman SV, Abraham WT, Kahwash R. Imaging Device Therapy: Essentials for the Imager. Heart Fail Clin 2019; 15:305-320. [PMID: 30832820 DOI: 10.1016/j.hfc.2018.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatment of patients with heart failure with reduced ejection fraction has evolved. Recently, a fully implantable remote hemodynamic monitoring sensor in the pulmonary artery was approved in the treatment of patients at risk of heart failure readmissions. Several novel devices designed to offload the left atrium by creating a small interatrial shunt are being investigated. Cardiac imaging plays a vital role in the selection process, implantation, and monitoring of individuals with such devices. This article discusses in detail various imaging techniques and key clinical points relating to several cardiac devices used in the treatment of patients with heart failure.
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Affiliation(s)
- Thura T Harfi
- Division of Cardiology, Department of Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA.
| | - Michael Wesley Milks
- Division of Cardiology, Department of Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - David A Orsinelli
- Division of Cardiology, Department of Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Subha V Raman
- Division of Cardiology, Department of Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - William T Abraham
- Division of Cardiology, Department of Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Rami Kahwash
- Division of Cardiology, Department of Medicine, The Ohio State University Wexner Medical Center, The Ohio State University, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
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Cardona A, Baker P, Kahwash R, Smart S, Phay JE, Basso C, Raman SV. Evidence of aldosterone synthesis in human myocardium in acute myocarditis. Int J Cardiol 2018; 275:114-119. [PMID: 30384979 DOI: 10.1016/j.ijcard.2018.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/17/2018] [Accepted: 10/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Myocarditis may be self-limited but has been identified as an important contributor to downstream cardiomyopathy. Aldosterone mediates myocardial damage in various conditions, but has not been considered specifically as a therapeutic target for inflammatory damage in acute myocarditis. We sought to demonstrate local aldosterone synthesis in human myocardium affected by acute myocarditis. METHODS We evaluated myocardial samples obtained via endomyocardial biopsy (EMB) for expression of CYP11B2, the final and key enzyme for aldosterone synthesis, from patients with acute myocarditis and from stable heart transplant recipients with no evidence of rejection as negative controls. Excised adrenal glands from patients with aldosterone-secreting adenomas were used as positive controls. An experienced cardiovascular pathologist blinded to clinical information rated CYP11B2 stains as negative, positive, or borderline, also recording location of any CYP11B2-positivity. RESULTS Sixteen patients' EMB samples showing definite acute myocarditis were identified (50% female). CYP11B2 was positive in 13/16 cases (81%), typically showing diffuse intracardiomyocyte cytoplasmic staining, vs. 2/16 borderline stains in transplant controls (p < 0.001 myocarditis vs. negative controls). All 3 adrenalectomy samples stained positive for CYP11B2 (diffuse intracellular staining). Importantly, no myocarditis or transplant patients were on aldosterone antagonist therapy at the time of biopsy. CONCLUSIONS In this proof-of-concept study, myocardium from patients with acute myocarditis demonstrates evidence and high prevalence of local aldosterone synthesis by immunohistochemistry that showed high accuracy, specificity, and sensitivity. Aldosterone warrants consideration as a specific target for therapy in patients with myocardial damage due to inflammation towards strategies that reduce downstream complications.
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Affiliation(s)
- Andrea Cardona
- Ohio State University, Heart and Vascular Center, Columbus, OH, USA; Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy
| | - Peter Baker
- Nationwide Children's Hospital, Anatomic Pathology, Columbus, OH, USA
| | - Rami Kahwash
- Ohio State University, Heart and Vascular Center, Columbus, OH, USA
| | - Suzanne Smart
- Ohio State University, Heart and Vascular Center, Columbus, OH, USA
| | - John E Phay
- Ohio State University, Surgical Oncology, Columbus, OH, USA
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Subha V Raman
- Ohio State University, Heart and Vascular Center, Columbus, OH, USA.
