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Lee C, Dow S, Henkin S, Morley BD, Rassias AJ, Taub C, Costa SP. A Sticky Situation: The Unfortunate Consequence of Chewing Gum. CASE (Phila) 2023; 7:212-214. [PMID: 37396473 PMCID: PMC10307584 DOI: 10.1016/j.case.2023.02.005] [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] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Foreign substances can interfere with the TEE probe, causing poor image quality. Operators should be aware of the reasons for diffusely anechoic TEE images. Poor identification of echocardiographic artifacts may lead to adverse outcomes.
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Affiliation(s)
- Christopher Lee
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon
| | - Sam Dow
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon
| | - Benjamin D. Morley
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon
| | - Athos J. Rassias
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon
| | - Cynthia Taub
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon
| | - Salvatore P. Costa
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon
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Ganesh R, Shi H, Biondi M, Truglio T, Rothstein E, Costa SP. SUCCESSFUL USE OF BIVENTRICULAR ASSIST DEVICES IN FULMINANT MYOCARDITIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04265-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Cheng XS, VanWagner LB, Costa SP, Axelrod DA, Bangalore S, Norman SP, Herzog C, Lentine KL. Emerging Evidence on Coronary Heart Disease Screening in Kidney and Liver Transplantation Candidates: A Scientific Statement From the American Heart Association: Endorsed by the American Society of Transplantation. Circulation 2022; 146:e299-e324. [PMID: 36252095 PMCID: PMC10124159 DOI: 10.1161/cir.0000000000001104] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Coronary heart disease is an important source of mortality and morbidity among kidney transplantation and liver transplantation candidates and recipients and is driven by traditional and nontraditional risk factors related to end-stage organ disease. In this scientific statement, we review evidence from the past decade related to coronary heart disease screening and management for kidney and liver transplantation candidates. Coronary heart disease screening in asymptomatic kidney and liver transplantation candidates has not been demonstrated to improve outcomes but is common in practice. Risk stratification algorithms based on the presence or absence of clinical risk factors and physical performance have been proposed, but a high proportion of candidates still meet criteria for screening tests. We suggest new approaches to pretransplantation evaluation grounded on the presence or absence of known coronary heart disease and cardiac symptoms and emphasize multidisciplinary engagement, including involvement of a dedicated cardiologist. Noninvasive functional screening methods such as stress echocardiography and myocardial perfusion scintigraphy have limited accuracy, and newer noninvasive modalities, especially cardiac computed tomography-based tests, are promising alternatives. Emerging evidence such as results of the 2020 International Study of Comparative Health Effectiveness With Medical and Invasive Approaches-Chronic Kidney Disease trial emphasizes the vital importance of guideline-directed medical therapy in managing diagnosed coronary heart disease and further questions the value of revascularization among asymptomatic kidney transplantation candidates. Optimizing strategies to disseminate and implement best practices for medical management in the broader end-stage organ disease population should be prioritized to improve cardiovascular outcomes in these populations.
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Affiliation(s)
| | | | | | | | | | | | - Charles Herzog
- Hennepin Healthcare/University of Minnesota, Minneapolis, MN
| | - Krista L. Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO
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Stock JD, Rothstein ES, Friedman SE, Gemignani AS, Costa SP, Milbridge AJ, Zhang R, Taub CC, O'Rourke DJ, Palac RT. Lateral annular systolic excursion ratio: A novel measurement of right ventricular systolic function by two-dimensional echocardiography. Front Cardiovasc Med 2022; 9:971302. [PMID: 36119732 PMCID: PMC9479059 DOI: 10.3389/fcvm.2022.971302] [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: 06/16/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionAccurate assessment of right ventricular (RV) systolic function has prognostic and therapeutic implications in many disease states. Echocardiography remains the most frequently deployed imaging modality for this purpose, but estimation of RV systolic function remains challenging. The purpose of this study was to evaluate the diagnostic performance of a novel measurement of RV systolic function called lateral annular systolic excursion ratio (LASER), which is the fractional shortening of the lateral tricuspid annulus to apex distance, compared to right ventricular ejection fraction (RVEF) derived by cardiac magnetic resonance imaging (CMR).MethodsA retrospective cohort of 78 consecutive patients who underwent clinically indicated CMR and transthoracic echocardiography within 30 days were identified from a database. Parameters of RV function measured included: tricuspid annular plane systolic excursion (TAPSE) by M-mode, tissue Doppler S', fractional area change (FAC) and LASER. These measurements were compared to RVEF derived by CMR using Pearson's correlation coefficients and receiver operating characteristic curves.ResultsLASER