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Abraham WT, Kuck KH, Goldsmith RL, Lindenfeld J, Reddy VY, Carson PE, Mann DL, Saville B, Parise H, Chan R, Wiegn P, Hastings JL, Kaplan AJ, Edelmann F, Luthje L, Kahwash R, Tomassoni GF, Gutterman DD, Stagg A, Burkhoff D, Hasenfuß G. A Randomized Controlled Trial to Evaluate the Safety and Efficacy of Cardiac Contractility Modulation. JACC Heart Fail 2018; 6:874-883. [PMID: 29754812 DOI: 10.1016/j.jchf.2018.04.010] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 04/24/2018] [Accepted: 04/24/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This study sought to confirm a subgroup analysis of the prior FIX-HF-5 (Evaluate Safety and Efficacy of the OPTIMIZER System in Subjects With Moderate-to-Severe Heart Failure) study showing that cardiac contractility modulation (CCM) improved exercise tolerance (ET) and quality of life in patients with ejection fractions between 25% and 45%. BACKGROUND CCM therapy for New York Heart Association (NYHA) functional class III and IV heart failure (HF) patients consists of nonexcitatory electrical signals delivered to the heart during the absolute refractory period. METHODS A total of 160 patients with NYHA functional class III or IV symptoms, QRS duration <130 ms, and ejection fraction ≥25% and ≤45% were randomized to continued medical therapy (control, n = 86) or CCM (treatment, n = 74, unblinded) for 24 weeks. Peak Vo2 (primary endpoint), Minnesota Living With Heart Failure questionnaire, NYHA functional class, and 6-min hall walk were measured at baseline and at 12 and 24 weeks. Bayesian repeated measures linear modeling was used for the primary endpoint analysis with 30% borrowing from the FIX-HF-5 subgroup. Safety was assessed by the percentage of patients free of device-related adverse events with a pre-specified lower bound of 70%. RESULTS The difference in peak Vo2 between groups was 0.84 (95% Bayesian credible interval: 0.123 to 1.552) ml O2/kg/min, satisfying the primary endpoint. Minnesota Living With Heart Failure questionnaire (p < 0.001), NYHA functional class (p < 0.001), and 6-min hall walk (p = 0.02) were all better in the treatment versus control group. There were 7 device-related events, yielding a lower bound of 80% of patients free of events, satisfying the primary safety endpoint. The composite of cardiovascular death and HF hospitalizations was reduced from 10.8% to 2.9% (p = 0.048). CONCLUSIONS CCM is safe, improves exercise tolerance and quality of life in the specified group of HF patients, and leads to fewer HF hospitalizations. (Evaluate Safety and Efficacy of the OPTIMIZER System in Subjects With Moderate-to-Severe Heart Failure; NCT01381172).
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Affiliation(s)
- William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio.
| | - Karl-Heinz Kuck
- Department of Cardiology, ASKLEPIOS Klinik St. Georg, Hamburg, Germany
| | - Rochelle L Goldsmith
- Exercise Physiology Laboratory, Columbia University Medical Center, New York, New York
| | - JoAnn Lindenfeld
- Department of Heart Failure and Transplant, Vanderbilt Heart, Nashville, Tennessee
| | - Vivek Y Reddy
- Department of Cardiac Arrhythmia Services, The Mount Sinai Hospital, New York, New York
| | - Peter E Carson
- Medical Intensive Care Unit, Washington VA Medical Center, Washington, DC
| | - Douglas L Mann
- Cardiovascular Division, Medicine, Washington University School of Medicine, St. Louis, Missouri
| | | | - Helen Parise
- R. P. Chiacchierini Consulting, Gaithersburg, Maryland
| | | | - Phi Wiegn
- Department of Clinical Cardiac Electrophysiology, Dallas VA Medical Center, Dallas, Texas
| | - Jeffrey L Hastings
- Department of Clinical Cardiac Electrophysiology, Dallas VA Medical Center, Dallas, Texas
| | - Andrew J Kaplan
- Department of Clinical Cardiac Electrophysiology, Cardiovascular Associates of Mesa, Mesa, Arizona
| | - Frank Edelmann
- Department of Cardiology and Pneumology, Universität Göttingen, Göttingen, Germany
| | - Lars Luthje
- Department of Cardiology and Pneumology, Universität Göttingen, Göttingen, Germany
| | - Rami Kahwash
- Department of Heart Failure & Transplantation, The Ohio State University Heart and Vascular Center, Columbus, Ohio
| | - Gery F Tomassoni
- Department of Clinical Cardiac Electrophysiology, Baptist Health Lexington, Lexington, Kentucky
| | - David D Gutterman
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Angela Stagg
- Clinical Trials, Impulse Dynamics, Orangeburg, New York
| | | | - Gerd Hasenfuß
- Heart Center of Göttingen, University Medical Center Göttingen, Göttingen, Germany
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Shah SJ, Feldman T, Ricciardi MJ, Kahwash R, Lilly S, Litwin S, Nielsen CD, van der Harst P, Hoendermis E, Penicka M, Bartunek J, Fail PS, Kaye DM, Walton A, Petrie MC, Walker N, Basuray A, Yakubov S, Hummel SL, Chetcuti S, Forde-McLean R, Herrmann HC, Burkhoff D, Massaro JM, Cleland JGF, Mauri L. One-Year Safety and Clinical Outcomes of a Transcatheter Interatrial Shunt Device for the Treatment of Heart Failure With Preserved Ejection Fraction in the Reduce Elevated Left Atrial Pressure in Patients With Heart Failure (REDUCE LAP-HF I) Trial: A Randomized Clinical Trial. JAMA Cardiol 2018; 3:968-977. [PMID: 30167646 PMCID: PMC6233816 DOI: 10.1001/jamacardio.2018.2936] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [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: 07/10/2018] [Accepted: 08/01/2018] [Indexed: 12/26/2022]
Abstract
Importance In patients with heart failure (HF) and left ventricular ejection fraction (LVEF) equal to or greater than 40%, a transcatheter interatrial shunt device (IASD; Corvia Medical) reduces exercise pulmonary capillary wedge pressure (PCWP) and is safe compared with sham control treatment at 1 month of follow-up. The longer-term safety and patency of the IASD has not yet been demonstrated in the setting of a randomized clinical trial (RCT). Objective To evaluate the 1-year safety and clinical outcomes of the IASD compared with a sham control treatment. Design, Setting, and Participants This phase 2, double-blind, 1-to-1 sham-controlled multicenter RCT of IASD implantation vs a sham procedure (femoral venous access and imaging of the interatrial septum without IASD) was conducted in 22 centers in the United States, Europe, and Australia on patients with New York Heart Association (NYHA) class III or ambulatory class IV HF, LVEF equal to or greater than 40%, exercise PCWP equal to or greater than 25 mm Hg, and PCWP-right atrial pressure gradient equal to or greater than 5 mm Hg. Main Outcomes and Measures Safety was assessed by major adverse cardiac, cerebrovascular, or renal events (MACCRE). Exploratory outcomes evaluated at 1 year were hospitalizations for HF, NYHA class, quality of life, a 6-minute walk test, and device patency. Results After 1 year, shunts were patent in all IASD-treated patients; MACCRE did not differ significantly in the IASD arm (2 of 21 [9.5%]) vs the control arm (5 of 22 [22.7%]; P = .41), and no strokes occurred. The yearly rate of hospitalizations for HF was 0.22 in the IASD arm and 0.63 in the control arm (P = .06). Median improvement in NYHA class was 1 class in the IASD arm (IQR, -1 to 0) vs 0 in the control arm (IQR, -1 to 0; P = .08). Quality of life and 6-minute walk test distance were similar in both groups. At 6 months, there was an increase in right ventricular size in the IASD arm (mean [SD], 7.9 [8.0] mL/m2) vs the control arm (-1.8 [9.6] mL/m2; P = .002), consistent with left-to-right shunting through the device; no further increase occurred in the IASD arm at 12 months. Conclusions and Relevance The REDUCE LAP-HF I phase 2, sham-controlled RCT confirms the longer-term patency of the IASD. Through 1 year of follow-up, IASD treatment appears safe, with no significant differences in MACCRE in patients receiving IASD compared with those who received sham control treatment. Trial Registration ClinicalTrials.gov identifier: NCT02600234.