was measurable in 75 (96%) of patients within the cohort. Right ventricular systolic dysfunction, by CMR measurement, was present in 37% (n = 29) of the population. LASER has moderate positive correlation with RVEF (r = 0.54) which was similar to FAC (r = 0.56), S' (r = 0.49) and TAPSE (r = 0.37). Receiver operating characteristic curves demonstrated that LASER (AUC = 0.865) outperformed fractional area change (AUC = 0.767), tissue Doppler S' (AUC = 0.744) and TAPSE (AUC = 0.645). A cohort derived dichotomous cutoff of 0.2 for LASER was shown to provide optimal diagnostic characteristics (sensitivity of 75%, specificity of 87% and accuracy of 83%) for identifying abnormal RV function. LASER had the highest sensitivity, accuracy, positive and negative predictive values among the parameters studied in the cohort.ConclusionsWithin the study cohort, LASER was shown to have moderate positive correlation with RVEF derived by CMR and more favorable diagnostic performance for detecting RV systolic dysfunction compared to conventional echocardiographic parameters while being simple to obtain and less dependent on image quality than FAC and emerging techniques.
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Affiliation(s)
- Jonathan D. Stock
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Division of Cardiology, White River Junction VA Medical Center, White River Junction, VT, United States
| | - Eric S. Rothstein
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- *Correspondence: Eric S. Rothstein
| | - Scott E. Friedman
- Division of Cardiology, White River Junction VA Medical Center, White River Junction, VT, United States
| | - Anthony S. Gemignani
- Division of Cardiology, White River Junction VA Medical Center, White River Junction, VT, United States
| | - Salvatore P. Costa
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Andrew J. Milbridge
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Division of Cardiology, White River Junction VA Medical Center, White River Junction, VT, United States
| | - Rui Zhang
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Division of Cardiology, White River Junction VA Medical Center, White River Junction, VT, United States
| | - Cynthia C. Taub
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- Division of Cardiology, White River Junction VA Medical Center, White River Junction, VT, United States
| | - Daniel J. O'Rourke
- Division of Cardiology, White River Junction VA Medical Center, White River Junction, VT, United States
| | - Robert T. Palac
- Division of Cardiology, White River Junction VA Medical Center, White River Junction, VT, United States
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Costa SP, Lentine KL. Silent myocardial infarction on preoperative electrocardiogram for kidney transplant patients: Impact on clinical outcomes may not be silent. Am J Transplant 2022; 22:1009-1011. [PMID: 35092141 PMCID: PMC9275814 DOI: 10.1111/ajt.16973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 01/25/2023]
Affiliation(s)
| | - Krista L. Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO
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Herzog CA, Simegn MA, Xu Y, Costa SP, Mathew RO, El-Hajjar MC, Gulati S, Maldonado RA, Daugas E, Madero M, Fleg JL, Anthopolos R, Stone GW, Sidhu MS, Maron DJ, Hochman JS, Bangalore S. Kidney Transplant List Status and Outcomes in the ISCHEMIA-CKD Trial. J Am Coll Cardiol 2021; 78:348-361. [PMID: 33989711 PMCID: PMC8319110 DOI: 10.1016/j.jacc.2021.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/26/2021] [Accepted: 05/03/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) and coronary artery disease frequently undergo preemptive revascularization before kidney transplant listing. OBJECTIVES In this post hoc analysis from ISCHEMIA-CKD (International Study of Comparative Health Effectiveness of Medical and Invasive Approaches-Chronic Kidney Disease), we compared outcomes of patients not listed versus those listed according to management strategy. METHODS In the ISCHEMIA-CKD trial (n = 777), 194 patients (25%) with chronic coronary syndromes and at least moderate ischemia were listed for transplant. The primary (all-cause mortality or nonfatal myocardial infarction) and secondary (death, nonfatal myocardial infarction, hospitalization for unstable angina, heart failure, resuscitated cardiac arrest, or stroke) outcomes were analyzed using Cox multivariable modeling. Heterogeneity of randomized treatment effect between listed versus not listed groups was assessed. RESULTS Compared with those not listed, listed patients were younger (60 years vs 65 years), were less likely to be of Asian race (15% vs 29%), were more likely to be on dialysis (83% vs 44%), had fewer anginal symptoms, and were more likely to have coronary angiography and coronary revascularization irrespective of treatment assignment. Among patients assigned to an invasive strategy versus conservative strategy, the adjusted hazard ratios for the primary outcome were 0.91 (95% confidence interval [CI]: 0.54-1.54) and 1.03 (95% CI: 0.78-1.37) for those listed and not listed, respectively (pinteraction= 0.68). Adjusted hazard ratios for secondary outcomes were 0.89 (95% CI: 0.55-1.46) in listed and 1.17 (95% CI: 0.89-1.53) in those not listed (pinteraction = 0.35). CONCLUSIONS In ISCHEMIA-CKD, an invasive strategy in kidney transplant candidates did not improve outcomes compared with conservative management. These data do not support routine coronary angiography or revascularization in patients with advanced CKD and chronic coronary syndromes listed for transplant. (ISCHEMIA-Chronic Kidney Disease Trial [ISCHEMIA-CKD]; NCT01985360).