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Affiliation(s)
- Sanjiv J. Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Associate Editor, JAMA Cardiology
| | - Ted Feldman
- NorthShore University Health System, Evanston Hospital, Evanston, Illinois
| | - Mark J. Ricciardi
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rami Kahwash
- Ohio State University Wexner Medical Center, Columbus
| | - Scott Lilly
- Ohio State University Wexner Medical Center, Columbus
| | | | - Chris D. Nielsen
- Medical University of South Carolina, Charleston
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | | | - Elke Hoendermis
- University Medical Center Groningen, Groningen, the Netherlands
| | | | | | - Peter S. Fail
- Cardiovascular Institute of the South, Houma, Louisiana
| | - David M. Kaye
- Alfred Hospital, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Anthony Walton
- Alfred Hospital, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | | | - Niki Walker
- University of Glasgow, Glasgow, United Kingdom
| | - Anupam Basuray
- OhioHealth Heart and Vascular-Riverside Methodist Hospital, Columbus
| | - Steven Yakubov
- OhioHealth Heart and Vascular-Riverside Methodist Hospital, Columbus
| | | | - Stanley Chetcuti
- University of Michigan, Ann Arbor
- VA Ann Arbor, Ann Arbor, Michigan
| | | | | | | | | | - John G. F. Cleland
- Robertson Centre for Biostatistics and Clinical Trials, Institute of Health & Well-Being, University of Glasgow, Glasgow, United Kingdom
- National Heart & Lung Institute, Imperial College, Kensington, London, United Kingdom
| | - Laura Mauri
- Baim Institute of Clinical Research, Boston, Massachusetts
- Harvard University, Boston, Massachusetts
- Now with Medtronic Inc, Boston, Massachusetts
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Breathett K, Maffett S, Foraker RE, Sturdivant R, Moon K, Hasan A, Franco V, Smith S, Lampert BC, Emani S, Haas G, Kahwash R, Hershberger RE, Binkley PF, Helmkamp L, Colborn K, Peterson PN, Sweitzer N, Abraham WT. Pilot Randomized Controlled Trial to Reduce Readmission for Heart Failure Using Novel Tablet and Nurse Practitioner Education. Am J Med 2018; 131:974-978. [PMID: 29555457 PMCID: PMC6098971 DOI: 10.1016/j.amjmed.2018.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 02/19/2018] [Accepted: 02/21/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Heart failure education programs are not standardized. The best form of education is unclear. We evaluated whether addition of a novel tablet application to nurse practitioner (NP) education was superior to NP education alone in reducing 30-day readmission after heart failure hospitalization. METHODS From February 2015-March 2016, patients admitted to a quaternary academic center with primary diagnosis of heart failure were randomized to 1) treatment - NP education plus tablet application (interactive conditional logic program that flags patient questions to medical staff), or 2) control - NP education. The primary outcome was reduction in 30-day readmission rate. Secondary outcomes included satisfaction and education assessed via survey. RESULTS Randomization included 60 patients to treatment and 66 to control. A total of 13 patients withdrew prior to intervention (treatment n = 4, control n = 1) or were lost to follow-up (treatment n = 3, control n = 5). The 30-day readmission rate trended lower for treatment compared with control, but results were not statistically significant (13.2% [7/53], 26.7% [16/60], respectively, P = .08). Similarly, satisfaction trended higher with treatment than control (P = .08). Treatment patients rated explanations from their physicians higher than control (Always: 83.7%, 55.8%, respectively, P = .01). CONCLUSIONS NP education plus tablet use was not associated with significantly lower 30-day readmission rates in comparison with NP alone, but a positive trend was seen. Patient satisfaction trended higher and heart failure explanations were better with NP education plus tablet. A larger study is needed to determine if NP education plus tablet reduces readmission rates following heart failure admission.
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Affiliation(s)
- Khadijah Breathett
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson.
| | - Scott Maffett
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Randi E Foraker
- Institute for Informatics, Washington University in St. Louis School of Medicine, Mo
| | - Rod Sturdivant
- Department of Mathematics and Physics, Azusa Pacific University, Calif
| | - Kristina Moon
- Division of Cardiology, University of Wisconsin, Madison
| | - Ayesha Hasan
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Veronica Franco
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Sakima Smith
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Brent C Lampert
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Sitaramesh Emani
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Garrie Haas
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Rami Kahwash
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Ray E Hershberger
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Philip F Binkley
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Laura Helmkamp
- University of Colorado Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora
| | - Kathryn Colborn
- University of Colorado Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora
| | - Pamela N Peterson
- Division of Cardiology, University of Colorado and Denver Health Medical Center, Denver
| | - Nancy Sweitzer
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson
| | - William T Abraham
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
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Breathett K, Maffett S, Foraker R, Sturdivant R, Moon K, Hasan A, Franco V, Smith S, Lampert B, Emani S, Haas G, Kahwash R, Hershberger R, Binkley P, Helmkamp L, Colborn K, Peterson P, Sweitzer N, Abraham W. Pilot Randomized Controlled Trial to Reduce Readmission for Heart Failure Using Novel Tablet and Nurse Practitioner Education. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Feldman T, Mauri L, Kahwash R, Litwin S, Ricciardi MJ, van der Harst P, Penicka M, Fail PS, Kaye DM, Petrie MC, Basuray A, Hummel SL, Forde-McLean R, Nielsen CD, Lilly S, Massaro JM, Burkhoff D, Shah SJ. Transcatheter Interatrial Shunt Device for the Treatment of Heart Failure With Preserved Ejection Fraction (REDUCE LAP-HF I [Reduce Elevated Left Atrial Pressure in Patients With Heart Failure]): A Phase 2, Randomized, Sham-Controlled Trial. Circulation 2017; 137:364-375. [PMID: 29142012 DOI: 10.1161/circulationaha.117.032094] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [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: 10/06/2017] [Accepted: 10/25/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND In nonrandomized, open-label studies, a transcatheter interatrial shunt device (IASD, Corvia Medical) was associated with lower pulmonary capillary wedge pressure (PCWP), fewer symptoms, and greater quality of life and exercise capacity in patients with heart failure (HF) and midrange or preserved ejection fraction (EF ≥40%). We conducted the first randomized sham-controlled trial to evaluate the IASD in HF with EF ≥40%. METHODS REDUCE LAP-HF I (Reduce Elevated Left Atrial Pressure in Patients With Heart Failure) was a phase 2, randomized, parallel-group, blinded multicenter trial in patients with New York Heart Association class III or ambulatory class IV HF, EF ≥40%, exercise PCWP ≥25 mm Hg, and PCWP-right atrial pressure gradient ≥5 mm Hg. Participants were randomized (1:1) to the IASD versus a sham procedure (femoral venous access with intracardiac echocardiography but no IASD placement). The participants and investigators assessing the participants during follow-up were blinded to treatment assignment. The primary effectiveness end point was exercise PCWP at 1 month. The primary safety end point was major adverse cardiac, cerebrovascular, and renal events at 1 month. PCWP during exercise was compared between treatment groups using a mixed-effects repeated measures model analysis of covariance that included data from all available stages of exercise. RESULTS A total of 94 patients were enrolled, of whom 44 met inclusion/exclusion criteria and were randomized to the IASD (n=22) and control (n=22) groups. Mean age was 70±9 years, and 50% were female. At 1 month, the IASD resulted in a greater reduction in PCWP compared with sham control (P=0.028 accounting for all stages of exercise). Peak PCWP decreased by 3.5±6.4 mm Hg in the treatment group versus 0.5±5.0 mm Hg in the control group (P=0.14). There were no peri-procedural or 1-month major adverse cardiac, cerebrovascular, and renal events in the IASD group and 1 event (worsening renal function) in the control group (P=1.0). CONCLUSIONS In patients with HF and EF ≥40%, IASD treatment reduces PCWP during exercise. Whether this mechanistic effect will translate into sustained improvements in symptoms and outcomes requires further evaluation. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifier: NCT02600234.