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Affiliation(s)
- Charles A Herzog
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA; University of Minnesota, Minneapolis, Minnesota, USA.
| | - Mengistu A Simegn
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA; University of Minnesota, Minneapolis, Minnesota, USA
| | - Yifan Xu
- NYU Grossman School of Medicine, New York, New York, USA
| | | | - Roy O Mathew
- Columbia V.A. Health Care System, Columbia, South Carolina, USA
| | | | - Sanjeev Gulati
- Fortis Flt Lt Rajan Dhall Hospital, New Delhi, Delhi, India
| | | | - Eric Daugas
- Department of Nephrology, Bichat, Assistance Publique-Hôpitaux, Paris, France
| | - Magdelena Madero
- Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | - Jerome L Fleg
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai, Cardiovascular Research Foundation, New York, New York, USA
| | - Mandeep S Sidhu
- Albany Medical College and Albany Medical Center, Albany, New York, USA
| | - David J Maron
- Department of Medicine, Stanford University, Stanford, California, USA
| | | | - Sripal Bangalore
- NYU Grossman School of Medicine, New York, New York, USA. https://twitter.com/sripalbangalore
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Mathew RO, Rosenson RS, Lyubarova R, Chaudhry R, Costa SP, Bangalore S, Sidhu MS. Concepts and Controversies: Lipid Management in Patients with Chronic Kidney Disease. Cardiovasc Drugs Ther 2020; 35:479-489. [PMID: 32556851 DOI: 10.1007/s10557-020-07020-x] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) remains an important contributor of morbidity and mortality in patients with chronic kidney disease (CKD). CKD is recognized as an important risk enhancer that identifies patients as candidates for more intensive low-density lipoprotein (LDL) cholesterol lowering. However, there is controversy regarding the efficacy of lipid-lowering therapy, especially in patients on dialysis. Among patients with CKD, not yet on dialysis, there is clinical trial evidence for the use of statins with or without ezetimibe to reduce ASCVD events. Newer cholesterol lowering agents have been introduced for the management of hyperlipidemia to reduce ASCVD, but these therapies have not been tested in the CKD population except in secondary analyses of patients with primarily CKD stage 3. This review summarizes the role of hyperlipidemia in ASCVD and treatment strategies for hyperlipidemia in the CKD population.
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Affiliation(s)
- Roy O Mathew
- Columbia V.A. Health Care System, 6439 Garners Ferry Road, Columbia, SC, 29209, USA. .,University of South Carolina School of Medicine, Columbia, SC, USA.
| | | | | | | | | | | | - Mandeep S Sidhu
- Albany Medical College and Albany Medical Center, Albany, NY, USA
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Gigliotti JN, Sidhu MS, Robert AM, Zipursky JS, Brown JR, Costa SP, Palac RT, Steckman DA, Malenka DJ, Kono AT, Greenberg ML. The association of QRS duration with atrial fibrillation in a heart failure with preserved ejection fraction population: a pilot study. Clin Cardiol 2017; 40:861-864. [PMID: 28586090 DOI: 10.1002/clc.22736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/25/2017] [Accepted: 05/01/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Heart failure is a significant cause of morbidity and mortality, yet patient risk stratification may be difficult. Prevention or treatment of atrial fibrillation (AF) may be an important strategy in these patients that could positively affect their outcome. It has been demonstrated that in patients with systolic dysfunction, prolonged QRS duration (QRSd), an easily measured electrocardiographic parameter, is associated with AF. HYPOTHESIS Prolonged QRSd is associated with an increase in prevalence of AF in patients with heart failure with preserved ejection fraction(HFPEF). METHODS Between February 2006 and February 2009, 718 patients were discharged with a diagnosis of HF from the Dartmouth-Hitchcock Medical Center. Of these, 206 had EF ≥50% by echocardiography performed within 72 hours of admission. After exclusions, 82 patients remained, of which 25 had AF and 57 had sinus rhythm. Characteristics of the AF and sinus-rhythm patients were compared in this pilot study. RESULTS After adjustment for age, prior diagnosis of HF, and left atrial area, there was a nonsignificant trend (odds ratio: 2.2, 95% CI of 0.3-17.2) for a QRSd >120 ms to be associated with AF. CONCLUSIONS Similar to results in patients with systolic dysfunction, patients with preserved EF may have an association between a prolonged QRSd and AF.
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Affiliation(s)
- Joseph N Gigliotti
- Department of Medicine(Cardiology), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Medicine(Cardiology), Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Mandeep S Sidhu
- Department of Medicine(Cardiology), Albany Medical Center, Albany, New York.,Department of Medicine(Cardiology), Albany Medical College, Albany, New York
| | - Alina M Robert
- Department of Medicine(Cardiology), St. Luke's Clinic, Boise, Idaho
| | | | - Jeremiah R Brown
- Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine, Hanover, New Hampshire
| | - Salvatore P Costa
- Department of Medicine(Cardiology), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Robert T Palac
- Department of Medicine(Cardiology), Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire.,Department of Medicine(Cardiology), White River Junction VA Medical Center, Vermont
| | - David A Steckman
- Department of Medicine(Cardiology), Albany Medical Center, Albany, New York.,Department of Medicine(Cardiology), Albany Medical College, Albany, New York
| | - David J Malenka
- Department of Medicine(Cardiology), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Medicine(Cardiology), Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Alan T Kono
- Department of Medicine(Cardiology), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Medicine(Cardiology), Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Mark L Greenberg
- Department of Medicine(Cardiology), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Medicine(Cardiology), Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
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Costa SP. Echocardiographic Predictors of Response to Cardiac Resynchronization Therapy in 2016: Can Quantitative Global Parameters Succeed Where Segmental Parameters of Dyssynchrony Have Fallen Short? Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.004953. [PMID: 27252360 DOI: 10.1161/circimaging.116.004953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Salvatore P Costa
- From the Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH.
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Wang A, Grayburn P, Foster JA, McCulloch ML, Badhwar V, Gammie JS, Costa SP, Benitez RM, Rinaldi MJ, Thourani VH, Martin RP. Practice gaps in the care of mitral valve regurgitation: Insights from the American College of Cardiology mitral regurgitation gap analysis and advisory panel. Am Heart J 2016; 172:70-9. [PMID: 26856218 DOI: 10.1016/j.ahj.2015.11.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 11/09/2015] [Accepted: 11/09/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The revised 2014 American College of Cardiology (ACC)/American Heart Association valvular heart disease guidelines provide evidenced-based recommendations for the management of mitral regurgitation (MR). However, knowledge gaps related to our evolving understanding of critical MR concepts may impede their implementation. METHODS The ACC conducted a multifaceted needs assessment to characterize gaps, practice patterns, and perceptions related to the diagnosis and treatment of MR. A key project element was a set of surveys distributed to primary care and cardiovascular physicians (cardiologists and cardiothoracic surgeons). Survey and other gap analysis findings were presented to a panel of 10 expert advisors from specialties of general cardiology, cardiac imaging, interventional cardiology, and cardiac surgeons with expertise in valvular heart disease, especially MR, and cardiovascular education. The panel was charged with assessing the relative importance and potential means of remedying identified gaps to improve care for patients with MR. RESULTS The survey results identified several knowledge and practice gaps that may limit implementation of evidence-based recommendations for MR care. Specifically, half of primary care physicians reported uncertainty regarding timing of intervention for patients with severe primary or functional MR. Physicians in all groups reported that quantitative indices of MR severity were frequently not reported in clinical echocardiographic interpretations, and that these measurements were not consistently reviewed when provided in reports. In the treatment of MR, nearly 30% of primary care physician and general cardiologists did not know the volume of mitral valve repair surgeries by their reference cardiac surgeons and did not have a standard source to obtain this information. After review of the survey results, the expert panel summarized practice gaps into 4 thematic areas and offered proposals to address deficiencies and promote better alignment with the 2014 ACC/American Heart Association valvular disease guidelines. CONCLUSION Important knowledge and skill gaps exist that may impede optimal care of the patient with MR. Focused educational and practice interventions should be developed to reduce these gaps.