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Affiliation(s)
- Ted Feldman
- NorthShore University Health System, Evanston Hospital, IL (T.F.)
| | - Laura Mauri
- Harvard Clinical Research Institute, Brigham and Women's Hospital, Boston, MA (L.M.)
| | - Rami Kahwash
- Ohio State University Wexner Medical Center, Cambridge (R.K., S.L.)
| | - Sheldon Litwin
- Ohio State University Wexner Medical Center, Cambridge (R.K., S.L.)
| | - Mark J Ricciardi
- Northwestern University Feinberg School of Medicine, Chicago, IL (M.J.R., S.J.S.)
| | | | | | - Peter S Fail
- Cardiovascular Institute of the South, Houma, LA (P.S.F.)
| | - David M Kaye
- Alfred Hospital and Baker Heart and Diabetes Institute Melbourne, Australia (D.M.K.)
| | | | - Anupam Basuray
- OhioHealth Heart and Vascular Physicians, Riverside Methodist Hospital, Columbus (A.B.)
| | - Scott L Hummel
- University of Michigan and VA Ann Arbor Healthcare System (S.L.H.)
| | | | | | - Scott Lilly
- Medical University of South Carolina, Charleston (S.L., C.D.N.)
| | | | | | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, IL (M.J.R., S.J.S.)
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Abstract
Sleep-disordered breathing (SDB) is a major health problem affecting much of the general population. Although SDB is responsible for rapid progression of heart failure (HF) and the worsening morbidity and mortality, advanced HF state is associated with accelerated development of SDB. In the face of recent developments in SDB treatment and availability of effective therapeutic options known to improve quality of life, exercise tolerance, and heart function, most HF patients with SDB are left unrecognized and untreated. This article provides an overview of SDB in HF with focus on practical approaches intended to facilitate screening and treatment.
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Affiliation(s)
- Rami Kahwash
- Section of Heart Failure and Transplant, Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, The Ohio State University, 473 West 12th Avenue, Columbus, OH 43210, USA.
| | - Rami N Khayat
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Davis Heart & Lung Research Institute, The Ohio State University, 473 West 12th Avenue, Columbus, OH 43210, USA
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49
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Pleister A, Kahwash R, Haas G, Ghio S, Cittadini A, Baliga RR. Echocardiography and Heart Failure: A Glimpse of the Right Heart. Echocardiography 2014; 32 Suppl 1:S95-107. [DOI: 10.1111/echo.12678] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Adam Pleister
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Rami Kahwash
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Garrie Haas
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Stefano Ghio
- Thoracic and Vascular Department; Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences; Universityà Federico II; Napoli Italy
| | - Ragavendra R Baliga
- Division of Cardiovascular Medicine; The Ohio State University Wexner Medical Center; Columbus Ohio
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50
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Ravi Y, Whitson B, Boyer P, Emani S, Hasan A, Franco V, Kahwash R, Crestanello J, Haas G, Higgins R, Sai-Sudhakar C. Has the Survival in Heart Transplant Recipients Older > 65years Improved Over the Decades? J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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