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Affiliation(s)
- Andrew Wang
- Department of Medicine, Duke University Medical Center, Durham, NC.
| | - Paul Grayburn
- Department of Medicine, Baylor Heart and Vascular Hospital and the Heart Hospital Baylor Plano, Houston, TX
| | - Jill A Foster
- Education Needs Assessment & Research, American College of Cardiology, Washington, DC
| | | | - Vinay Badhwar
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - James S Gammie
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Salvatore P Costa
- Department of Medicine, Dartmouth-Hitchcock Medical Center, New Lebanon, NH
| | | | - Michael J Rinaldi
- Sanger Heart and Vascular Institute, Carolinas HealthCare System, Charlotte, NC
| | - Vinod H Thourani
- Department of Surgery, Emory University Medical Center, Atlanta, GA
| | - Randolph P Martin
- Valvular and Structural Heart Disease, Piedmont Healthcare, Atlanta, GA
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Costa SP, Beaver TA, Rollor JL, Vanichakarn P, Magnus PC, Palac RT. Quantification of the Variability Associated with Repeat Measurements of Left Ventricular Two-Dimensional Global Longitudinal Strain in a Real-World Setting. J Am Soc Echocardiogr 2014; 27:50-4. [DOI: 10.1016/j.echo.2013.08.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Indexed: 10/26/2022]
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Costa SP. Putting the Comparison of 2008 and 2011 Appropriate Use Criteria for Stress Echocardiography in Perspective: Can Screening in Solid Organ Transplant be Appropriate? J Am Soc Echocardiogr 2013; 26:344-7. [DOI: 10.1016/j.echo.2013.02.005] [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: 10/27/2022]
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Vanichakarn P, Beaver TA, Costa SP, Czum JM, Palac RT. An unusual left atrial mass in hypertrophic cardiomyopathy: the role of multimodality imaging. Echocardiography 2013; 30:E111-3. [PMID: 23305199 DOI: 10.1111/echo.12097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Pantila Vanichakarn
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
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Lentine KL, Costa SP, Weir MR, Robb JF, Fleisher LA, Kasiske BL, Carithers RL, Ragosta M, Bolton K, Auerbach AD, Eagle KA. Cardiac disease evaluation and management among kidney and liver transplantation candidates: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. J Am Coll Cardiol 2012; 60:434-80. [PMID: 22763103 DOI: 10.1016/j.jacc.2012.05.008] [Citation(s) in RCA: 254] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Lentine KL, Costa SP, Weir MR, Robb JF, Fleisher LA, Kasiske BL, Carithers RL, Ragosta M, Bolton K, Auerbach AD, Eagle KA. Cardiac disease evaluation and management among kidney and liver transplantation candidates: a scientific statement from the American Heart Association and the American College of Cardiology Foundation: endorsed by the American Society of Transplant Surgeons, American Society of Transplantation, and National Kidney Foundation. Circulation 2012; 126:617-63. [PMID: 22753303 DOI: 10.1161/cir.0b013e31823eb07a] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abstract
Chronic kidney disease is now widely accepted as an independent risk factor for coronary disease and the dialysis population may represent the highest risk subgroup. Among all dialysis patients, a cardiac cause of mortality has been estimated at 40%. In addition, prior studies have demonstrated that when cardiac catheterization is obtained in a consecutive series of asymptomatic diabetic patients on dialysis the rates of coronary disease can approach 50%. However, the ability to define the problem continues to be greater than the ability to treat or prevent it. Coronary revascularization strategies have limitations in the general population which are amplified in the dialysis population. The ability to accurately diagnose an acute coronary syndrome is more difficult, clinical outcomes have a smaller margin of benefit, and technical challenges result in higher complication rates. Recent data demonstrate an inverse relationship between glomerular filtration rate and the risk of presenting with an acute myocardial infarction rather than unstable angina suggesting that patients with CKD may have a unique pathophysiologic profile that is more prone to plaque rupture. However, these "vulnerable" plaques typically are associated with stenoses <50% prior to rupture and are thus poor targets for revascularization and perhaps best treated with medical therapy. Although the benefits of revascularization may continue to outweigh the risks in the context of acute coronary syndromes, preventive strategies would have to overcome the lower margin of benefit and higher complication rates.
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O'Mara JE, Fruechte EM, Palac RT, Costa SP. Regional Patterns of Dyssynchrony: Lateral Wall Delay Is Desirable but Not Essential for Left Ventricular Remodeling in Biventricular Pacing. Echocardiography 2012; 29:554-9. [DOI: 10.1111/j.1540-8175.2011.01656.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
Fibromyalgia (FM) is a syndrome that can be associated with several rheumatic diseases. However, no study has evaluated its frequency in patients with primary antiphospholipid syndrome (PAPS). The objective of this study was to analyze the frequency of FM in PAPS patients compared with healthy controls, to determine the possible associations between FM and PAPS features, and also to evaluate quality of life and depression in these patients. This case–control study included 30 PAPS patients (by the Sapporo criteria) and 40 healthy subjects. Demographic and clinical data, drug use, and antiphospholipid antibodies were analyzed. FM was diagnosed based on international criteria (ACR). Questionnaires on quality of life, including the Short Form 36 Health Survey (SF-36), Beck Depression Inventory (BDI), Fibromyalgia Impact Questionnaire (FIQ), and Visual Analog Scale (VAS), were also applied. PAPS patients and controls were similar in mean age as well as in distributions of gender and Caucasian race. Mean disease duration was 5.4 ± 4.2 years. A diagnosis of fibromyalgia was made in five (16.7%) PAPS patients and no controls ( p = 0.012). PAPS patients had more diffuse pain (53% vs. 0%, respectively, p < 0.0001), ≥11 tender points (23% vs. 5%, respectively, p = 0.032), and a greater total number (175 vs. 57, respectively, p < 0.0001) as well as median number of tender points per patient than controls (5 [0–18] vs. 0 [0–11], respectively, p < 0.0001). PAPS patients had lower values in all dimensions of the SF-36, as well as higher FIQ scores, higher BDI scores, more depression diagnoses according to BDI results, and increased VAS in comparison with controls. Analysis of PAPS patients with FM compared with those subjects without FM revealed no significant differences regarding demographic features or thrombotic or clinical events; however, PAPS patients who also had FM had lower values in SF-36 dimensions as well as higher FIQ (82.6 ± 9.6 vs. 33.6 ± 29.8, respectively, p < 0.0001) and VAS scores (6.6 ± 2.97 vs. 3.25 ± 3.11, respectively, p = 0.03). BDI scores, in contrast, were similar in both groups. In conclusion, one-fifth of PAPS patients had fibromyalgia and a low quality of life when compared with healthy subjects.
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Affiliation(s)
- SP Costa
- Rheumatology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - LV Lage
- Rheumatology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - LM Henrique da Mota
- Rheumatology Service, Hospital Universitário de Brasília, Universidade de Brasília, Brasília-DF, Brazil
| | - JF de Carvalho
- Rheumatology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Friedman SE, Palac RT, Zlotnick DM, Chobanian MC, Costa SP. A call to action: variability in guidelines for cardiac evaluation before renal transplantation. Clin J Am Soc Nephrol 2011; 6:1185-91. [PMID: 21511835 DOI: 10.2215/cjn.09391010] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Candidates for renal transplantation are at increased risk for complications related to cardiovascular disease; however, the optimal strategy to reduce this risk is not clear. The aim of this study was to evaluate the variability among existing guidelines for preoperative cardiac evaluation of renal transplant candidates. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A consecutive series of renal transplant candidates (n=204) were identified, and four prominent preoperative cardiac evaluation guidelines, pertaining to this population, were retrospectively applied to determine the rate at which each guideline recommended cardiac stress testing. RESULTS The rate of pretransplant cardiac stress testing would have ranged from 20 to 100% depending on which guideline was applied. The American Heart Association/American College of Cardiology (ACC/AHA) guideline resulted in the lowest rate of testing (20%). In our population, 178 study subjects underwent stress testing: 17 were found to have ischemia and 10 underwent revascularization. The ACC/AHA approach would have decreased the number of noninvasive tests from 178 to 39; it would have identified only 4 of the 10 patients who underwent revascularization. The three other guidelines (renal transplant-specific guidelines) recommended widespread pretransplant cardiac testing and thus identified nearly all patients who had ischemia on stress testing. CONCLUSIONS The ACC/AHA perioperative guideline may be inadequate for identifying renal transplant candidates with coronary disease; however, renal transplant-specific guidelines may provoke significant overtesting. An intermediate approach based on risk factors specific to the ESRD population may optimize detection of coronary disease and limit testing.
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Affiliation(s)
- Scott E Friedman
- Section of Cardiology, Dartmouth Medical School/ Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756-0001, USA
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20
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Beaver TA, Steiner J, Sullivan CD, Costa SP, Palac RT. Two-Dimensional Longitudinal Strain in Patients with Aortic Stenosis Can Be Reliably Acquired at the Bedside without Additional Benefit of Offline Analysis. Echocardiography 2010; 28:22-8. [DOI: 10.1111/j.1540-8175.2010.01275.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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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21
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Robert AM, Sidhu MS, Brown JR, Foote H, Beaver TA, Costa SP, O'Rourke DJ, Palac RT, Malenka DJ, Kono AT. Heart Failure With Preserved Ejection Fraction in a Real World Patient Population: How Good Is Echocardiography at Identifying Elevated Left Ventricular Pressure? J Card Fail 2010. [DOI: 10.1016/j.cardfail.2010.06.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Zlotnick DM, Axelrod DA, Chobanian MC, Friedman S, Brown J, Catherwood E, Costa SP. Non-invasive detection of pulmonary hypertension prior to renal transplantation is a predictor of increased risk for early graft dysfunction. Nephrol Dial Transplant 2010; 25:3090-6. [PMID: 20299337 DOI: 10.1093/ndt/gfq141] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Early graft dysfunction is a significant complication after renal transplantation and is a marker of adverse outcomes. Although multiple predictors of graft dysfunction have been previously described, the reported prevalence of pulmonary hypertension (pulmonary HTN) in the dialysis population (40-50%), along with biologic and physiologic principles, led us to hypothesize that pulmonary HTN might be an additional risk factor for early graft dysfunction. METHODS We performed a retrospective study that screened all adult renal transplants performed at our institution over a 3-year period and limited the evaluation to those subjects who had an estimated pulmonary artery systolic pressure on a preoperative echocardiogram report (n = 55). The primary outcome of this study was to investigate the impact of pulmonary HTN on early graft dysfunction using a combined endpoint of delayed graft function or slow graft function. RESULTS Among patients receiving a living donor kidney, early graft dysfunction was not observed regardless of pulmonary HTN status. However, among patients receiving a deceased donor kidney, pulmonary HTN was found to be associated with a significant increased risk of early graft dysfunction (56 vs 11.7%, P = 0.01). Univariate and multivariable logistic regression supported this observation as an independent risk factor beyond potential confounding recipient, donor and graft-based risk factors for early graft dysfunction (P < 0.05). CONCLUSION Pulmonary HTN detected on non-invasive imaging prior to renal transplantation appears to be an independent predictor of early graft dysfunction among those patients who receive a deceased donor kidney.
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Affiliation(s)
- David M Zlotnick
- Cardiology, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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23
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Kim RJ, Siouffi S, Silberstein TA, Costa SP, Brown JR, Greenberg ML. Management and clinical outcomes of acute cardiac tamponade complicating electrophysiologic procedures: a single-center case series. Pacing Clin Electrophysiol 2010; 33:667-74. [PMID: 20132505 DOI: 10.1111/j.1540-8159.2010.02691.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac perforation with tamponade is an infrequent occurrence during an electrophysiologic procedure. The customary approach to management includes volume resuscitation followed by pericardiocentesis. Such a procedure, however, is not without its own risk, especially when performed emergently. We hypothesized that some patients experiencing this type of complication can be managed successfully in a conservative fashion, without the need for an additional invasive procedure. METHODS We retrospectively analyzed the clinical outcomes and echocardiographic features of 33 consecutive patients who experienced this complication during cardiac electrophysiology (EP) procedures performed at our institution from 1988 to 2007. Nineteen patients (58%) were managed conservatively with intravenous fluids and vasopressors (Group A). Fourteen patients (42%) were managed invasively with pericardiocentesis (Group B). RESULTS The mean systolic blood pressure at diagnosis did not differ between the two groups (64 vs 71 mmHg, P = 0.134). The mean lengths of hospitalization (4.7 vs 4.9 days, P = 0.75) and survival to hospital discharge (100% in both groups) were also similar. A large pericardial effusion (>or=2 cm) was seen predominantly among Group B patients. There was a statistically significant temporal trend toward managing this type of complication invasively (P = 0.038). CONCLUSION Among patients who experience cardiac perforation as an acute complication of EP procedure, there appears to be a role for conservative management in a subset of patients who do not have echocardiographic evidence of a large effusion and who respond well to initial stabilizing measures consisting of fluids and vasopressors.
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Affiliation(s)
- Robert J Kim
- Section of Cardiac Electrophysiology, University of Florida/Shands, Jacksonville, Florida, USA.
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24
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Olson JJ, Costa SP, Young CE, Palac RT. Early Mitral Filling/Diastolic Mitral Annular Velocity Ratio is Not a Reliable Predictor of Left Ventricular Filling Pressure in the Setting of Severe Mitral Regurgitation. J Am Soc Echocardiogr 2006; 19:83-7. [PMID: 16423674 DOI: 10.1016/j.echo.2005.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Indexed: 10/25/2022]
Abstract
The early mitral filling velocity (E)/early diastolic mitral annular velocity (E') ratio is increasingly being used as a simplified approach to estimate left ventricular (LV) filling pressure. The validity of applying this Doppler parameter to patients with severe mitral regurgitation is unknown. We retrospectively identified 20 patients in sinus rhythm who had LV end-diastolic pressure (LVEDP) invasively measured within 72 hours of a full echocardiogram including diastolic parameters. We observed a poor correlation between E/E' ratio and LVEDP in these patients (r = -0.07, P = not significant). Previously described E/E' cut-off values did not accurately identify patients with low, intermediate, and high LVEDP. Of the diastolic parameters measured, the most significant correlation with LVEDP was found with mitral deceleration time (r = -0.66, P = .002) and systolic/diastolic peak velocity ratio (r = -0.52, P = .02). We conclude that E/E' ratio is not reliable in predicting LV filling pressure in the setting of severe mitral regurgitation, and that in these cases mitral deceleration time or systolic/diastolic peak velocity ratio may be better indicators of LVEDP.
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Affiliation(s)
- Jeffrey J Olson
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA
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25
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Costa SP, Koyama J, Sam F, Falk R. Reduced longitudinal strain rate in patients with cardiac amyloid despite preserved fractional shortening equals that of dilated cardiomyopathy. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81224-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Costa SP, Sam F, Falk RH, Colucci WS, Davidoff R. Strain rate imaging in idiopathic cardiomyopathy: More sensitive than tissue doppler and potential application as a contractility index. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81225-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Costa SP, Yeon SB, Kissinger KV, Chuang MC, Manning WJ. Comparison of real-time imaging cardiac magnetic resonance for left ventricular volumes with conventional imaging in patients with atrial fibrillation: Is real-time required? J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81316-5] [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: 11/25/2022]
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Furuya H, Nakazato M, Saraiva MJ, Costa SP, Sasaki H, Matsuo H, Goto I, Sakaki Y. Tetramer formation of a variant type human transthyretin (prealbumin) produced by Escherichia coli expression system. Biochem Biophys Res Commun 1989; 163:851-9. [PMID: 2675831 DOI: 10.1016/0006-291x(89)92300-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A variant of human transthyretin(TTR, prealbumin) with methionine for valine substitution at position 30 is a major component of amyloid fibrils found in patients of familial amyloidotic polyneuropathy(FAP) type I, an autosomal dominant genetic disease. But the molecular nature of the variant TTR has been obscure, because most of plasma TTR from FAP patients is a mixture of variant and wild type TTR and no pure preparation of the variant has been available. For this reason, we constructed a system in which the variant type TTR was efficiently synthesized. In this system, the recombinant variant TTR was first synthesized as a fusion protein with E. coli outer membrane protein A (ompA) signal peptide, processed to eliminate the signal peptide and finally secreted to the culture medium. The final concentration of the recombinant variant TTR in the medium was about 5 mg/l. SDS polyacrylamide gel electrophoresis and gel filtration analysis suggested that the recombinant variant TTR can form tetramer as seen for native one. Purification of the protein was accomplished by only two steps of chromatography.
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Affiliation(s)
- H Furuya
- Research Laboratory for Genetic Information, Kyushu University, Fukuoka, Japan
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